– Marianne Tellier, Shamirah Nakalema, Siri Tellier, and Andisheh Jahangir
WoMena is a Danish founded NGO that promotes the use of evidence-based, effective reproductive health technologies and solutions such as menstrual cups through research, advocacy, and project implementation in Uganda.
Explain your approach (SRHR, WASH, gender), and intervention?
WoMena has a broad view on menstrual health including physical, mental, social, and structural aspects, which we translate into a set of intervention activities:
Menstrual health facility assessments to understand local logistical challenges.
Menstrual health training (and if we have time, SRHR training) with a comprehensive curriculum including: puberty, female anatomy, vaginal coronas, menstrual cycle, menstrual hygiene, nutrition, pain management, and methods (pros/cons, use, disinfection and storage).
Creating support structures for example involving parents, community members, teachers, training of trainers, health workers, and political/local leaders in communities.
Educating local rights bearers on advocacy tools aimed at encouraging local duty bearers to effectively manage water and sanitation facilities.
Emphasizing male involvement for example fathers and male community members, male teachers, and boys in schools.
Monitoring the use of the products and evaluating the acceptability and following up to address the challenges in relation to the use of the product.
Scaling up projects by designing pilots with the next steps in mind (for example, cost-efficiency).
Educating at the top through national advocacy.
Effective knowledge management including active review of scientific literature to enable internal learning.
To do this, we employ both paid local and international staff and volunteers, which contributes to a richness of perspectives and energy to implement our programs, and achieve social impact.
What makes your approach unique?
WoMena’s educational approach is unique in several ways. Our approach is context based, and our standard curriculum is usually tailored to the needs of the local population. We also use locally available materials, for easier accessibility and affordability of the menstrual management materials we distribute. We believe that when something is so new, like the menstrual cup, and knowledge is so low, you need to go into the fundamentals, personal stories, as well as a lot of honesty, to build people’s trust, such as: how many holes women have, pros and cons of cups, and how difficult it is when you take out your cup the first time. Furthermore, we believe in a life-skills based educational approach. Such an approach recognizes that different people learn in different ways—therefore we like to make our trainings interactive, with lots of questions, physical props that people can touch, illustrations, energizers, learning through movement, friendly competitions and time for participant demonstrations.
We train trainers and educate many groups in the community, so that everyone feels included. We are conscious that men and communities have a role to play so that the new user has a supportive environment. We do pre- and post-training tests to see whether our training has had an impact and monitor how well we are doing. Last, but not least, we have also designed a whole training module with different training methods, as this is an essential part of quality training at WoMena.
WoMena’s five training principles include:
Create trust and good environment for discussion
Ensure people understand what you are teaching them (and why)
Ensure people remember what you teach them
Interactivity and participatory
Plan and manage your training well.
What kind of impact have you had?
Our approach has had many layers of impact. The projects we support measure 75–94% uptake and 82% long-term continued use of menstrual cups among girls/women receiving our education and programming. Through our community involvement model we have seen considerable break down of taboos about menstrual health, opening up new avenues for important discussions in communities, while catalyzing change to male participants’ perceptions of menstrual health (WoMena 2018a; Gade and Hytti 2017). Through our impact evaluations we know that thousands of women and girls have expressed increased feelings of freedom and comfort during their periods after starting to use the products, which research demonstrates can have a positive, trickle-down effect on girls’ school performance (WoMena 2018b; Gade and Hytti 2017).
We also work at a systemic level to address menstrual equity issue including effectively advocating for the inclusion of menstrual cups in a Uganda’s national menstrual hygiene management curriculum in 2018 training manual drafted by the Ministry of Education, as well as the waiver of value-added tax for menstrual cup importation. We have built the capacity of ten NGOs to deliver MHM trainings around cup-related projects. We have also partnered to develop training materials for AFRIpads, which led to us has a potential reach of 1 million girls and women. We are currently completing similar work and developing educational materials for Ruby Life. Lastly, we have built capacity and provided meaningful learning experiences for +100 volunteers from Denmark, Sweden, Iran, Finland, Uganda, US, UK, Lithuania, Germany, and Spain.
How did you develop your curriculum and who did you consult?
WoMena’s training curriculum was developed in 2012 with the Red Cross and further improved upon through research and project testing in 2013 and 2014. However, our first official comprehensive curriculum was produced and implemented in 2015 based on examples from organizations working with similar environments and target groups. This included resources produced or used by the Red Cross, school readers from Uganda, Kenya, and Tanzania, menstrual cup supplier user materials, group participation materials, as well as expert materials on specific topics such as hymens from the Swedish Association for Sexuality Education. The initial draft was developed for an internal training of trainers by a group of six volunteers in consultation with actors in the field of reproductive health, such as Ruby Life, Menstrual Cup Uganda, and Reproductive Health Uganda. As a relatively new area of research and programming, we consulted with our internal volunteer Medical Advisory Team on particular topics to ensure it met the highest quality standards. We ensured our educational materials were useful in a variety of settings, so we designed the material to be user friendly and flexible, with suggestions on how the content could be tailored for different contexts.
Later updates to our main curriculum included lessons learned and questions from the field, brainstorms and curriculum development projects with partners such as AFRIpads, and updates based on new publications of relevant curriculum from the Uganda Ministry of Education and Sports. We also further developed our material on hymen and virginity with inputs from experts dedicated to this topic.
Now, when we implement new projects, our training curriculum is tailored to the specific context by involving community health professionals and local leaders as part of the design process. Also, as education is not limited to training, our knowledge management team prepares FAQ sheets to answer in depth questions asked by implementers, women/girls, and community leaders on topics such as Toxic Shock Syndrome, hymens, menstrual irregularities, and infections.
What languages do you use and are there any tensions or conflicts about the language you use for menstrual health education?
Our main curriculum is in English, although we have almost finished developing a Danish curriculum for Danish contexts. We are also finalizing the translation of our training tool designed for northern Uganda humanitarian contexts into Juba Arabic. In Uganda, we have different trainers who speak various local languages. In most cases they are able to deliver the training in the local language, though we sometimes use translators to deliver our trainings. Local trainers (such as teachers or other community members) are always trained to deliver the training and are also provided with menstrual products for their personal use so they are personally familiar with how the products work. WoMena’s trainers then support the local trainers in teaching beneficiaries with teachers sometimes translating the content of the training where necessary.
We rarely experience tensions related to the language we use, although people are often surprised to hear others speak so openly about menstruation and vaginas. Usually when we experience hesitancy around product use, we engage in open dialogue regarding the products (and any issues around its use) and ensure that all beneficiaries understand that uptake is totally optional.
What do you wish could be included in future curricula about menstrual health?
There is a need to increase the focus of MH education on other parts of women’s bodies especially myths around hymens, vaginal coronas, and virginity. This must first focus on increased knowledge around basic female anatomy by health professionals as well as the social connotations surrounding it. All training curricula should ensure versatile activities and active participation of beneficiaries, and move toward explanations through illustrative means, rather than simply text and words. Lastly, it would greatly improve implementation to have the best training curriculums translated into different local languages.
What does the future of MH education and curricula look like?
In Uganda and many other countries, the future for MHM education is bright. For example, MHM and menstrual cups are now included in the national curriculum in Uganda. There is more advocacy work being done by implementers of MHM with government and local leaders receiving more information regarding menstrual health issues. Male involvement in MHM education is also increasing, with the participation of men and boys in educational and advocacy initiatives at the grass root levels. Last but not least, WoMena is concentrating more on low-literacy populations in its curricula development which helps us to meet the needs of the most vulnerable populations. We can’t wait!