Carrying Capacity

Hubeida, Hamdia, Humu, Huzeima, Sumaya, and Rukaya in Accra's commercial district of Old Fadama, also known as Agbogbloshie.



PHOTOGRAPHS BY Alhassan Fatawu

The work of kayayei in Ghana’s Kantamanto Market is grueling for the women and girls who carry loads of clothing waste upon their heads. The Frontline shares the words of Liz Ricketts, cofounder of The Or Foundation, which is dedicated to fostering new opportunities for these women.

*These names have been changed to protect private medical data and to honor The Or Foundation’s agreement with certain program participants who wish to remain anonymous. We are only sharing the first names of the women and girls we do name to protect their medical information and their autonomy from their families with whom they share a last name.


It’s common to feel a sense of relief upon cleaning out our closets and donating what we no longer want. But in a world consumed by excess stuff, that feeling is fleeting, and the truth is heavy. 


Here in Ghana’s Kantamanto Market, women work as kayayei, a Ga and Hausa word that means “she who carries the burden.” They carry 120-pound bales filled with clothing on their heads—most of which is donated by people in the Global North. Kantamanto is the largest resale and upcycling economy in the world, successfully recirculating at least 25 million garments every month. Sitting next to retailers are rows of tailors adding seaming to stretch-to-size garments, designers producing small-batch upcycled collections, and cobblers salvaging broken shoes. Kantamanto has been resisting the advancing frontier of disposability culture for decades, but of the 15 million garments that enter the market every week, roughly 40% leave as waste: burnt in piles around the city, filling dumpsites, clogging gutters, and washing out to sea. 


It is here in Accra where Big Fashion’s waste crisis is made visible, where our excess hits the ground and the debts of an entire industry pile up.

An unnamed kayayo carries her child—and a clothing bale—through Kantamanto Market in Accra, Ghana.

Who moves all this clothing? The kayayei are paid a meager 30 cents to $1 per trip to transport bales to stalls, storage, and disposal sites. Given the imbalance of power, every actor within Kantamanto—the kayayei and retailers alike—are laboring in service of foreign profit, foreign-defined sustainability, and foreign waste management “solutions.”


The organization I cofounded, The Or Foundation, works closely with girls and women who head-carry secondhand bales in Kantamanto. Over the last year, we have been collaborating with an Accra-based chiropractor, Dr. Naa Asheley Dordor, and her team at Nova Wellness Center to understand the physical implications and social drivers of head carrying. Together, we are able to assess and treat five girls a week, as well as offer ongoing treatment and new career opportunities. 


The following moments, taking place in and out of the doctor’s office (and not in any chronological order), represent some of the dots that this research connects, revealing the many intersections between women’s health, climate change, and fashion’s waste crisis.

Hamdia, Humu, Sumaya, and Huzeima outside of Hamdia’s residence in Accra’s neighborhood of Old Fadama.

DAY 1: It’s my 35th birthday, and I find myself sitting next to Sala*, a girl who doesn’t know her age. She thinks she is around 18 years old, but Dr. Dordor believes Sala is only 16. Dr. Dordor puts up her x-rays and points to Sala’s growth plates—they are still open. Her body is still growing. Sala has been working as a kayayo for almost 10 years, so she has been carrying loads since she was 6. She is the mother of a 2-year-old boy; his age she knows. Sala isn’t the first girl to learn her age through our Chiropractic Research and Treatment Program. In fact, most participants do not know how old they are until they are sitting in this room, seeing the stress they feel reflected in the images of their bones. Dr. Dordor often says that we are seeing the spine of a 60-year-old in a teenager’s body.


I catch myself thinking, first, of surface-level privileges: the birthday parties Sala missed and the cakes uneaten. Then, I remember that no birth date likely means she has no identification: no card to help her access healthcare, school, or skills training. Fuck cake.

Fast fashion is a life-squashing manifestation of greed that has rendered all clothing waste.


DAY 2: A trail of girls descends from a village near Yendi. Some as young as 4, dressed in vibrant skirts and faded secondhand tops, the girls kick up red dust on their way to the river, their bowls and Kufour gallons swinging next to them or tucked under their arms. They are light footed, their gait irregular and playful, heads turning freely to talk to one another. On their way back from the river, these same bowls and jugs are fixed atop their heads. There’s less bounce to their step, and their arms take turns steadying the load. I can see the water move back and forth with their bodies, the weight shifting organically as their feet step forward and down. Many will take more than one trip per day, walking about a mile uphill each way. 


For every 40 girls making their way to the water, there is a boy. These boys are fewer and older than the girls. They have bikes, speeding up the trip to the river. On their return home, the boys strap their water jugs to their bikes and roll their load up the hill. The girls do not have such tools. Their body is the tool—even at 4 years old.


