Menstrual Hygiene Management

Context

Menstruation is a natural, normal biological process experienced by all adolescent girls and women, yet it is not spoken about openly causing unnecessary embarrassment and shame. India’s 113 million adolescent girls are particularly vulnerable at the onset of menarche. At this time they need a safe environment that offers protection and guidance to ensure their basic health, well-being and educational opportunity is realised. Lack of a separate and usable girl’s toilet in schools and a toilet at home leaves adolescent girls and women to face the indignity of open defecation. However, safe and effective menstrual hygiene management, or ‘MHM’ is a trigger for better and stronger development for adolescent girls and women.

About the guidelines

Menstrual hygiene management is an integral part of the Swachh Bharat Mission Guidelines (SBM-G). The Menstrual Hygiene Management Guideline is issued by the Ministry of Drinking Water and Sanitation to support all adolescent girls and women. It outlines what needs to be done by state governments, district administrations, engineers and technical experts in line departments; and school head teachers and teachers.

Menstrual hygiene management framework

In considering the specific sanitation and hygiene requirements of adolescent girls and women, state governments and district administrations have a responsibility for putting in place the following. The framework highlights the essential elements of a menstrual hygiene management programme that should be integrated in to other government schemes.

Menstrual hygiene management in the Swachh Bharat (G) guideline

• Funds available under the IEC component may be used for IEC in this matter and to raise awareness and skills on Menstrual Hygiene Management in all places and specifically amongst adolescent girls in schools. IEC plans should include this component for raising awareness among all stakeholders. Funds under the SLWM components can also be used for setting up of incinerators in schools. IEC plans should include this component for raising awareness among all stakeholders.
• Issues relating to women’s personal hygiene namely menstrual hygiene are to be focused under the SBM (G). Girls and women have hygiene and sanitation needs linked to their menstrual cycle. Women suffer in the absence of knowledge about safe practices on MHM.
• There are several examples where CSOs and SHGs have worked with the community, informed them about menstrual hygiene practices and also developed economic models to meet the demand for sanitary napkins. This is one area where CSOs and SHGs can play a key role.

In addition to making sure that every household has a toilet, governments and all stakeholders must make sure that,

• Every adolescent girl and woman, and their families, including men and adolescent boys, must have awareness, knowledge and information so that menstruation is understood and can be managed safely with confidence and dignity.
• Every adolescent girl and woman must have easy access to sufficient, affordable and hygienic menstrual absorbents during menstruation.
• Every adolescent school girl must have access to a separate toilet with private space for cleaning, washing. This includes access to adequate and sustained water supply and soap.
• Every adolescent girl must have access to infrastructure for disposal of used menstrual absorbant, and should know how to use it.

Basic definitions

It is important to understand what menstruation is, and how simple management interventions along with positive attitudes can make a lasting difference to the lives of every adolescent girl and woman. The following definitions are helpful.

Who needs information to what, why and how

Menstruation is still a taboo in India and it is common for people across society to feel uncomfortable about the subject. To ensure that adolescent girls and women have the necessary support and facilities, it is important that the wider society, communities and families must challenge the status quo and break the silence around menstruation. It is therefore the responsibility of those with influence – including government officials and teachers, to find appropriate ways to talk about the issue and take necessary action.

Who needs information and why

While only adolescent girls and women menstruate, everyone in society needs to have a basic understanding of it. For example,

State

• State level officials because Secretaries, State Project Director, SSA, RMSA, Project Director, National Health Mission and others have a responsibility to frame relevant state policies, make decisions on budgets, provide strategic oversight and monitor programmes.

District

• Zilla Panchayat CEO because they ensure coordination and convergence and give special focus to this intervention among line departments.
• District Magistrates/District Collectors, because they unlock and direct programme and policy support, ensure financial allocations and monitoring.
• District Education, Health and ICDS Officers, because they need to orient, ensure commitment, and streamline appropriate monitoring at the Block and Gram Panchayat levels.
• Public health engineers because they design sustainable technical facilities that must take into account the needs of adolescent girls.
• Health staff and doctors because they provide not only factual knowledge and health care support but must also afford dignity and privacy to new mothers, and support adolescent girls seeking advice.
• Community frontline workers because they can make sure clear messages about menstruation as a normal biological process reach families and out of school girls.

