Menstrual hygiene matters: guidelines for practitionersA synthesis of best practice in menstrual hygiene management (MHM)

1 The issueHalf of the world’s people menstruate for a significant part of their lives, yet this issue has been largely neglected by the water, sanitation and hygiene (WASH) sector and key decision-makers. As a result, over a billion women and girls are denied their rights – to gender equality, WASH, education, health and dignity – and national and international development goals will not be achieved.

2 The projectRationale: There is a lack of systematic studies analysing best practices in MHM and no comprehensive resources to provide guidance on what works in different contexts to encourage replication of successful approaches.

Purpose: To improve the lives of girls and women around the world by supporting opportunities for better MHM practices.

Objective: To produce a guideline for practitioners setting out the key elements of MHM programmes and how to contextualise them – based on an assessment and synthesis of existing knowledge and successful approaches.

Methodology:• Reviewing documentation. • Interviews with MHM practitioners. • Synthesising the existing literature in MHM

guidelines.• Cataloguing MHM documentation and

resources.

Piecing together the menstrual hygiene management jigsaw

MHM is complex and needs to be addressed holistically and in context as a package of services that includes:• A voice and space to talk about the issue, involving women,

girls, men and boys. • Availability of accurate information on menstruation and

menstrual hygiene.• Appropriate and affordable sanitary protection materials

for managing menstrual blood.• Facilities for washing, drying and storing or disposing of

used materials.• Privacy and hygienic facilities for changing and washing.

Whose responsibility?

The division of responsibility for who takes action on menstrual hygiene management is unclear. Because a number of sectors have some level of responsibility, there is a risk that the issue is overlooked or there is a confusing multiplication of responses.

A cross-sector issue involving:

•Water, sanitation and hygiene. •Reproductive, adolescent and general health.•Education.•Community development. •Social protection.•Private sector.

Sidra, 28, "The hygiene class was really beneficial for all of us, especially the lessons on menstrual hygiene. They gave us napkins and taught us to use a new one for each cycle and then to burn them. Before, we were using pieces of old cut clothes, which we would wash and use until they were too dirty to be of use anymore."

MHM in different socio-cultural and geographic contexts

Women and girls face particular challenges in some socio-cultural and geographic contexts. For example, their usual coping mechanisms for obtaining sanitary protection materials, bathing with dignity and privacy, and washing or disposing of their menstrual materials are disturbed in emergency situations, where they may be forced to live in close proximity with male relatives or strangers.

Women and girls in vulnerable situations

Dealing with menstrual hygiene when it is already difficult to access hygienic water, sanitation and hygiene facilities poses a double challenge.

Vulnerable women and girls,

such as those with disabilities,

incontinence or HIV/AIDS, or living in extreme poverty,

conflict situations or custody, are likely to face additional

challenges in managing their

menstruation.

Sanitary protection - supply, use and disposal

It is critical to identify:

•User preference.•Disposal options.•Affordability.•Ability to wash and dry re-usable materials. •Knowledge and ability for hygienic use and disposal.

A young woman in Bangladesh makes cotton sanitary pads which are considered

by many women to be affordable, comfortable and hygienic.

WaterAid registered charity numbers 288701 (England and Wales) and SC039479 (Scotland)

WaterAid transforms lives by improving access to safe water, hygiene and sanitation in the world’s poorest communities. We work with partners and influence decision-makers to maximise our impact.

Researchers: Thérèse Mahon Sarah HouseSue Cavill

Contact: theresemahon@wateraid.org

Photo: WaterAid/Caroline Irby

Photo: Alixandra Fazzina NOOR for WaterAid Photo: WaterAid/Layton Thompson

Photo: ASM Shafiqur Rahman/WaterAid

4 Critical gaps• Examplesofcross-sectoralcollaboration responding to MHM. • Examplesofgoodpracticeinmonitoring and evaluation for MHM. Key indicators and impact assessment.•Successfulapproachestoengagemenand boys in MHM at different levels.• SuccessfulapproachestoMHMforwomen and girls in the most vulnerable situations.

5 Next steps• Collaboratewithorganisationsto co-publish for broader ownership, dissemination and field testing of MHM guidelines.• DevelopanMHMforumtosharebest practice and promote advocacy.• Furtherworktoaddressgapsinknowledge – especially impacts on health and education.

3 Findings

A hidden issue. A woman from Chhattisgarh conceals her menstrual cloth at home.

Photo: CARMDAKSH Photo: Moto Michikata/REDR

MHM training for both male and female UNHCR staff in Uganda.