From Rags to Empowerment: An NGO's Stitch-and-Strive Mission Against Menstrual Poverty in Ghana’s Upper West Region

Poverty & Inequality

Ghana grapples with stark regional disparities in poverty and healthcare access. While the country boasts of progress in some regions, the burden of hardship falls unevenly. The Upper West Region stands as a glaring instance, with nearly half its population facing extreme poverty, compared to less than a third in the Northern Region and under a quarter in the Upper East Region. These disparities extend to healthcare, with access to doctors dipping to a worrying 14% in the Upper West Region compared to the national average of 40%. This uneven distribution of both poverty and healthcare raises urgent questions about equitable development and social justice in Ghana and paints a poignant picture of Ghana's uneven development, where geography can significantly affect life chances and access to basic necessities.

In general, women across the nation often experience marginalization and face traditional biases that label them, hindering their efforts to enhance their well-being. Although Ghana's overall poverty rate is decreasing, the three Northern Regions, particularly the Upper West Region, have seen only minimal improvements, with poverty rates remaining two to three times higher than the national average. A recent United Nations survey reveals that many individuals, particularly women and children, endure daily life in extreme poverty, with children sometimes lacking food and exhibiting signs of malnutrition.

Sexual Abuse

A 2014 UNICEF baseline survey, conducted in collaboration with the Ministry of Gender, Children, and Social Protection, underscored the widespread occurrence of sexual abuse and exploitation in various Ghanaian communities. Notably, married men, teachers, and respected adults in these communities emerged as the primary perpetrators of sexual abuse against girls. The detrimental consequences of such abuse include teenage pregnancies, abortions, and the contraction of sexually transmitted infections. Additionally, the report highlighted the disturbing phenomenon of girls being coerced away from their parents to live temporarily with men or boys for sexual purposes, or even being abducted and sexually abused for extended periods.

This reprehensible practice often results in the defilement of numerous girls. The baseline study shed light on the alarming reality that children in certain communities in the Upper West Region engage in transactional sex as a means to procure money for essential items. A significant proportion of these children are orphans, abandoned, neglected, or hail from impoverished backgrounds. Consequently, the region recorded one of the highest rates of commercial sexual exploitation in the country, with a staggering 66.7 per cent of children reporting the occurrence of this deplorable phenomenon according to the report.

Menstrual Poverty 

On a normal schooling day, Anastasia wakes to the familiar dread of another flow. Scraps of worn fabric offered scant protection, shame burning brighter than the morning sun. In Ghana's Upper West Region, menstruation is not just a biological fact; it is a barrier to empowerment. The issue of period poverty, often defined as insufficient access to menstrual hygiene resources, information, and facilities, is widespread across rural Ghana. Faced with societal stigma, girls frequently miss classes and may abandon their education entirely when confronted with this challenging situation. According to estimates by the United Nations, one out of every ten girls in Sub-Saharan Africa misses school during menstruation, amounting to as much as 20% of a school year.

Due to a lack of funds for menstrual products, reports indicate that some girls resort to engaging in amorous relationships with older men, perpetuating a cycle of dependence and exploitation that can result in unintended pregnancies and early motherhood. Men exploit their advantage by enticing girls into transactional sexual arrangements, offering menstrual products in exchange, as emphasized by Adjoa Nyanteng Yenyi, an advocate for adolescent sexual health with the United Nations Population Fund (UNFPA) in Ghana. Research conducted by the Kenya Medical Research Institute and the U.S. Centers for Disease Control and Prevention in rural Western Kenya indicated that 10% of surveyed 15-year-old girls had engaged in sexual activities with men to obtain menstrual products.

Bleeding Shame

In rural areas of the Upper West Region, eight out of every ten adolescent girls interviewed by TRANSID LBG cannot recall the last time they used disposable sanitary pads. They expressed discomfort with using rags but revealed they are compelled to resort to them due to the unaffordability of disposable pads. Many of these girls noted feeling uncomfortable attending classes when using cloth during their menstrual periods.  During our training sessions on handmade reusable pads, a participant shared the impact of pad poverty on her life, stating, "Whenever I have my period, it's always a sad situation for me. I usually don't have money to buy a pad from the little money I get from selling firewood during market days. As a result, I choose not to go to school and prefer staying at home." (Doris, resident of Tuggo)

In urban areas where sanitary products and health support are more accessible for adolescent girls, they are expected to navigate their periods with relative ease. However, in deprived regions, such as rural communities, the process has been made challenging by extreme poverty. The impact extends beyond younger girls, affecting older women who report a decline in disposable pad usage. Many rural women now resort to using rags, contributing to widespread period poverty as they cannot afford disposable sanitary pads. Adolescent Reproductive health experts argue that, using ersatz materials like pieces of cloth as menstrual pads can expose girls to general bacterial infections. While rags were historically used by women during their periods, health experts warn against this practice, linking it to various infections. Without proper care medical practitioners emphasize the dangers of using rags for menstruation, stating that bacterial and fungal infections can easily be transmitted through unclean rags. They emphasize that when these infections go undiagnosed and untreated, there is a risk of them spreading from the urinary system to the reproductive organs, potentially leading to infertility.

