evidence-based interventions to address menstrual health challenges

Evidence-Based Interventions to Address Menstrual Health Challenges

Presented byMichael Dhatemwa Mawambi

Introduction• Women start menstruating from the age of

13 up to 50 years (but can start as early as 8 years old)

• 26% of the world’s female population is of reproductive age. Millions of women/girls are menstruating.

YET: Millions of these girls and women continue to face challenges and barriers associated with menstruation…?Limit potential for equality, education, Income generation & societal participation

(UN 2010, WaterAid 2012, McMahon et al. 2011)

Background

SIMAVI MHMProgramme Manual

TRAINING OF TRAINER(ToT)

GUIDE

TRAINER POWERPOINT PRESENTATION

TRAINING HAND-OUTS

Global: 2030 Agenda of SDGs

Five Key Priorities: ‘MHM in Ten’

SIMAVI

Methodology

• Objective: Gather evidence of lived experiences.

• Rationale: Extensive and critical literature reviewKey informant interviews Review of relevant programmes

• Focused on Asia & Africa.• Examples of good practices/interventions

Key Findings

Puberty: Menstruation and Menstrual Health Management

• Puberty (10 and 11 years of age)This period is marked by first menstruation (menarche) for females(UNICEF 2015).

• This is an abrupt change for most girls, most especially without any guidance and knowledge (Neginhal 2010, Jothy and Kalaiselv 2012).

Menstrual Health Management

• Menstrual Health Management (MHM) is defined as; • Using a clean menstrual management material• Place to Change in privacy• Using soap and water for washing• Access to facilities to dispose of used menstrual

management materials. (UNICEF /IRC 2012).

Embarrassment

ShameDiscrimination

Discomfort

MENSTRUATION

(UNICEF 2015, UNESCO 2014, and Mason et al. 2013, WaterAid 2012)

USER-FRIENDLY WASH FACILITIES

SUSTAINABLE SUPPLY OF MHM MATERIALS

KNOWLEDGE, AWARENESS AND INFORMATION ABOUT MENSTRUATION

MHM

MHM NEEDS…

Discussion of Evidence

Biggest challenges: Lack of basic knowledge about puberty and the reproductive system. (Therese & Maria 2010).

Knowledge, Awareness and Information

‘Culture of Silence’ The source and reliability of information attained by girls influences the way they manage their menses. 66% Africa, 84.51% Asia.

• Ignored in homes (families), schools and communities (FAWE-U 2003, Kirk and Sommer 2006:2)

• Girls always struggle to obtain information on menstruation and puberty (Muito 2004; McMahon et al. 2011; Mason et al. 2013)

• Parents vs School

Image Credit: serendip.brynmawr.edu

Use of sanitary materials is extremely important to girls during menstruation (safety, health & comfort)

• Majority lack access to safe and quality MHM products and materials (Dasgupta and Sarkar 2010).• Affordability and availability of sanitary pads (Kirk and

Sommer 2006) • Most materials used are less clean and unhygienic for

absorbing menstrual blood (House etal 2012, Tamiru et al 2015, FAWE-U 2003, Sommer et al 2015).

Sustainable Menstrual Materials and Supplies

• Unable to remain comfortably in class during their menstrual cycle (Kirk, 2005).

• Drop out of school due to lack of sanitary pads. (UNICEF and WHO (2012) .

• Discriminated against at home from touching anything in the house, and some even fail to go to work due to menstruation (Shukla, 2005).

• Patriachial societies: Men make the final decisions about provisioning in a home.

Sustainable Menstrual Materials and Supplies

Image Credit: naharnet.com

PRODUCT TYPE WASHABLE/ DISPOSABLES

PRODUCT SAMPLE

Locally Produced disposable Sanitary Pads for commercial purposes.

Disposable Others include Maka-pads, SHE Rwanda etc

Locally Produced Sanitary Pads for commercial purposes.

Washable/ reusable

Include; Afri-pads, Zana-pads, EcoFemme(India), Mariam seba(ethopia) etc

Home-made Produced Sanitary Pads

Reusable These materials can be leaves, pieces of cloth (e.g., strips of sari, resu), tissues, or cotton

Commercially Produced premium Sanitary Pads

Disposable Others include Johnson & Johnson, Whisper, Kotek etc)

Affordability and Availability of Sanitary Pads

Case StudySHE Project; Rwanda: A Social

Entrepreneurship Approach to MHMCreating Male Champions in India

Case Study 2: In India, WaterAid and Vatsalya groups for boys, youths, and married males.

Case Study 1: Rwanda - pad manufacturing to generate income, raise awareness and provide education.

User-friendly Facilities and Services

• Many schools, poor households and communities have very poor sanitation facilities (UNESCO 2013, UNICEF 2012, Caruso 2013).

• Facilities are unpleasant, unsafe with little or no privacy (UNICEF 2012, Caruso 2013)

• Not segregated by gender- harassment and even violence (Sommer 2010, Tamiru 2015).

• No water & soap, drying facilities • No disposal mechanisms (Crofts 2012, Sommer 2013, Pillitteri 2011,

Sommer 2009).

Pit Latrine Image Credit: observers.france24.com

Design of toilets and health facilities meet the needs of menstruating girls and women.• Inclusion of people with disabilities• Participate in the design

Facilities available for soaking, washing and drying reusable protection pads and cloths.

Environmentally friendly and hygienic collection and disposal systems for sanitary protection materials

School-led and community-led Total sanitation.

Innovative and Sustainable Programme Interventions for MHM Facilities

Credit: Plan International

Case StudyPakistan Approach to Total Sanitation (PATS) programme.Zambia - USAID/SPLASH integrates MHM into the education system.

Case Study 2:USAID/SPLASH integrates MHM into the education system

Case Study 1: Pakistan Approach to Total Sanitation (PATS) programme

USER-FRIENDLY WASH FACILITIES: Access to clean water supply, Environmentally friendly and hygienic collection and disposal systems, rooms for changing, washing pads and cleaning the body.

SUSTAINABLE SUPPLY OF MHM MATERIALS:• Hygienic,• Affordable• environmentall

y friendly • Appropriate

menstrual Health protection materials, etc

KNOWLEDGE, AWARENESS AND INFORMATION ABOUT MENSTRUATION:• Information,• Awareness-

raising and • Opportunities for

dialogue to change attitudes and practices

MHM

Policy Recommendations

Integration of MHM into Educational Policies and Programmes.

Greater MHM Advocacy Increased Government Support

Gaps in Evidence & Research• Correlation between MHM and school absenteeism is mixed

and varies significantly across countries.• Impact of poor menstrual health on other health issues (e.g.

STIs and vaginal infections), development, and empowerment outcomes. (Kerner, Brad, and Seung Lee 2016, Grant 2013, Sumpter 2013).

• Few MHM programmes target out-of-school girls. • Few organizations have conducted a rigorous evaluation of

MHM product programming.• Policymakers and sanitation service providers lack training

Key Recommendations

MHM needs an integrated, sustainable approach – beyond handing out disposable pads. Engaging the Wider CommunityHarnessing New TechnologyInvestment in Product InnovationResearch and Development

Thank You