Water Currents: Menstrual Hygiene Day 2020

Thursday, May 28 is Menstrual Hygiene (MH) Day and to mark the occasion, this special issue brings together the voices and actions of nonprofits, government agencies, individuals, the private sector, and the media to advocate for all menstruators.

The inability to manage menstruation prevents millions of women and girls from reaching their full potential. Lack of education and accurate information on menstrual hygiene management (MHM) issues, persisting taboos and stigma, limited access to hygienic menstrual products, and poor sanitation infrastructure are some of the factors that undermine the educational opportunities, health, dignity, and social status of women and girls around the world.

USAID works to address these factors by developing design standards for female-friendly facilities, creating educational resources, promoting the availability of MH supplies, and destigmatizing menstruation. USAID also works with host governments to draft national MHM strategies.

The USAID Water, Sanitation and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) project and the Columbia University Mailman School of Public Health provided content suggestions for this issue.

In Focus

Events
May 28, 2020, Menstrual Hygiene Day 2020 – MH Day helps raise awareness and change negative social norms around MHM and engage decision-makers to increase the political priority and catalyze action for MHM, at global, national, and local levels. Content on the website includes Campaign MaterialsMHM ResourcesNews, and additional information.

May 28, 2020, Webinar. Dignity, Agency, Power: Exploring the Linkages Between Women’s Economic Empowerment and Workplace MHM – In this webinar, the USAID WASHPaLS project will present the current body of evidence related to MHM and women’s opportunities for economic empowerment and growth worldwide, as well as early efforts of an action research initiative to further understand this relationship. Here is the link for registration and additional information

Overviews
Improving the Impact of Menstrual Health Innovations in Low- and Middle-Income Countries: A Theory of Change and Measurement FrameworkJournal of Global Health Reports, March 2020. This paper seeks to introduce the Theory of Change and Monitoring and Evaluation (M&E) framework as supportive resources that provide a common framework for the global community as both investors and social entrepreneurs seek to develop more scalable menstrual solutions globally.

How Do Women and Girls Experience Menstrual Health Interventions in Low- and Middle-Income Countries? Insights from a Systematic Review and Qualitative MetasynthesisCulture, Health & Sexuality, March 2020. Exposure to new menstrual products led to changes in women’s and girls’ expectations of what a menstrual material should offer, with recipients highly valuing reduced fears of leakage and improved freedom of movement. After learning how to use new products or receiving educational materials, women and girls reported feeling more empowered and aware of the physiological process of menstruation.

Menstrual Cup Use, Leakage, Acceptability, Safety, and Availability: A Systematic Review and Meta-AnalysisThe Lancet Public Health, July 2019. This review states that menstrual cups are a safe option for menstruation management and are being used internationally. Further studies are needed to explore cost-effectiveness and compare the environmental impact of different menstrual products.

Advancing the Measurement Agenda for Menstrual Health and Hygiene Interventions in Low- and Middle-Income CountriesJournal of Global Health, June 2020. Advocacy efforts for MHM continue to grow, the evidence base is expanding, and governments and policymakers are finally starting to take notice. The guidance offered through the “MHM in Ten” agenda, and the Theory of Change and M&E framework for scaling menstrual health innovations, provide insights for a collective way forward.

What’s Missing in MHM? Moving Beyond Hygiene in Menstrual Hygiene ManagementSexual and Reproductive Health Matters, December 2019. Menstrual taboos clearly have a substantial impact on well-being yet are unaccounted for in the current working definition of MHM. A more holistic approach is needed. Actors beyond the WASH and education sectors are beginning to push at these boundaries.

'It’s Like a Burden on the Head': Redefining Adequate Menstrual Hygiene Management throughout Women’s Varied Life Stages in Odisha, IndiaPLoS One, August 2019. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India, at various life stages with a view toward improving international monitoring of MHM.

Advancing Gender Equity by Improving Menstrual Health: Opportunities in Menstrual Health and HygieneFSG, April 2020. Although some global data sets are starting to include menstrual health and hygiene (MHH) metrics in their surveys, no unified set of metrics exists to measure the scale of the challenge and understand nuances across contexts. This limits the level of funding for research and interventions focused on MHH, and hinders a comprehensive understanding of how MHH is linked to a range of life outcomes.

National Monitoring for Menstrual Health and Hygiene: Is the Type of Menstrual Material Used Indicative of Needs Across 10 Countries? International Journal of Environmental Research and Public Health, April 2020. Surveys monitoring population health and sanitation are increasingly seeking to monitor menstrual health. In the absence of established indicators, these surveys have most often collected data on the type of menstrual material used. This study investigated whether such data provides a useful indication of women’s menstrual material needs being met.

