Long Read

Ritu, an example of evidence-informed programming

Together with RedOrange -a Bangladeshi  media and communication agency-, knowledge institute TNO, and with support of the Embassy of the Kingdom of the Netherlands (EKN), Simavi implements the Ritu programme to promote menstrual hygiene management in Bangladesh. Our main goal is to improve the health, well being, and social and economic participation of women and girls. For Simavi, this is a unique programme as it combines SRHR and WASH from the start, it covers all three components of our Theory of Change, and it is the first time Simavi has implemented such a rigorously evaluated programme.

Menstrual health is a highly relevant theme as it plays a role in the interplay between health, hygiene and development issues. Though menstrual health has recently gained attention in the global development agenda, it is still a taboo subject in many places around the world. In Bangladesh, social norms and cultural beliefs concerning the body and blood preclude any open discussion of menstruation. Mothers do not talk about menstruation with their daughters and teachers are too shy to discuss the topic in their classrooms. Girls are therefore often not prepared for their first period and women and girls lack the necessary skills and information to hygienically manage their periods.

In addition, limited access to clean water, proper sanitation facilities and sanitary products make it difficult for women to manage their menstruation hygienically. Where schools do not have toilets, this can be a barrier for girls to attend and it is known to be a factor in girls not attending school. The result is that many girls and women around the world face considerable physical and social challenges during their menstruation. They experience discomfort and an increased occurrence of infections. Girls tend to feel insecure during their menstruation and are constantly worried about leaks and being teased by boys.

Goal

Besides interventions to improve menstrual health, Ritu also aims to address a broader set of barriers that girls face during their adolescence. The goal is to enable every girl and woman in Bangladesh to manage their menstruation and not be hindered during their period from going to school, working or participating in everyday life. This will empower girls and women by increasing their social and economic participation. More specifically, the programme aims to raise the social and economic participation of girls between 9 and 13 years old living in Netrokona, Bangladesh and achieve the following impacts on health and well-being:

  • increased knowledge and improved attitudes to and practices for menstrual hygiene among girls, boys, men and women;
  • increased commitment towards MHM by the government and civil society in Bangladesh;
  • girls have access to better MHM facilities at schools and affordable and biodegradable sanitary napkins.

Evidence-informed programming

The Ritu programme was compiled in an evidence-informed programme design process. There are two important benefits to this:

  1. The mix of chosen interventions is based on a combination of available evidence from rigorous impact studies, programme evaluations and in-depth field research into the specific situation in Netrokona.

The programme started with a six-month inception phase, during which evidence was gathered. Using this evidence, the Ritu team and the team from the Impact Centre Erasmus selected a mix of interventions that will create maximum impact. For example, as there is evidence that interventions in schools have a positive impact on girls’ menstrual health, the focus of the programme is on school interventions. It was also found that WASH facilities need to be in place for girls to practice newly learned behaviour. We therefore carefully sequenced our interventions so that the toilets are ready before we start teacher training. Another example is that in our needs assessment we explored the traditional and potential roles of mothers and fathers in girls’ menstrual hygiene. Mothers were found to be the key providers of menstrual hygiene information to girls, including the restrictions that girls need to adhere to. They will therefore be given information on menstrual hygiene and the skills to share this with their daughters. Fathers play a minimal role in information sharing, but do play a role in managing the family income. The programme will therefore focus on encouraging fathers to prioritise expenditure on sanitary napkins and WASH facilities to support their daughters in managing their menstruation.

2. The interventions will be evaluated in a randomised controlled trial to fill in gaps in the existing evidence.

In our evaluation we also aim to generate the first rigorous evidence on the impact that MHM interventions in schools have on school attendance and performance. During the programme, the attendance and performance of girls will be monitored closely in implementation and control schools. In addition, we will measure the impact of our interventions on the overall well-being of girls during their menstruation as well as their broader SRHR and WASH impacts. We will also evaluate learning questions that can inform future Simavi programmes. One of the learning questions that we will explore is the added value of community interventions, as this is one of the three pillars of Simavi’s Theory of Change. Since there is little evidence on this, we will compare school interventions with school and community interventions.

Interventions

The programme combines SRHR and WASH interventions in schools and communities. Our local WASH partner DORP uses a budget tracking method that involves school management committees and students in identifying the MHM needs of their schools and helps them to access funding from the local government. We will follow the same process in communities. We aim for strong community involvement in obtaining the resources needed to install the toilets. We will also educate parents and give them support with building MHM friendly toilets. MHM friendly toilets are easily accessible for girls, have clean water, soap, discreet waste disposal and sufficient space for girls to manage their menstruation.

Our local SRHR partner BNPS will train schoolteachers to give menstrual health lessons to educate girls and boys about menstruation. We will work with headmasters, teachers and school management committees to create a menstrual health friendly school environment in which girls have the necessary facilities and feel comfortable attending school during their menstruation. In communities we will work with women’s leaders to educate and activate parents to support girls during their menstruation. At the national level, we will create a platform of NGOs and government and private sector stakeholders to learn from each other and jointly advocate for the inclusion of more elaborate information on menstrual health in the secondary school curriculum.

In addition to the targeted interventions in Netrokona, RedOrange will train journalists and implement a nationwide media campaign, including TV series and famous role models, to start the conversation about menstruation.

TNO will work closely with a local private partner to produce and distribute the biodegradable sanitary napkins. The aim is to make an affordable product that meets the needs of the girls and women in our programme and at the same time does not burden the environment.

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