Authors : A.S. Kuhlmann, K. Henry, L. Lewis MD Wall
Site of publication : ncbi.nlm.nih.org
Type of publication : Article
Date of publication : June 2017
The United Nations defines adequate menstrual hygiene management as “women and adolescent girls using a clean menstrual management material to absorb or collect blood that can be changed in privacy as often as necessary for the duration of the menstruation period’’.
Particularly in poor countries, girls and women face substantial barriers to achieving adequate menstrual management. Menstrual hygiene management is an increasingly important (yet often unrecognized) issue that is heavily intertwined with girls’ education, empowerment, and social development.
The current status of menstrual hygiene management in resource-poor countries
It is frequently concluded that menstrual hygiene management is worse for girls in rural areas and for those who attend public schools (which tend to serve families of lower socioeconomic status).
Girls in resource-poor countries around the world tend to use old cloths, tissue paper, cotton or wool pieces, or some combination of these items to manage their menstrual bleeding. Qualitative studies indicate that girls who know about commercial sanitary products may prefer these products because they are seen as more comfortable and less likely to leak, but for many girls such products are usually unavailable and/or unaffordable.
Furthermore, knowledge about menstruation and menstrual hygiene tends to be higher in girls from urban areas compared with rural girls and in older as compared with younger adolescent girls.
Menstrual hygiene management is an increasingly important (yet often unrecognized) issue that is heavily intertwined with girls’ education, empowerment, and social development
Girls from resource-poor countries around the world attribute frequent school absences to difficulties managing their menses. Absenteeism appears to be closely associated with lack of privacy and limited availability of water and sanitation facilities at schools.
Qualitatively, women and girls recognize that the way they manage their menstrual blood may be unhygienic, but they do not have better alternatives. Nonetheless, girls are often highly resourceful at making sanitary ‘pads’ out of whatever materials are available.
Interventions to improve menstrual hygiene management in resource-poor countries
Nearly all of the interventions were purely educational in nature, most of them taking place in or through the school setting. Overall, there is moderate evidence that education-based interventions can improve menstrual hygiene knowledge and practices among schoolgirls in resource-poor countries.
Additional perspectives, future research and advocacy directions
Eight of the 11 commentaries and editorials on menstrual hygiene management were penned in the last decade, demonstrating how this issue has started to gain prominence.
Sommer has advocated for adding menstrual hygiene management to the agenda of access to clean water and improved sanitation in schools and to including menstrual hygiene management as part of the response to humanitarian emergencies.
Education interventions were found to improve knowledge, awareness, and some menstrual hygiene practices, but documenting the effect of menstrual hygiene management on school attendance and dropout rates is much more difficult, given how poorly records are often kept and the often-ambiguous reasons for school absence.
Absenteeism appears to be closely associated with lack of privacy and limited availability of water and sanitation facilities at schools
Major barriers to improved menstrual hygiene among girls include a lack of awareness and support from teachers, many of whom are male; lack of familial support; lack of cultural acceptance of certain menstrual hygiene products; limited economic resources to purchase commercially produced products; inadequate water and sanitation facilities at school with concurrent concerns about washing, privacy, and menstrual pad disposal; cramps, pain, and discomfort associated with menstruation irrespective of the menstrual hygiene products used; and travel difficulties to/from school, which can extend time away from home and increase the likelihood of leaks/ stains, embarrassment, and discomfort.
Considering how culturally and religiously embedded beliefs and practices about menstruation are, it is important to understand better the decision- making process for girls’ school enrollment and to extend intervention efforts beyond female relatives only to include all of those involved in the decision-making process.
Increasing male understanding of menstruation and the importance of menstrual hygiene man-agement is likely to emerge as a key consideration in improving both school attendance and the availability of suitable water and sanitation facilities at schools in poor countries.
Finally, the literature on water and sanitation regard- ing schools in resource-poor countries is currently disconnected from the literature on menstrual hygiene management. Much of the menstrual hygiene literature mentions the importance of having good access to water and sanitation in schools, but few menstrual hygiene interventions actually attempt to address these issues.
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