Menstrual Health and Hygiene (2023)

Context

Menstrual Health and Hygiene (SMH) is essential for the well-being and empowerment of women and adolescents. On any given day, more than 300 million women around the world are menstruating. In total, an estimated 500 million do not have access to menstrual products or adequate facilities for menstrual hygiene management (MHM). To effectively manage their periods, girls and women need access to water, sanitation and hygiene (WASH) facilities, accessible and appropriate menstrual hygiene materials, information on good practices and a supportive environment where they can manage their periods without shame or stigma.

According to the WHO/UNICEF Joint Monitoring Program 2012, menstrual hygiene management is defined as:

“Women and adolescent girls use clean menstrual control material to absorb or collect menstrual blood, which can be changed in private when necessary, use soap and water to wash their bodies as needed, and have access to safe and convenient facilities for dispose of used blood. menstrual control materials. They understand the basic facts about the menstrual cycle and how to manage it with dignity and without discomfort or fear.”

The challenges faced by menstruating girls, women and others go beyond a basic lack of supplies or infrastructure. Although menstruation is a normal and healthy part of life for most women and girls, in many societies the menstruating experience remains constrained by cultural taboos and discriminatory social norms. The consequent lack of information about menstruation leads to unhygienic and unhealthy menstrual practices and creates misconceptions and negative attitudes, which motivate, among other things, shame, bullying and even gender-based violence. For generations of girls and women, poor menstrual health and hygiene is exacerbating social and economic inequalities, negatively impacting their education, health, safety and human development.

The multidimensional problems faced by menstruating women require multisectoral interventions. WASH practitioners alone cannot find all the solutions to address the cross-cutting issues of inadequate sanitation facilities, lack of information and knowledge, lack of access to quality and affordable menstrual hygiene products, and stigma and social norms associated with menstruation. Research has shown that approaches that can effectively combine information and education with the right infrastructure and menstrual products, in a supportive policy environment, are most successful in avoiding the negative effects of poor MHH; in short, a holistic approach that requires collaborative and multidimensional responses. .

Education

In low-income countries, half of schools lack adequate water, sanitation and hygiene services, which are crucial to enable girls and teachers to manage menstruation (UNICEF 2015). Many studies argue that inadequate sanitary facilities affect girls' experiences at school, leading them to miss classes during menstruation or even drop out of school. Schools that have female-friendly facilities and incorporate information about menstruation into the curriculum for both girls and boys can reduce stigma and contribute to better education and health outcomes.

• A meta-analysis of the menstrual hygiene situation among adolescent girls in India found that a quarter of girls did not attend school during menstruation due to a lack of adequate toilets (Van Eijk et al. 2016).

• In South Sudan, 57% of adolescent girls interviewed reported staying home during menstruation due to lack of private changing rooms at school (Tamiru et al. 2015).

• A study in Kenya found that 95% of menstruating girls missed one to three days of school, 70% reported a negative impact on their grades, and more than 50% reported falling behind in school due to menstruation (Mucherah and Thomas 2017).

• A survey in Bangladesh found that only 6 percent of schools provide health and hygiene education, and only 36 percent of girls had prior knowledge about menstruation before their first period (World Bank 2017c).

• A sanitary napkin intervention in Ghana found that after six months of free sanitary napkin provision and puberty education programmes, girls were absent significantly less from school (Montgomery et al. 2012).

Health

When girls and women have access to safe and affordable sanitary supplies to control their periods, they reduce the risk of infections. This can have cascading effects on overall sexual and reproductive health, including reduced teen pregnancy, maternal outcomes, and fertility. However, poor menstrual hygiene can pose serious health risks, including reproductive and urinary tract infections, which can lead to infertility and birth complications in the future. Not washing your hands after changing menstrual products can spread infections like hepatitis B and yeast infections.

• Studies have found that distributing sanitary napkins to girls leads to a significant reduction in sexually transmitted infections and bacterial vaginosis (Benshaul Tolonen et al. 2019; Phillips-Howard et al. 2016).

• The lack of facilities for the hygienic management of menstruation can cause discomfort and psychological stress and increase the shame and sometimes depression experienced by women and girls due to taboos and stigma related to menstruation (Sweetman and Medlands 2017).

Gender equality

Promoting menstrual health and hygiene is an important way to safeguard women's dignity, privacy, bodily integrity and, consequently, self-efficacy. Raising awareness about MHH contributes to building an enabling environment for non-discrimination and gender equality where women's voices are heard, girls have choices about their future, and women have choices to become leaders and managers.

• Discriminatory social norms, cultural taboos and the stigma associated with menstruation can lead girls to engage in dangerous practices.