It’s easy to see why girls might migrate from this village to Accra to take up the kayayei trade. As several have told us themselves, they grow up carrying weight atop their heads, so moving somewhere where they can be paid for this labor only makes sense. They don’t see any other way to make money at home, and many hope that, as kayayei, they will save enough money to build a business selling cold beverages or braiding hair. 


But the loads carried at home and the loads carried in Kantamanto are not the same.

An unnamed kayayo with child carries her bale in Kantamanto Market. In front of her, the yellow words on the car read, “Macho Man,” a sobering reminder of the patriarchal system that likely pushed her into this work.

Water is a life-giving necessity most often carried in a bowl that most girls can lift off of themselves and down to the ground with ease. Fast fashion is a life-squashing manifestation of greed that has rendered all clothing waste. Girls and women working as kayayei in Kantamanto cannot lift the 120-pound bales without assistance. When they reach their destination, kayayei drop their load by jerking their heads forward, their necks pushing it away from their bodies as they let the bale fall to the ground in front of their feet with a thud. It is not uncommon for the excess clothing to break their feet in the process.


A bowl of water can be half empty—the weight determined by the carrier and adjusted to her age and energy level. But a secondhand clothing bale is a commodity. Despite containing hundreds of garments in varying sizes with the markings of individual humans—sweat, ketchup stains, stretched collars, names written into tags by mom––clothing bales are not designed to match the unique variations of the human form that will transport them; their size and weight has been predetermined solely to maximize efficiency and profit. 


Big Fashion’s race to the bottom has transformed clothing into nothing but weight being shuffled around the world. Similarly, many of the girls fetching water from the river will be transformed into kayayei, their individual identities rendered invisible by their position at the bottom of Accra’s social ladder, and their bodies used as a forklift to transport a commodity already deemed as waste by the people who sent it here.

Humu at her residence in Old Fadama.

DAY 3: We welcomed five younger girls to the program today. These five girls do not know their exact age, but most are younger than 11. Four of the girls have lost the natural curvature of their neck. Asana* has a fracture, and Rafia* has trouble breathing when she carries. The clothing she is carrying weighs more than Rafia herself. Four of these five girls constitute emergency cases: they need to be removed from the kayayei trade as soon as possible. 


I have participated in campaigns against child labor with the clarity of someone who has never met a working child. And, now, here I am in a room with five girls for whom going home is not an option because of abuse, child marriage, or lack of family. There is no school they can afford or trust over the security of earning their daily bread. In many ways, childhood has passed them. Still, we cannot place them in our apprenticeship program because the legal working age is 16 in Ghana.


I am angry. I am confused. I am at capacity. 


These girls may be young, but I am naive. 

Is it possible we do not know what to do with women who step outside of the box they were placed within?


DAY 4: My colleague Sammy and I decide to pass through the railroad on our way to the market. As I reach the gate at the railroad station, I see that men are charging an entrance fee of 50 pesewas. This station is largely unused, so they do this every few weeks, I presume, to cover basic maintenance in lieu of any profits earned via traveling passengers. 


As I hand over my coins and pass into the market, a girl no older than 12 is standing to my left with a secondhand clothing bale atop her head, her eyes breathing urgency into the man fumbling to find change for her bill. Standing is the most painful and dangerous thing a kayayo can do; the weight has nowhere to go but down.


This girl is working for someone else, yet she is paying to transport her laboring body through this specific entrance. I am reminded of something my colleague Chloe said: “Kayayei are not seen as human. They are considered a form of transportation. You have trotro, taxi, bike, and kayayo.” 


I have heard adults refer to kayayei as “a menace,” “a thorn in the side of development,” “a plague,” and of course “the problem.” I have also been warned against making them “too comfortable” and advised to focus on “controlling the population” because ultimately “the solution” is to force these girls back from where they came. “The issue is that they are leaving their husbands and breaking up families,” one man recently argued, insinuating that the girls and women migrating to work as kayayei were stepping out of their natural place—even as he speaks to me, someone who is also working far from where I was born.

Huzeima displays waste t-shirts in The Or Foundation’s No More Fast Fashion Lab. The shirt reads,”My favorite season is the fall of the patriarchy.”
The Or Foundation is helping transition kayayei out of the trade so that they can, instead, pursue work where they’ll learn new skills, protect their health, and earn a higher wage. The foundation’s No More Fast Fashion Lab serves as both a community center and lab to convert old clothes into something fresh.

What is my natural place? My migration is palatable and considered the sum of my individual choices and privileges. Their migration is considered the problem. But the majority of girls and women working as kayayei made the choice to migrate. Whatever their motivations, it does no good to pretend that forcing them back to the north, further stripping them of agency, is the “solution” they came looking for.


