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Is Menstrual Hygiene and Management an Issue for Adolescent School Girls? a Comparative Study of Four Schools in Different Settings of Nepal

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Is Menstrual Hygiene and Management an Issue for Adolescent School Girls? a Comparative Study of Four Schools in Different Settings of Nepal Report Is menstrual hygiene and management an issue for adolescent school girls? A comparative study of four schools in different settings of Nepal WaterAid/MarcoWaterAid/Anita Betti Pradhan Acknowledgement We would like to take the opportunity to the Principal, teachers and the to express our sincere gratitude to all students of class ten of Pushpa Kunja those who have in some way High School, Samakhusi, Kathmandu for contributed to bring this study in the their participation and cooperation during final shape it is now. In particular, we pre-testing of the instruments of this would like to thank the adolescent study; Nepal Water for Health (NEWAH), school girls who participated in this Biratnagar and Chandra Jyoti Integrated study with all enthusiasm. Special Rural Development Society (CIRDS), gratitude goes to Dr. Amit Bhandari & Mahadevbesi, Dhading for coordination Ms. Savitri Gurung for their technical and support for data collection in Morang work & support and the Principals & and Dhading districts respectively; and teachers of all four schools (Shree Bhavana Bhatta and Babu Ram Panta of Mahakali Secondary School-Dhading, Youth Action Nepal, Kathmandu for their Shree Devi Secondary School-Morang, assistance provided throughout the Shree Bal Uddhar Secondary School- study. We hope that this study will serve Kathmandu, Shree Devi Secondary the purpose of informing the strategies School-Lalitpur) that were included in and actions of any concerned the study for all their cooperation and stakeholders in improving the menstrual support even at short notices. hygiene and management particularly of Similarly, we are very much thankful adolescent girls. A WaterAid in Nepal publication March 2009 A copy of the report can be downloaded from www.wateraid.org/nepal WaterAid’s mission is to overcome poverty by enabling the world’s poorest people to gain access to safe water, sanitation and hygiene education. Executive summary i Contents Executive summary ii Background 1 Objective 3 Methodology 3 Ethical considerations 4 Limitations 5 Results 5 Knowledge and beliefs 6 Experience during menstruation 8 Practices of seclusion, exclusion and absenteeism 10 Hygiene practices 13 Discussion 17 Recommendations and conclusion 20 References 22 Is menstrual hygiene and management an ii issue for adolescent school girls? Executive summary Menstrual hygiene and management is an mothers (51%) or sisters (41%). However, issue that is insufficiently acknowledged the information provided was mainly and has not received adequate attention about the use of cloth and the practice of in the reproductive health and Water, rituals and restrictions constructed around Sanitation and Hygiene (WASH) sectors in the polluting effect of menstruation. developing countries including Nepal and Abdominal pain is the most common its relationship with and impact on medical problem experienced by the achieving many Millennium Development survey respondents (85%). Mental stress is Goals (MDGs) is rarely acknowledged. also common, particularly due to constant Studies that make the issue visible to the worry that others may know about their concerned policymakers and inform menstruation. Seclusion and exclusion practical actions are very much warranted. practices were widespread, particularly This small scale study was undertaken with among Bahun, Chhetri and Newar caste the objective of determining the prevailing groups. About 89% of the survey knowledge and experiences of menstrual respondents practice some form of hygiene and management, and their restriction or exclusion, the commonest implications, among adolescent schools one being abstaining from religious girls in rural and urban settings of Nepal. activities (68%). The socio-cultural reasons are based on concepts of "pollution" This is a descriptive cross-sectional study in surrounding the menstruation. Survey which mixed methods (quantitative and showed that about half of the respondents qualitative) were applied. Data was (53%) had been absent in school at least collected from 204 adolescent school girls once due to menstruation. Many girls from four government secondary schools, though physically present in the school, one in each of Dhading, Morang, Lalitpur were unable to perform well due to poor and Kathmandu districts, using self- concentration and attention resulting from administered structured close-ended the constant worry. Lack of privacy for questionnaires, focus group discussions cleaning and washing (41%) was the major (FGD), and semi-structured in-depth reason identified by survey respondent for interviews. Four main