A Rite of Passage: A Mixed Methodology Study about Knowledge, Perceptions and Practices of Menstrual Hygiene Management in Rural GambiaBMC Public Health, March 2019. Taboos, secrecy, and embarrassment associated with discussing menstruation hinder adolescents from seeking advice from parents and teachers on appropriate MHM practices.

How Does a Social and Behavioral Change Communication (SBCC) Intervention Predict Menstrual Health and Hygiene Management: A Cross-Sectional Study. BMC Public Health, August 2019. Future programs should use SBCC to improve MHM behavior but involve families, peers, and community members to a greater extent to improve attitudes toward menstruation and reduce restrictions within the community.

Touch for Health: Use of Pavlovian Processes with Physical Touch as a Means to Improve Menstrual Hygiene Management Initiatives, Measured by Willingness to Pay (WTP)PharmacoEconomics, July 2019. Results show a statistically significant difference between the WTP figures of those females allowed interaction with the kits prior to being surveyed and those who did not. This confirms the positive impact of physical presence/touch on motivations to use/acquire hygiene-related tools.

Measuring Menstrual Hygiene Experience: Development and Validation of the Menstrual Practice Needs Scale (MPNS-36) in Soroti, UgandaBMJ Open, January 2020. This study describes the development and validation of the Menstrual Practice Needs Scale (MPNS-36), which measures the extent to which respondents’ menstrual practices and environments meet their needs. The MPNS-36 demonstrated acceptable reliability and validity. It is the first measure to capture perceived menstrual hygiene and may be useful across a range of study designs.

Menstrual Health and Hygiene Management and WASH in Urban Slums: Gaps in the Evidence and RecommendationswH2O: The Journal of Gender and Water, March 2020. Through a review of literature, this article seeks to highlight critical interlinkages among urbanization, sanitation, and menstruation, and identify important gaps in the existing menstruation-related evidence base that have implications for the health and well-being of adolescent girls and women.

Inclusive MHM
Feasibility Study of a Menstrual Hygiene Management Intervention for People with Intellectual Impairments and their Carers in NepalInternational Journal of Environmental Research and Public Health, October 2019. The Bishesta campaign is an MHM intervention developed to meet the specific needs of people with intellectual impairments and their carers. The Bishesta campaign appears to be a feasible intervention to ensure that one of the groups most vulnerable to exclusion from MHM interventions is not left behind.

Systematic Review of Menstrual Hygiene Management Requirements, its Barriers, and Strategies for Disabled PeoplePLoS One, February 2019. This review found little evidence on the requirements of disabled people and their carers in managing their menstruation but identified a range of barriers. This gap in evidence is important, as the consequences of failing to meet the menstrual hygiene needs of disabled people include shame, social isolation, and even sterilization.

MHM and Economics
Menstrual Hygiene Management and Women's Economic Empowerment: A Review of Existing EvidenceUSAID WASHPaLS, December 2019. To better understand the experiences of working women globally, the WASHPaLS project conducted a review of the limited evidence on the adequacy of MHM in the workplace to identify the cost-effectiveness, sustainability, and scalability of approaches to improve conditions. This report presents the findings of the review, describes some of the challenges experienced by working women, and provides guidance for future investments.

MHM and Innovation
2020 Learnings from the Field: Menstrual Hygiene Management in Ethiopia and NigerKOIS, April 2020. A team visited ongoing MHM projects in Niger and Ethiopia and met with NGOs, government institutions, development organizations, and beneficiaries to gain an understanding of the effectiveness of MHM activities. This document presents key learnings and insights of these field visits.

Duke and UNICEF Announce First Innovation Accelerator Social EnterprisesUNICEF, February 2020. By emphasizing local solutions that put girls and women at the center, the Innovation Accelerator cohort will collectively bring much-needed MHH solutions to communities and in turn, help empower the next generation.

MHM and Education
Improving School Attendance and Positive Feelings about Menstruation for Girls in Ghana through a Holistic Menstrual Health and Hygiene Management ApproachGlobal Communities, May 2020. Girls reporting difficulties in attending schools dropped from 47 percent to 10 percent as a result of this USAID–supported pilot intervention. This suggests that a holistic MHM approach that includes providing sustainable period products and education effectively reduced barriers to girls’ school attendance.

