Menstrual hygiene management
Menstrual hygiene management (MHM) is about access to feminine hygiene products to absorb or collect menstrual blood, privacy to change the materials, and access to facilities to dispose of used menstrual management materials. Menstrual hygiene management can be particularly challenging for girls and women in developing countries, where clean water and toilet facilities are often inadequate. Menstrual waste is largely ignored in schools in developing countries, despite it being a significant problem. Menstruation can be a barrier to education for many girls, as a lack of effective sanitary products restricts girls' involvement in educational and social activities.
Menstrual Hygiene Day creates an occasion for publicizing information about menstrual hygiene management issues in the media. The day offers an opportunity to actively advocate for the integration of menstrual hygiene management into global, national and local policies and programmes.
An accepted definition of menstrual hygiene management (MHM) is:
- "Women and adolescent girls use a clean material to absorb or collect menstrual blood, and this material can be changed in privacy as often as necessary for the duration of menstruation.
- MHM also includes using soap and water for washing the body as required; and having access to facilities to dispose of used menstrual management materials."
The "value chain" related to menstrual hygiene management includes four aspects: awareness, access, use as well as waste management.
The term “menstrual health” is broader than menstrual hygiene. It encompasses both the menstrual hygiene management practices and the broader systemic factors that link menstruation with health, well-being, gender, education, equity, empowerment, and human rights (in particular the human right to water and sanitation).
Menstrual hygiene management can be particularly challenging for girls and women in developing countries, where clean water and toilet facilities are often inadequate. In addition, traditional cultures make it difficult to discuss menstruation openly. This limits women’s and adolescent girls’ access to relevant and important information about the normal functions of their own body. This directly affects their health, education and dignity. Access to information can be considered a human right.
Currently there are about 3.73 billion women in the world. According to the World Health Organization (WHO), 52% , or 1.9 billion, of those women are of reproductive age, thus menstruating (WHO,2018). Women at some point in their life will go thru the reproductive age and thus, will experience menstruation. In 2016, Loughnan, Libbet C., Rob Bain, Rosemary Rop, Marni Sommer, and Tom Slaymaker. discussed findings by the Water Supply and Sanitation Council (WSSCC) having estimated that daily 300 million women are menstruating. On average, according to the WSSCC, a women will spend about 3,500 days during her life menstruating.
Many young girls and women of menstruating age live in poor socio-economic environments. WIlber, Torondel,Hameed, Mahon and Kuper (2019)  state that 663 million people lack basic access to safe water, and 2.4 billion people lack adequate access to basic sanitary conditions. For women and girls, the lack of safe, accessible water, sanitation and hygiene (WASH) is particularly troubling during menstruation and childbirth. According to data collected and reported on, Loughnan (2017) points out that half a billion (or 13%) of women lacked a place to defecate, have little to no privacy for menstrual hygiene management, and 3/4 of those lacked access to soap and water.
In a 2014 study conducted in India, the researchers found that as many as 42% of women who participated in the study did not know about sanitary pads or from where in their anatomy menstruation originated. "Most of them were scared or worried on first menstruation." Worldwide, in 2018, one in three women does not have access to a working toilet at all. Menstrual hygiene management issues have been ignored by professionals in the water, sanitation and hygiene (WASH) sector, and in the health and education sectors, too.
Poor MHM may affect the reproductive tract, but the specific infections, the strength of effect, and the route of transmission remain unclear. In India, a majority of girls are at risk for reproductive tract infections (RTI) because of poor MHM and RTI can lead to various disabilities if not treated early on. Reproductive tract infections are the cause of 30–50% of prenatal infection. Due to prejudices surrounding the issue, some women in India do not eat or take showers during their menstruation.
Sanitation facilities at schools
The onset of menstruation is challenging for school-aged girls in low-income settings. Impacts can include school absenteeism, missed class time, reduced participation, teasing, fear and shame, and risky adaptive behaviours. Further challenges that menstruating school girls face are a lack of knowledge, communication, and practical guidance prior to menarche and during menstruation; inadequate water, sanitation, and hygiene (WASH) facilities; and ineffective or unavailable menstrual management materials.
