Break the Taboo. Period.
Best Practices for Menstrual Hygiene Management
Menstruation is a normal biological process and a key sign of reproductive health, yet in many cultures it is treated as something negative, shameful or dirty. The continued silence around menstruation, combined with limited access to information at home and in schools results in millions of women and girls having very little knowledge about what is happening to their bodies when they menstruate and how to deal with it. A study from UNICEF revealed that 1 out of 3 girls in South Asia knew nothing about menstruation prior to getting it, while 10% of girls in India believe that menstruation is a disease (WaterAid 2013, Menstrual Hygiene Matters).
Menstrual Hygiene Management (MHM) is an important issue in gender equality. Many female students miss school or may drop out to avoid the shame and stress associated with being unable to manage their periods. Furthermore, some societies exclude women and girls from participating in social activities when menstruating. This puts women and girls at an unfair advantage with an inability to reach their potential.
In addition to persisting taboos, many women and girls face challenges with managing their periods safely due to a number of factors, including limited access to affordable and hygienic sanitary materials and disposal options, leaving many to manage their periods in ineffective, uncomfortable and unhygienic ways. In some contexts, natural materials such as mud, leaves, dung or animal skins are used to manage the menstrual flow. These problems are further exacerbated by insufficient access to safe and private toilets and lack of clean water and soap for personal hygiene. As a result, menstruating girls and women often feel ashamed and embarrassed.
The following are nine best practices for Menstrual Hygiene Management that can be applied across a number of contexts where women and girls have limited access to WASH including low income countries and in humanitarian emergencies. Context is important, as each country and setting will come with its own unique issues that must be incorporated into the project design. These practices can help NGOs (non-government organisations), social enterprises, corporations, or any group working in the field of water and sanitation.
1. Conduct formative research to understand the context where MHM project is needed
Formative research is imperative as each setting will have different opportunities and challenges that will impact on program design. For example, research conducted by the International Federation of Red Cross and Red Crescent Societies (IFRC) found that in countries where female genital cutting is practiced (such as Somalia, Yemen and Indonesia), women and girls need more sanitary pads as increases the number of days women menstruate. Focus group discussions and key informant interviews can be conducted to reveal key issues women and girls experience when trying to manage their menses.
2. Provide safe and accessible toilets with washing facilities
Gender-separated facilities are needed with a clean, functioning toilet with a door that can lock. If toilets are not secure, girls will avoid using them and often wait a whole day to change their sanitary pad or avoid going to school on the days they are menstruating. This has negative health and social impacts. A garbage bin is also needed to dispose used menstrual pads/tampons, and access to soap and water for washing hands and reusable pads.
3. Provide clear information about menstruation for adolescent girls
Understanding the physiological process of menstruation, reproductive health and adulthood is crucial. Many girls in low income countries receive limited or no guidance prior to menstruation about what it is or how to practically manage it. This can lead to gender discrimination, poor school attendance or drop out, low self-esteem and confidence, and social isolation. Female teachers, leaders, mothers and other trusted adults can be taught to provide MHM information to young girls and women. Lessons can be incorporated into the school curriculum, at youth clubs and girls-only sessions at religious institutions.
4. Source locally-produced reusable and/or biodegradable sanitary pads, tampons or menstrual cups
Some companies are developing innovative private sector solutions to improve access to quality menstrual products including reusable and/or biodegradable pads and tampons. Menstrual cups are also becoming more commonly used. Saathi is a social enterprise and manufacturing company in India that makes manufactures sanitary pads using plant-based materials for the leak-proof outer layers of the napkin, therefore they are eco-friendly, biodegradable and compostable. More examples are available in the WaterAid Menstrual Hygiene Matters resource.
5. Work with schools to target adolescent girls and young women
Research published by PLOS Medicine has found that menstruation impacts girls’ monthly attendance and drop-out rates in schools. There are three components that are essential to any school-based program: the provision of MHM guidance, fostering an enabling physical and social school environment, and the distribution of menstrual products.
6. Provide MHM programs in formal and informal work places such as market places and factories
Many programs are working to improve MHM facilities in schools, however those not in school or older women often do not have opportunities to improve their MHM. Safe and hygienic sanitation facilities are needed in public spaces, especially in urban slums and humanitarian contexts, to reduce anxiety, fears and vulnerability associated with walking long distances to find a toilet.
7. Work with communities to break down cultural taboos surrounding menstruation
Boys, men and other key influencers in the lives of women and girls such as teachers, doctors and relatives, play an important role in changing social norms, dispelling harmful myths and taboos surrounding menstruation, and encouraging girls’ healthy transition from puberty into adulthood. It would help to provide puberty education for both boys and girls with gendered lens on MHM, using behaviour change communication (BCC) methods, to reduce stigma and bullying at schools, and to address the social taboos surrounding menstruation and bring about discussion and change.
8. Ensure safe disposal of menstrual products
Safe disposal of used menstrual products is an important and often overlooked component of MHM. Safe disposal may include incineration where possible and ensuring garbage cans are available with a system of waste removal. Biodegradable and/or reusable menstrual products can help improve safe disposable and alleviate the tonnes of waste produced that take roughly 500–600 years to decompose.
9. Collaborate across sectors and include dialogue with leaders in WASH, education, sexual and reproductive health and corporate partners
Multi-sectoral collaboration is needed as MHM is a cross-cutting issue. Policy makers and key leaders across the above departments need to be engaged and come together to determine and implement appropriate solutions. Corporations are also showing more interest in developing innovative solutions to address MHM.
Days for Girls is a US-based company that aims to increase access to menstrual care and education by developing global partnerships, cultivating social enterprises, mobilizing volunteers, and innovating sustainable solutions that shatter stigmas and limitations for women and girls. Their movement has reached more than one million girls globally.
World Vision is working with schools and communities in Papua New Guinea (PNG) to raise awareness on the importance of integrating menstrual hygiene management in WASH (water, sanitation and hygiene) programming. This paved the way for concerned groups to work together to create an enabling environment that addressed gaps in MHM. Making it an integral component of all WASH programmes enhances women’s and girls’ fulfillment of their rights to health, education, dignity and gender equity.
(References can be found at the end of this page)
The article was taken from a research on Tips and Best Practices for Menstrual Hygiene Management by Karen Hobday, Gender and Hygiene Promotion Advisor of Asia P3 Hub.
Karen is an experienced public health consultant with a demonstrated history of working at the World Health Organization, development sector and higher education industry. She is skilled in maternal health, health promotion, sustainable development, humanitarian work, and research design/analysis. Karen is currently undertaking a PhD focused in global maternal health at the Menzies School of Health Research, Charles Darwin University, Australia.
References for the article:
WASH United — Menstrual Hygiene Management
Puberty Education and Menstrual Hygiene Management
Menstrual Hygiene Matters: A resource for improving menstrual hygiene around the world
An Opportunity to Address Menstrual Health and Gender Equity
Improving menstrual hygiene management in emergencies: IFRC’s MHM kit
Putting menarche and girls into the global population health agenda
A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools
‘MHM in Ten’: Advancing the MHM Agenda in WASH in Schools
Discussion Paper: Towards Gender Equality Through Sanitation Access
