This blog argues that the menstrual health of people living with disabilities (PWDs) in Nigeria should be factored into pandemic responses.  

The theme of the 2021 International Day of Persons with Disabilities was “towards an inclusive, accessible, and sustainable post COVID-19 world.”  This theme comes at a crucial point in time, where the participation of persons with disabilities (PWDs) is needed more than ever, especially in sexual and reproductive health (SRH) programming.

According to the World Health Organization (2021), about 15% of the world’s population live with a disability. PWDs in many settings are disproportionately impacted by COVID-19. This is due to the greater likelihood that they some people could develop severe COVID-19 infection, as well increased isolation that could lead to poor mental health, and further restricted access to health and social care. Women and adolescent girls with disabilities face a two-tiered level of discrimination – first as women, and second, as PWD. During the pandemic, they reported severe difficulties in managing their menstrual health during the COVID-19 pandemic. This could be because they were isolated before the pandemic and became increasingly isolated during it. It could also be because they were not included in the co-design of appropriate menstrual health programmes in Nigeria.

The World Report on Disability (2011) reported that about 25 million PWDs live in Nigeria. PWDs often face discrimination, stigma, and shame. In January 2019, Nigeria enshrined the Discrimination Against Persons with Disabilities (Prohibition) Act in law – nine years after Nigeria ratified the United Nations Convention on the Rights of Persons with Disabilities. This Act (2018) promised the full integration and inclusion of PWDs in society, and an end to the discrimination experienced by PWDs. This was made possible by the persistent and relentless advocacy efforts of disability advocates and human rights activists.

Nigeria is a largely patriarchal country, and the Disability Act makes no consideration for the doubled layer of discrimination faced by women with disabilities. Although the Act highlighted the need for access to adequate healthcare services for PWDs, it makes no special distinctions for menstruation. This evident gap deprives women and adolescent girls living with disabilities of their inherent right to dignity and the privacy needed to manage me of their menstrual health. UN Women (Nigeria) have suggested that since the onset of COVID-19, the gap in accessing information and health services, and the inclusion of people with lived experience in decision-making has widened.

Access to menstrual health is a human rights and public health issue. That means that interventions to address menstrual health need to be co-designed to capture the views of people whose needs sit at the intersections of society, and menstrual health mainstreaming should occur for future pandemic preparedness.

Menstrual health is multifaceted – including access to affordable, safe, and appropriate period products, private, safe, and well-lit spaces and hygienic disposal, and availability of culturally sensitive and contextually-specific reproductive health information.

In Nigeria, adolescent girls without disabilities are often taught about menstrual health and hygiene in schools and provided with free period products by non-governmental organisations (NGOs) . Whereas women and adolescent girls with disabilities in Nigeria often lack access to menstrual health information and support services –  access  that could have been further restrictred due to lockdown measures.

Often, women and adolescent girls with disabilities are not able to manage their menstruation with the privacy and dignity that they require, because they do not have the products or specially adapted spaces that they need. Furthermore, a lack of access to adequate menstrual health services in schools for adolescent girls can cause them to miss or drop out of their education.

So, how do we can we support women and adolescent girls with disabilities to attain menstrual health in the context of COVID-19 and beyond?

Recommendations

To ensure that the menstrual health needs of women and adolescent girls with disabilities are not neglected, discussions around sexual and reproductive health (SRH)  should include representation from the National Commission of Persons with Disabilities. We believe that PWDs should be involved in the translation of the Disability Act (2018) into practice, so that any delays in implementation as a result of COVID-19 can be overcome because it could reach the most vulnerable people in the population for efficiently.

We believe the right to menstrual health for PWD’s should be further enshrined in law. For example, other Nigerian States could learn from Cross River state, which recently passed a Sexual and Reproductive Health Rights (SRHR) bill (2017) ensuring inclusion of women and adolescent girls with disabilities .

We also suggest that the Nigerian Government and NGOs should co-create enabling environment so that women and adolescent girls with disabilities can attain menstrual health by working with them to co-design, implement, monitor, and govern future programmes . This could include support PWDs and their caregivers/families in the following areas:

• Generating menstrual health information in braille and sign language.
• Stipends to cover menstrual products for PWDs (which can sometimes be costly) particularly for those living in low-socioeconomic households.
• Providing better access to spacious and private toilets, period products, soap, toilet paper, and hygienic disposal so they can manage their menstruation.
• Offering individuals with physical or cognitive impairments further support to help them clean and dispose of their products.

The COVID-19 pandemic has exposed the deep inequalities in our society, and the need for inclusive health programmes and pandemic preparedness. The menstrual health needs of women and adolescent girls with disabilities should be included in pandemic preparedness. – which is impossible without the insights of those with lived experience. Offering them the opportunity to co-lead the creation of inclusive and appropriate policy and practices could ensure that their menstrual health needs are met, and no one is left behind during future pandemics, epidemics and health threats.

As the saying goes, that “Nothing about us without us.”

Notes

This blog was written by:

Ruth Oladele, Nigeria Correspondent, Pandemic Periods

Iquo Mkpang, Representative from the Physically Challenged Association of Nigeria

Toyosi Ayodele, Research Associate, Pandemic Periods, Nigeria  

Dr Jennifer Martin, Director, Pandemic Periods, Global

Image credit: EU Humanitarian Aid in Nigeria by Samuel Ochai is licensed under CC BY-NC-ND 2.0.