Menstrual Health Intervention and School Attendance in Uganda (MENISCUS-2): A Pilot Intervention Study. BMJ Open, January 2020. The pilot study showed that the multicomponent MHM intervention was acceptable and feasible to deliver, and potentially effective in improving menstruation knowledge and management.

Girls’ Attendance at School after a Menstrual Hygiene Intervention in Northern EthiopiaInternational Journal of Gynecology & Obstetrics, February 2020. This is one of the first large studies to show a positive relationship between menstrual hygiene interventions and girls’ school attendance. These positive results suggest such interventions should be expanded to other schools in northern Ethiopia.

Menstrual Hygiene Management in Rural Schools of Zambia: A Descriptive Study of Knowledge, Experiences, and Challenges Faced by SchoolgirlsBMC Public Health, January 2019. When menstruating, schoolgirls in rural Zambia would rather stay home than be uncomfortable, inactive, and embarrassed due to inadequate MHM facilities at school. 

Menstrual Hygiene Preparedness Among Schools in India: A Systematic Review and Meta-Analysis of System- and Policy-Level ActionsInternational Journal of Environmental Research and Public Health, January 2020. Less than half of the girls surveyed had an awareness of menstruation before menarche. The study noted that teachers did not serve as a common source of information about menstruation to girls. Only half of the schools provided separate toilets for girls.

Monitoring Menstrual Health and Hygiene: Measuring Progress for Girls on Menstruation; Meeting ReportColumbia University and WSSCC, 2019. This meeting focused on menstruation-related issues impacting girls in and out of school, and the corresponding report briefly details the meeting justification and background, key discussions, and proposed next steps.

Pupil Absenteeism, Measurement, and Menstruation: Evidence from Western KenyaColumbia Center for Development Economics and Policy, March 2019. The study concluded that providing sanitary pads reduces absenteeism by 5.4 percentage points.

MHM and Humanitarian Situations
Menstrual Hygiene Management in Emergencies Toolkit. IRC and Columbia University led a three-year initiative to develop a toolkit that provides guidance to organizations on how to rapidly integrate MHM into existing programming across sectors and phases. This toolkit was informed by an extensive desk review, qualitative assessments with a range of humanitarian actors and organizations, and direct discussions with girls and women living in emergency situations.

A Synthesis Report Analyzing Menstrual Hygiene Management within a Humanitarian CrisisOIDA International Journal of Sustainable Development, November 2019. Negative consequences of poor MHM practices may include reproductive tract infections and skin irritation, as well as stress and diminished dignity. In the presence of a crisis, such consequences are further aggravated due to geographical displacement.

UNICEF Guide to Menstrual Hygiene MaterialsUNICEF, July 2019. This document provides guidance on the selection and procurement of appropriate materials and supplies for menstrual hygiene management, particularly during humanitarian response.

MHM and Waste Disposal
Menstrual Hygiene Management and Waste Disposal in Low and Middle-Income Countries—A Review of the LiteratureInternational Journal of Environmental Research and Public Health, November 2018. The review showed that disposal of menstrual waste is often neglected in MHM and sanitation value chains, leading to improper disposal and negative impacts on users, sanitation systems, and the environment.

Thermal Treatment Solution for Menstrual Hygiene Sanitary ProductsGates Open Research, August 2019. Safe Hygiene for Everyone is a fully automated sanitary pad sterile disposal unit. The innovation is designed for use with multiple fuel sources and in shared and public settings, including schools, airports, bus and train stations, cinemas, markets, malls, hotels, factories, restaurants, public toilets, and dormitories.

Technical Brief No. 1 on Menstrual Hygiene Safe Disposal: Observations from Menstrual Waste Disposal Practices in Shared and Public Toilet Spaces (India)Gates Open Research, August 2019. The findings from this study reiterate the need for responsive public sanitation facilities that cater to the menstrual hygiene needs of women in low and middle-income settings.

Technical Brief No. 2 on Menstrual Hygiene Safe Disposal: Informing Standards Development for Small-Scale Incinerators Frequently Deployed in Shared & Public Spaces (India)Gates Open Research, August 2019. Incinerator technologies in India vary widely, and include simple fuel-assisted burning chambers made of brick, tin, or terracotta; small-scale electric incinerators; large and mid-sized commercial electric incinerators; and biomedical incinerators.

Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing CountriesJournal of Environmental and Public Health, February 2018. Education about environmental pollution and health hazards associated with menstrual products is needed, and awareness should be raised to emphasize the use of reusable sanitary products. This includes the use of natural sanitary products made from materials like banana fiber, bamboo fibers, sea sponges, and water hyacinth.


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