Menstrual hygiene management:
the basics
Introduction
• What are menstruation and menstrual
hygiene management (MHM)?
• Challenges faced by girls and women
• MHM and health
• Key components of MHM
• Inclusive MHM
• Cross-sectoral roles
• Menstrual hygiene matters resource book
What is menstruation?
• A natural bodily function and
vital sign of good reproductive
health
• Girls typically start to
menstruate between ten and 18
years old
• Results in bleeding from womb
(uterus) and through the vagina
• Usually occurs monthly for
between two to seven days
• Average amount of blood lost is
30-40ml – some lighter flow
and some heavier flow days
Picture: Kanyemba A (2011) Growing up at school, a
guide to menstrual management for school girls.
Zimbabwe: Water Research Commission, South Africa.
The menstrual cycle
Days
1-7:
8-11:
12-15:
16-25:
26-28:
•
•
Process
menstruation
tissue and blood
line the walls of the
uterus
ovulation
lining of uterus dissolves
(if the egg is not fertilised)
the lining detaches,
leading to menstruation
Approx. every 28 days but may be
21-35
May be irregular, especially in first
1-2 years
Picture: Based on UNICEF (no date) Flow with it, babe!
Let’s talk about feminine hygiene. East Africa.
Menstruation is a vital sign of
health
•
It is a natural process and a vital sign of the
healthy reproductive cycle of women and
girls.
•
It is not a sickness but women and girls may
suffer from abdominal pains, nausea,
tiredness, headache, back ache or discomfort.
•
Women and girls may also have feelings of
sadness or irritation due to hormonal
changes.
•
These experiences vary from person to
person and over time.
Menstrual hygiene definition
Women and adolescent girls are using a clean
menstrual management material to absorb or collect
menstrual blood, that can be changed in privacy as
often as necessary for the duration of a menstrual
period, using soap and water for washing the body
as required, and having access to safe and
convenient facilities to dispose of used menstrual
management materials.
They understand the basic facts linked to the
menstrual cycle and how to manage it with dignity
and without discomfort or fear.
Drafted by JMP Hygiene Working Group, 2012
Challenges faced by girls and
women
• Lack of sanitary protection materials
– leading to embarrassment and stress due to
leakage and smell
• Lack of menstrual hygiene-friendly facilities
– so unable to change materials and wash,
leading to absence from school or work
• Fear of using the latrine
– due to staining or lack of privacy or unsafe
location
Excluded from WASH facilities
• In some communities, women and girls are
not allowed to use water sources during
menstruation.
• In communities in Gujarat, India, 91% of girls
reported staying away from flowing water.
• In a study in South Asia, 20% of the women
interviewed, who had access to toilets, did
not use them during their periods, partly due
to fear of staining the toilet.
Challenges faced by girls and
women
• Less concentration and participation
– including standing up to answer questions at
school, due to worries about leakage or pain
• Lack of knowledge
– leading to fear, embarrassment and
unhygienic practices
• Exclusion from daily activities
– due to discomfort, concern over leakage or
cultural restrictions
Lack of knowledge, guidance and
support
“I didn’t know what was happening or what to do to
manage menstruation. I used cotton wool, pages from an
exercise book, leaves from trees. I suffered much
embarrassment at school because I leaked and stained
my uniform.”
Woman, Tanzania
“Guidance and support at school is more important than
anything. There is nobody to talk to. When we have
problems we just run from class and go home.”
Student, Malawi
Excluded from home
“The gods get angry if we enter the house
during menstruation. I don´t worry about
myself but I can´t sleep properly when my
daughter is in chhaupadi, vulnerable to
snakes and the freezing cold.”
Woman, Nepal
Menstrual hygiene and health
•
Limited evidence on actual health impacts,
but plausible link with poor menstrual
hygiene.
•
Distinction between menstrual disorders and
health conditions associated with poor
menstrual hygiene.
•
Menstrual hygiene may be a greater
challenge for those suffering incontinence,
fistula or female genital mutilation.
What is health?
Health is a state of complete physical,
mental and social well-being and not merely
the absence of disease or infirmity.
World Health Organization (1948)
Breaking the chain of silence
Women and
girls’ lack of
involvement
in decision
making
Lack of
information
and
awareness
Lack of
social
support
Lack of
access to
products
and facilities
Menstrual hygiene requires
• access to accurate and pragmatic
information
• access to menstrual hygiene materials
• access to facilities that provide privacy
• access to water and soap within a place
that provides an adequate level of privacy
• access to disposal facilities for used
menstrual materials
Pragmatic information
Pictures and photo (clockwise from left): WaterAid; Sommer M; UNICEF; Tridhara Photography/ Anisur Rahman
MHM-friendly WASH facilities
Latrine design Bangladesh
•
Wider chamber
•
Washing platform
and water inside
cubicle
•
Rail for
drying/hanging cloths
•
Disposal?
Photo: WaterAid
MHM-friendly WASH facilities
School latrine design India
•
Water inside the
latrine
•
Integrated incinerator
•
Disposal bin
Photo: WaterAid
Sanitary materials, supply, and
disposal
Pictures and photo (left to right):
AFRIpads; Tridhara Photography/ Anisur Rahman; WaterAid
All girls and women are not the
same
• Culture, language,
religion
• Household context
• Living in institutions
• Age and maturity
• Differently-abled
• Especially vulnerable
or marginalised
circumstances
Photo: WaterAid/ Caroline Irby
Vulnerable and marginalised
contexts
Photo: WaterAid/ Therese Mahon
Challenges faced by girls with
disabilities
•
Less access to facilities,
materials and information
•
Unable to see leaks or
extent of blood
•
Have to sit on dirty latrine
to change pads or cloths
•
May need support to
change their pads or cloths
•
Cannot communicate their
pain or discomfort and may
have heightened sensitivity
Illustration: IASC WASH Cluster Visual Aids Library
Sector roles
• WASH
• Health
• Education
• Gender
• Private sector
• Social
protection
Photo: Tridhara Photography/ Anisur Rahman
Menstrual hygiene matters:
a practical and comprehensive resource
Photos: Tridhara Photography/ Anisur Rahman; Moto
Michikata
Menstrual hygiene matters
training guide and resource book
available for download at:
www.wateraid.org/mhm