Menstrual hygiene: rising up the global development agenda

5 min read
Image: WaterAid/Mani Karmacharya

This Menstrual Hygiene Day was the biggest and loudest yet, bringing the issue and its impact on the lives of women and girls to audiences around the world. Thérèse Mahon, WaterAid’s Interim Head of Region for South Asia, explains our approach to promoting menstrual hygiene management and ensuring that all women and girls can manage their periods safely and with dignity.

On 28 May we celebrated the third annual Menstrual Hygiene Day. Around the world people worked together to raise awareness of women and girls’ right to menstruate without shame, fear and embarrassment, and to be able to manage their monthly periods safely, privately and with dignity.

WaterAid produced a short film – ‘Period Drama’ – to humorously highlight the challenges women and girls have faced throughout the ages. As part of our awareness-raising strategy, we asked girls in Nepal to document their experiences of menstruation through photographs, with compelling results; the girls’ perspectives highlighted the cultural restrictions and expectations placed on them during menstruation, and their desire to challenge some of these.

Three components of a core issue

That there is now a day dedicated to menstrual hygiene awareness, and that the collective voices raised on 28 May are growing in strength every year, is testament to the importance of the issue.

Menstrual hygiene is an essential part of WaterAid’s integrated approach to water, sanitation and hygiene (WASH), and of our contribution towards gender equity in homes, communities, education, health and the workplace.

Our menstrual hygiene management (MHM) approach includes work around three main components.

First, providing pragmatic information and creating spaces where people can speak openly about menstruation. This is absolutely critical, to enable females and males to understand the facts and how women and girls can take care of themselves during periods, and to tackle the taboos and misconceptions around menstruation through informed discussion. Women and girls, who are often left out of decision making, also need to voice their needs and concerns, and contribute to making decisions and finding solutions.

Second, we promote and provide WASH facilities that are suitable for MHM and for disposing of menstrual hygiene materials such as disposable pads. It is essential that women and girls have somewhere clean, private and safe to wash themselves and change their materials, to wash reusable cloths with soap and water and dry them effectively.

Sabina, a teenage girl from Sindhuli, Nepal

Need of water for cleanliness: I always wash my clothes in this tap stand. This tap stand runs water only in the morning for few hours so water is not adequate and most of the time this place is crowded. During menstruation we need more water to keep us clean but due to limited water accessibility it is very difficult to maintain cleanliness.  I do not get adequate water to clean myself. Water is very essential for cleanliness.Sirthauli, Sindhuli, Nepal, April 2016. Taken by Sabina Gautam.
Image: WaterAid/Sabina Gautam

I always wash my clothes at this tap stand. It only runs water in the morning for a few hours, so most of the time this place is crowded. During our periods we need more water to keep us clean, but due to the limited supply it is very difficult.

Sushma, a teenage girl from Sindhuli, Nepal ​​​

Need for MHM friendly latrines: This is the girl’s toilet of our school. We are in urgent need of MHM friendly toilet. The one we use doesn’t lock properly. If someone is inside, other person has to wait outside pushing the door for her. Because of lack of latrines in our school, we have to wait in the long line. This is very problematic for us and we are need of more girls’ friendly latrines. Sirthauli, Sindhuli, Nepal, April 2016. Taken by Sushma Diyali.
“This is the girls' toilet at our school. It doesn’t lock properly. If someone is inside, someone else has to wait outside, pushing the door. Because of the lack of toilets we have to wait in a long l

This is the girls' toilet at our school. It doesn’t lock properly. If someone is inside, someone else has to wait outside, pushing the door. Because of the lack of toilets we have to wait in a long line. This is why we need more girl-friendly toilets.

Third, we promote the supply, use and disposal of safe, appropriate, affordable and sustainable menstrual hygiene materials. It is important that women and girls are able to make choices about what is most suitable for them in the context of their lives. It is also important for the sustainability of water and sanitation systems that toilets and sewers are not blocked by used sanitary materials.

Equity, rights and integration

In our new Global Strategy, equity and rights, and integration with other sectors including education and health, are key priorities for WaterAid. In relation to MHM this requires working with those who are most marginalised and whose voices are least heard, such as women and girls with disabilities and those in emergency contexts.

Women and girls with disabilities may face additional attitudinal, physical and institutional barriers to managing their menstruation. A Focus Group Discussion we undertook with disabled women in Tanzania revealed that some people assumed that because they were disabled they did not menstruate.

In emergency contexts women and girls may be displaced, living in closer proximity with strangers, have less access to water, sanitation and menstrual materials, and be unable to use the coping strategies they develop during everyday life. During the Nepal earthquake, WaterAid and partners supported women and girls with sanitary pads, soap, water and temporary latrines, and provided information on menstruation and how to use the hygiene kits provided.

Working from the ground up

In South Asia, we have been working on MHM for more than 12 years, and cover a wide range of initiatives that we are involved in with our partners, encompassing service provision, capacity building and advocacy.

Across the region we provide menstrual hygiene sessions in schools and communities (including awareness raising with men and boys too) and for government departments. In Bangladesh, we joined forces with the largest adolescent health network of the country, Shorno Kishoree Network Foundation, to raise awareness of MHM through public broadcasting, reaching millions of adolescent girls. In India, we are working with the Women and Child Development (WCD) Department in four states to promote menstrual hygiene among women and adolescent girls through training of government frontline workers.

At the global level we are contributing to building evidence on the barriers and solutions for menstrual hygiene, engaging with education and reproductive health sectors to develop more comprehensive approaches, and contributing to the development of global monitoring indicators to track progress on MHM in relation to the Sustainable Development Goals.

From our experience we have realised that the first step towards addressing MHM is to build the confidence and competence of our staff, partners and others to speak about menstrual hygiene, engage others and to understand how we can work on the issue. Based on our learning, we have developed an MHM training guide for practitioners that provides step-by-step sessions, from breaking the silence to designing interventions.

It is fantastic to see so many dedicated people and organisations working on MHM and, that this is now on the global development agenda. Many challenges remain, including building more evidence of what works, how to monitor progress, integrating MHM across the WASH, education and reproductive health sectors to provide services from menarche to menopause, and ensuring those who are most marginalised are reached.

At WaterAid we will continue to innovate, learn and collaborate with others to find solutions that work for all women and girls, everywhere.