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10 August 2016

Menstrual Hygiene Management in Bangladesh: A needs assessment

This year Simavi began a new Menstrual Hygiene Management (MHM) programme in Bangladesh: Ritu. The programme’s goal is to improve menstrual hygiene management for girls at school, by raising awareness of menstruation, increasing access to sanitary pads, supporting the construction of MHM-friendly toilets, and addressing taboos surrounding the issue.

To ensure that the programme meets the specific context of our intervention area and the specific needs of our target group, a needs assessment was conducted to identify and examine the MHM needs of girls in grades 6-8 in six schools. Boys and girls, parents, teachers and community leaders were interviewed to gain as much insight as possible into the MHM situation in the schools and local communities so that the Ritu programme could meet their needs most effectively. The barriers found in the needs assessment can be grouped under three topics:

1) poor access to adequate WASH facilities

2) taboos restricting females’ behaviour during menstruation.

3) a lack of knowledge of biological processes

These are interconnected, causing layers of complex obstacles to safe MHM. These also negatively impact girls’ health, psychological wellbeing and education. It was found that one of the most evident consequences of this situation is absenteeism from school. The majority of menstruating girls that were interviewed reported missing 2 to 3 days of school during their menstruation. One of the reasons cited by girls is the lack of WASH facilities in schools but a more serious factor that was mentioned in the assessment is the general taboo on girls moving freely during menstruation.

Inadequate WASH facilities

The assessment found that WASH facilities in the six schools are entirely inadequate. The number of toilets in the schools for the number of students is grossly insufficient, sometimes with 8 times more students per toilet than the global recommended standard. There is no soap or running water in the toilets, making it impossible for hygiene to be maintained. Most of the time, girls use WASH facilities in their villages; and the girls who use cloth pads wash these in their village too. Therefore these WASH facilities form a key part of their current MHM practice.

Existing taboos & restrictions

The taboos and restrictions relating to menstruation generally fall into four categories: 1) religious taboos; 2) restrictions around food; 3) taboos regarding menstrual blood; 4) constraints on freedom of movement. These limit girls’ choices and actions during menstruation, which result in feelings of shame and misery. Most of these taboos create a negative environment that impacts on the opportunity for open dialogue and support for girls during their menstruation.

Lack of knowledge

The taboos mentioned above create a barrier of secrecy around menstruation. This is worsened by a general lack of knowledge on the biological causes of reproduction, puberty and menstruation. Parents, teachers, girls, boys and the community in general have very low levels of knowledge beyond physically observable facts. Despite puberty being included in the school curriculum, girls and boys still do not receive sufficient education on the subject; teachers are embarrassed to discuss these issues and simply using gestures to explain the facts and skip key facts. Many girls interviewed said that they did not receive any classes on these issues and had been asked to read the relevant chapter at home.

Recommendations of the report

The needs assessment was only one of the inputs we used to define the Ritu programme, alongside the experience we have built up with our expertise in WASH and SRHR.  Below we outline some  recommendations of the report:

First, MHM-friendly WASH facilities cannot solely be tackled by installing hardware. A new toilet will not lead to MHM-friendly WASH facilities unless the toilets are maintained, clean, and have running water, soap and a disposal system. This requires a shift in the current school culture and the community, as identified in the needs assessment. This was already included as a cornerstone of the Ritu programme, and Simavi will work with partners and stakeholders to achieve this through a step by step planning and implementation.

Second, while 60% of the girls reported that they use sanitary pads, these are often expensive and safely disposing of the pads proves a challenge due to lack of MHM-friendly facilities. Therefore access to safe options for MHM such as development of a low cost biodegradable sanitary pad needs to be explored.

Third, to address the taboos surrounding menstruation, it is important to work with community members on positive messaging around MHM. Presenting MHM issues as essential for girls’ health and wellbeing will hopefully allow greater dialogue around adherence to taboos. It was recommended that the Ritu programme should focus on educating mothers since they are the ones who guide girls in MHM practices and will engage boys, fathers, teachers, leaders and community to create a safe environment for MHM. It was also recommended to establish a wider enabling environment for women to challenge certain taboos, through raising awareness with the wider community.

Finally, to address the lack of MHM knowledge, the recommendation is that girls must be supported to understand the changes to their bodies as part of a wider focus on gender equality, with an emphasis on self-esteem and challenging self-stigma around menstruation. Working with teachers to ensure that they have the necessary facts and that they are prepared to teach these subjects should be prioritised.  It is also recommended that training with teachers must espouses a gender equality perspective.

Moving forward

Addressing all of the barriers to ensure safe MHM requires a holistic effort both in schools and within the community. It is not enough to provide MHM friendly WASH facilities, there must be support for girls to use these services and a shift to prioritising girls’ health and education during their menstruation.

Therefore the Ritu programme uses a threefold approach to: 1) empower  girls, women, men and boys (communities) to have a better understanding of MHM and engage in healthy behaviour, including accessing safe and quality MHM services; 2) build an enabling environment in which government and civil society actors show more commitment towards MHM; 3)  ensure that affordable and sustainable MHM services are in place and utilised.

With the Ritu programme we aim to empower every girl and woman in Bangladesh with increased social and economic participation. This will also directly and indirectly improve their health and wellbeing and also empower girls, women, men and boys and the communities with a better understanding of MHM.

This programme is a joint initiative of Simavi, RedOrange and Knowledge Institute TNO in close collaboration with local partner organisations in Bangladesh.  It is supported by the Netherlands Ministry of Foreign Affairs. Read more about the Ritu programme and the programme’s needs assessment in full here, and for more information on Simavi’s MHM expertise, click here.

 

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