Menstrual hygiene in emergencies – MHM ToT for emergency WASH trainers – 5 April 2013
Start-up kit of training materials and visual aids
Start-up kit of training and visual aids contents
Item
Description
No
1
Bag for kit
1
2
CD of resource
materials
2
Hard copy of
Menstrual Hygiene
Matters
1
3
Notes
See the table which follows for the contents.


Main CD with most of the training materials
Second CD will a few MHM related videos
Source: Developed by a team at WaterAid with contributions from a wide
range of people from around the world. Co-published by 18 organisations
and reviewed by 21 individuals and / or teams.
Background resource for trainers – covering the following in module and
associated toolkits:
1. Menstrual hygiene - the basics
2. Menstrual hygiene - getting started
3. Menstrual hygiene – sanitary protection materials and disposal
4. Working with communities on menstrual hygiene
5. Working with schools on menstrual hygiene
6. Menstrual hygiene in emergencies
7. Supporting women and girls in vulnerable, marginalised or special
circumstances
8. Menstrual hygiene in the workplace
9. Research, monitoring and advocacy
4
MHM for schoolgirls
in low income
countries flyer
2
Source: WEDC, Loughborough University
Flyer on menstrual hygiene management for schools girls in low income
contexts. Covers: Problems faced by menstruating schoolgirls; Cultural
and religious restrictions; and practical considerations.
wedc.lboro.ac.uk/resources/factsheets/FS007_MHM_A4_Pages.pdf
Hardcopies of girls books
5
Girls book – Ghana
1
Source: Developed by T. Nana Mokoah Ackatia-Armah and Dr Marni
Sommer of Know and Grow, Inc.
http://www.growandknow.org/Grow_and_Know/about_us.html
Book for girls in Tanzania to learn about growing up and menstruation.
Includes the basics, case studies by other girls and information on busting
myths and looking after herself during menses.
Also provided on the CD.
6
Girls book –
Tanzania
1
Source: Developed by Dr Marni Sommer of Know and Grow, Inc.
http://www.growandknow.org/Grow_and_Know/about_us.html
As above – but for girls in Tanzania
Also provided on the CD.
7
Girls book Cambodia
1
Source: Developed by Dr Marni Sommer of Know and Grow, Inc. and
Susan Connolly
http://www.growandknow.org/Grow_and_Know/about_us.html
1
As above – but for girls in Cambodia. Also provided on the CD.
Laminated cards
8
Card 1 Emergency latrine
–A
1
Source: Picture by D. Makamba/UNICEF
A latrine constructed by people displaced due to flooding in Tanzania:

9
10
Card 2 Emergency latrine
–B
Card 3 Emergency latrine
–C
1
No privacy, difficult to manage menstruation from this latrine
Source: Picture by D. Makamba/UNICEF
A latrine in a camp for displaced people due to flooding in Tanzania:
1

Better than A as has privacy within the individual units and has a tippy
tap for hand-washing (but with no drainage or soap)

But the block is for both men and women (half indicated for each) and
the hand-washing facility is for both men and women, which a woman
or girl may be reticent to use if she has blood on her hands during her
menstrual period
Source: Picture by S. Raza/OXFAM-GB
A latrine and shower unit block for women displaced by an earthquake in
Pakistan – the latrine and shower units are in a single block with screening
to make entrance more private and a hand-washing unit inside before the
user exits the screened area. Both men and women’s units were designed
the same way.
In addition in some blocks in strategic locations (not in all blocks) an extra
unit was included to include a private laundry slab inside another screen
(see the silver screen in the top left hand corner of the block). This is so
that women or girls can if they want wash their menstrual cloths or other
private items in a private setting.


11
Card 4 Emergency latrine
–D
1
Source: Picture by N. Villeminot/ACF France
This block was constructed for people displaced by the earthquake in
Pakistan. It has latrines and shower units and a communal laundry area
and the whole block is screened. Hot water is provided inside and a small
fee is paid for use. Both men and women’s blocks were designed in the
same way, but located separately.

