“If women can have moustaches we can all talk about menstruation”. With this message WASH United kicked off May MENSTRAVAGANZA, a 28-day campaign to raise awareness and break the silence around menstruation and menstrual hygiene.
Messages are posted on the campaign website:
wash-united-may-menstravaganza.tumblr.com and
on Twitter using hashtag #MENSTRAVAGANZA
Posted in Campaigns and Events, Hygiene Promotion
A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management. PLoS ONE 8(4) 2013.
Sumpter C, Torondel B
Background – Differing approaches to menstrual hygiene management (MHM) have been associated with a wide range of health and psycho-social outcomes in lower income settings. This paper systematically collates, summarizes and critically appraises the available evidence. 
Methods – Following the PRISMA guidelines a structured search strategy was used to identify articles investigating the effects of MHM on health and psycho-social outcomes. The search was conducted in May 2012 and had no date limit. Data was extracted and quality of methodology was independently assessed by two researchers. Where no measure of effect was provided, but sufficient data were available to calculate one, this was undertaken. Meta-analysis was conducted where sufficient data were available.
Results – 14 articles were identified which looked at health outcomes, primarily reproductive tract infections (RTI). 11 articles were identified investigating associations between MHM, social restrictions and school attendance. MHM was found to be associated with RTI in 7 papers. Methodologies however varied greatly and overall quality was low. Meta-analysis of a subset of studies found no association between confirmed bacterial vaginosis and MHM (OR: 1.07, 95% CI: 0.52–2.24). No other substantial associations with health outcomes were found. Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in management methods reduce school absenteeism.
Conclusion – The management of menstruation presents significant challenges for women in lower income settings; the effect of poor MHM however remains unclear. It is plausible that MHM can affect the reproductive tract but the specific infections, the strength of effect, and the route of transmission, remain unclear. There is a gap in the evidence for high quality randomised intervention studies which combine hardware and software interventions, in particular for better understanding the nuanced effect improving MHM may have on girls’ attendance at school
Posted in Dignity and Social Development, Sanitation and Health
Tagged menstrual hygiene, MHM
Global Review of Sanitation System Trends and Interactions with Menstrual Management Practices, 2012.
Kjellén, M., C. Pensulo, P. Nordqvist and M. Fogde. Stockholm Environment Institute.
This review of sanitation system trends and interactions with menstrual management practices has been conducted as part of the broader project on Menstrual Management and Sanitation Systems. 
It starts with a review of trends in the development of urban sanitation systems and then explores the interaction between menstrual management and sanitation systems, mainly relating to the issue of disposal of used menstrual blood absorption materials. Finally, it proposes a framework of interactions by positioning a range of issues of particular relevance for menstrual management into the different parts of the sanitation system.
JENdA: Journal of Culture and African Women Studies, (20) 2012
The Gendered Nature of Schooling in Ghana: Hurdles to Girls’ Menstrual Management in School
Marni Sommer, Nana Mokoah Ackatia-Armah
Read the full article (subscription required) at: www.africaknowledgeproject.org/index.php/jenda/article/view/1578
View the table of the contents of the whole issue at:
www.africaknowledgeproject.org/index.php/jenda/issue/view/137
This article explores girls’ voiced experiences of menstruation and schooling in rural and urban Ghana. The study was conducted in the Greater Accra Region (rural and urban) and the Tamale-Tolon-Kumbungu Districts of Northern Ghana. These regions are predominantly populated by the Ga-Dangme, and the Dagbani. The major aim of the study was to better understand the intersection of menarche, menstrual management and schooling for pubescent girls in Ghana, in order to adapt a Tanzania’s girl’s puberty book to the Ghana context.
The methodology included a comparative case study using participatory research with adolescent girls in and out of school. The research highlighted the significant gap in girls’ understandings around menstrual onset and overall pubertal body changes, along with aspects of the school physical and social environment that create barriers to girls’ successful attendance and participation during monthly menses. The findings highlight the importance of girl-focused approaches to developing guidance for healthy transitions through puberty.
