Menstrual Health In Rural Laos
The Importance of Local Involvement and Leadership in Sustainable Women’s Empowerment Programs
Leyla Isin-Xiong, who manages all our programs throughout Laos, discusses the gender equality issues faced by women in the country and how she spearheaded a menstrual health initiative to tackle a key women’s health issue head-on. She also shows how important it is to develop local leaders to ensure the success of any sustainable development program.
I can’t remember a time in my life when gender equality wasn’t important to me. I think I was born with a fire inside me that only grew as I did. I’ve always advocated for the women around me and analyzed situations both personal, professional, national and international from a gendered perspective, amongst others. But it was when I began studying International Relations at university and chose to specialize in globalization with a focus on development, that I really began applying this to the context of sustainable development. Then, when I moved to Laos for work, fell in love, married a local and became immersed in the culture and its people, I formed personal connections with many women and girls in Laos, especially those in my extended family.With this, I gained an insight into their lives. I found a catalyst for the fire inside of me.
When I first arrived in Laos, in July 2015, the GVI Laos Project consisted of our Teaching Buddhist Novice Monk Program and our Children and Young Adults Program. In Laos, only males can join the temples as Novice Monks and with this, gain access to the Buddhist Education system (a dual curriculum with Buddhist and secular subjects taught simultaneously at Monk School). This meant that the number of male students receiving educational support from GVI was disproportionate to that of female students.
I approached my program manager at the time and asked if we had plans to address this. She said, ‘Absolutely, let’s do it!’
Gender in Laos
When developing programs, it is extremely important to engage with the local community to learn about their needs and to work directly with them. This is the only way to ensure that programs are aligned to their culture and needs and that the program will be sustainable and benefit the community in the long-term. With this in mind, we began a research and consultation process concerning the topic of gender in Laos with the local community in Luang Prabang. We decided to interview both men and women from different areas and socio-economic backgrounds to get a rounded view of gender in Laos.
We asked questions like ‘Should we start a project for women in Laos?’ ‘If we were going to start a project for women, what do you think would be needed, what would it look like, and what would you like to learn?’ We also asked questions about how people in Laos perceive gender and about what the challenges faced by women in Laos are. Those consulted felt that the main gendered issues in Laos were:
- Entrenched gender roles, domestic violence and low-confidence in women.
- Unequal access to education for girls, in terms of primary, secondary, high school, and tertiary education.
- Dependency on the informal sector for work, which can result in a lack of self-sufficiency, poverty, and exclusion from economic participation.
They wished to have a program which provided:
- More access to education for girls and women.
- More access to English language lessons for girls and women.
- Vocational English language lessons to help women improve employment opportunities.
- Computer and sewing skills training, among others.
- Health-related information and training.
- Business knowledge and skill training.
From here, we set about developing a Women’s Empowerment Project proposal based on the needs identified throughout this process.
The GVI Laos Women Empowerment Project
The GVI Laos Women Empowerment Project officially launched in April of 2016 with two English classes of 15 existing female students that ran for one hour, five days a week.
Since then, the project has grown organically based on the needs of the community. Today, our English Language Program has approximately 50 students. We also run computer and sewing skills workshops and are assisting a group of locals in setting up their own micro-enterprise. Our Health Program also engages the community in topics such as puberty, self-esteem, body image, nutrition, and first aid. Our local staff and international volunteers have also developed and regularly deliver gender equality workshops which aim to facilitate discussions and awareness surrounding gender topics with both men and women in the community.
Most recently, our Health Program has expanded its focus to menstrual health through education and sustainable menstrual health kits and it all started with a little colorful bag, a spirited 13-year-old and a group of students on the floor of a classroom talking about when they first got their period…
The Colorful Bag
I was first introduced to Days for Girls by one of the most unlikely people. In 2016, a male Australian volunteer in his 50’s came to me with a beautiful little patterned bag. He handed it to me and said he knew someone in Australia who had made it and had asked him to give it to someone in Laos.
