Dr Chi Eziefula is an Associate Professor in Infection at Brighton and Sussex Medical School. She tells us about balancing clinical practice, research, and teaching, and her SSRP-funded project examining menstrual health in Africa and the UK.

 Your SSRP project is called Luna Connection. Could you please summarise it?

The project sits at the intersection of three areas: menstrual health, human rights and social justice, and environmental sustainability. My research partners and I have collaborated with experts and leaders in those areas in Uganda, Kenya, and Sudan.

To ascertain the status of menstrual health in those countries, we conducted policy reviews and in-depth interviews with stakeholders such as policymakers (including at the Ministries of Health), people working in NGOs, community leaders, educators like headteachers and schoolteachers, and young people’s advocates.

This topic is really pertinent in every economic and social setting. There are pioneering approaches to menstrual health in Northeast and East Africa that aren’t in place here in the UK, and there’s a shared benefit in examining those approaches.

Why did you select Uganda, Kenya and Sudan as case studies?

Uganda has a country commitment to Menstrual Health via the Menstrual Hygiene Management Charter since 2015. We explored how that is reflected in policy in Uganda. Kenya has a progressive Menstrual Health and Management Policy established in 2020. In Sudan, we collaborated with Ahfad University for Women, which is an institution that supports the higher education and empowerment of women in the region, including championing women’s health at the academic level and in terms of impact in the community. We collaborated with a Professor of Reproductive Health and Rights, Professor Nafisa Bedri at the University. This collaboration extended across a time of civil unrest and is impact on the University and colleagues.

What does Uganda’s menstrual charter entail?

The charter brings into focus that menstrual health is an important issue: for health, education, equality, and infrastructure like water supply and sanitation. The onset of menstruation is synchronous with the decline of girls’ attendance at school compared to boys in many countries and there is impact on education here in the UK as well. This has a lot to do with access to menstrual products and also how comfortable and easy it is to menstruate at school.

When did you start researching menstrual health?

I am a medical doctor specialising in infectious diseases, microbiology and tropical medicine. My research up to now has been in infectious diseases, especially malaria. A few years ago I took up the co-directorship of the Centre for Cultures of Reproduction, Technologies and Health (CORTH) at the University of Sussex, and that coincided with my attendance at global health conferences on global women’s health. It became exceedingly clear to me that within all genres of global health, a focus on women’s health is needed. Attending to the disparities in women’s health supports the health of men and women.

When I reflected on medical practice, it became apparent that there is a lack of knowledge around an essential process that occurs in female bodies. We have a lack of tools and an incomplete understanding of what can create hormonal thriving. There are significant human rights issues that arise from this lack. I decided to explore the area academically, and Luna Connection was the funded project that started a global health collaboration, thanks to SSRP.

Why is menstrual health a health, human rights and social justice, and sustainability issue?

From the perspective of health, we still do not understand how to support health in the body of a person who menstruates, from the point of view of hormonal thriving, what it means to be in a cycling body, and the consequences of going against the flow of that body.

For human rights and social justice, we’re looking at the intersection of poverty and menstrual health. Navigating menstruation typically requires a purchase of menstrual products, so poverty raises lots of issues around affordability and attendance at school, self-esteem and gender inequity. In many countries including the UK, this exposes female-bodied people to gender-based violence. For instance, there is a lot of data on people engaging in transactional sex to afford menstrual products, and exposure to risk in domestic settings through being out of school because of menstruation. In some of the countries we’ve collaborated with, a young girl may be seen as sexually mature when she starts menstruating, and therefore eligible for marriage. But the girl isn’t yet a mature woman. So that’s another issue.

From the environmental point of view: for the last 80 years of so, women have been purchasing menstrual products that are plastic-containing and single-use. Some commonly used menstrual products take up to 800 years to biodegrade in landfill. One typical packet of menstrual pads contains as much as five plastic bags of plastic. There is also potential leeching of plastic and other compounds into the human body because the mucosa [the tissue that lines the inside of various organs and body cavities such as the vagina] absorbs chemicals more easily than other parts of the body. There is currently no requirement to label menstrual products with what is actually in the product. The Women’s Environmental Network is working to raise awareness of this.

How accessible are reusable menstrual health products?

There are reusable products which can be reused for several years. They are available in shops, online and there is increasing awareness about them. There are many solutions in the countries we worked with, for instance making products at home using a sewing machine. Some initiatives use locally sourced materials and offer workshops that teach people how to make their own menstrual pads.

What are your takeaways from the studies you have conducted in Uganda, Sudan and Kenya that could be applied here in the UK?

A core takeaway is around dignity, where outdated and harmful perceptions of menstruation as dirty or shameful or wasteful can be transformed through education and cultural awareness. We can be transported to a place where society has a very different set of values and beliefs towards the natural healthy processes that happen within a women’s body.

Is menstrual health taught in schools in the UK?

That’s something we’ve been really scrutinising here in Sussex. We’ve been conducting interviews in schools to understand what education is offered about menstruation and how schools support people who are menstruating through their school years. Most school curricula will focus on menstruation in a very siloed way, which is mostly about how to manage menstruation. This education may be delivered only once in primary and secondary schools, and may be taught only to girls, which could promote taboo and embarrassment. There is something to be said for it being taught to all genders. It is clear that education is needed that extends beyond the basic biology, that also covers dignity and empowerment in a cycling body, and how that impacts one’s physical, psychological and social health.

You spin a few plates, splitting your time between teaching, research, and clinical practice. How do you balance it all?

I am a medical doctor, and I’ve been doing research throughout my medical career. I decided to become a clinical academic, because practicing medicine alone meant I couldn’t focus on the determinants of health. I was working at the front end, supporting health once people had become unwell, but what interested me was supporting the promotion of good health and prevention of illness. I also wanted to look at the social determinants of good health. I enjoy teaching undergraduates, postgraduates and qualified doctors. All of those aspects complement each other in giving me a wider perspective and enabling me to communicate through my work, including with people in the community and patients, so I don’t get stuck in the ivory tower.

Is it stressful, or do you have managing strategies?

It’s a work in progress. It’s important to have balance and to look after one’s own physical and mental health when there are a lot of demands, particularly when working in health and education systems that have their inherent pressures. One of the most important things is having good colleagues and good communication with different people.

Is there anything else you’d like to mention?

The first thing is that there is a period dignity project going on at the University. It’s really important we are able to provide free menstrual products for women and people who menstruate. We are providing free products across campus. BSMS give out reusable menstrual products to first-year students. We also give talks throughout the year around menstrual health and the other themes explored in Luna Connection.

Also, the Women’s Environmental Network is advocating for a new act being proposed in the UK Parliament. It’s called the Menstrual Health, Dignity and Sustainability Act. It’s really exciting. We want to advocate for this as much as possible, and generate awareness on campus and elsewhere.

Dr Eziefula research supports the fulfilment of the following SDGs:

SDG 3 – Good Health and Well-being
SDG 4 – Quality Education
SDG 5 – Gender Equality
SDG 6 – Clean Water and Sanitation
SDG 10 – Reduced Inequalities
SDG 12 – Responsible Consumption and Production
SDG 13 – Climate Action
SDG 14 – Life Below Water
SDG 15 – Life on Land