RADKE 2013 Menstrual Hygiene Management - 130826-1

Menstrual Hygiene Management
Naomi Radke, seecon international GmbH
Menstrual Hygiene Management 1

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Menstrual Hygiene Management

Contents
1. Introduction
2. Beliefs, Myths and Taboos
3. Menstrual Hygiene, Human Rights and MDGs
4. Health Risks of Poor Menstrual Hygiene Management
5. Menstrual Hygiene Management: Hardware
6. Menstrual Hygiene Management: Software

1. Introduction
Menstruation
52% of women worldwide are in reproductive age and most of them

thus are menstruating monthly.
Still, the majority of them are not in conditions to take care of their
menstruation in a hygienic manner or are impaired by it.
Menstruation is supposed to be invisible and silent.
Source: KJELLEN ET AL. (2012) Source: http://www.mcmaster.ca/museum/Exhibitions_Fierce.html [Accessed:

07.08.2013]

Harmful restrictions
In some cultures, women and girls are told that

• During their menstrual cycle they should not bathe (or they will
become infertile)
• Touch a cow (or it will become infertile)
• Look in a mirror (or it will lose its brightness)
• Touch a plant (or it will die)
Young women chatting

about menstrual issues.
Source: UNICEF (2008)


Other restrictions
Restrictions on girls during their menstrual

period in Afghanistan, India, Iran and
Nepal. Source: (HOUSE et al. 2012).


Relieving restrictions
Women may appreciate the ‘banishment’ to menstrual huts as

they are given a rest period from the normal intensity of daily
chores.
Zulu menstruation hut.

Source: RINDSTAD (2013)


Parental Education
Education by parents about reproductive health, sexuality and

related issues is often a no-go area leading to a low knowledge and
understanding on these issue
Source: http://phil2100dsu12a.wordpress.com/2012/07/10/abortion-the-solution-is-viability/ [Accessed: 07.08.2013]


Lack of facilities and sanitary products (1/2)
... Can push many girls out of school.

Relationship between menstrual hygiene and school drop-out of girls
from the higher forms due to lack of facilities, affordable sanitary
products, fear of bloodstains and more.
Millenium Development Goal (MDG) 2: Achieve universal primary

education
 Participation of girls especially in Africa and Asia lags far behind
the boys’ in higher forms of primary education
Millenium Development Goal (MDG) 3: Promote gender equality and

promote women
 The lacking behind in primary education to not providing
adequate facilities and sanitary products infringes gender equality
and the promotion of women

Lack of facilities and sanitary products (2/2)
Stigma around menstruation hurts human rights, especially human

dignity but also the right to non-discrimination, equality, bodily
integrity, health, privacy and the right to freedom from inhumane
and degrading treatment from abuse and violence.


Health risks
• Poor protection and inadequate washing facilities may increase

susceptibility to infection
• In case of female genital cutting: blockage and build-up of blood

clots is created behind the infibulated area: pain, additional
infection risk
• Risk of infection higher than normal during period as the blood

forms a pathway into the uterus


Inappropriate hygiene practices (1/3)
Certain practices are more likely to increase the risk of infection

e.g. using unclean rags. Inappropriate practices often due to the
non-affordability of sanitary products for poor women.
Findings from Bangladesh:
• 80% of factory workers are women
• 60% of them were using highly chemically charged rags from the
factory floor for menstrual cloths
• Infections are common, leading to 73% of women missing work for on
average six days a month
• Women had no safe place either to purchase cloth or pads or to
change/dispose of them
• When women are paid by piece, those six days away present a huge
economic damage to them but also to the business supply chain

• Unclean sanitary pad materials (local infections/bacteria can

travel up the vagina and enter uterine cavity)
• Changing pads infrequently (skin irritation by wet pads)
• Insertion of unclean material into vagina (easier infection , also
of uterine cavity)
• Using highly absorbent tampons during light blood loss or no
menstruation (toxic shock syndrome, vaginal irritation)
Source: HOUSE ET AL. (2012)


• Wiping from back to front following urination or defecation

(bacteria can travel easier into vagina)
• Unprotected sex (increased risk of sexually transmitted
diseases)
• Unsafe disposal of used sanitary materials or blood (risk of
infecting others with diseases)
• Frequent douching (forcing liquid into vagina can introduce
bacteria into uterine cavity)
• Lack of hand-washing after changing a sanitary towel (can
spread infections)


Sanitary protection materials (1/4)
It is critical that any programme aiming to support women or girls

with sanitary protection materials involves them in the planning
discussions and decisions about the options to be supported.
Schoolgirls participating in a
menstrual cup project.
Source: APHRC (2010)


Disposable sanitary towels

• In resource-poor settings often
very expensive and hard to
dispose of
• Often difficulty of proper
disposal (generates solid waste)
• But reduce barriers of girls
staying at school


Cloth or cloth pads

• A sustainable sanitary option,
but it must be hygienically
washed and dried in the
sunlight (natural steriliser)
• But shame of drying the clothes
outside, so often hide them in
damp unhygienic places
Locally made reusable cloth

pads and cloth in Kenya.