12
13
This is better than A and B as it provides a private place for
undertaking personal hygiene, but in this case it was located a bit near
to a bank and hence the wall height had to be increased a bit to
prevent seeing inside the screen.
See also cards 5 and 6.
Card 5 - Screened
block with handwashing inside
1
Card 6 - Private
washing slab plus
drying line
1
This is better than A, B and C – as it provides a private location for
personal hygiene, with hot water, a roof and also has solid walls for
additional privacy.
Source: Picture by S. House/OXFAM-GB
This is a similar block to that shown in card 3 but on another site in
Pakistan. This block does not have the internal washing slab, but shows
the hand-washing container inside the screen and the screened area.
Source: Picture by S House/OXFAM-GB
This shows the inside of the private laundry unit / washing slab within the
toilet and shower blocks, as shown in card 3. The small laundry slab
drained away inside the unit and a drying line was included above the
slab.
In one camp the slabs were used and feedback was positive. In this camp
2
the units were located inside the blocks as they were larger and there was
space to include them.
In another camp the units were located on the outside of the screened
blocks but with a door inside, as these screened blocks were smaller. But
in this second site the women reported not using them. When asked why it
was noted that the men became curious of the extra units on the outside
of some blocks (as there were not the same attached to the men’s blocks)
and started poking holes in the plastic sheets to see what was inside.
A lesson from the experiences of the units identified in cards 3 and 6, and
from other experiences elsewhere, is that the provision for a laundry area
or a space for the management of menstrual hygiene materials or washing
during menses should be discrete (essential) and something that can be
used also at other times. This is because women and girls do not like
other women and girls as well as men and boys knowing that they have
their menses.
It may be that having shower units with drainage that keeps any blood
stained water from the public eye would be enough. If so, designing in
extra space in some units with a small seat or concrete block that women
and girls can sit on to do their laundry, or for people with mobility
limitations, will make the showers easier for use for managing menses.
14
Card 7 - End
disposal options
1
Source: Various – see card
This card shows some options for end disposal of sanitary materials:





Open pit for burning;
Temporary incinerator;
In a pit latrine pit;
Burying;
Small incinerator attached to a latrine block.
None of the end disposal options are perfect and will need to be
established based on the context.
The critical considerations are:
15
Card 8 - Waste
disposal bin design
1

How will the MHM materials be collected or taken to the disposal point
discretely and without anyone knowing that is what is happening?

If disposed of in a latrine pit, the pit will fill up quicker, and will be more
difficult if it is to be emptied by suction tanker.

Materials cannot be disposed of in a pour flush latrine because they
can cause blockages.

There will be some chemicals / fumes produced from burning or
incineration in anything other than a high temperature incinerator.
However, for small volumes, or for temporary periods, or in areas
where there is space and hence more dilution for smoke / fumes such
(such as outside of high density areas), burning or incineration may
still be the best option. More research is still needed in this area.
Source: Pictures by the Government of Tanzania / Rashid Mbago
These pictures show some simple designs of bins which could be used for
the collection of menstrual hygiene sanitary protection material wastes.
The issues to look at when comparing containers are:




Are they washable?
Do they have a lid and hence can keep in the smell?
Are they easy to carry to dispose of?
Are they available in the local area (where possible?)
3
Just including a collection container in a latrine unit is however not
enough. There also needs to be a system for the continued collection and
emptying of the containers and the end disposal of the materials. If the
emergency is likely to last for some time the system must be sustainable
for this period of time.
16
17
Card 9 – Shower
design
Card 10 – Plastic
pants
1
Source: Picture from the WASH Visual Aids Library
This card shows a shower unit under construction in an emergency
context. The card is useful to ask the question is this design appropriate
for women and girls to use for showing in a camp situation?
1

The positive design features of this unit are: the solid walls; the piped
water; the concrete slab and presumably the drainage (which can’t be
seen). Presuming that the door will be fixed on with a lock inside this
would also be a positive design feature for women and girls.

