This comprehensive, peer-reviewed handbook presents practical guidance on how to address menstrual hygiene within a range of water and sanitation, health and education programmes. It builds on detailed research to find out what issues women and girls face and how these are being addressed in many developing countries. The handbook focuses on practical examples, drawing on what is already being implemented in different contexts to encourage replication. It contains extensive training resources and ideas. The text below is taken from the Modules 1 and 2.
Why considering menstrual hygiene is important for all
Globally, approximately 52% of the female population (26% of the total population) is of reproductive age. Most of these women and girls will menstruate each month for between two and seven days. Menstruation is a natural part of the reproductive cycle, in which blood is lost through the vagina. However, in most parts of the world, it remains taboo and is rarely talked about. As a result, the practical challenges of menstrual hygiene are made even more difficult by various socio-cultural factors.
To manage menstruation hygienically, it is essential that women and girls have access to water and sanitation. They need somewhere private to change sanitary cloths or pads; clean water for washing their hands and used cloths; and facilities for safely disposing of used materials or a place to dry them if reusable. There is also a need for both men and women to have a greater awareness of menstrual hygiene. Currently, cultural practices and taboos around menstruation impact negatively on the lives of women and girls, and reinforce gender inequities and exclusion.
Menstrual hygiene has been largely neglected by the water, sanitation and hygiene (WASH) sector and others focusing on sexual and reproductive health, and education. As a result, millions of women and girls continue to be denied their rights to WASH, health, education, dignity and gender equity. If the situation does not change, it may not be possible for development programmes to achieve their goals.
A cycle of neglect
Lack of involvement in decision-making
Women and girls are often excluded from decision making and management in development and emergency relief programmes. At the household level, they generally have little control over whether they have access to a private latrine or money to spend on sanitary materials. Even when gender inequalities are addressed, deeply embedded power relations and cultural taboos persist; most people, and men in particular, find menstrual hygiene a difficult subject to talk about. As a result of these issues, WASH interventions often fail to address the needs of women and girls.
Lack of information and awareness
Young girls often grow up with limited knowledge of menstruation because their mothers and other women shy away from discussing the issues with them. Adult women may themselves not be aware of the biological facts or good hygienic practices, instead passing on cultural taboos and restrictions to be observed. Men and boys typically know even less, but it is important for them to understand menstrual hygiene so they can support their wives, daughters, mothers, students, employees and peers. In the development sector, there is a lack of systematic studies analysing the impact of menstrual hygiene and resources for sharing best practice. This resource aims to address the latter.
Lack of access to products and facilities
Women and girls often find menstrual hygiene difficult due to a lack of access to appropriate sanitary protection products or facilities (eg a private space with a safe disposal method for used cloths or pads and a water supply for washing hands and sanitary materials).
Lack of social support
Taboos surrounding menstruation exclude women and girls from many aspects of social and cultural life as well as menstrual hygiene services. Such taboos include not being able to touch animals, water points, or food that others will eat, and exclusion from religious rituals, the family home and sanitation facilities. As a result, women and girls are often denied access to water and sanitation when they need it most.
Impact on education
Many schools do not support adolescent girls or female teachers in managing menstrual hygiene with dignity. Inadequate water and sanitation facilities make managing menstruation very difficult, and poor sanitary protection materials can result in bloodstained clothes causing stress and embarrassment. Teachers (and male members of staff in particular) can be unaware of girls' needs, in some cases refusing to let them visit the latrine. As a result, girls have been reported to miss school during their menstrual periods or even drop out completely. With studies linking child survival more closely to their mother's education level than their poverty level, factors that reduce educational opportunities for girls potentially have wide ranging implications.
Impact on health
Menstruation is a natural process; however, if not properly managed it can result in health problems. Reports have suggested links between poor menstrual hygiene and urinary or reproductive tract infections and other illnesses. Further research and robust scientific evidence are needed in this area. The impact of poor menstrual hygiene on the psychosocial wellbeing of women and girls (eg stress levels, fear and embarrassment, and social exclusion during menstruation) should also be considered.
Impact on sustainability
Neglecting menstrual hygiene in WASH programmes could also have a negative effect on sustainability. Failing to provide disposal facilities for used sanitary pads or cloths can result in a significant solid waste issue, with latrines becoming blocked and pits filling quickly. Failure to provide appropriate menstrual hygiene facilities at home or school could prevent WASH services being used as intended.
Additional challenges in emergencies
Women and girls face particular challenges in emergency situations, where they may be forced to live in close proximity to male relatives or strangers. Their usual coping mechanisms for obtaining sanitary protection materials, bathing with privacy, and washing or disposing of menstrual materials are disturbed. In some cases, conflict restricts their movement and makes it difficult to collect water or find somewhere to manage menstruation safely and with dignity. With little or no money to buy soap and non-food items such as buckets and bowls, it is impossible to maintain personal hygiene or wash and dry sanitary materials properly.
Additional challenges for girls and women in vulnerable, marginalised or special circumstances
Marginalised women and girls, such as those who are homeless or living with illnesses like HIV, face multiple layers of exclusion that affect their daily lives. Homeless women and girls are often unable to obtain hygienic sanitary materials or access water and somewhere to bathe. As a result, they cannot manage menstruation with privacy, sometimes resorting to washing and using sanitary cloths taken from refuse tips. Those with disabilities face additional accessibility barriers to accessing WASH facilities due to limited consideration of their needs in the design process. Carers of people with disabilities or HIV/AIDS do not always have the appropriate knowledge to provide menstrual hygiene support.
Reasons to get men and boys involved in menstrual hygiene
Men and boys have an important role to play in supporting women and girls in their menstrual hygiene management, as fathers, brothers, uncles, peers or colleagues. This may be:
| • | To provide support at home or school when a girl faces her first period or a woman has an embarrassing or difficult experience. | ||||
| • | As the head of the household who controls the finances, to ensure female family members can afford appropriate sanitary protection materials. | ||||
| • | As a community member who can challenge taboos, social norms and stigma, and influence the attitudes of others (both male and female). | ||||
| • | As teachers or employers, ensuring that the school or work environment makes it easy for girls and women to manage menstruation with dignity. | ||||
| • | As professional engineers, social development specialists, managers or medical professionals, supporting programmes for improving the menstrual hygiene context for girls and women. | ||||
Adolescent girls' group selling sanitary pads they have made, Bangladesh.
It is important for boys and men to respect girls and women. Educating boys (particularly from adolescence) on the challenges and struggles girls face could help reduce teasing and help them become more understanding and supportive husbands and fathers.
Girls and women have been known to have been so desperate for sanitary products that they have traded sex or favours with men to be able to obtain them. By helping boys and men to better support their friends, sisters, wives and daughters in regards to menstrual hygiene, this risk can be minimised.
Men as menstrual hygiene advocates and champions
Nixon Otiena Odoyo, 16, noticed that in his mixed secondary school in Nyanza Province of Kenya, girls were dropping out of school at a much higher rate than boys. As a member of the Teens Watch Club, he heard how girls in the group could not afford to buy sanitary towels and were therefore embarrassed to stay in school. Nixon responded with a campaign called “Keeping girls in school”. He proposed a fundraising football tournament, attracting people from different villages. The event was a great success and raised 50,000 Kenyan shillings (US$650). With the money, the group bought 1,000 sets of sanitary towels and over a month gave them to 500 girls in more than ten schools in slums across Nairobi. The schools were very happy and said girls' attendance improved greatly as a result.
Related Research Data