Tampon Taxes

Adding to the complexity, and exacerbated by the current surge in inflation affecting the prices of essential items, Ghana imposes a 20% import tax and an additional 12.5% Value Added Tax (VAT) on menstrual pads, classifying them as luxury items. The Ghanaian Revenue Authority's categorization has resulted in increased costs for disposable sanitary pads, with prices rising from approximately GH¢5 to GH¢17 between January 2022 and February 2023 due to inflation.

This is against the backdrop that in 2020, the government pledged to eradicate taxes on sanitary pads and distribute free pads to students and low-income women. Members of parliament, government officials, and the speaker stressed the necessity of eliminating these tariffs to enhance the menstrual hygiene of students, particularly girls. Despite numerous public statements, little has been done since the announcement, and menstrual hygiene products continue to be taxed, in spite of promises made by successive governments. Advocates are urging African countries to abolish taxes on menstrual products, often referred to as tampon taxes in the West, to improve affordability. However, only a few countries, such as Kenya, Rwanda, and South Africa, have taken such measures.

Sewing Dignity

In ancient times, women used various materials like papyrus, wooden sticks, and cloth strips for menstrual hygiene. Cloth pads, though present for a long time, gained prominence during World War I when nurses improvised by folding bandage strips due to resource shortages. Over time, the popularity of cloth pads declined with the introduction of disposable pads. In the face of challenging circumstances in which girls find themselves in the Upper West Region, various organizations and individuals are actively assisting young women and girls who face difficulties affording sanitary pads. One notable organization is TRANSID LBG, an NGO based in the Upper West Region, which has been providing training to schoolchildren on making their own reusable sanitary products. Some participants highlighted the benefits of the training they received.

“Although I used cloth whenever I had my period, I did not know sewing it into a pad could help me this way. This training has really helped me and I will teach my sisters how to make some” (Salima, a JHS 1 student)

“They are not as comfortable as the ones we buy from the stores, but I think they are far better than just folding cloth and using as pad” (Paula, a JHS 3 student)

"It is good that you are training teachers to make these reusable pads, when we go back and teach our students many girls will benefit, especially those from very poor backgrounds” (Joyce, a Teacher)

TRANSID is committed to the belief that empowering girls and women from low-income families to make reusable pads constitutes a sustainable approach to eradicating period poverty. In the previous year, the NGO successfully trained 40 girls from four schools in the Jirapa and Wa West Districts. Looking ahead to the coming months of 2024, TRANSID has ambitious plans to extend its impact by training 50 teachers and 500 girls on making their own reusable pads with locally sourced materials. This initiative will be implemented in selected districts of the Upper West Region.

Impact and Hope

The primary advantage of reusable cloth pads lies in their eco-friendly nature, being made from biodegradable materials, thereby reducing overall waste. These pads, composed of durable fabrics, are gentle on the body, minimizing the risk of rashes, odours, and infections when changed and washed appropriately. Cloth pads also, offer a comfortable and health-conscious alternative to disposable options. They are chemical-free, reducing the risk of skin irritation and rashes. Customizable in thickness and size, cloth pads provide a more comfortable fit, and their use minimizes concerns about foul smells and toxic shock syndrome associated with extended use of tampons. Additionally, from a cost perspective, while cloth pads may seem to be of inferior quality, their long-term durability makes them a cost-effective choice.  

Despite their advantages, cloth pads come with some challenges. Maintaining cloth pads, including washing and storage, can be perceived as a task. While cloth pads promote a healthy period, some women find it challenging to embrace the concept of reusable sanitary pads. Adolescent girls, in particular, may be hesitant due to the perceived effort involved washing and drying them appropriately, especially considering the physical discomfort and frequent changes during their menstrual cycle.

Ensuring proper care for cloth pads is crucial due to their non-disposable nature. Washing them during the menstrual cycle is essential, and understanding the cleaning process is equally important. TRANSID is dedicated to advocacy and public education to promote the use of cloth pads. Our team engages in training women and girls in liquid soap making, incorporating baking soda, an effective detergent for stains and disinfection. Studies suggest that cloth pads when washed in a solution of detergent, baking soda, or vinegar removes stains, while vinegar acts as a fabric softener, preserving the absorbency of the cloth pad. This commitment to education and practical solutions underscores TRANSID's activism to promote proper care for cloth pads and menstrual hygiene.

The Way Forward

Menstruation is a natural phenomenon and should not under any circumstances hinder women and girls from pursuing their dreams. Efficient and sustainable solutions are essential in tackling menstrual poverty. A promising strategy involves introducing reusable products, such as menstrual cups, into policymaking discussions. To ensure unhindered access to menstrual hygiene products and services, sustainable interventions are crucial. The government's role is vital, and consideration should be given to abolishing taxes on sanitary pads while promoting the use of reusable pads. Emulating successful examples from countries like Kenya, South Africa, Botswana, and Zambia, Ghana should provide free pads to schoolgirls and promote affordable, reusable alternatives like cloth pads and washable liners. The status quo in the Upper West Region, marked by poverty, inequality, and menstrual struggles, reveals a story of resilience and creativity, epitomized by organizations like TRANSID LBG. The narrative is far from ordinary, intertwined with threads of hope and the promise of a more equitable future. After all, menstruation is a natural phenomenon and should not be a barrier to women and girls achieving their dreams.

The writer, Prince Caesar Tampah is the Executive Director of TRANSID LBG

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