1. Callister, Lynn Clark PhD, RN, FAAN

Article Content

Emma, a 13-year-old girl who is HIV positive through perinatal transmission, lives in Kibera, Ayana, one of the largest slums in Africa, where 25% of girls in the slum are orphaned because of AIDS. Emma was abandoned by her father when her mother died of AIDS. Although impoverished and often discriminated against, bright-eyed Emma has a dream to someday become a physician and treat other girls who are HIV positive. She is determined to stay in school in order to make her dream a reality. Like many African girls, however, she has a problem once a month-she has no available method to contain her menstrual flow. She is terrified each month that her school uniform will become soiled and she will be teased by her classmates. Like many African girls, Emma has used cloth, rugs, cotton, and even leaves and dirt for menstrual management. If she uses a precious piece of cloth (Kanga), she has to wash it by hand and hang it under her bed in order to keep it out of sight. Another problem Emma and other girls encounter is that often there are no separate bathroom facilities for girls and no proper way to dispose of objects they use to absorb their menstrual blood in a public place.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

In many developing nations, girls do not receive the same opportunities for formal schooling as their male counterparts for a variety of reasons, including being taken out of school by their families to work and supplement the family income, care for younger siblings, or perform household chores. As young women enter adolescence, they face a particularly challenging life transition that is fraught with emotional and physical changes. Puberty has an impact on body image and a sense of self-worth that may be exacerbated by ignorance. In East Africa, educators report that many young adolescent women have a high rate of absenteeism from school during their monthly menstrual periods because of lack of knowledge combined with a lack of resources for sanitary protection. Embarrassment about menstruation, although common among young adolescents everywhere, is magnified in these youngsters who have no way to protect their privacy with appropriate absorptive products. Recently, Proctor & Gamble partnered with the Girl Child Network (GCN) and the Forum of African Women Educators (FAWE) to provide 15,000 girls with enough sanitary towels to last 2 years. The goal of the "Always Stay in School Program" is to improve school attendance. Proctor & Gamble, GCN, and FAWE enlisted media support to provide education and solicit contributions to the project. As a result, in Kenya, taxes and customs fees were removed to make sanitary supplies more affordable to adolescent women and their families.


A commitment has been made by Proctor & Gamble to provide $200,000 and 4 million feminine hygiene products as a pilot project with young women, educators, and African communities in Kenya, Tanzania, and Malawi. This is a collaborative effort among Proctor & Gamble, UNICEF, and FAWE. They are joining forces with HERO, an awareness-building and fundraising initiative of the United Nations that is launching the Protecting Futures program.


The Always Stay in School Program is also undergoing a systematic outcomes evaluation to provide scientific evidence that this initiative can enhance self-esteem, foster empowerment of young African women, increase their knowledge of healthy practices to promote their health and well-being, and manage menstruation. According to Nada Dugas, Associate Director of External Relations, by December 2007, baseline results confirmed that this initiative is making an important difference. The program will undergo revisions periodically to make it more effective and widely available to East African adolescent women. Future plans are also being made to develop an advocacy campaign together with other international organizations and nongovernmental organizations (NGOs) to advocate for making puberty education and feminine hygiene products available for all young women.


This program supports two of the United Nations millennium development goals: promoting gender equity and ensuring children a complete primary education. It is a great example of global partnering to improve the lives of vulnerable young women through education, empowerment, and the provision of needed resources. This initiative received the 2007 Global Leadership Award from the United Nations. Nada Dugas reported that on a recent trip to Africa, "We met with 30 girls and had the chance to discuss their challenges and aspirations. These girls were an inspiration, with their resilience and their power to overcome despair and misery." For more information about this significant initiative to promote the health and well-being of young women globally, contact Nada Dugas at