Integrating menstrual hygiene management (MHM) into the school water, sanitation and hygiene agenda

The integration of menstrual hygiene management (MHM) into existing water, sanitation and hygiene approaches in low-income countries is long overdue. This briefing paper presents an illustrative overview of existing research, programming and policy to date, with recommendations for the way forward in terms of research and programming priority areas. Of critical importance to any approach is the incorporation of girls’ voiced experiences and perspectives on their own needs for managing menses successfully in school, and the importance of adapting interventions to the local context. While attention to the issue of MHM for school girls is growing, much remains to be done, and the water and sanitation community has an important role to play in moving this effort forward

WASH in Schools Empowers Girls' Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference 2013

This publication brings together the key elements of the 16 presentations made at the Second Annual Virtual MHM in WinS Conference at UNICEF Headquarters in New York City on 21 November 2013. Building on recommendations from the MHM 2012 virtual conference, the 2013 conference focused on the research tools and instruments being used to explore MHM barriers and practices and to evaluate the interventions being trialed or implemented in various contexts

A Toolkit for Integrating Menstrual Hygiene Management (MHM) Into Humanitarian Response: The Full Guide

The menstrual hygiene management (MHM) in Emergencies project is a collaboration between the International Rescue Committee and Columbia University's Mailman School of Public Health, and is supported by Research for Health in Humanitarian Crises (R2HC). The aim of this project is to improve the guidance available to humanitarian responders who need to incorporate MHM into their programming during emergencies. Formative assessments were conducted in two humanitarian response settings (Myanmar and Lebanon) at the onset of the project in addition to interviews with global humanitarian experts, a major meeting of specialists across sectors and agencies, and a desk review. The toolkit was then piloted in an on-going emergency context (refugee camps in Tanzania) where it was evaluated and further improved upon.The toolkit looks at MHM from a multi-sectoral perspective and aims to give practical, streamlined guidance to humanitarian workers. The toolkit is co-published by 27 leading organizations that work in the humanitarian sphere.

Menstrual Health and Hygiene Management and WASH in Urban Slums: Gaps in the Evidence and Recommendations

The rapid urbanization and development of megacities across many low- and middle-income countries creates new challenges in global health; this is particularly true for women and girls who are disproportionately affected by poor urban planning, inadequate sanitation infrastructure, and limited access to water. Urban slums serve to reinforce many gendered inequalities, as reflected in poor sexual and reproductive health outcomes and various other health and wellbeing indicators. Women and adolescent girls in urban slums are particularly vulnerable in relation to their experiences of menstruation, given the limited access they may have to safe, private spaces with water for changing, washing, bathing, and laundering reusable pads, menstrual cloths and pads, and insufficient access to culturally acceptable, adequate disposal mechanisms for used menstrual materials. On-going taboos and stigma around menstruation likely augment these challenges in urban slum contexts; however, there exists limited literature on the intersection of menstrual hygiene management with water and sanitation systems in urban slums in low- and middle-income countries. Through a review of literature, this article seeks to highlight critical interlinkages between urbanization, sanitation, and menstruation, and identify important gaps in the existing menstruation-related evidence base that have implications for the health and wellbeing of adolescent girls and women

Managing menstruation in the workplace: an overlooked issue in low- and middle-income countries.

The potential menstrual hygiene management barriers faced by adolescent girls and women in workplace environments in low- and middle-income countries has been under addressed in research, programming and policy. Despite global efforts to reduce poverty among women in such contexts, there has been insufficient attention to the water and sanitation related barriers, specifically in relation to managing monthly menstruation, that may hinder girls' and women's contributions to the workplace, and their health and wellbeing. There is an urgent need to document the specific social and environmental barriers they may be facing in relation to menstrual management, to conduct a costing of the implications of inadequate supportive workplace environments for menstrual hygiene management, and to understand the implications for girls' and women's health and wellbeing. This will provide essential evidence for guiding national policy makers, the private sector, donors and activists focused on advancing girls' and women's rights

Putting menarche and girls into the global population health agenda

Abstract: Menarche, the onset of menstruation is a fundamental part of a girl’s transition from childhood to adolescence. Studies show that girls in many countries experience menarche with insufficient information and support. Girls from around the world report feeling ashamed and afraid. The potential health effects of such experiences include a weakening of girls’ sense of self-confidence and competence, which in turn may comprise girls’ abilities to assert themselves in different situations, including in relation to their sexuality and sexual and reproductive health. There is an important need for the public health community to assure that girls receive the education and support they need about menstruation, so they are able to feel more confident about their bodies, and navigate preventable health problems – now and in the future. For too long, the global health community has overlooked the window of opportunity presented by menarche. Family planning programs have generally focused their efforts on married couples and HIV programs have focused safer sex promotion on older adolescent girls and boys. Starting the conversation at menarche with girls in early adolescence would fully use this window of opportunity. It would engage young adolescent girls and be a natural first step for later, more comprehensive conversations about sexuality, reproduction and reproductive health. There are a number of initiatives beginning to tackle the provision of puberty information to girls and boys, but the global health community is overdue to set a global standard for the provision of such guidance. Keywords: Menarche Adolescent girls Population healt

Menstrual hygiene management among adolescent schoolgirls in low- and middle-income countries: research priorities.