PLoS ONE, Oct 2012.
Sanitary Pad Interventions for Girls’ Education in Ghana: A Pilot Study
Paul Montgomery, et al.
Background – Increased education of girls in developing contexts is associated with a number of important positive health, social, and economic outcomes for a community. The event of menarche tends to coincide with girls’ transitions from primary to secondary education and may constitute a barrier for continued school attendance and performance. Following the MRC Framework for Complex Interventions, a pilot controlled study was conducted in Ghana to assess the role of sanitary pads in girls’ education.
Methods – A sample of 120 schoolgirls between the ages of 12 and 18 from four villages in Ghana participated in a non-randomized trial of sanitary pad provision with education. The trial had three levels of treatment: provision of pads with puberty education; puberty education alone; or control (no pads or education). The primary outcome was school attendance.
Results – After 3 months, providing pads with education significantly improved attendance among participants, (lambda 0.824, F = 3.760, p<.001). After 5 months, puberty education alone improved attendance to a similar level (M = 91.26, SD = 7.82) as sites where pads were provided with puberty education (Rural M = 89.74, SD = 9.34; Periurban M = 90.54, SD = 17.37), all of which were higher than control (M = 84.48, SD = 12.39). The total improvement through pads with education intervention after 5 months was a 9% increase in attendance. After 3 months, providing pads with education significantly improved attendance among participants. The changes in attendance at the end of the trial, after 5 months, were found to be significant by site over time. With puberty education alone resulting in a similar attendance level.
Conclusion – This pilot study demonstrated promising results of a low-cost, rapid-return intervention for girls’ education in a developing context. Given the considerable development needs of poorer countries and the potential of young women there, these results suggest that a large-scale cluster randomized trial is warranted.
Posted in Africa, Hygiene Promotion
Tagged Ghana, menstrual hygiene, Sanitary napkin
Menstrual hygiene matters is an essential resource for improving menstrual hygiene for women and girls in lower and middle-income countries. 
Nine modules and toolkits cover key aspects of menstrual hygiene in different settings, including communities, schools and emergencies.
This comprehensive resource:
In her foreword, Catarina De Albuquerque, UN Special Rapporteur on the human right to safe drinking water and sanitation, states:
This resource brings together, for the first time, accurate, straightforward, non-judgemental knowledge and practice on menstrual hygiene programming from around the world to encourage the development of comprehensive and context specific approaches to menstrual hygiene.
Download the complete report (PDF, 16.4 Mb)
Download the report introduction (PDF, 1.1 Mb)
Menstrual hygiene matters has been produced with input from a wide range of experts and organisations. It was jointly funded by WaterAid and the SHARE research consortium.
“We don’t talk about it at all !” The taboo of menstruation in rural Maharashtra, a major deterrent in achieving menstrual hygiene | Source: Urmila Chanam, IndiaWaterPortal, Oct 2, 2012
Priyanka, 13 and a chirpy adolescent girl studying in a government school in a village called ‘Rohini Gaun’ 25 kms from Wardha in Maharashtra blushes and says, “We don’t talk about it at all!”. That is how deep seated the taboo around menstruation is in rural India and our society as a whole, where mothers do not discuss it with their daughters or even among themselves. It is something to be ‘hidden’ from each other and the men folk of the household as if it never happened! Priyanka gushes and says, “I got my menses when I turned thirteen few months ago and till that very time, I had no information about what menstrual cycle is.” She says her mother told her nothing to prepare her for the change in her physiology and her life in general. “Menstruation onset turned my life upside down in more ways than one,” Priyanka says regretfully, as if she felt she had been better off before it began.
The Wash Yatra Team with the class on menstrual hygiene
In rural India as a whole, menstruation is a taboo writ with stigma not permitting discussion or even information seeking. Because of the shame and superstitions associated with this monthly biological occurrence, these women are impacted by poor menstrual hygiene. On an average a woman has 3000 days of menstruation in her lifetime, which begins from 8-16 years and ends in her late forties or early fifties, with very real and practical needs like material for absorption of menstrual blood, facilities for proper disposal of used materials with privacy and dignity.
