“Bitten By Shyness”: Menstrual Hygiene Management, Sanitation, and the Quest for Privacy in South Africa

ABSTRACT

Little is known about how menstruation is managed in low-income settings and whether existing sanitation systems meet women’s needs. Using the ‘Photovoice’ method with 21 women in participatory workshops and in-depth interviews, we collected data on menstrual hygiene management in three sites in Durban, South Africa. All women reported using disposable sanitary pads. Although they were aware that disposable pads were nonbiodegradable, incompatible with waterborne flush systems, and fill up pit latrines, they had little experience with reusable products. Considerable energy was devoted to concealing and containing ‘menstrual waste,’ and women expressed concern about inadequate privacy during menstruation. All sites lacked discreet disposal options and reliable water access, while outdoor sanitation facilities were considered unsafe. Findings highlight the need for advocacy to improve safety and privacy of facilities for women in this setting.

KEYWORDS:

• Low-income settings
• menstrual hygiene products
• privacy
• sanitation
• South Africa

Notes

1. This is available on the PATH website: http://www.path.org/blog/2013/04/manage-menstruation/

2. All place names and names of participants are pseudonyms.

3. Unless otherwise indicated, all quotations cited in the article are from interviews.

Additional information

Funding

This article is based on research funded by the Bill & Melinda Gates Foundation. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation.

Notes on contributors

Fiona Scorgie

Fiona Scorgie, PhD, is a senior researcher at the Wits Reproductive Health and HIV Institute and a Visiting Researcher at the Centre for Health Policy, School of Public Health, at the University of the Witwatersrand, Johannesburg. She has more than 15 years’ experience in ethnographic research in South African settings, with research interests in women’s health, qualitative methodologies, and religion and ritual.

Jennifer Foster

Jennifer Foster, PhD, works at PATH, providing expertise in the design, implementation, analysis, and coordination of research and product development. Recent projects include sanitation system research in Bihar, India, and acceptability research on the SILCS diaphragm in Durban, South Africa.

Jonathan Stadler

Jonathan Stadler, PhD, is a senior researcher and Technical Head of Research at the Wits Reproductive Health and HIV Institute. He has extensive rural and urban research experience in southern Africa, and specialises in ethnographic research on clinical trials of HIV prevention biotechnologies.

Thokozile Phiri

Thokozile Phiri is a researcher at CAPRISA in Durban, South Africa, with a Master’s degree in Population studies from the University of KwaZulu-Natal. Her interests are women’s health and well-being, HIV/AIDS, and sexual and reproductive health.

Laura Hoppenjans

Laura Hoppenjans has a background in gender and indigenous studies, with expertise in North African indigenous livelihoods. She holds a Master’s degree from the University of Washington, and currently works on Global Policy & Advocacy programming for the Bill and Melinda Gates Foundation.

Helen Rees

Helen Rees is the executive director of the Wits Reproductive Health and HIV Institute, a personal professor of Obstetrics and Gynaecology at the University of the Witwatersrand and an honorary professor at the London School of Hygiene and Tropical Medicine. She has more than 150 publications in the field of reproductive health, HIV prevention, vaccines and STIs, and has chaired many national and global committees including for WHO, UNAIDS, and NIH.

Nancy Muller

Nancy Muller is a senior program officer at PATH, with 25 years’ experience in evaluating health technologies. She currently leads efforts to improve women and children’s health and well-being through menstrual hygiene management, household air pollution, and injection safety.