#NoMoreLimits: Good menstrual hygiene empowers women and girls to rise

By Guangzhen Chen and Thorsten Kiefer

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School training on MHM in Kenya ©WASH United

How do women manage their personal menstrual hygiene needs in environments without adequate latrines (or indeed any latrines), a sufficient supply of easily accessible and clean water, soap for washing, affordable and available sanitary products, and a mechanism for appropriately disposing of used sanitary materials? There are no easy answers and at least 500 million women and girls globally lack adequate facilities for menstrual hygiene management (MHM.)

In many societies around the world, cultural stigma and taboos associated with menstruation and MHM, combined with an overall culture of silence around the topic, limit the ability of women and girls to fully and equally participate in society, undermining their overall social status and self-esteem.

For adolescent girls, menstruation can directly affect educational opportunities. UNICEF estimates that barely half of them have access to adequate water sources in schools. And in many parts of the world, the availability of sanitation is deeply gendered. For example, in Tunisia, only 20 percent of schools provide adequate sanitation for girls, in contrast to 99 percent for boys. A meta-analysis of 138 studies on MHM in India, for instance, found that up to a quarter of girls reported missing school during their periods. When a girl receives secondary education, she marries later, has fewer, healthier children and is less likely to experience sexual violence. She also contributes to society’s overall growth and income, with evidence that increasing secondary education for girls by 1% results in an annual income increase of 0.3% per capita. So, promoting MHM is not only a sanitation matter — it is also an important step towards helping young girls achieve their full potential.

Recent research from the World Bank gives us some country-level snapshots. In Nigeria, the Bank estimates that 25 percent of women lack adequate privacy for defecation or menstrual hygiene management. In Guatemala, menstruating women who are among the 12 percent of the extremely poor reported struggling to find facilities to change and dispose of their used sanitary materials. And the same research found that in Tajikistan, although most schools have separate sanitation facilities for girls and boys, only one school in every fifty has water available in girls’ cubicles for MHM.

Of course, one of the first steps in tackling a challenge is understanding its scale. That’s why a recent report by the World Bank and the Inter-American Development Bank provides an overview of innovations in the monitoring of water, sanitation and hygiene (WASH) impact measures. One such proposed indicator monitors ‘equity’ in sanitation, which assesses whether menstruating women and girls are able to wash and change in privacy while at home, and whether they are able to attend social activities, school, or work during their menstruation.

Both contributing to and building upon such evidence are projects and programs across the world. In Ghana, the Bank is providing sanitation infrastructure and hygiene education in over 260 schools. This project was shaped by focus group discussions with nearly 160 students across schools in five Municipal Assemblies, which found inadequate WASH facilities and sanitary products, and negative cultural norms were reducing girls’ attendance. The same project also includes culturally appropriate training for teachers on how to promote awareness of MHM among their female and male students. And an education project in Haiti conducted a qualitative survey to understand the issues affecting girls’ school attendance and acted upon the results by incorporating an MHM component into their project.

Although some progress has been made, there are still many areas that require further engagement to ensure that MHM becomes a larger part of efforts to bring about gender equality. Most of the current work has occurred within the confines of the Water and Education sectors. Yet menstruation is intertwined with wider social norms and cultural practices and poor MHM affects the entire life of women and girls, including their health and access to employment.

Sandie Okoro, Senior Vice-President and General Counsel for the World Bank Group, joins #NoMoreLimits campaign on Menstrual Hygiene Day 2018 and calls to stop taboos around menstruation. © World Bank

One area where we clearly need to intensify our efforts is raising awareness for the importance of MHM and changing negative social norms around the issue. Menstrual Hygiene Day (MH Day) on 28 May is an excellent opportunity to get started with that. Working with WASH United, the initiators and coordinator of MH Day, the Bank uses its voice to raise the importance of MHM through social media. Beyond that, MH Day offers us the opportunity both to assess and learn from the challenges and progress, and to think further on how to deepen the agenda. To ensure that in the future, women and girls are not limited by something as natural and normal as their periods.