recurrent themes have being absent during menstruation. This is been identified in the analysis: a) usually because of lack of water or due to knowledge and beliefs b) experiences minor issues, such as missing door locks, during menstruation c) seclusion, exclusion even when infrastructure of toilet is and absenteeism and d) hygiene practices. present. The large majority of survey respondents Most of the survey respondents (66%) (92%) had known about menstruation used re-usable cloths to absorb menstrual before their menarche, particularly from flow during menstruation, the use being Executive summary iii significantly higher among rural than urban Further, lack of small things required for school girls. The use of old piece of cloth maintaining basic hygiene during was significantly higher among rural girls. menstruation, like privacy, water supply and Not knowing about its availability (41%) waste disposal compound the situation. and high cost (38%) are the major reasons, as perceived by the survey Conscious efforts need to be made to respondents, for girls not using disposable address lack of privacy, which is an single-use sanitary pads. The low cost and important determinant for proper practice ease of availability of rag cloth was seen of menstrual hygiene and also school to the mostly commonly used by girls in attendance. In most cases this may mean both rural and urban settings, however managing the resources thoughtfully and many of them preferred sanitary pads. The problem-solving as the situation arises - participating girls wash their genitals on an small measures that can really help to average two to three times a day during provide supportive environment for menstruation. However, this may be menstrual hygiene both at home and in difficult in school due to poor facility for the school. Realizing the needs and cleaning and washing or disposing interest to use sanitary pads, innovative absorbent cloth. Only around half of the ways have to be identified for making respondents have toilet with adequate pads available and affordable to school privacy at home (55%) and about two-fifth girls belonging to all segments of society. have at school (42%). On average the girls It is clear that the reproductive health change the absorbent material between 2 implications of menstruation and its to 3 times in a day and use one re-useable management, and its effect on quality of cloth for 3 cycles. Disposal of used cloths life permeating school and other social and napkins was a challenge in both activities are many for the adolescent urban and rural schools. school girls. These invariably call for all stakeholders to urgently address Restrictions during menstruation that limit entrenched and incorrect menstrual daily activities and routine are widely perceptions, and enable proper hygiene practiced. These manifest from beliefs that practices amongst this segment of the a woman during her menstruation is ritually population. There is a significant need for dangerous, which can result in them organizations working in the Reproductive spoiling food and plants, biological and Health and Water, Sanitation and Hygiene social processes. Abnormal physical (WASH) sectors to work concertedly conditions, particularly dysmenorrhoea and towards developing appropriate policy and excessive bleeding, as well as the mental adequate actions on the hitherto neglected stress during menstruation affects the daily issue of menstrual hygiene and lives and routines of adolescent schoolgirls management. to a varying degree, particularly the quality of presence at school in terms of attention Key words: Menstruation, Hygiene, and concentration in curricular activities. Adolescent Girls, Water, Sanitation Is menstrual hygiene and management an iv issue for adolescent school girls? Background 1 Background Nepal, being a signatory to the Delhi girls and boys. They offer privacy, Declaration 2008: "Sanitation for Dignity convenience and safety. But most and Health", in the Third South Asian sanitation programmes necessarily do not Conference on Sanitation (SACOSAN), mention the special needs of women and needs to make major efforts to ensure adolescent girls who use latrines to that "the special needs of women (e.g. manage menstruation. It's a need that has menstrual hygiene management) are been excluded from latrine design/ integrated in planning, implementation, construction as well as hygiene education monitoring and measurement of packages. Even reproductive and (sanitation) programme outcomes" (The preventive health programmes in Delhi Declaration, SACOSAN-III 2008). developing countries like Nepal often do Although often not acknowledged, it is not address the issue and moreover they clear that measure to adequately address focus mainly on the reproductive functions menstrual hygiene and management will of married women. directly contribute to MDG-7 on environmental sustainability. Additionally, Menstruation,
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