EDUCATION/CONFERENCES
PhD in Menstrual Hygiene Management at WEDC, Loughborough University. (More information)
The Water, Engineering and Development Center (WEDC) is exploring the possibility of supporting a student to carry out PhD research related to MHM. In some exceptional cases, funding for international students may be considered under the WEDC scholarship program.
Conference on Exploring Menstruation Hygiene Management Practices, September 27, 2012. (Registration information)
A joint conference between UNICEF and Columbia University’s Mailman School of Public Health will review the range of MHM approaches being initiated or implemented at the research, program, and policy levels, and share lessons learned to date with the broader WASH in Schools community around the world.
FACT SHEETS/REPORTS
Developing an Affordable Sanitary Pad, 2012. PATH. (Link)
PATH’s solution is to develop and advance low-cost menstrual management options for girls and women in low-resource settings. Findings from focus group discussions and literature reviews indicate that girls and women are interested in disposable products that offer better absorbency and have a cheaper price tag than available options. The paper also discusses reusable options (cloth pads and menstrual cups) that can last for several years.
Managing Menstrual Hygiene in Emergency Situations: How Far from Reality?2012. D Wickramasinghe. (Full text, pdf)
This paper explores the issue of MHM in emergency situations. It also discusses common obstacles that are encountered in promoting effective and hygienic menstrual practices in disaster relief programs. Learning from the tsunami relief activities in 2004, this article describes strategic actions to build capacity and develop processes to respond to the needs of menstruating women.
Menstruation Hygiene Management for Schoolgirls in Low-Income Countries, 2012. WEDC. (Full text, pdf)
This fact sheet outlines the problems experienced by menstruating schoolgirls in low-income countries. The fact sheet also evaluates simple solutions to these problems including the use of low-cost sanitary pads and suggests ways in which MHM can be included in water, sanitation, and hygiene (WASH) programs.
The Water, Engineering and Development Centre (WEDC), UK, is exploring the possibility of supporting a student to carry out PhD research related to Menstrual Hygiene Management (MHM). In some exceptional cases, funding for international students may be considered under the WEDC scholarship programmes. In all cases, very strong academic credentials and an outstanding research idea will be expected.
If you are interested contact Dr. Julie Fisher outlining your relevant experience, qualifications and area of interest by 31 August 2012.
Related publication:
Crofts, T. and Fisher, J., 2012. Menstrual hygiene in Ugandan schools: an investigation of low-cost sanitary pads. Journal of water, sanitation and hygiene for development ; vol. 2, no. 1 ; p. 50-58. Available at: <https://dspace.lboro.ac.uk/dspace-jspui/handle/2134/9399>
Low Cost Handmade Sanitary Pads! From Design to Production A Step Forward in Menstrual Hygiene Promotion in Pakistan, 2012.
By Hina Israr & Syed Shah Nasir, IRSP-Pakistan
ABSTRACT: “In order to manage the basic phenomena of menstruation, sanitary materials are used by women of all ages, almost from 14 to 45 years of age, though branded material are available in urban areas but difficult in rural, in those areas where such materials are available, they are expensive and difficult to afford and manage as well, so it has been planned by IRSP to introduce MHM specific low cost technologies in Pakistan for not just providing ease in their practices but also for paving way for women empowerment through involving them in large scale sanitary pad production.”
SuSanA Duncan Mara’s Sanitation Blog SuSanA Forum
 | RAJASHEKAR on India, West Bengal: hygiene ma… |
 | dietvorst on Sanitation promotion history:… |
 | Tilmann Vorhoff on Sanitation promotion history:… |
 | Janice Whitehead on UNICEF launches groundbreaking… |
 | Anil sengar on India: scheme for low-cost san… |
 | Martin Obondo on Rose George – Reflection… |