I quickly learned that the bag came from Days for Girls, an international NGO dedicated to increasing women’s access to menstrual health education and sustainable menstrual healthcare solutions. The founder, Celeste Mergens, created and trialed the kit herself after a volunteer project in Kenya where she experienced first-hand the challenges women and girls face surrounding menstruation. Ten years later, Days For Girls has reached over 1,000,000 women with its project.
There are two parts to the Days For Girls Initiative, Menstrual Health Education, and Sustainable Menstrual Health Kits. The little colorful bag was one of these kits.
Each Menstrual Health Kit is designed for comfort and hygiene, using materials that aid in absorbency and mechanisms that helps with comfortable wear. The kits components are all washable and can last for up to 3 years if care instructions are followed. The kit also includes two pairs of underwear, a washcloth, and soap to ensure utmost hygiene. An illustrated tracking sheet helps women monitor their menstrual cycles. To make them easier and more convenient to use, there is a ziplock bag to place soiled liners in to soak when they cannot be washed immediately. All components are kept in a uniquely patterned bag.
The Menstrual Health Education Program covers:
- The female and male reproductive systems;
- A phased description of the menstrual cycle;
- Tracking the menstrual cycle;
- The link between menstruation and reproduction;
- Instruction on how to use the menstrual kit;
- And sanitation and hygiene best practices while menstruating and using the kit.
I have spent a lot of time in the rural areas of Laos when I’ve had my period, particularly with my husband and our family in their village. I have experienced challenges and frustration finding somewhere to dispose of my tampons and pads, how uncomfortable it is, and how I looked forward to going back home to Luang Prabang the next day. But, I get to go home the next day. This is what these women go through every month. At home I have access to sanitary items, a luxury that I learned from my husband’s family and my Lao female friends and students, that women and girls in rural areas of Laos do not always have. That is why I thought the kits were incredible and would work for women in Laos. However, just because I thought the kit was great, did not mean it would be great for a Lao woman or that they would use it. This would need to be determined by Lao women, not by me.
Around the same time, we were about eight months into our Women’s Empowerment project, which focused on English classes and workshops for women and girls in Laos. We had 50 young girls in the program and our health program was in its infant stages. We delivered a series of workshops on self-esteem, body image, and internet safety.
We then tried puberty. The students found this subject uncomfortable and were not yet ready to discuss something so personal. We decided to table the idea and focus on another subject the students were interested in.
The colorful bag sat on the shelf amongst textbooks, files, and flashcards, waiting for the right time.
A Spirited 13-Year-Old
Our Women’s Empowerment English class features an eclectic mix of personalities. Most are from the Lao countryside who have moved to the city to gain greater access to education.
In early 2017, I walked into the English class to teach one afternoon, and Miss P, one of these long-term students, a 13-year-old, who is quite possibly the most outspoken young woman I have met here, was sitting at her desk, holding her abdomen and breathing dramatically.
I asked her what was wrong and she sighed dramatically. ‘Teacher,’ she sighed ‘I am sick.’ I asked her if she had her period in English, but she hadn’t learned the English vocabulary before, so I asked her in Lao. She immediately sat up straight, as if my Lao had cured her period pain, and said ‘Teacher, how do I say that in English?’
And there I was, in a classroom in Laos writing ‘Do you have your period?’ on the whiteboard and drilling for pronunciation. Miss P, naturally, began practicing her new-found English phrase with pride and applying it to grammatical structures she already knew. ‘Do you have your period? I have my period. Does she have her period? She has her period. Teacher, do you have your period?’
This caught the attention of the other girls as they filtered in for class, who all huddled around the one table copying the phrase in their books and practicing asking each other. ‘Teach us, teacher,’ they all said with a twinkle in their eyes. It was at that moment that I knew they were ready.
Our First Menstrual Health Workshop
After that, we began developing a menstrual health workshop tailored to the girls in our program. A few weeks later, we pushed all the tables to the side of the walls and sat on a mat on the floor of the classroom in a circle and shared our period stories. Over the course of a week, we covered male and female reproductive systems, how this links to menstruation, each phase of the menstrual cycle as well as Lao beliefs and traditions concerning menstruation in Laos. We also had a ‘yoga for period pain’ lesson which the girls loved. After the class, Miss P was even found playing yoga instructor to girls who had not attended the menstruation workshop.
