Prioritising periods and preventing unwanted pregnancy: addressing menstrual and reproductive health in Timor-Leste and Papua New Guinea

Etelvina Vita Da Costa, 15 (centre), outside the new toilet block at Ailuli Pre-Secondary School in Same, Manufahi District, Timor-Leste (WaterAid/Greenwood)

The largest ever generation of girls are entering a critical time in their education as they move into adolescence. Challenges in managing their reproductive health, however, can pose significant barriers to educational attainment. This limits girls’ social and economic prospects and perpetuates gender inequality.

Adolescent pregnancy is a major factor in poor school attendance, as last year’s Guttmacher Institute report highlights. More alarmingly, it is a leading cause of death and disability for girls aged 15-19. In Timor-Leste, less than 1% of girls aged 15-19 have used contraception, and 20% of 19-year-olds have begun childbearing, according to their 2010 DHS report. In Papua New Guinea (PNG), 22% of girls have had at least one child, contributing to the country’s high maternal mortality.

Poor menstrual health (MH) poses similar challenges to girls’ health and education. Menstruation is often shrouded in stigma and taboo, which are perpetuated by poor knowledge. This limits girls’ ability to manage menstruation in hygienic and dignified ways, resulting in poor health and school absenteeism. A recent Ugandan study found girls missed up to 24 school days per year (11%) due to menstruation.

While evidence on MH and school attendance in the Asia-Pacific is poor, exploratory research in Timor-Leste highlights that understanding of menstruation is limited, with girls unaware of menstruation prior to menarche. Research also shows menstruation can be a deterrent from attending school, but access to appropriate facilities and products can help overcome this. New research is currently being undertaken on these issues in Solomon Islands, Fiji, and PNG with funding from the Australian Government, which will provide further evidence on MH in the Pacific.

Lucia Pereira, 14, in a classroom at Ailuli Pre-Secondary School in Same, Manufahi District, Timor-Leste (WaterAid/Greenwood)

Globally, some influential women are speaking out around MH – Chelsea Clinton penned an essay on the topic last month, and Michelle Obama delivered a landmark speech last year. Global coalitions such as the Global Partnership for Education recognise that cross-sectoral partnerships are needed to address MH. #Itsbloodytime is an online movement calling on world leaders to prioritise menstrual hygiene for girls’ education. Here in Australia there has been campaigning to stop the tampon tax, not to mention last year’s ‘I got that flow’ viral video by Australian comedy group Skit Box.

Reproductive health has also been in the news. There has been a public outcry in response to the U.S. Administration’s reinstatement of the harmful and counterproductive Mexico City Policy – greatly expanded to apply to all global health funding for the first time – and a renewed rallying of support for family planning and the sexual and reproductive health rights of women and girls. Responses range from internet memes of seven male administrators signing an Executive Order on women’s reproductive health decisions to the global She Decides initiative, raising awareness and funding to ensure full access to sexual health and family planning worldwide.

While the links between pregnancy and menstrual health are obvious, programming approaches have been disparate. The water, sanitation and hygiene (WASH) sector has focused on menstrual health and hygiene, while the health sector has focused on sexual and reproductive health (SRH). While both sectors are often working towards the same goal of supporting girls to stay in school, the two issues are rarely looked at together.

Now, however, there is opportunity to harness the global momentum on MH and SRH and bring these issues together to better meet the needs of women and girls. Both issues fall on the reproductive health spectrum and share common barriers that could logically be addressed simultaneously: poor knowledge and awareness; limited access to appropriate services and facilities; and poor availability of appropriate methods and products.

For Timor-Leste and PNG, with rapidly increasing youth populations, this is a crucial opportunity to improve adolescent health and address the barriers to education. In both countries, adolescent pregnancy is a major contributing factor to poor school attendance and completion. Similarly, the inability of many girls to manage menstruation in hygienic and dignified ways, or to access quality and affordable sanitary products, contributes to poor health and social outcomes, including school absenteeism.

In an innovative new partnership supported by the Australian Government through the Gender Action Platform, Marie Stopes International Australia (MSIA) and WaterAid Australia aim to tackle these two areas simultaneously, recognising that both reproductive and menstrual health are critical to girls’ ability to be healthy, educated and empowered.

