Menstrual Hygiene Management
Naomi Radke, seecon international GmbH
Menstrual Hygiene Management
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Menstrual Hygiene Management
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Contents
1. Introduction
2. Beliefs, Myths and Taboos
3. Menstrual Hygiene, Human Rights and MDGs
4. Health Risks of Poor Menstrual Hygiene Management
5. Menstrual Hygiene Management: Hardware
6. Menstrual Hygiene Management: Software
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1. Introduction
Menstruation
52% of women worldwide are in reproductive age and most of them
thus are menstruating monthly.
Still, the majority of them are not in conditions to take care of their
menstruation in a hygienic manner or are impaired by it.
Menstruation is supposed to be invisible and silent.
Source: KJELLEN ET AL. (2012)
Menstrual Hygiene Management
Source: http://www.mcmaster.ca/museum/Exhibitions_Fierce.html [Accessed:
07.08.2013]
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2. Beliefs, Myths and Taboos
Harmful restrictions
In some cultures, women and girls are told that
• During their menstrual cycle they should not bathe (or they will
become infertile)
• Touch a cow (or it will become infertile)
• Look in a mirror (or it will lose its brightness)
• Touch a plant (or it will die)
Young women chatting
about menstrual issues.
Source: UNICEF (2008)
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2. Beliefs, Myths and Taboos
Other restrictions
Restrictions on girls during their menstrual
period in Afghanistan, India, Iran and
Nepal. Source: (HOUSE et al. 2012).
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2. Beliefs, Myths and Taboos
Relieving restrictions
Women may appreciate the ‘banishment’ to menstrual huts as
they are given a rest period from the normal intensity of daily
chores.
Zulu menstruation hut.
Source: RINDSTAD (2013)
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2. Beliefs, Myths and Taboos
Parental Education
Education by parents about reproductive health, sexuality and
related issues is often a no-go area leading to a low knowledge and
understanding on these issue
Source: http://phil2100dsu12a.wordpress.com/2012/07/10/abortion-the-solution-is-viability/ [Accessed: 07.08.2013]
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3. Menstrual Hygiene, Human Rights and MDGs
Lack of facilities and sanitary products (1/2)
... Can push many girls out of school.
Relationship between menstrual hygiene and school drop-out of girls
from the higher forms due to lack of facilities, affordable sanitary
products, fear of bloodstains and more.
Millenium Development Goal (MDG) 2: Achieve universal primary
education
 Participation of girls especially in Africa and Asia lags far behind
the boys’ in higher forms of primary education
Millenium Development Goal (MDG) 3: Promote gender equality and
promote women
 The lacking behind in primary education to not providing
adequate facilities and sanitary products infringes gender equality
and the promotion of women
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3. Menstrual Hygiene, Human Rights and MDGs
Lack of facilities and sanitary products (2/2)
Stigma around menstruation hurts human rights, especially human
dignity but also the right to non-discrimination, equality, bodily
integrity, health, privacy and the right to freedom from inhumane
and degrading treatment from abuse and violence.
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4. Health Risks of Poor Menstrual Hygiene Management
Health risks
• Poor protection and inadequate washing facilities may increase
susceptibility to infection
• In case of female genital cutting: blockage and build-up of blood
clots is created behind the infibulated area: pain, additional
infection risk
• Risk of infection higher than normal during period as the blood
forms a pathway into the uterus
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4. Health Risks of Poor Menstrual Hygiene Management