In many parts of sub-Saharan Africa, girls can miss up to 5 days of school a month or drop out entirely due to insufficient access to water, sanitation and hygiene (WASH) facilities and menstrual hygiene products. Improving access to WASH facilities can actually increase girls' attendance at school. A program for school sanitation in Bangladesh increased girls' enrollment at school by 11%.
Menstrual waste is largely ignored in schools in developing countries, despite it being a significant problem. Girls' access to water and sanitation at school is only available at 47% and 46% of all schools globally. Often, school toilets for girls (if they even exist) are missing bins for menstrual waste collection with the result that pads may be spread all around the school compound area. This pollutes the environment and also causes embarrassment for the school girls.
Access to materials
A lack of affordable hygiene products means inadequate, unhygienic alternatives are used, which can present a serious health risk. Menstrual cups offer a long-term solution compared to some other feminine hygiene products because they do not need to be replaced monthly. The quality of the material also makes them a reliable and healthy menstrual hygiene solution, as long as there is access to clean water for washing them.
Girls and women in the workplace often miss work because they don't have access to sanitary materials and places of employment in some countries don't provide resources for women or even have "proper toilets." Women in Bangladesh who work in factories have reported that due to the cost of sanitary products for menstruation which they could not afford, they have resorted to using "factory-floor rags in place of pads and tampons, leading to dangerous infections and missed work."
Menstruation can be a barrier to education for many girls, as a lack of effective sanitary products restricts girls' involvement in educational and social activities. Often they do not attend school due to fear of leaking, shame or embarrassment, period pain or inadequate sanitation facilities that do not allow them to wash or change in privacy. This applies mainly to schoolgirls from low-income families, since disposable hygiene products are a monthly expense that many females simply cannot afford.
Adequate sanitation facilities and access to menstrual hygiene products are just one part of the solution to menstrual taboos that impede women's progress in many developing countries. Knowledge is critical for girls to feel comfortable with menstruation and to gain a positive awareness of their bodies.
U.S. and UK
Many low-income and/or homeless girls and women in the inner cities of the United States cannot afford sanitary supplies. Food banks in New York report that feminine hygiene products are in high demand. Homeless women in the United States may face the challenge of not being able to shower or use the communal toilet in homeless shelters as often as they need to in cases where there are restrictions on toilet usage. In New York, proposals to help lower income women access menstrual sanitary supplies includes proposals to remove the sales tax on feminine hygiene products and "distributing free tampons in public schools." Sales tax are levied on menstrual supplies in 36 states. On May 1, 2018 The National Diaper Bank Network, which provides millions of diapers to poor and low income parents and advocates for policy change around basic needs, launched the Alliance for Period Supplies and began distributing free period products through allied organizations across the U.S. Homeless women in other industrialized countries, such as the United Kingdom, face problems affording tampons and sanitary napkins.
Disposal of used materials
A review in 2018 found that disposal of menstrual waste is often neglected in sanitation systems. This leads to improper disposal and negative impacts on users, the sanitation systems and the environment.
Cultural, religious and traditional beliefs — particularly in developing countries — can lead to restrictions that women or girls face during their period. In some societies, women do not wash their bodies, shower or bathe during menstruation. They may not be allowed to use water sources during menstruation. Even if they have access to toilets, they might not use them because of the fear of staining the toilet bowls (in the case of dry toilets or flush toilets where the flush is not powerful). This impairs the use of menstrual cups compared to pads as the cups are normally emptied into toilets.
Expanding the discussion to include consideration of waste management is part of the attempt to "normalize" conversations about menstruation.
Approaches for improvements
MHM in schools should not be a stand-alone programme but should be integrated with existing programmes on WASH in schools, school health and nutrition programmes, puberty education programmes, and emergencies.
In rural Bolivia a menstrual hygiene management game was developed for school girls, that stimulated detailed responses, and diversified participatory activities in focus group discussions. The board game helped to ease girls’ discomfort discussing menstruation.
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