The design features which are not good are: the gap around the
bottom is not good for women and girls for a shower unit as men or
boys could look underneath and see the woman or girl inside. If the
woman or girl is menstruating then also the blood may also be seen
which may also prevent the use of the unit. Also the lack of a roof may
not always be ideal (depending on the location and context). In one
instance men were climbing a water tower located nearby a shower
block which did not have a roof. This allowed them to see into the
units when women were showering.
Source: Part of a set of IEC cards developed by USAID/Hygiene
Improvement Project, Plan International, UWASANET, Ministry of Health,
Republic of Uganda, 2010 – This guidance was first developed by the
USAID Hygiene Improvement Project (HIP). WASHplus, the follow on
project to HIP, continues to build on the evidence base and growing body
of experience integrating WASH into care and support activities for
PLWHA.
For information and more materials visit: www.washplus.org
These plastic pants can be used for a woman or girl who is bed bound or
incontinent. They can be made locally from a plastic bag and elastic.
Further examples of these training materials are included on the CD.
18
Card 11 – Care of
women with HIV –
menstrual period
management
1
Source: From the same set of materials as 17.
An IEC card for using with people being trained in home based care for
people with HIV. On good practices when caring for women and girls who
are menstruating. Note that when women and girls are very sick their
period may stop, but with the wider availability of Anti Retro Virals women
and girls with HIV are now starting to menstruate more.
For information and more materials visit: www.washplus.org
19
Card 12 – Care of
women with HIV –
disposal or cleaning
of menstrual blood
soaked material
1
Source: From the same set of materials as 17.
An IEC card for using with people being trained in home based care for
people with HIV. On good practices for handing or disposing of menstrual
blood when caring for women and girls with HIV. Note that when women
and girls are very sick their period may stop, but with the wider availability
of Anti Retro Virals women and girls with HIV are now starting to
menstruate more.
For information and more materials visit: www.washplus.org
20
Card 13 –
AFRIpads care
instruction card
1
Source: AFRIpads Ltd, Uganda
IEC instruction card for use and care of AFRIpad re-usable pads. Includes
step by step instructions and dos and don’ts.
4
www.afripads.com
21
Card 14 – Girl with
a disability at the
entrance to a latrine
1
Source: By Rod Shaw of WEDC, Loughborough University
The picture is useful to highlight the additional challenges that women with
disabilities have when accessing WASH facilities and in particular latrines.
This also poses challenges for managing their menstruation. This card
highlights the importance of considering the needs of women and girls
with mobility limitations when designing facilities.
Refer to Module and Toolkit 7 of the MHM resource for more information.
http://wedc.lboro.ac.uk/resources/factsheets/FS007_MHM_A4_Pages.pdf
22
Card 15 – Woman
drying her
menstrual cloths in
the sun
1
Source: From UNICEF Afghanistan
Example of an IEC card to promote discussion on good practice with
MHM. Other examples are on the CD.
Samples of sanitary protection materials
Note: The following are only samples of sanitary materials available – a wide range is available of similar and
different types and brands.
23
MakaPads pack +
samples
1
95% biodegradable pads made from papyrus and waste paper. Made in
Uganda by small businesses of people who are living in poverty, have
HIV, or were previously abductees of the Lord’s Resistance Army.
Developed by Technology for Tomorrow, Makerere University in Uganda.
www.t4tafrica.co
The pads come in various designs: normal absorbance; higher
absorbance; with wings; without wings.
See page 256 in the MHM resource for more background on the design
and manufacture of these pads and a case study of one of the production
units making the pads on page 168.
24
AFRIpads set of reusable pads
1
Set of sanitary pads, holders and plastic storage pouches developed by
AFRIpads (U) Ltd in Uganda and made by workshops of women in rural
areas in Uganda. www.afripads.com
A set lasts for around one year for multiple times of re-use, but probably
can be used for longer.
This pack has: 2 pad holders which clip onto underwear / panties; 5