That colorful bag on the shelf then finally got the chance to shine. We showed it to the girls and asked for their thoughts and feedback. They were fascinated by it and all wanted one.
At the end of the workshop, I was approached by two of our older students, Tarn Khounvilaila and Soua Vang, as well as our local Community Liaison, Ly Ly. I will never forget their faces. They were equal parts liberated, elated, shocked and determined. They said, ‘Teacher Leyla, how did not we know this? This has changed everything for us. Now you have to help us tell everyone else. These determined young women would go on to become the leaders of our Menstrual Health Initiative.
Research is always important before setting up any community development project, and so myself and our Community Liaison Lyly got to work. We went beyond the group of girls in our program to ascertain general knowledge in regards to menstruation, particularly in rural areas, and access to sanitary products.
We found a general lack of access to education surrounding menstruation and challenges in accessing sanitary products, particularly in rural and remote areas. We also found some common beliefs that would be labeled “misconceptions” in the West. For example, many Lao women believe that you cannot eat pickled mangoes or a specific type of eggplant when you have your period, or play sport. Some believed that their period was supposed to come on the same date each month and that washing your hair could throw off the timing.
Lyly and I then connected with Days For Girls and became the first official representatives of Days For Girls in Laos. This is how the Days For Girls GVI Luang Prabang team was born.
The main aim of our project was for it to be locally led. Rather than having Westerners deliver the workshops in English and then translating the information, we wanted local women to teach local women in their own native languages. This is what sustainable development is all about, empowering local people to empower their own communities and ensuring that if myself or GVI were to leave that the project would still continue on. Although it takes more time and effort to work in this way, the results are worth it.
Our objectives, developed in consultation with local women, were as follows:
- To increase access to menstrual health education in rural and remote areas in Laos.
- To increase access to menstrual health products and sanitary items in rural and remote areas in Laos.
To do so, we aimed:
- To distribute Days For Girls kits and deliver the education program in remote and rural areas of Laos. This was because, in the city, there is greater access to sanitary items and education than in remote and rural areas;
- To educate a local team of women on menstrual health and have them certified as the first ever Ambassadors of Women’s Health in Laos. They would then be able to deliver the Days For Girls education workshops in the native languages of the local women at their own discretion;
- To source kits from volunteer teams internationally but to eventually transition from this over to a micro-enterprise model where we assist a group of locals to start their own business sewing the kits. This would not only make the menstrual health project more sustainable but it would also contribute towards the local economy.
Before we went ahead with our project, we first needed to trial the concept. It is always important to conduct a pilot project to assess the viability of a program and to conduct monitoring and evaluation to assess impact. We did not want to be delivering workshops and distributing kits if they were not useful or helpful to the community.
In June 2017, we conducted our pilot program using kits that were generously donated from a Days For Girls Geelong Coast Team in Australia. Over the course of two weekends, we delivered the Days For Girls education program and kits to 60 women in a rural village three and a half hours from Luang Prabang.
As our local leaders were not 100% ready to lead the workshops themselves, myself and our Community Liaison Lyly conducted the workshops and were assisted by three of our students including Tarn and Soua, two volunteers and a GVI staff member, Katie Ippolito. These three students then connected in small groups with the women and girls after the workshops to answer questions and show them how to use their kits again.
We were honored that a district nurse attended the first of these workshops. She approached us at the end to express how supportive she was of the initiative and confirmed our original research on the lack of menstrual health education and sanitary products in rural and remote areas of Laos. She also bought several of her nursing colleagues to attend the second workshop.
