Hide My Shame: Challenges of Menstrual Hygiene in Informal Settlements in Nairobi, Kenya

Background and Purpose: Poverty presents challenges to acquiring basic necessities like food and clothing in informal settlements. Menstrual hygiene issues are prominent in these settlements as many women lack access to water, toilets, and basic materials, such as affordable sanitary pads, cloths, and underwear. Privacy can be difficult. Most houses are a single room without toilets or running water and are shared by all family members. Consequently, most women rely on communal toilets that are shared by 20 or more families; have limited hours of operation; and may lack doors, locks, lighting, and places to dispose of single-use sanitary materials. Without necessary resources and privacy to safely manage menstruation, women are at risk for reproductive and urinary tract infections and psychosocial distress. Despite these challenges, there is a paucity of research focused on menstrual hygiene management (MHM) in informal settlements. This paper explores women’s MHM strategies and experiences in the Mathare Valley Informal Settlement in Nairobi, Kenya.

Methods: Data was collected in Mathare in 2015-2016. Mathare is the second largest informal settlement in Nairobi. Fifty-five female residents, five from each of the 11 major villages in Mathare, were interviewed. We used maximum variation sampling to invite participants who represented diverse experiences, demographic characteristics, and access to water and sanitation in Mathare. Interviews were transcribed verbatim and translated from Swahili to English. Guided by grounded theory, transcripts were coded thematically using NVivo qualitative software.

Results: For some women, culture and beliefs influence their willingness to discuss MHM. Some stated it is shameful to discuss MHM with their children and for women/girls to cook for others while menstruating. Economic challenges prevented most women from regularly purchasing sanitary towels. Instead, they use, wash, and re-use pieces of old clothes. Some used re-usable pads; but without access to water, re-using these pads can be unsafe. Most stated that they disposed of MHM products in the river due to the limited availability of rubbish bins in shared toilets. Others disposed of products with household rubbish in open drainages, burnt them, or flushed them even while knowing that the toilets might block.

Conclusion and Implications: Challenges to MHM for women in informal settlements include the lack of affordable MHM products; cultural barriers to MHM; and lack of privacy, water, and ways to safely dispose of products. Consequently, women regard MHM as shameful, embarrassing, and stressful and associate MHM with illness and infection. Lack of appropriate MHM product disposal may also negatively impact the environment. There is a need for policy, advocacy, development, and social enterprise agencies to engage women in these communities to inform strategies, policies, product development, and interventions, that create safe spaces for women to privately and hygienically manage menstruation in informal settlements and create affordable MHM products and places for MHM product disposal. Furthermore, social workers and healthcare providers should consider the MHM challenges in informal settlements as they seek to provide more comprehensive and holistic care to women and girls in these communities.