winged pads; 3 straight pads; and 2 plastic bags for storing the pads when
soiled before washing.
A lot of thought has gone into the design of these pads and testing and
feedback by women in Uganda who prioritised that the pads would dry
quickly over absorbency. Hence the material used is not cotton but a
synthetic fabric, as cotton takes longer to dry. The pads come in different
colours, so that for families with more than one girl, each girl can know
which her own set of pads are.
See page 353 in the MHM resource for more background on the design of
these pads.
A laminated IEC card for instructing how to use, wash and dry the pads is
also available – see the laminated card 13 in this set.
25
Menstruation belt
1
This is a commercially produced elastic belt for use with pads with loops to
hold in place the sanitary pad. Local versions are sometimes be made.
26
Pad with loops
1
This is a commercially produced pad with loops to be used with the belt
above. Similar designs are sometimes made locally.
27
Pad for slight
1
It is possible to buy commercially available sanitary pads that can be used
5
incontinence
for menstruation but also for incontinence. This is one example for a
woman or girl will slight incontinence. Other sizes and absorbencies are
available as well as pads for feacal incontinence and for men. These pads
are all of higher absorbency than sanitary pads for menstruation, as the
volume of liquid from urine is higher than for menstruation.
28
Panti liners (small)
2
A range of panti liners are available commercially. These are used for
regular discharge in-between periods and can also be useful at the start of
a period to catch the first drops of blood before changing over to higher
absorbency pads for the higher flow days.
29
Disposal pads
(medium)
1
A wide range of sanitary pads are available commercially – of different
designs, thickness, absorbency, with perfume or without perfume etc. This
is one example of a standard pack of disposable sanitary pads.
Disposable sanitary pads are also made locally in some contexts using
cotton cloth and cotton wool as the absorbent.
30
Dark cloth (soft
texture)
1
This is an example of some dark coloured cloth (cotton Jersey) with a soft
texture.
31
Light cloth (medium
texture)
1
This is an example of some light coloured cloth (cotton Calico) with a
medium texture.
32
Light cloth (soft
texture)
1
This is an example of some light coloured cloth (cotton) with a soft texture.
33
Towelling (rough
texture)
1
This is an example of some dark coloured cloth with a rough texture. This
is an absorbent fabric, but too rough for using alone. It can however be
wrapped in a softer cloth which would then be next to the skin.
34
Tampon with
applicator
1
This is an example of a tampon which is inserted into the vagina to catch
the menstrual flow. The cord remains outside of the body and is used to
pull it out when it needs changing. When inside the body the tampon
expands with the liquid from the blood forming a seal to prevent the blood
from coming out of the vagina. This version has an applicator which is
used to insert the tampon without putting fingers inside the body. The
applicator would need to be disposed of.
35
Tampon without
applicator
1
This is the same as the above in 34 but does not have an applicator for
insertion. Insertion is done by the finger of the user. Hygiene is very
important when inserting anything inside the vagina.
36
Panties /
underwear /
knickers
1
This is one sample of panties / underwear / knickers. Different girls and
women will need different sizes. For most pads and cloth a pair of panties
will be needed to keep them in place.
Low cost locally made panties can sometimes suffer from weak elastic
which wears out in a short period of time. If this happens the panties will
not stay up.
Women and girls would need several pairs to be able to wash and dry
them and still be able to wear a pair at the same time.
37
Photocopies of
sanitary product
packages
1
set
Photocopies have been included of the packages of the samples which
are included but not in their original packaging.
A photocopy is also included of a set of pads for mothers who have just
given birth. These are much larger than standard pads because the flow of
blood can be much higher for several days after child birth.
6
Main CD contents
Folder
1 Menstrual
hygiene
matters
Notes
Menstrual hygiene matters; A resource for improving
menstrual hygiene around the world:




In high resolution – complete
In high resolution – by module and toolkit
In low resolution – complete
In low resolution – by module and toolkit
www.wateraid.org/mhm
2 MHM TOT for
emergency
WASH
trainers

Agenda

Start-up toolkit list including CD contents

Feedback form
Session contents:

Session plans

PPTs

Exercise handouts and facilitator notes
Session folders also include – handouts:
3 PowerPoint
presentations
&
Other
example
session plans
4 IEC &
photographs

IFRC – MHM trial, Burundi – Info sheet

Hayden, T / UNICEF – ‘FGD Guide’ and ‘Summary
of Findings’ table (extracted from the full report
located in folder 7)

House, S (2013) Sanitary protection for emergency
responses – overview of considerations for
selection of sanitary protection materials and
examples / case studies of current practices by
humanitarian organisations
Additional PPT presentation (in addition to those in
section 2 above):
MHM training and awareness raising
Other example session plans:

2 hr session integrated into 2 day learning event

AusRC & RedR – 1 hr stand alone MHM session in
HP training

RedR & UNHCR – MHM integrated into WASH
facilities for hygiene session

RedR & UNHCR – MHM integrated into NFI
session

MHM - IEC - Afghanistan (UNICEF)

MHM - IEC - Bangladesh (SHEWA-B)

Photos - Sanitary products

Photos - WASH facilities
This resource publication
(pp352) includes the basics on
MHM and modules and toolkits
on a range of different areas
including MHM in emergencies
and sanitary protection areas.
Useful as background reading
for trainers or to use for
reference to answer specific
questions.
Training materials as used in
the MHM ToT for emergency
WASH trainers on the 5 April
2013 in the RedR offices,
London.
Supported by:




WaterAid
RedR
SHARE
Sarah House
A series of short PPTs which
can be adapted or combined as
required.
Note that these have been
adapted for the set of PPTs
included in folder 2 as used for
the 5 April ToT training day.
These provide examples of IEC
materials used for discussing
menstrual hygiene.
These photographs and
pictures can be used for
7

Photos - Awareness raising
training materials.
Please credit the photo or
picture as indicated when
using them.
5 Girls and
teachers MHM
booklets

Afghanistan (girls and teachers) – The
Government of Afghanistan and UNICEF

Cambodia (girls) – Dr Marni Sommer and Susan
Connolly

Ghana (girls) – T. Nana Mokoah Ackatia-Armah
and Dr Marni Sommer
These are examples of girls
MHM booklets or teachers
training materials from a
number of countries that are
either available on the web or
where permission has been
given for inclusion.

Tanzania (girls and teachers training materials) –
Dr Marni Sommer
Others exist including in local
languages.
http://www.growandknow.org/Grow_and_Know/about_
us.html

Tanzania – teachers sensitisation materials for
using girls MHM book – Sommer, M / UNICEF

India (girls) – The Government of India and
UNICEF
indiasanitationportal.org/sites/default/files/MHM_Book.
pdf

Sierra Leone (girls) - The Government of Sierra
Leone and UNICEF

Zimbabwe (girls – English, Ndebele, Shona) –
Anna Kayemba / Aquamour
http://www.ecosanres.org/index.htm
6 Laminated
cards in startup kit
See the table above for the listing and associated
descriptions.
These cards have been
included in the trainers start up
kit.
7 Supporting papers and presentations
MHM and HIV

Various materials from WASHplus / HIP in Uganda

WASHplus presentation at UNC, 2012
For more info on the HIV virus in menstrual blood refer
to:
http://www.aidsmap.com/Viral-load-in-vaginalfluid/page/1322891/
These materials have been
developed to train carers of
people with HIV in safe WASH
practices. The elements which
relate to MHM have been
included here but a link via the
WASHplus website has been
provided on the document
entitled ‘Please read this
document first’.
A PPT also included which
provides an overview of the
issues in relation to the safe
handling of menstrual blood for
women and girls who have HIV.
MHM in
emergencies

ACF warm bathing shelter design, Pakistan

Hayden, T (2012) MHM in emergencies – research
on UNICEF and partners emergency responses

Two papers from WEDC conferences relating to
MHM in emergencies (Pakistan, Uganda) -
This folder includes three
papers and four presentations
which include case studies or
elements relating to MHM in
emergencies.
8
http://wedc.lboro.ac.uk/knowledge/conference_sea
rch.html

One paper from South Asia Hygiene Practitioners
Workshop relating to MHM in emergencies (Sri
Lanka)