Several months later, we conducted monitoring and evaluation assessments of the women and girls who received kits during our pilot program. The results were extremely positive. It showed that all the women were using their kits and liked them. It also showed that those who worked on farms said that they no longer have to skip going to work when they have their period so they can keep helping their families even while menstruating. Similarly, those at school said they used to have to miss school when they had their period, but since getting a kit, they no longer missed school, thereby not missing out on classes and education. The only constructive feedback was that they wished to have more liners for the cold season when it might not dry as quickly. We were happy to organize these.
With this feedback and the support of three local women, we set about planning phase one of our Menstrual Health Initiative. We were yet to decide on a specific location.
Setting Up Sewing Workshops
Now that we knew that the project was viable, we began taking actions in line with our objectives. One of the objectives of the initiative was to assist a team of local women to make their own business sewing the kits. We were extremely grateful to receive a generous donation of materials, resources and a snap/button machine from Sarah Ramsey Giles and The Chaoyang Beijing Days for Girls Team that we added to the materials we had already sourced. We were also lucky enough to welcome Days For Girls North Canterbury New Zealand Team Leader Kathryn Lynskey to our Women’s Empowerment Project. She brought over kits from New Zealand to contribute and spent 4 weeks in Luang Prabang, teaching several local women, including our three local team leaders, to sew the kits from start to finish. The aim was for these women to either create their own business or have the skills to then pass these on to others who would do so. We also began sourcing materials locally. While Kathryn could have spent the time sewing kits herself, having her teach local women would have more of a sustainable long-term impact and this is why we chose to have her do this instead.
Partnering with The Bamboo School Foundation
I had arranged a meeting with Isabel Montano, Bamboo School Foundation General Manager, to get to know NGOs in the area and connect around our shared passion for development in Laos. My husband, Valee Xiong, who is one of GVI Laos’ two Community Liaisons, accompanied me to this meeting.
After giving overviews of our programs and having a friendly talk and discovering our shared passion for women and gender equality, Valee piped up and said ‘Oh Isabel, I know the Bamboo School Foundation and the founder.’
It turns out, Ban Houay Lor, a mountain village in the Mung Ngoi area in Northern Laos where my husband Valee was born, was Bamboo School Foundation’s first project village and the bamboo school in this village is the Bamboo school where the Foundation first got its name and where 5 of his younger siblings attended primary school (Valee had attended primary school in a hut previously used as a classroom before the school was built). In fact, the founder, Bodo, was the first foreigner that Valee ever met when he was 10 years old. Before this meeting, I had never heard this story.
After learning that Valee knew Bodo, Isabel wanted to help them reunite after 13 years, so she invited us to Nong Khiaw, a village close to Mung Ngoi where Bobo was due to arrive the following month. In the weeks that followed, we wrote up a partnership proposal for Phase One of our Menstrual Health Initiative and finalized our partnership with Bamboo School Foundation.
We had found our location. Together, in partnership with Bamboo School Foundation, we would approach six of the villages, both Hmong and Khmu, that the Foundation works with to see if they would be interested in the project being carried out in their villages.
International and local partnerships are a great way to work towards common goals and objectives. By combining ideas, knowledge, resources and the efforts of more local and international individuals, you can strive to achieve more and have an increased capacity to develop and carry out initiatives. While there can be challenges that can arise, such as a large number of opinions or diverging expectations, fostering partnerships between NGO’s and others organisations and working hard to strengthen them can enhance a program and result in a greater positive sustainable impact.
The Importance of Engaging Men in Women’s Empowerment
In November 2017, we met with Isabel from Bamboo School Foundation to conduct a site visit to all six villages, to meet with the chiefs and women to gauge their interest in the project.
I have always known that the empowerment of women, gender equality, and women’s health are not just women’s issues, but human issues. Engaging men, half of the world’s population, in this effort too would be the best way forward. I also knew that the support of the village chiefs was vital for conducting the project and for the education and kits to have a lasting positive impact. We needed to be respectful of local customs and traditions, to get permission to deliver the workshops and to ensure the village chiefs and males in the village were supportive of the continued use of the kits after we left. It was during this visit that I witnessed first-hand the important role that men play in women’s empowerment and menstrual health on multiple levels.