Inappropriate hygiene practices (1/3)
Certain practices are more likely to increase the risk of infection
e.g. using unclean rags. Inappropriate practices often due to the
non-affordability of sanitary products for poor women.
Findings from Bangladesh:
• 80% of factory workers are women
• 60% of them were using highly chemically charged rags from the
factory floor for menstrual cloths
• Infections are common, leading to 73% of women missing work for on
average six days a month
• Women had no safe place either to purchase cloth or pads or to
change/dispose of them
• When women are paid by piece, those six days away present a huge
economic damage to them but also to the business supply chain
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4. Health Risks of Poor Menstrual Hygiene Management
Inappropriate hygiene practices (2/3)
• Unclean sanitary pad materials (local infections/bacteria can
travel up the vagina and enter uterine cavity)
• Changing pads infrequently (skin irritation by wet pads)
• Insertion of unclean material into vagina (easier infection , also
of uterine cavity)
• Using highly absorbent tampons during light blood loss or no
menstruation (toxic shock syndrome, vaginal irritation)
Source: HOUSE ET AL. (2012)
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4. Health Risks of Poor Menstrual Hygiene Management
Inappropriate hygiene practices (2/2)
• Wiping from back to front following urination or defecation
(bacteria can travel easier into vagina)
• Unprotected sex (increased risk of sexually transmitted
diseases)
• Unsafe disposal of used sanitary materials or blood (risk of
infecting others with diseases)
• Frequent douching (forcing liquid into vagina can introduce
bacteria into uterine cavity)
• Lack of hand-washing after changing a sanitary towel (can
spread infections)
Source: HOUSE ET AL. (2012)
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5. Menstrual Hygiene Management: Hardware
Sanitary protection materials (1/4)
It is critical that any programme aiming to support women or girls
with sanitary protection materials involves them in the planning
discussions and decisions about the options to be supported.
Schoolgirls participating in a
menstrual cup project.
Source: APHRC (2010)
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5. Menstrual Hygiene Management: Hardware
Sanitary protection materials (2/4)
Disposable sanitary towels
• In resource-poor settings often
very expensive and hard to
dispose of
• Often difficulty of proper
disposal (generates solid waste)
• But reduce barriers of girls
staying at school
Source: HOUSE ET AL. (2012)
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5. Menstrual Hygiene Management: Hardware
Sanitary protection materials (3/4)
Cloth or cloth pads
• A sustainable sanitary option,
but it must be hygienically
washed and dried in the
sunlight (natural steriliser)
• But shame of drying the clothes
outside, so often hide them in
damp unhygienic places
Locally made reusable cloth
pads and cloth in Kenya.
Source: HOUSE ET AL. (2012)
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5. Menstrual Hygiene Management: Hardware
Sanitary protection materials (4/4)
Menstrual cup
• New technology appropriate for poor women and girls
• Cup made of medical silicone rubber that is inserted into the
vagina to collect menstrual blood
• Removed and emptied less frequently than sanitary pads
• Needs to maintain a high standard of hygiene especially during
insertion, removal and general cleaning
Menstrual Cup by The
Moon Cup (UK).
Instructions for menstrual cups.
Source: RUBYCUP (2013)
Menstrual Hygiene Management
Source:
http://www.mooncup.com/photographs.
html [Accessed: 07.08.2013]
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5. Menstrual Hygiene Management: Hardware
Sanitary protection materials – advantages/disadvantages (1/2)
Sanitary protection
Advantages
option
Natural materials (e.g. 
Free
mud, cow dung, leaves) 
Locally available
Strips of clothes