Four presentations from the EEHF, 2012 with
MHM elements (Somalia, Bangladesh, UNICEF,
training) http://www.shareresearch.org/NewsAndEvents/Det
ail/eehf_2012_schedule
Paper by Sommer, M on menstrual hygiene in
humanitarian emergencies – not included in the CD:
MHM in
schools in
emergencies

http://www.washinschools.info/docsearch/title/1787
09

UNICEF WASH in schools in emergencies
teachers manual and flash cards:
http://www.unicef.org/wash/schools/

Inter-Agency Network for Education in
Emergencies: a) Pocket guide to gender http://toolkit.ineesite.org/toolkit/Toolkit.php?PostID
=1059

Socio-cultural,
gender,
disability &
WASH
Inter-Agency Network for Education in
Emergencies: b) Gender responsive school, water,
sanitation and hygiene http://toolkit.ineesite.org/toolkit/Toolkit.php?PostID
=1071

WEDC MHM for schoolgirls fact sheet wedc.lboro.ac.uk/resources/factsheets/FS007_MH
M_A4_Pages.pdf

Inclusive School, Sanitation & Hygiene Education
(SSHE) manual – Government of India http://indiasanitationportal.org/16376 (has designs
of school latrines which are accessible with
integrated shoots feeding to incinerators for
menstrual hygiene materials)

Two technical briefs (OXFAM) – one on sanitation
for people with physical disabilities and one on
socio-cultural considerations for public health
engineering in emergencies - http://policypractice.oxfam.org.uk/our-work/water-healtheducation/wash-technical-briefs

Accessibility features with sizes (CCBRT)

Gender and WASH handbook (IASC) –
http://www.humanitarianresponse.info/clusters/wat
er-sanitationhygiene/resources?field_document_type_tid=All&fi
eld_clusters_tid=All&field_locations_tid=All&field_o
rganizations_tid=All&title=&page=1

Gender and WASH checklist / tip sheet (IASC) http://www.humanitarianresponse.info/document/ia
sc-gender-wash-checklist
Two of the documents in this
folder relate to WASH in
schools in emergencies and
include content relating to
menstrual hygiene.
The WEDC fact sheet does not
relate specifically to emergency
contexts but is still of use as it
brings together the range of
issues for MHM for schoolgirls
in a few pages.
The inclusive WASH manual
from the Government of India
has some latrine designs for
schools which have integrated
incinerators and water within
the latrine units.
A few simple notes and
checklists with guidance on
improving accessibility of
WASH facilities in emergencies
and for considering gender
issues.
9
MHM in
WASH Cluster
– HP project Accountability
The booklet developed by the HP Project under the
WASH Cluster on accountability.
http://www.humanitarianresponse.info/document/hapwash-accountability-handbook
Particularly useful because it
documents ways of obtaining
feedback on WASH needs and
services which is essential
when considering MHM in
emergencies.
Second CD - Videos
Fold
er
1 Vide
os
Notes
Kotex series of videos of girls straight
talking about menstrual hygiene from the
US context:
A series of short videos – the first being an overview
and then 4 in more detail, with young women
straight talking about menstruation.

Introduction

Spread the Word (3.35n)
Good ice breaker. Humorous in style. Useful for
highlighting how taboo the issue is around the world
in all countries.

Break the silence: Take action with
generation know (3.23)
The following clips from these videos work well as
an introduction to the subject:

Bust a myth: Take action with
generation know (3.27)

Change the message: Take action with
generation know (3.27)



Break the silence – 0 to 1.17 min
Bust a myth – 0 to 2.49 min
Change the message – 0 t0 2.35 min
http://www.adweek.com/news/advertisingbranding/straight-talk-menstruation-adthats-causing-quite-stir-147501
TED Series talk: By Mr Muruganantham on
how he designed and tested low costs pads
and a machine for making them
http://www.ted.com/talks/arunachalam_mur
uganantham_how_i_started_a_sanitary_na
pkin_revolution.html
Wonderful amusing and inspiring video of a TED talk
by Mr Muruganantham explaining the process he
went through to develop the machine for which he
gives the blue print free.
Not related to emergencies but an inspiring video
that participants would enjoy watching.
Has various lessons included within it about
menstrual hygiene.
10