Tiri Masawi
WINDHOEK – Emily Amagola (not real name) is a 17-year-old schoolgoing Namibian girl living in Katutura, Windhoek’s predominantly black high density suburb.
In Katutura, many poor girls face the grim reality of poverty caused by an unequal distribution of wealth in the country every day.
According to the World Bank Financial analysis in 2018, Namibia is one of the countries with high inequality in the world, with the gap between the rich and poor growing wider and wider by the day.
For Amagola, poverty does not only mean difficulties in receiving the next meal, but also a sad reality that affect even the basic women needs like affording sanitary pads during her menstrual cycle.
This is despite that the average prize for sanitary pads in Namibia stands between N$16 and N$50 a packet. While this might sound like a meagre amount, not so for the many young girls from marginalised communities and families in Namibia.
Akin to the reality associated with unavailability of funds to buy sanitary pads monthly to keep herself in school during her menstrual cycle, Amagola is now resorting to using a hormonal injection to control menstrual flow.
This is despite the fact that the Namibian government dispatches these contraceptives for other reasons other than controlling menstrual cycle as over usage exposes teenagers to after effects in life.
“I have been accessing the hormonal injection for a year now. I receive these from any state hospital or clinic and I was introduced to these by my friend. Every time I use the injection, then I will not experience my menstrual cycle for at-least three months. This is better for me because I do not have to spend money that I don’t have to buy pads in shops.
“I think it’s actually not fine that I won’t have my menstrual periods for three months but I have no choice because I cannot afford them,” a rather worried Amagola said.
While speaking to this journalist, she seems very worried, narrating that she also realise that the continuous use of hormonal injections could expose her to potentially challenging conditions later in life.
“We get counselling from the hospitals before we receive these and we know there might be complications for us in future but what can we do,” she said.
Alas, her rather disheartening challenge of not being able to afford sanitary wear is not hers alone, but rather familiar to many young adolescents in Namibia, worse still those in the side-lined communities.
About 800 kilometers from Amagola towards the north eastern part of the country, the practice is rife in the Kavango East and west as well as the Zambezi regions.
Ironically these are some of Namibia’s poorest regions.
Executive Director in the Namibian Ministry of Health and Social Services Ben Nangombe is a rather worried man. Speaking about this issue, Nangombe does not hide the fact that government is alarmed with the use of hormonal injections by young teenagers to control their menstrual flow.
“Availing of contraceptives is a practice that we do as a the government to give women control of their reproductive health but any use of these contraceptives other than what we prescribe is not condoned at all. We do not expect anyone to use these contraceptives for any other reason other than what they are availed for because they have potential complications in the reproductive cycle of these young women at a later stage,” Nangombe said.
He also explained that government will soon roll out campaigns to sensitise women on the use or misuse of contraceptives. Perhaps more worrisome for Nangombe is how widespread the issue is in his country.
“We have spoken to directors of health in the three regions (Kavango East and West as well as Zambezi) and they confirmed this, however, we have not heard worrisome reports from other regions,” he said.
According to Nangombe, Namiba has clearly defined laws when it comes to the distribution of contraceptives to adult females but the issue of these being used by the teenage girls for menstrual control is a cause of concern.
Women Lobby Group Sister Namibia have their own horror story to tell about the challenges faced by Namibian young girls in accessing sanitary wear.
“Our research show that some girls in the Zambezi and Kavango regions even use pounded dry leaves or leaves to control their menstrual flow. This is very worrisome. As a result, we have distributed close to 2000 sanitary towels countrywide to poor girls to help them in these times. We are also working with government through the ministry of education to make sure that girls who cannot afford disposable sanitary pads will receive re-usable ones which can last for months,” said Elsareen Katiti, the Public Relations Officer of Sister Namibia.
She also raises concern over the use of hormonal injections by teenage girls in controlling their menstrual cycles. “Well, there are two sides to it. One being that we are happy that the girls are taking control of their reproductive health but also rather worrisome as the use of some of these contraceptives exposes them to health complications in the future,” she said.
According to Katiti, it is not acceptable that any girl has to miss school because they cannot afford sanitary wear. However, her alarm does not defeat the reality associated with this challenge.
An independent medical practitioner, Edmand Mnasti believes the use of hormonal injections to control menstrual cycle among teenage girls is a definite no.
“As medical practitioners, we never prescribe injectables to young girls. why? Because it’s hormones and they are working by interfering with the natural hormonal circle of the girl. So whilst they don’t have long standing effect physically and in terms of reproduction or other diseases, they are known to cause long delays to conception. Now when you are talking about a young lady, you know she is going to get married and want to have a child, especially in Africa where having a child is very important. Now these medicines delay by up to two years the conception cycle,” he said.
Dr Munatsi also added: “It may look like something small that you will say it’s just a delay but when you get into contact with ladies who are trying to have a baby but the baby is not coming, two years is like forever. Cut injections for young ladies even if it is for just contraception.”
“For stopping menses, that is the last approach that we will encourage, because in any case, the injection is being bought so you may think that you are saving on the pads but you are not saving, the injection, it’s just that you are getting them from the state and when these problems I am talking about falls before you, then you are crowding the state hospital again consulting about delayed conception which is caused by nothing but the injections themselves,” he said.
*Tiri Masawi is an independent journalist corresponding for BBC on various issues. He is enrolled in media-related studies with the Namibian University of Science and Technology (Nust). The original version of this piece was written for BBC Women’s and Health Desk.