Woman in Bonanamo, PNG (MSIA/Greenwood)

In PNG and Timor-Leste, the partnership will test one of the first integrated health and WASH approaches in the region, offering a holistic solution to improving girls’ health and education. Sexual and reproductive health services (including family planning) and menstrual health education will be provided to adolescent girls and boys, as well as adult community members, in rural and urban Timor-Leste and PNG. Facility upgrades will take place so school toilets are better equipped, and more discrete and local sanitary product development will be tested by women entrepreneurs. The project will also strengthen cross-collaboration and learning within the development sector. A new community of practice will be developed to encourage greater collaboration, joint action and learning among diverse Australian and regional development practitioners.

The project success lies in leveraging WaterAid and MSIA’s unique strengths to deliver strong technical responses (service delivery and infrastructure). The emphasis on shared learning, partnership and strengthened organisational practice will make a valuable contribution to other practitioners – recognising little to no literature or experience exists on the intersection between SRH/family planning and MH.

To find out more about the project, click here.

Batya Atlas is Senior Manager, External Relations for Marie Stopes International Australia. Chelsea Huggett is the Equality, Inclusion and Rights Advisor for WaterAid.

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Batya Atlas

Batya Atlas is the Senior Manager, External Relations for Marie Stopes International Australia. With a background in finance and project management and a Master’s in Public Health, Batya has over 14 years’ experience in international public health, including field posts in Nepal and Viet Nam. She is passionate about tackling inequality and empowering women.

Chelsea Huggett

Chelsea Huggett is the Technical Lead – Equality and Inclusion at WaterAid Australia, leading programming, research and advocacy on menstrual health and hygiene.


  • Ladies,

    I am from Papua New Guinea and have started up a project in partnership with Bridgetown Days for Girls in Australia, in the Province I’m living in. Has any of you heard of Days for Girls?? Check Days for Girls International out on the Web or if you want to know more, you can contact me on my gmail.

  • The PNG National Population Policy (NPP) 2015-2024 is in line with the commitment to the International Conference on Population and Development’s (ICPD) Plan of Action signed by the PNG government focuses on sexual and reproductive health including family planning as a key component. The last NPP (2000-2010) and its current successor were formulated with this commitment in mind. Community health posts (CHPs) staffed with a trained midwife and able to provide deliveries and antenatal care would do so much more to reducing high infant/child and maternal mortality situation in the country. Further, family planning and education go hand in hand in post poning age at first marriage and age at which a women has her first baby thereby reducing chances of any complications due to risky fertility behavior (having children outside ages 22-36, spacing of having children by a year or two, having more children, etc). Furthermore the ICDP recognizes both the intangible and tangible outcomes of reproductice health but often times, only the tangible is the main aim of programmes. These considerations should be kept in mind when talking about reproductive health generally.

  • Linking these aspects of girls’ feminine health will make advances in both hygiene and family planning more effective. Girls’ self-respect and education will benefit, and they will gain a better position in the community. This program is impressively thoughtful and sensitively articulated, and should provide convincing data for growth.

  • Such a well thought out, integrated approach from two respected and impactful organisations – in two countries with the most vulnerable women and girls in the Asia-Pacific region. Will be really interested to read further as the project implementation progresses, to hear about the on-the-ground challenges. So please to read of Australia’s ongoing and critical commitment to women and girls.

  • Great that these two DFAT funded programs are highlighted in this blog. The mentioned research in Fiji, Solomon Islands and PNG is funded through Pacific Women Shaping Pacific Development and is exploring how women’s and girls’ acess to menstrual hygiene impacts on their participation in education and income generation. The research findings will be widely distributed.

  • Great initiative! Really important to see this connection between menstrual hygiene initiatives, reproductive health services and family planning education as well. Anyone who has ever had the extra burden of (non-technical term here…) ‘nightmare periods’ (i.e. women living with PCOS or endometriosis, for example) in particular would feel empathy for women and girls in this position without access to healthcare, information, products or facilities. Without education and healthcare access, women experiencing problematic periods might not know that they are a symptom of a bigger problem, or something that can sometimes be better managed (i.e. through the use of birth control) — this ‘grin and bear it’ approach still happens in developed countries as well, and these conditions definitely impact on school/work attendance. So the connection makes a lot of sense for so many reasons.

    Also I find it really sad that many girls haven’t had any education about menstruation prior to menarche. I mean, I would have been terrified if I didn’t know that was supposed to happen, right? So important that SRH education and information is made available — we live in these bodies, we should be empowered to understand them and make informed decisions about them.

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