Menstrual cup
• New technology appropriate for poor women and girls
• Cup made of medical silicone rubber that is inserted into the
vagina to collect menstrual blood
• Removed and emptied less frequently than sanitary pads
• Needs to maintain a high standard of hygiene especially during
insertion, removal and general cleaning
Menstrual Cup by The

Moon Cup (UK).
Source:
Instructions for menstrual cups. http://www.mooncup.com/photographs.
Source: RUBYCUP (2013) html [Accessed: 07.08.2013]


Sanitary protection materials – advantages/disadvantages (1/2)
Sanitary protection Advantages Disadvantages

option
Natural materials (e.g.  Free  High risk of contamination
mud, cow dung, leaves)  Locally available  Difficult and uncomfortable to use
Strips of clothes  Easily available in the  If old cloths are not cleaned well they
local market can become unhygienic.
 Re-usable  Users need somewhere private, with a
water supply and soap, to wash and
dry the cloths.
Toilet paper or tissues  Easily available in the  Loses strength when wet and can fall
local market apart.
• Difficult to hold in place.
• May be too expensive for the poorest
users
Re-usable pads  Available locally or on the  Users need somewhere private, with a
internet water
 Income generation  supply and soap, to wash and dry the
opportunity, if locally pads.
made  Cost is prohibitive to many potential
 Cost effective as are re- users, if commercially produced
usable
 More environmentally-
friendly than disposable
pads


Sanitary protection materials – advantages/disadvantages (2/2)
Sanitary protection Advantages Disadvantages
option
Tampons  Convenient and comfortable  Not available in many contexts.
to use  Cost is prohibitive to any potential users.
 Generates a lot of waste to dispose, not
environmentally-friendly.
 May not be culturally appropriate,
particularly for adolescent girls, as need to
be inserted into the vagina.
 Hygiene and availability of water and soap
for hand-washing are particularly important,
as need to be inserted into the vagina.
Menstrual cups  Re-usable  May not be culturally appropriate for use,

 Only need emptying, washing particularly for adolescent girls, as need to
and drying be inserted into the vagina.
 Hygiene and availability of water and soap
are particularly important, for washing
hands and menstrual cup, as need to be
inserted into the vagina.
 Expensive first investment outlay.
Panties/ Underwear  Useful for keeping a sanitary  Cost may be prohibitive to potential users.
product in place.  Cheap elastic can wear out relatively
• Good for keeping the vaginal quickly.
area hygienic.


Sanitary infrastructure
Absence of clean and private sanitation facilities that allow for

menstrual hygiene may discourage girls from attending
school when they menstruate.
• Menstrual hygiene: e.g. lockable toilets, closed bin for
sanitary item disposal, sink for hand washing and cleaning of
clothes (both inside toilets)
• 1 in 10 school-age African girls do not attend school during
menstruation or drop out, due to this absence
• Teachers’ instruction time in school will be reduced by 10-
20%
 To manage menstruation
hygienically, it is essential
that women and girls have
access to water and
sanitation Source: HOUSE ET AL. (2012)


Disposal
• If lack of opportunities, dispose secretly and easily: thus on

defecation field, river or garbage dump
• Blocking toilets/filling up pits
Disposing of non-biodegradable sanitary pads in

pit latrines leads to quick filling and thus
shortened service of the pit. Source: HOUSE ET AL. (2012)


Education
• Education and information (in combination with hygiene and sex

education) empowers women and girls with factual information
about their bodies and how to look after them
• Teachers are rarely trained in teaching menstrual hygiene and

consequently rarely teach it; male teachers may feel cultural
norms forbid them


Further software. Awareness Raising
• Promoting good practices for Menstrual Hygiene Management:
- How to capture the blood

- How to dispose of the cloth, pad, cotton
- How to keep yourself clean during the period
- How to manage the stomach pain from your period
- For an overview see Table 1.6 (p. 39, HOUSE et al. 2012)
• Community-wide approaches that include boys and men

(Physical barriers are often connected to social barriers. Social
barriers have to be overcome!)
• Integrate Menstrual Hygiene Management into a wider hygiene

promotion approach on Water, Sanitation and Hygiene including
risks and good practices

Example of promoting menstrual hygiene management:
Mother’s Day - Zambia
Mother’s day: one day off work per month.
Silent belief that this day was thought for a day of relief whilst
having menstruation.

