Last Saturday, Michelle ObamaMichelle LeVaughn Robinson Obama2020 is not a family affair, for a change Former speechwriter says Michelle Obama came up with 'when they go low we go high' line CBC marks 400th anniversary of slaves' arrival in US MORE encouraged girls in Siem Reap, Cambodia to stay in school so they could learn to use their voice and speak up for their rights.  Obama was in Cambodia as part of the Let Girls Learn initiative that was launched by the Obamas last month and aims to provide support for educating the 62 million girls around the world who are not in school.  But did Mrs. Obama go looking for the school toilets?

In 2012, a Cambodian adolescent schoolgirl used her voice to tell us this: “When I was in lower secondary school, I was sitting and doing my exam, and I felt sore in my stomach and lower back. After I finished my exam, I went outside…I felt something sticky on my trousers.  I stood up and saw a lot of blood.  I was so afraid and I didn’t know what happened to me, and felt very embarrassed that someone might see it.” 

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The numerous media stories covering the first lady’s visit to Cambodia highlight all the reasons that girls in Cambodia and elsewhere in the world may not be in school.  These include, for example, ongoing gender inequalities, poverty, parental fears that girls will be at risk of physical or sexual violence, and family concerns about the distance girls have to walk to school.  Absent from the reporting or from Mrs. Obama’s remarks was mention of the challenges menstruating schoolgirls must face in attending schools that lack access to adequate water and sanitation facilities.

Recent evidence from Cambodia suggests that adolescent girls receive inadequate guidance about their menstrual periods, causing experiences of shame, fear and embarrassment, and attend schools that frequently lack toilets.  A survey conducted by the Cambodian government in 2012 indicated that out of 10,455 schools, 31 percent did not have any latrines on school grounds.  These findings are not dissimilar from data on school water and sanitation facilities in other low-income countries, including countries targeted by the Let Girls Learn initiative, such as Ghana and Uganda.

The Ministry of Education, Youth and Sport (MoEYS) in Cambodia is beginning to act on this problem.  In 2013, they approved for use in the school curriculum a Cambodia girl’s puberty book aimed at 10-14 year old girls.  The book incorporates guidance and support for girls on getting your period and managing menstruation in school.  In 2014, the MoEYS collaborated with UNICEF and UNFPA to order over 130,000 copies of the girl’s book for distribution in schools.  

However much work remains to be done in order to improve the lives and school-going experiences of the millions of girls in Cambodia who are trying to attend schools – or who will attempt to attend schools – with support from the Let Girls Learn initiative.  

Remarkably, the new initiative does not incorporate attention to menstrual hygiene management in schools.  Two weeks ago at a Q&A session following a panel on menstruation and education at the annual Comparative International Education Society conference held in Washington, DC, the message conveyed about the US Government’s education initiatives in low-income countries was that until evidence proving the link between providing water and toilets in schools or menstrual management education to girls could demonstrate an improvement in attendance rates or performance in school achievement, there would be little to no investment in this arena.  Although the reality of limited global resources for investing in girls is not an insignificant issue, and decisions must be made on the best evidence available, as a full professor at a well-known education university asked in response to this news, “where has the common sense gone in our investing?”

Michelle Obama shared a story during her remarks in Cambodia, that of having been a little girl whose life was transformed by education, and how personal this new initiative feels to her.  Hopefully the schools she attended as a small girl in the USA had toilets and water so that as her body changed and she had to learn to manage her period in a coed environment where adolescent embarrassment and confusion usually reigns, she could manage her menstruation with dignity, privacy and comfort.  Most likely the schools the Obama’s two teenage daughters attended did not lack of sanitation facilities.  The same cannot be said for Cambodian girls today, or for girls attending schools in other low resource contexts around the world.

In 2012, Cambodian schoolgirls drew for us their imaginary perfect toilet for girls.  It included the most basic of needs – a rubbish bin, a water supply, and a mirror – with toilets to be moved a distance from the boys’ toilets. Cambodian girls have used their voices to tell us what they need to stay in school.  The Let Girls Learn initiative is remiss in not responding to this call. 

Sommer is associate professor of Sociomedical Sciences at the Mailman School of Public Health, Columbia University.