Schools and communities

• Head teachers, teachers and school staff because they have a vital role in sensitizing boys and girls, inculcating skills and ensuring they have access to basic water, sanitation and hygiene facilities. An early and appropriate intervention by a teacher can make the difference between an adolescent girl staying in school or dropping out at the onset of menarche.
• Girls and women because they spend on average 3000 days of their lives menstruating.
• Men and boys because they need to positively support their sisters, daughters, wives, aunts and mothers.
• Community leaders, civil society and self-help groups because they act as role models and help society to challenge prejudice and discrimination towards menstruating adolescent girls and women

Roles of various ministries on MHM

What needs to be achieved

State level

Convergence and coordination with different ministries, departments and schemes

• State specific MHM operational guidelines/policies/ district level plans
• Definition and monitoring of KPIs
• Awareness creation around MHM through well targeted communication and media plans
• Training and capacity building on all levels
• Sharing of good practices with central ministry as well among districts

District level

• Awareness creation around MHM within society
• Training and capacity building at district, block and school levels
• Convergence with different departments and schemes
• Ensure implementation of MHM guidelines and policies
• Share good practices with other districts
• Monitoring of KPI and indicators

School level

Provide support

• To become empathetic to girl’s challenges and needs
• To help girls overcome stigma and shame associated with menstruation

Education

• MHM related trainings with school girls (and boys maybe too)
• School WASH facilities
• Assure clean WASH facilities, operation and maintenance
• Sustain supply of water and soap
• Safe disposal of used menstrual absorbent
• Provision of emergency sanitary napkins

Working with adolescent girls

Printed and verbal information about menstruation and menstrual hygiene management is crucial for girls Without it the majority face adolescence with no prior knowledge of what is happening to their bodies and why. Working with girls will assist them to feel more confident about managing their menstruation privately and effectively in school and at home Teachers should take in to account the learning needs of different girls and treat the needs of each sensitively. While working with girls it will be important to understand the number of menstruating girls and the number of girls reaching menarche. Separate sessions can be taken with girls in both categories. However, the girls who are menstruating will need a lot more support. It is also advised to build a trust and rapport over time and to repeat sessions regularly so that girls feel comfortable to talk about menstruation.

Working with adolescent boys, male teachers and parents

Informed adolescent boys, male teachers and parents contribute to a supportive environment for adolescent girls in school and at home. Working with boys also helps to ensure that girls are free from ridicule and treated with respect and dignity throughout their school life and beyond. This will include:

• Explaining to boys what menstruation is and their role in supporting the girls and women around them; and discuss issues of boys’ puberty
• Providing male teachers with information to better inform them about the needs of adolescent girls
• Talking to parents about MHM in the context of girl’s access to education, school completion and access to a toilet and soap and water at home.

Establishment of child peer support groups

The establishment of support groups, such as the Girls Hygiene Clubs, perhaps linked to the child cabinets is an essential part of ensuring peer-to-peer learning and sharing of information. Such groups work well when girls are in charge, take responsibility, provide peer advice and represent girls’ views at school meetings. In the same manner, support groups among girls out of school can be created and the girls to be engaged in the process as described above. Toilet cleaning should not be a duty assigned to such clubs.

Providing adolescent girls with menstrual hygiene management choices

Managing menstruation in a hygienic way involves not only access to basic sanitation facilities, soap and water but also to so-called menstrual absorbents. Every adolescent girl and woman should use menstrual absorbents based on informed choice. Indian adolescent girls and women use different menstrual absorbents, not all of which are ‘hygienic’, however no girl should face ridicule or shame in this situation. Rather efforts should be made to increase access to hygienic options.

Menstrual absorbents: advantages and disadvantages

Note : It does not include tampons and menstrual cups, as they are not commonly available or used in India.
Adapted from: Source: Mahon, T., Cavill.S & House, S (2012) “Menstrual hygiene matters, a resource for improving menstrual hygiene around the world” WaterAid.