Is it possible that we are uncomfortable with the choices these girls have made because their choice to work a backbreaking job at the age of 10 only proves our failures as the adults of this world?


Is it possible we do not know what to do with women who step outside of the box they were placed within? 


Is it possible that many girls and women migrate in search of a form of freedom and respect that has nothing to do with comfort?

DAY 5: Several members of the Kayayei Youth Association, another kayayei-centered organization we work with, asked us to meet in their office to discuss gender-based violence. There has been a string of attacks, almost nightly for weeks, where a few men have sexually assaulted a group of girls as they walk from where they sleep (in a public outdoor concrete space) to the toilet. One of the girls was murdered after reporting the incident. 


Many girls and women working as kayayei experience sexual assault. If they are injured or fall sick and cannot work, then they may not be able to make rent and lose the little shelter they have, making them vulnerable to abuse. 


The most common “solution” presented to these women as their ticket out of poverty and abuse is to learn to sew. Because making clothing is a “job that women can do.” But making clothing won’t solve any of the challenges these women face when the fashion industry has driven the value of clothing into the ground.

Now, there is almost always a fire burning at the dumpsite, the steady stream of excess transformed into air pollution.


DAY 6: While a woman is stretched out on the adjustment bed awaiting treatment, her son walks over and places his hands on his mom’s neck. He looks up at Dr. Dordor, whose hands are next to his, seeking guidance on what to do. We all giggle. 


Every Friday since mid-August, we have welcomed five girls working as kayayei to Dr. Dordor’s office. There is usually a baby or two in tow. In October, Sharifa* came with her son who was only a few months old. He had a cough that grew worse throughout the day, and we could see that he was struggling to breathe.

Hamdia holds her friend’s baby in Old Fadama.

We facilitated Sharifa’s decision to return home to northern Ghana with her son. He died this month.


When we met Sharifa, she was staying in Old Fadama, a settlement near Kantamanto. She carried her son on her back while carrying bales. At nightfall, she’d return home to the small room she shared with her son and her sisters. This room sits just feet from a dumpsite where some of the clothes she carried would end up.


This dumpsite has nearly tripled in size during the pandemic with more secondhand clothing, plastic packaging, and e-waste arriving every day. To stop the mountain of trash from toppling over into the river, which empties into the sea just a kilometer away, the people who live near this dumpsite have had to burn one face of the mountain, leaving behind charred shoes, melted leggings, and crunchy polyester tops. Now, there is almost always a fire burning at the dumpsite, the steady stream of excess transformed into air pollution. 


I have no doubt that the fumes from this burning pile of stuff killed Sharifa’s son.

Huzeima sits in front of new yardage made from waste t-shirts in The Or Foundation’s No More Fast Fashion Lab.

DAY 7: In her chiropractic assessment, Huzeima points to where she’s in pain and describes how she often gets dizzy when she carries a bale. She has been taking painkillers every day for months, sometimes multiple times per day, so she has stomach ulcers as a result. Without the painkillers, she wouldn’t be able to carry enough loads to pay for her daily expenses: rent, food, water, and access to the toilet and shower. 


I later ask Dr. Dordor how the girls can possibly work despite the pain. “They are numb to it,” she says. Dr. Dordor explains that kayayei are repeatedly injuring themselves to maintain their job. Imagine banging your arm against the wall over and over again. At first, it would hurt, but at some point, your arm would grow numb. 


Many x-rays of kayayei show severe deterioration of the spinal column. Most have lost the natural curvature of their neck, and their cartilage has disappeared. Some even exhibit a reverse curve. One woman’s neck bones have expanded, pushing into her trachea and making it hard for her to breath or swallow. In almost every session, we have two to three emergency cases. “It is only a matter of time,” Dr. Dordor says. Any day now, these girls could be killed if they simply tilt their necks the wrong way while carrying a bale. This is more likely to happen if they are numb to the pain signals that their body is sending.


Huzeima now works with us at our No More Fast Fashion Lab. She still experiences debilitating pain from her ulcers. The harm done to her neck can be managed—but not reversed. At least Huzeima no longer needs painkillers to survive; she can simply take a break when her body needs it.

These photos show the types of injuries kayayei incur on the job. (Photographs Courtesy of The OR Foundation)

DAY 8: Driving along the road that hundreds of girls take from villages across northern Ghana to an Accra-bound bus, we see a faded sign from 2014 that reads, “Expanding Climate Change Resilience In Northern Ghana Project.”