BACKGROUND: A lack of adequate guidance on menstrual management; water, disposal, and private changing facilities; and sanitary hygiene materials in low- and middle-income countries leaves schoolgirls with limited options for healthy personal hygiene during monthly menses. While a plethora of observational studies have described how menstrual hygiene management (MHM) barriers in school impact girls' dignity, well-being, and engagement in school activities, studies have yet to confirm if inadequate information and facilities for MHM significantly affects quantifiable school and health outcomes influencing girls' life chances. Evidence on these hard outcomes will take time to accrue; however, a current lack of standardized methods, tools, and research funding is hampering progress and must be addressed. OBJECTIVES: Compile research priorities for MHM and types of research methods that can be used. RESULTS: In this article, we highlight the current knowledge gaps in school-aged girls' MHM research, and identify opportunities for addressing the dearth of hard evidence limiting the ability of governments, donors, and other agencies to appropriately target resources. We outline a series of research priorities and methodologies that were drawn from an expert panel to address global priorities for MHM in schools for the next 10 years. CONCLUSIONS: A strong evidence base for different settings, standardized definitions regarding MHM outcomes, improved study designs and methodologies, and the creation of an MHM research consortia to focus attention on this neglected global issue

Beyond menstrual hygiene: addressing vaginal bleeding throughout the life course in low and middle-income countries.

Girls and women experience numerous types of vaginal bleeding. These include healthy reproductive processes, such as menstruation and bleeding after childbirth, but also bleeding related to health conditions, such as fibroids or cancer. In most societies, the management of menstruation is handled covertly, something girls are often instructed about at menarche. The management of other vaginal bleeding is often similarly discreet, although behaviours are not well documented. In many societies, cultural taboos frequently hinder open discussion around vaginal bleeding, restricting information and early access to healthcare. Additionally, the limited availability of clean, accessible water and sanitation facilities in many low and middle-income countries augments the challenges girls and women face in conducting daily activities while managing vaginal bleeding, including participating in school or work, going to the market or fetching water. This paper aims to highlight the key vaginal bleeding experiences throughout a woman's life course and the intersection of these bleeding experiences with their access to adequate water and sanitation facilities, information and education sources, and supplies. The aim is to address the silence around girls and women's vaginal bleeding and their related social, physical and clinical management needs across the life course; and highlight critical gaps that require attention in research, practice and policy around this neglected topic of health and gender equality

Improving the impact of menstrual health innovations in low- and middle-income countries: a theory of change and measurement framework

There exists growing global attention focused on tackling the menstrual management related challenges facing adolescent girls and women in low- and middle-income countries (LMIC). This includes a surge of growth in new and locally produced menstrual products, often accompanied by innovative distribution approaches aimed at enhancing accessibility, along with the provision of menstruation-related education. Increasing global investments support the development of such products by local and international menstrual innovators, with the aim of shifting from product development towards achieving scale. Parallel to such efforts, there is a need for rigorous monitoring to evaluate the process and impact of implementation, to ensure resources are effectively utilized. In response, a new measurement model was developed that includes a Theory of Change (ToC) and measurement framework, to enable improved measurement of the impact and growth of menstrual product innovations. These tools aim to help investors to more effectively monitor and assess the impact of investments. They will also support social entrepreneurs, innovators, and non-governmental organizations to adopt approaches that are most effective for impacting the lives of menstruating adolescent girls and women across LMIC. This paper seeks to introduce the ToC and monitoring and evaluation framework as supportive resources that provide a common framework for the global community to utilize as both investors and social entrepreneurs seek to develop more scalable menstrual solutions globally

A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools

Summary Points: There is an absence of guidance, facilities, and materials for schoolgirls to manage their menstruation in low- and middle-income countries (LMICs). Formative evidence has raised awareness that poor menstrual hygiene management (MHM) contributes to inequity, increasing exposure to transactional sex to obtain sanitary items, with some evidence of an effect on school indicators and with repercussions for sexual, reproductive, and general health throughout the life course. Despite increasing evidence and interest in taking action to improve school conditions for girls, there has not been a systematic mapping of MHM priorities or coordination of relevant sectors and disciplines to catalyze change, with a need to develop country-level expertise. Columbia University and the United Nations Children's Fund (UNICEF) convened members of academia, nongovernmental organizations, the UN, donor agencies, the private sector, and social entrepreneurial groups in October 2014 (“MHM in Ten”) to identify key public health issues requiring prioritization, coordination, and investment by 2024. Five key priorities were identified to guide global, national, and local action