The choice and preference for an option depends on individual preference, price, availability in the local market and convenience. Simple, clear and factually correct information helps girls to decide which menstrual absorbent to use, free from judgement by others.

MHM infrastructure in Schools

Every school is required to have basic water and sanitation infrastructure so that girls and female staff can privately manage menstruation hygienically and with dignity. Essential facilities are:

• Separate toilets for girls and boys and ideally also for male and female teachers.
• Water supply (based on approximately 500 litres water storage capacity for 100 children), soap availability for hand washing and space for washing laundering menstrual absorbent.
• Facilities for safe disposal of used menstrual absorbents".

Beyond the provision, infrastructure should be operated and maintained properly. These toilets for girls have to be so designed that they can be easily used by girls with physical disabilities.

Water and soap in every school is essential. Both are needed for girls, boys, and staff to wash hands with soap after toilet use and before eating food. Girls and female staff must have clean, easily accessible water and soap to wash them, wash their clothing if soiled, and wash menstrual cloths or reusable napkins. Water must be inside the toilet, ideally either via a tap or a dedicated container in each cubicle. A mug should be provided to allow girls to dispense water for their own personal cleaning and to clean the toilet if required.

Every person in the school community regardless of gender or caste should have access to a clean and well-maintained toilet. Adolescent girls and female teachers have special sanitation requirements.

• Separate toilet and sanitation blocks located in safe location to assure privacy/adequate privacy wall, based on a ratio 1 toilet for every 40 girls (and/or 1 urinal for every 20 girls).
• Adequate space in the cubicle for girls to change their napkins/cloth and to wash themselves.
• Toilet cubicles with a shelf, hooks or niche to keep clothing and menstrual adsorbents dry.
• A well-positioned mirror so that girls can check for stains on their clothes.
• A private bathing or changing units, including a place for drying their reusable menstrual absorbent

Safe disposal of menstrual Waste

It is important to consider safe menstrual hygiene disposal options and ensure that girls and female teachers know how to use them. Common practices range from unsafe to safe, with unsafe disposal being unacceptable.

PHED/RD engineers can provide guidance on assessing different safe disposal options and ensure proper planning, design, budgeting and operation and maintenance thereof. Consultation with girls' and their endorsement on the practical aspects is important to ensure use. For example, locating the disposal point near the girls' changing area, and ensuring the facility is out of sight to boys.

Collection

Disposal bins are a good and affordable collection option. These must be placed within the toilet, or very close by it, ideally provided for each cubicle. Bins must be washable and must have close fitting lids to minimise seepage of odour or waste before mass disposal. Depending on the type and location of the final disposal, there might be a need for an emptying schedule of individual bins, and transport to the disposal site. It is recommended to designate a point person of the school staff to be responsible and accountable for this. To avoid transport, some incinerators have been built in with chutes directly adjacent to toilet building.

Safe disposal

Safe disposal means ensuring that the process of destruction of used and soiled materials is done without human contact and with minimal environmental pollution. Unsafe disposal-throwing used cloth into ponds,rivers, or in the fields exposes others in the area to decaying material and should be avoided. Offsite disposal can be organized with the communal or town solid waste collection and management system. If a hospital with a safe and treatment unit for hazardous waste is nearby, this might be a best solution to explore. However, this is unfortunately not a viable option for many rural schools, and transport will be a logistical and financial challenge. Options for on-site disposal includes disposal deep burial, composting, pit burning and incineration. The right option depends on key factors such as amount and type of materials, the available budget (investment and O&M costs) and environmental considerations. The following table shows the recommendations for different types of material and disposal options.

• Burning in open heap should be totally avoided. If burning is the only option, a deep pit should be used.

Recommended options for disposal of different materials

In addition to these factors, socio-cultural perceptions might play a role in choice and use of the solution. In some areas of India there is resistance to burning through incinerators, yet a burning pit may be more acceptable. There might be also the false perception that disposing of their menstrual management products in pit latrines prevents from being used in witchcraft.

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Source: Department of Drinking Water and Sanitation