A woman washes clothes in Lake Chad in Ngouboua, Chad, in 2015.

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Dr. Dina Saintilmon Medical Doctor, & Pandemic Periods, Haiti 

Dr. Claudy Junior Pierre MD, Resident, field epidemiology, Haiti

Dr. Alhelí Calderón Villarreal, MD MPH, & Corresponsal de México

Haiti needs to prioritise menstrual health!

First SARS-CoV-2 case in Haiti was confirmed on March 19, 2020. Although the pandemic did not produce the slaughter in the number of cases expected as seen in other countries including the Dominican Republic due to poor living conditions, precarious public transportation, and disbelief of Haitians towards the disease, however, it has brought a lot of problems that have added to the precariousness of certain socio-economic households. Healthcare infrastructure was overloaded and limited in its capacity – there was a severe lack of human resources and personal protective equipment – so it is unsurprising that menstrual health was not considered before or during COVID-19. 

Like most settings, menstrual health needs are multi-dimensional  in Haiti, and it has been exacerbated by limited access to adequate water, cleaning, bathing products, private spaces, and hygienic disposal. According to the EMMUS-VI 2016-2017 survey, in only 14% of cases is water accessible on place. More than half of households (56%) take less than thirty minutes overall to to get water. This proportion differs, however, between urban (71%) and rural households (71%) and rural households (46%). While the post-COVID-19 survey found that only 1 in 5 households (21.3%) had running water at home and just over half (54.5%) have a space available for handwashing with soap or detergent widely available in 88% of these spaces. More than half of households (57.2%) spend less than households (57.2%) spend less than 30 minutes fetching water and more than a quarter (25.2%) spend between 30 minutes and 1 hour. Under these conditions, it is difficult to have good prevention because just half of the households (50.3%) have a space and soap or detergent

This situation highlights the difficulties faced by Haitian families in observing measures aimed and addressing the spread of COVID-19. As the data from both surveys indicate, access to water remains a major challenge for most of the Haitian of the Haitian population. With the onset of the COVID-19 pandemic, the population’s need for population’s need for water is increasing, as water represents one of the fundamental conditions for to respect the rules of hygiene or the measures to prevent the spread of the disease. Approximately 30.2% of women report that their hygienic needs (especially related to menstruation) are not met. This situation existed long before the pandemic for most of them (82.8%) but of them (82.8%) but worsened with the pandemic for 17.2% of them. With COVID-19 pandemic, menstrual needs [1] were much more present and shortages have increased[2] . At the same time, purchasing power has fallen sharply and people find it difficult to meet their basic needs and cover the purchase of menstrual products. Alternatively, the cost of menstrual products has increased, which has made them much less accessible. This has been especially difficult to those less able to manage greater economic hardship, especially as menstrual products are often considered to be of lesser importance in the budget.

However, it’s difficult for adolescent girls and women from low socioeconomic backgrounds in disadvantaged environment to ensure personal care during their period due to deprivation of decent toilets, drinking water sources, access to menstrual products, etc. Moreover, women in prison in Haiti face these challenges and even more limitations managing their menstrual health such as getting menstrual products and dispose of them properly after use.

In some underprivileged neighborhoods of Port-au-Prince[3]  (capital of Haiti), several adolescent girls are forced to miss several days of school per month. This is because they do not have access to functional toilets and water at school [4] or they do not have enough money to buy menstrual products. Sometimes they miss school also for fear of facing the look of their classmates, in case their clothes are stained with blood. All these facts could have direct consequences on schooling of adolescent girls in Haiti. 

Since menstrual products arrived to Haiti in the 1960s, no measures are taken to control the quality of menstrual products. [5] Currently, there are a variety of brands but not all are 100% cotton and therefore some are more absorbent than others. According to several gynecologists, some adolescent girls and women develop allergic reactions due to the poor quality of the products which led to. The trade-in of menstrual products is not regulated in Haiti. The distrust developed towards menstrual products has led to their replacement with less suitable protections such as unconditioned linen, thus increasing the risk of genitourinary infections. 

Good menstrual health requires that adolescent girls have access to information about the physiological process of menstruation and reproductive health. The Haitian Ministry of Education does not have a sex education programmes, so, no courses are included in the school curriculum. Additionally, many health professionals in rural areas are not sufficiently informed on the subject. Many young girls who have never heard of their period are surprised or afraid when their first period starts. It is common that young girls hide from their parents for a long time when their periods start because they are ashamed of what they would think of them. As soon as a girl reaches puberty, she begins to experience a recurring reality. It is said that this is the moment when she has become a “full-fledged woman since she is ready to give birth.” 

Every month, they are subjected to remarks and comments that leave nothing to be desired and have no scientific basis. For example “When you have your period, it is forbidden to touch and even approach a newborn baby, it can have stomach pains.” In addition, taking antibiotics during menstruation is considered normal, which could cause antibiotic resistance. In Haiti, du of the lack of information on menstrual health, there are a lot of prejudices relative to the menstruation. Sometimes when a woman expresses herself a bit vigorously, is in a bad mood or disagrees with someone, the first reaction is to ask her if she has her period. It’s  to believe that women are prisoners of their hormones and can only act at the goodwill of this periodic flow.

Menstrual products traders have complained about not selling their products because of rising prices and declining purchasing power of women. For traders who sell on the streets, the unsold products remained exposed for a long time to UV rays, which degraded them. Additionally, confinement exacerbates the accessibility problem by limiting and making trade difficult. The confinement and school closing due to COVID-19 prevented schoolgirls from getting supplies at their schools, which sometimes were places of free distribution.

Recommendations

A limited number of non-governmental organizations and some feminist organizations are the only responses to these challenges. Civil society have been promoting menstrual health in public spaces, distributing hygiene  kits, and providing sexual education training for adolescent girls without government support. 

Haiti’s national and local governments must classify menstrual products as essential items and cover the cost of menstrual products. This decision and intervention should be an integral part of the National Program of the Ministry of Education and the Action Plan of the Ministry of Public Health and Population to enable menstrual and sexual health access and education. 

Men and boys must be equally engaged to enable them to understand that menstruation is a natural process essential to the existence of humanity. Certain stereotypical beliefs and ignorance can harm not only women and girls, but also the community as a whole, as they influence public health decision-making[6] .

Additionally, better accessibility[7] [8] [9]  to clean water and private and secure spaces for menstruation management are needed. Menstrual products should be subsidized and controlled by the actors involved with a critical look on how menstrual products are shipped and distributed in local places.

The lack of accessibility to information and menstrual products reflects gender inequality has been exacerbated in Haiti during the COVID-19 pandemic. Still far from it, we have a feeling of hope for a future where young women manage to live their periods with dignity, thus contributing to their full development[10] .


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