While gender roles and traditions may be shifting in the urban and more industrialized areas of Laos, this is not as rapid in rural and remote areas. In these areas, traditional beliefs and entrenched gender roles continue, with men playing the dominant decision-making role, as they are believed to be “stronger, smarter and harder working”. In each village, there is a village chief and sometimes a 2nd and 3rd male in command. These men are in charge of all village happenings and represent their villages at the district level.
Valee took complete leadership of this visit and all the meetings with the village chiefs. It was incredible to watch Valee, a 23-year old from the area, who had been a Novice Monk for seven years and gained access to education in Luang Prabang, connect with Village Chiefs from the Mung Ngoi area where he was born and advocate for women’s health issues. He explained why supporting women benefits the whole village, why menstrual health education and sanitary items such as the kits are so vital and how this links to increased work and education for females. He also showed the kits to the villages chiefs and demonstrated how to use them without an ounce of embarrassment or shame.
It was fantastic to see how each village chief wholeheartedly supported the initiative. We also made efforts to engage with the women in the villages to see if they were interested. Their reaction was priceless. We got a resounding, ‘Yes, please come back!’. One village chief even stated, ‘You have my support. I say yes, but you also need to ask the women.’ He called a meeting with all the women and Valee spoke to them about the project and the kits.
We were told by the village chiefs to expect approximately 400-500 women and girls throughout the six villages. It was time to begin planning logistics.
The First Ambassadors of Women’s Health in Laos
Now that we had the support of the six villages, it was planning and organizing time. Our three local leaders, Lyly, Tarn, and Soua, were determined to complete their training with Days For Girls so that they could deliver the workshops in the women’s native languages independently.
For four weeks, Lyly, Tarn, and Soua were guided by several volunteers, including a biology teacher. They studied the female and male reproductive systems, learned all about menstruation and all successfully completed the Days For Girls online course. These determined women became the first ever Lao women to be Days For Girls Ambassadors of Women’s Health.
Our Community Liaison Lyly and our former student, and now National Scholar, Soua, are both Hmong (one of Laos’ many ethnic minority groups). Both speak Hmong, Lao, and English. Tarn is Khmu (another of Laos’ ethnic minority groups) and speaks two dialects of Khmu in addition to Lao, and English. After learning the topics in English and Lao they set out to ensure that they could deliver the workshops in the women’s native languages of Hmong and Khmu.
We also began sourcing extra kits from abroad. We are incredibly grateful to the DFG network in Australia including DFG Canberra, DFG Fig Tree, DFG Geelong Coast, and DFG Emu Plains who collectively donated 350 kits to the initiative that I collected while on holiday in Australia and shipped to Laos. We also began sewing more kit components and packing kits to ensure we had enough. Then we had to figure out how we were going to transport 500 kits, two volunteers, myself and three local women to and from the villages in the mountains and between them.
When I lived in Australia, I was a very organized, structured, on-time kind of person. However, my role as Program Manager with GVI in Laos has changed me. I am in a unique position directly between largely Western volunteers and a Western organization that runs according to Western concepts of time and structure, and the Lao people and culture that runs differently.
In Laos, everything is on Lao time, which is less structured and usually what we would consider to be late. Plans change at the last minute constantly and sometimes even after the last minute. Time is more fluid here, if you say 1 pm, you really mean between 1 pm and 2 pm. It’s more on a spectrum than rigid and static. Here in Laos, I plan everything down to the last detail with almost absolute certainty that the plan will change. That is why I make a second and sometimes a third plan, even though I know that things will inevitably change and I will need to adapt and solve problems on the spot. This is by no means a criticism of Laos culture or their concept of time, neither Western or Lao is right or wrong. It just is. Flexibility is now my mantra and I have Lao time to thank for becoming a more relaxed, flexible person.
So, we planned everything down to the last detail, drew up a schedule and arranged specific transport based on local knowledge of the area, but knew that along the way we would need to adapt and change based on the reality on the day, taking each change and challenge as it came, all the while saying ‘Bor pen yang,’ which means ‘no worries.’ This is all part of working in a foreign country; adapting and accepting these differences with no judgment.
