evidence-based interventions to address menstrual health challenges
TRANSCRIPT
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