Farmers tell us that the dry season is only growing drier, that droughts are becoming more severe. They would normally have seed in the ground by now, but they are waiting on the rain. We ask a government official about what actions are being taken to mitigate the impacts of desertification, and he says they are distributing agrochemicals and increasing access to tractors.


It’s not the answer we are hoping for, but it’s not surprising. Desertification has already hit his constituencies, and they are suffering physically and economically. There isn’t enough food to eat. Fathers are without the help of their sons who have noticed the red flags and migrated to the cities. Daughters and wives are walking farther to get water, which means less time for other house and field work. Tractors and agrochemicals might not stop desertification, but they might ensure people do not starve—at least not this year—even if they make the damage worse in the long run. 


Many of the girls and women who work as kayayei in Kantamanto migrate because the pressures of climate change compound existing drivers. Their family farms no longer generate enough food to sustain them or to trade for cash. They are carrying more and more water farther and farther, uncompensated. They see their brothers being given license to search for greener pastures. 


Climate and economic migration are becoming one and the same.

The oversupply of fast fashion garments depresses the value of clothing overall, squeezing people tighter and tighter the further you travel down the secondhand supply chain.


DAY 9: A meeting is coming up later today between Dr. Dordor and the Kantamanto retailers, tailors, and kayayei. We want to make sure the girls have time to express themselves before everyone else arrives. We know this meeting will be difficult.


After watching a video about a girl named Asana, who once worked as a kayayo in Kantamanto, the girls share how the video makes them feel. Fadilu* says that watching it was surreal because she never truly watches her sisters carry the bales. In survival mode, she doesn’t have time to question what she and her sisters are doing. Watching Asana carry the bales, Fadilu realized just how inhumane her job is and the role she plays within the larger ecosystem of fashion. 


Another girl, Marium*, says that in the time she’s spent in our programs and away from carrying, she has realized she might have been enslaved when she was working as a kayayo. 


Every bale is a gamble for Kantamanto’s retailers. Many exist in a debt cycle that they cannot shake. Retailers may be spending a lot of money on kayayei relative to their overall business expenses, but the girls working as kayayei earn less than a dollar per trip, barely enough to eat. The oversupply of fast fashion garments depresses the value of clothing overall, squeezing people tighter and tighter the further you travel down the secondhand supply chain.


Onto whom should the burden of changing this system fall? 


Onto whom should the burden of making the workplace safer for kayayei fall?


At this meeting, we ask Kantamanto’s retailers and tailors to take on their share of responsibility and work in solidarity with us and the girls who carry their bales to call for system-level change. They agree to break loads apart into smaller weights where they can and to work with us on restructuring the market to allow for other transport methods. This is the beginning of a much larger conversation and collective undertaking.

Hubeida, Hamdia, Huzeima, and Humu take a walk in Accra, Ghana.

DAY 10: Huzeima has ensured we are all aware that today is her birthday. 


Now that she no longer has to take painkillers to manage the impacts of carrying bales, Huzeima is sleeping well and revealing new parts of herself. She often waltzes into the office in bold head-to-toe monochrome outfits. Huzeima is an award-winning actress who has starred in multiple Dagbani films. She is also a dancer, regularly performing on Sundays for her sisters and the community where she stays in Old Fadama.


It took our team a while to understand that “sister” does not always refer to blood relatives but, rather, to the bond formed between kayayei. We have come to understand that regardless of what drives the girls to migrate from their hometown to Accra, they survive because of the sisterhood that is formed between them. 


Most girls work alongside their roommates, traveling to and from Kantamanto as a family. Along the railroad tracks, young girls massage one another’s temples as they rest in between loads. At home, they braid one another’s hair and joke about boyfriends as they mend their dresses. At our office, Huzeima and her sister apprentices have become mentors, welcoming new sisters every week to Dr. Dordor’s chiropractic care.


As our team takes a break to dance, eat cake, and celebrate Huzeima, I think about how fast fashion has pushed past planetary and human thresholds. Have we all become numb to the pain signals?


We are all at capacity. 


It is time for a break.

The Or Foundation and Nova Wellness Center have welcomed over 60 girls to the Kayayei Chiropractic Research and Treatment Program, which will conclude with 100 participants in May 2022. A formal report will follow, detailing the study results and offering recommendations for both Ghana and international decision makers. Through its complimentary Mabilgu Program (mabilgu translates to sisterhood in Dagbani), The Or Foundation transitions as many girls as possible out of the kayayei trade and into new jobs, including working at the foundation’s No More Fast Fashion Lab for Community Design where the apprentices upcycle and recycle textile waste from Kantamanto. The Or Foundation is also working to expand the role that women play in Accra’s economy by training girls to do jobs that are traditionally reserved for men. If you would like to support this work, reach out to Liz and her team at

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