GVI Laos Menstrual Health Initiative Phase One
On December 16th, 2017 at 5 am, we began the three-and-a-half-hour journey by van to our first stop. Here, we had some breakfast and transferred our luggage and the kits to the pickup truck that would transport the kits up the mountain, while we all climbed into a 4×4. Next was the three-hour journey up the mountain where we needed to get out of the vehicle on multiple occasions as the dirt road was too steep, so we walked both because of the weight and because it was unsafe to be in the vehicle at certain points.
Over the course of five days, in partnership with Bamboo School Foundation, we visited five of the six villages. We used all types of transport: vans; pick-up trucks; 4×4’s hiking; boats; and tuk-tuks; to navigate our way between the villages, starting at the villages at the top of the mountain and working our way down. Lyly and Tarn delivered seven menstrual health workshops in Khmu and Lao. Tarn was assisted by two volunteers who had helped her to complete their Days For Girls certification at her request.
While we had confirmed the dates and times, in almost every village when we arrived, the women had already gone to the farm to work for the day and who could blame them; they shouldn’t have to change their schedules for us. So, as anticipated we adapted. We were happy to be flexible and work around what was best for them.
Most of our workshops were either by torchlight around 7pm- 8pm or in the early hours of the morning before the women went to the farm. We were happy to see how many men in each village also came to the workshops to learn about menstruation and how this connects to reproduction. We were also humbled by the hospitality of all of the village chiefs and their families who welcomed us into their homes and shared their meals with us.
In January 2018, we returned to the top of the same mountain in Mung Ngoi to deliver our final workshops for phase one. This was in the Hmong village which could not participate during December. It was Hmong New Year, which is a celebration when the rice harvest has finished for the year. It lasts for one week where the Hmong people dress in their traditional dress and celebrate with traditional food, games, and music.
It was the journey up the mountain this time when we were not so lucky with our transport. Our vehicle got completely bogged down in the mud and we were stuck halfway up the mountain for several hours. The camaraderie of the area was amazing to see, though, and villagers came from throughout the surrounding area as soon as they heard to help us out. Having successfully made it to our destination, we stayed the night. Lyly and Soua then delivered two workshops in Hmong simultaneously in the early hours of the following morning.
Overall, throughout phase one of our menstrual health initiative, we distributed 359 kits in six villages over nine large menstrual health workshops and four one-on-one sessions for women who could not leave their homes due to illness or recent childbirth. This brought the total to 419 women with greater access to menstrual health education and sustainable menstrual health materials since our Pilot program.
The Future of the Menstrual Health Initiative
We are now at a point where we are planning for Phase 2 and have removed all volunteer involvement from the education and kit distribution parts of the process. Our local leaders are completely responsible and do not need us anymore. That is what sustainable development is all about. One of them has even approached me about having taken the initiative to have a meeting with her village chief to get his permission to run the workshops and distribute kits in her own village.
We are focusing our volunteers’ efforts on the final objective of transitioning to a micro-enterprise model where a local team of women can run their own self-sustaining business sewing the kits. Eventually, we will not be needed at all.
In April 2018, our local leaders will return to the six villages from Phase One and conduct monitoring and evaluation to assess the impact of the kits and if there are any changes or additions needed. Preliminary feedback has already been gathered from the village chiefs, which has all been positive. They have requested more kits, including heavy flow liners. We have also received requests from surrounding villages for the program.
The Future of Women’s Empowerment in Laos
The future of women’s empowerment in Laos is in the hands of the Lao people, of Lao women and men of all ethnic groups. It is not foreigners that can change Lao, it is Lao people, Lao women, and men. GVI’s role and my own has been to provide opportunities for these men and women to seize and engage with, to become their own thought leaders.
Overall, although I am writing the article, the aim is for me to become obsolete. It is these incredibly inspiring Lao women, who share the same fire inside them that I do, that are leading the charge and having a positive impact on their own communities through increasing menstrual education and access to sanitary products in rural Laos.
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