• A study in Egypt found that many female students reported not bathing during menstruation because it is considered a social taboo to come into contact with water during the menstrual cycle (ElGilany, Badawi, and El-Fedawy 2005).

• A study in Nepal found that many girls were forced to stay in a hut or sleep in fields during their periods, despite the government outlawing this practice (Thompson et al. 2019).

Economy

Improving menstrual hygiene and providing access to affordable menstrual materials can help improve girls' and women's access to education, opening up more options for employment, advancement and entrepreneurship, thereby unlocking women's contributions to the overall economy rather than keeping them At home. In addition, women's hygiene products are a multi-million industry that, if used well, can generate income for many and significantly boost economic growth.

• Girls who drop out of school have limited employment opportunities and often marry early and start having children, further reducing their income-earning options.

• Women without adequate female sanitary facilities in the workplace lose wages for days of work missed during menstruation and are seen as unreliable workers, reducing promotion options.

• Due to financial constraints or limited markets, many girls and women do not have access to adequate menstrual products.

Environment

Disposable sanitary products contribute to large amounts of waste globally. Ensuring women and girls have access to quality, sustainable products and improving disposal management of menstrual products can make a world of difference to the environment.

• Each year, the average woman throws away about 150 pounds of non-biodegradable waste. In India alone, around 121 million women and girls use an average of eight non-compostable disposable sanitary napkins per month, generating 1.021 million sanitary napkin waste per month, 12.3 billion sanitary napkins per year and 113,000 metric tons of annual menstrual waste (Bhor and Ponkshe 2018; RUTA 2017).

Increasing opportunities for women to access proper menstrual health and hygiene is critical for the World Bank Group to achieve its development results. GHM spans many development sectors, and the Bank approaches this through collaboration and a holistic approach, as demonstrated by recent examples of Bank operations:

• Nobangladesh, aRural Water, Sanitation and Hygiene Project for the Development of Human Capitalis giving women access to microcredit loans and sanitation grants to invest in home WASH facilities. In addition, the project is facilitating behavior change and training sessions on the importance of menstrual hygiene and safely managed WASH facilities. At the community level, the project will build suitable facilities for MHH in public places and promote women's representation and leadership in water resource management committees. Access to finance will be provided to 150 women entrepreneurs to help them market and sell soaps, sanitizers and menstrual hygiene products at their doorsteps. This will improve menstrual hygiene practices, especially among those who are very timid and reluctant to buy them in public markets.

•Noin coup, andWater Supply and Sanitation Projectis promoting design approaches to ensure sanitation and hygiene facilities are built in schools to meet the needs of women and girls. This includes gender-separated facilities with locks, lighting, trash bins, and handwashing stations with soap and water. Behavior change and hygiene promotion campaigns will be carried out incorporating MHH, aimed at students, teachers, parents and the community in general.

• OGAMA Water and Sanitation Projectnoganalaunched an in-depth qualitative study to understand the influences of school-based MHM interventions on adolescent girls' educational engagement. Under the project, toilets were built in more than 260 schools in the Greater Accra metropolitan area. All facilities include separate girls' toilets and changing rooms, with lockable doors, sinks, and safe, hygienic spaces to dispose of used sanitary products.

• OWater Supply, Sanitation and Hygiene Expansion Project, a multi-sectoral WASH project inLao Democratic Republic, employs an approach of nutritional convergence with the provision of infrastructure services and behavior change at the community and family level. The project aims to address low school attendance among adolescent girls by ensuring that school sanitary facilities have functional single-sex toilets with a reliable supply of soap and water. Educational materials on hygiene and GHM will also be provided and distributed.

• In rural areas ofMozambique, the primary school completion rate is only 14% for men and 8% for women, severely limiting livelihood opportunities. Few schools have adequate toilet facilities and those that do are poorly maintained and unsuitable for MHH. HeUrban Sanitation Projectis responding with a sanitation and hygiene promotion marketing campaign that emphasizes improving menstrual hygiene for girls and women. It is financing the construction of 78 toilets in schools and markets in two project cities. Standard designs include handwashing facilities, accessibility for people with disabilities, and MHH services. Hygiene promotion and MHH activities will be carried out in schools, including training for teachers and students. These approaches will inform future interventions in schools across the country.

publications

Menstrual Health and Hygiene Resource Pack: Tools and Resources for Work Teams(PDF)

Provide sustainable sanitation services for all in WASH interventions through a menstrual hygiene management approach

Improving toilet hygiene and handwashing practices during and after the COVID-19 pandemic in Indonesian schools

High tide: a new look at water and gender

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blogs

Menstrual health and hygiene empowers women and girls: how to make sure we get it right

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It is time to act. Period.

Reflections of a mother on Menstrual Hygiene Day

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external sources

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