Toilet paper or tissues

Disadvantages


Easily available
local market
Re-usable
in
Easily available
local market
in
the 

the 
•
•
Re-usable pads




Available locally or on the 
internet
Income generation

opportunity, if locally
made

Cost effective as are reusable
More
environmentallyfriendly than disposable
pads
High risk of contamination
Difficult and uncomfortable to use
If old cloths are not cleaned well they
can become unhygienic.
Users need somewhere private, with a
water supply and soap, to wash and
dry the cloths.
Loses strength when wet and can fall
apart.
Difficult to hold in place.
May be too expensive for the poorest
users
Users need somewhere private, with a
water
supply and soap, to wash and dry the
pads.
Cost is prohibitive to many potential
users, if commercially produced
Source: HOUSE ET AL. (2012)
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5. Menstrual Hygiene Management: Hardware
Sanitary protection materials – advantages/disadvantages (2/2)
Sanitary protection
option
Tampons
Advantages

Disadvantages
Convenient and comfortable 
to use




Menstrual cups


Re-usable

Only need emptying, washing
and drying


Panties/ Underwear

Useful for keeping a sanitary

product in place.

• Good for keeping the vaginal
area hygienic.
Not available in many contexts.
Cost is prohibitive to any potential users.
Generates a lot of waste to dispose, not
environmentally-friendly.
May not be culturally appropriate,
particularly for adolescent girls, as need to
be inserted into the vagina.
Hygiene and availability of water and soap
for hand-washing are particularly important,
as need to be inserted into the vagina.
May not be culturally appropriate for use,
particularly for adolescent girls, as need to
be inserted into the vagina.
Hygiene and availability of water and soap
are particularly important, for washing
hands and menstrual cup, as need to be
inserted into the vagina.
Expensive first investment outlay.
Cost may be prohibitive to potential users.
Cheap elastic can wear out relatively
quickly.
Source: HOUSE ET AL. (2012)
Menstrual Hygiene Management
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5. Menstrual Hygiene Management: Hardware
Sanitary infrastructure
Absence of clean and private sanitation facilities that allow for
menstrual hygiene may discourage girls from attending
school when they menstruate.
• Menstrual hygiene: e.g. lockable toilets, closed bin for
sanitary item disposal, sink for hand washing and cleaning of
clothes (both inside toilets)
• 1 in 10 school-age African girls do not attend school during
menstruation or drop out, due to this absence
• Teachers’ instruction time in school will be reduced by 1020%
 To manage menstruation
hygienically, it is essential
that women and girls have
access to water and
sanitation
Source: HOUSE ET AL. (2012)
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5. Menstrual Hygiene Management: Hardware
Disposal
• If lack of opportunities, dispose secretly and easily: thus on
defecation field, river or garbage dump
• Blocking toilets/filling up pits
Disposing of non-biodegradable sanitary pads in
pit latrines leads to quick filling and thus
shortened service of the pit. Source: HOUSE ET AL. (2012)
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6. Menstrual Hygiene Management: Software
Education
• Education and information (in combination with hygiene and sex
education) empowers women and girls with factual information
about their bodies and how to look after them
• Teachers are rarely trained in teaching menstrual hygiene and
consequently rarely teach it; male teachers may feel cultural
norms forbid them
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6. Menstrual Hygiene Management: Software
Further software. Awareness Raising
• Promoting good practices for Menstrual Hygiene Management:
-
How to capture the blood
How to dispose of the cloth, pad, cotton
How to keep yourself clean during the period
How to manage the stomach pain from your period
For an overview see Table 1.6 (p. 39, HOUSE et al. 2012)
• Community-wide approaches that include boys and men
(Physical barriers are often connected to social barriers. Social
barriers have to be overcome!)
• Integrate Menstrual Hygiene Management into a wider hygiene
promotion approach on Water, Sanitation and Hygiene including
risks and good practices
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6. Menstrual Hygiene Management: Software
Example of promoting menstrual hygiene management:
Mother’s Day - Zambia
Mother’s day: one day off work per month.
Silent belief that this day was thought for a day of relief whilst
having menstruation.
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References
KJELLEN, M., PENSULO, C., NORDQVIST, P., FOGDE, M. (2012): Global Review of Sanitation System Trends and
Interactions with Menstrual Management Practices. Report for the Menstrual Management and Sanitation Systems
Project. Stockholm: EcoSanRes, Stockholm Environmental Institute (SEI). URL:
http://www.irc.nl/docsearch/title/180836 [Accessed:05.08.2013]
HOUSE, S.; MAHON, T.; CAVILL, S. (2012): Menstrual hygiene matters. A resource for improving menstrual hygiene
around the world. London: WaterAid. URL:
http://www.wateraid.org/what%20we%20do/our%20approach/research%20and%20publications/view%20publication?id=0
2309d73-8e41-4d04-b2ef-6641f6616a4f [Accessed:05.08.2013]
RINDSTAD, S. (2013): Symbolic Meaning of Menstruation. Available at:
http://pub209healthcultureandsociety.wikispaces.com/Symbolic+meaning+of+menstruation+across+different+cultures+
and+perspectives [Accessed:07.08.2013]
RUBY CUP (2013): http://www.ruby-cup.com [Accessed: 08.03.2013]
UNICEF (2008): Sharing simple facts. Useful information about menstrual health and hygiene. New York: United Nations
Children's Fund (UNICEF). URL: http://www.unicefiec.org/document/sharing-simple-facts-useful-information-aboutmenstrual-health-and-hygiene-booklet-english [Accessed: 08.03.2013]
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