References
KJELLEN, M., PENSULO, C., NORDQVIST, P., FOGDE, M. (2012): Global Review of Sanitation System Trends and
Interactions with Menstrual Management Practices. Report for the Menstrual Management and Sanitation Systems
Project. Stockholm: EcoSanRes, Stockholm Environmental Institute (SEI). URL:
http://www.irc.nl/docsearch/title/180836 [Accessed:05.08.2013]
HOUSE, S.; MAHON, T.; CAVILL, S. (2012): Menstrual hygiene matters. A resource for improving menstrual hygiene
around the world. London: WaterAid. URL:
http://www.wateraid.org/what%20we%20do/our%20approach/research%20and%20publications/view%20publication?id=0
2309d73-8e41-4d04-b2ef-6641f6616a4f [Accessed:05.08.2013]
RINDSTAD, S. (2013): Symbolic Meaning of Menstruation. Available at:

http://pub209healthcultureandsociety.wikispaces.com/Symbolic+meaning+of+menstruation+across+different+cultures+
and+perspectives [Accessed:07.08.2013]
RUBY CUP (2013): http://www.ruby-cup.com [Accessed: 08.03.2013]
UNICEF (2008): Sharing simple facts. Useful information about menstrual health and hygiene. New York: United Nations
Children's Fund (UNICEF). URL: http://www.unicefiec.org/document/sharing-simple-facts-useful-information-about-
menstrual-health-and-hygiene-booklet-english [Accessed: 08.03.2013]

“Linking up Sustainable Sanitation,
Water Management & Agriculture”
SSWM is an
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Menstrual Hygiene Management

Naomi Radke, seecon international GmbH

Menstrual Hygiene Management 1

Copyright & Disclaimer

Menstrual Hygiene Management

Menstrual Hygiene Management 3

52% of women worldwide are in reproductive age and most of them

Menstruation is supposed to be invisible and silent.

Source: KJELLEN ET AL. (2012) Source: http://www.mcmaster.ca/museum/Exhibitions_Fierce.html [Accessed:

2. Beliefs, Myths and Taboos

In some cultures, women and girls are told that

Young women chatting

Menstrual Hygiene Management 5

2. Beliefs, Myths and Taboos

Restrictions on girls during their menstrual

Menstrual Hygiene Management 6

2. Beliefs, Myths and Taboos

Women may appreciate the ‘banishment’ to menstrual huts as

Zulu menstruation hut.

Menstrual Hygiene Management 7

2. Beliefs, Myths and Taboos

Education by parents about reproductive health, sexuality and

Source: http://phil2100dsu12a.wordpress.com/2012/07/10/abortion-the-solution-is-viability/ [Accessed: 07.08.2013]

Menstrual Hygiene Management 8

3. Menstrual Hygiene, Human Rights and MDGs

... Can push many girls out of school.

Millenium Development Goal (MDG) 2: Achieve universal primary

Millenium Development Goal (MDG) 3: Promote gender equality and

3. Menstrual Hygiene, Human Rights and MDGs

Stigma around menstruation hurts human rights, especially human

Menstrual Hygiene Management 10

4. Health Risks of Poor Menstrual Hygiene Management

• Poor protection and inadequate washing facilities may increase

• In case of female genital cutting: blockage and build-up of blood

• Risk of infection higher than normal during period as the blood

Menstrual Hygiene Management 11

4. Health Risks of Poor Menstrual Hygiene Management

Certain practices are more likely to increase the risk of infection

4. Health Risks of Poor Menstrual Hygiene Management

• Unclean sanitary pad materials (local infections/bacteria can

Source: HOUSE ET AL. (2012)

Menstrual Hygiene Management 13

4. Health Risks of Poor Menstrual Hygiene Management

• Wiping from back to front following urination or defecation

Source: HOUSE ET AL. (2012)

Menstrual Hygiene Management 14

5. Menstrual Hygiene Management: Hardware

It is critical that any programme aiming to support women or girls

Menstrual Hygiene Management 15

5. Menstrual Hygiene Management: Hardware

Disposable sanitary towels

Source: HOUSE ET AL. (2012)

Menstrual Hygiene Management 16

5. Menstrual Hygiene Management: Hardware

Cloth or cloth pads

Locally made reusable cloth

Menstrual Hygiene Management 17

5. Menstrual Hygiene Management: Hardware

Menstrual Cup by The

Menstrual Hygiene Management 18

5. Menstrual Hygiene Management: Hardware

Sanitary protection Advantages Disadvantages

Menstrual Hygiene Management 19