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Synthesis Report Menstrual Hygiene Management in Schools in South Asia Synthesis Report

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Synthesis Report Menstrual Hygiene Management in Schools in South Asia Synthesis Report Menstrual hygiene management in schools in South Asia Synthesis report Menstrual hygiene management in schools in South Asia Synthesis report Written by Tracey Keatman, Sue Cavill, and Thérèse Mahon Acknowledgements The consultants (Tracey Keatman and Sue Cavill) would like to extend their gratitude to the various interviewees from UNICEF, WaterAid and other organisations working on MHM in schools in South Asia who have contributed their time, insights and support to this analysis. Particular thanks go to Thérèse Mahon (WaterAid Regional Programme Manager South Asia), Therese Dooley (Regional Advisor WASH, UNICEF Regional Office for South Asia) and Antonio Marro (WASH Specialist, UNICEF Regional Office for South Asia) for their guidance, insights, management and on-going support throughout the analysis process. The editorial contributions of Tom Burgess and Richard Steele are highly appreciated. The views expressed herein belong to the authors and do not necessarily represent the position or views of WaterAid or UNICEF. Any omissions or misinterpretations should also be attributed to the consultants. Menstrual hygiene management in schools in South Asia Synthesis report Menstrual hygiene Contents management in schools Summary 2 in South Asia 1 Background to the report 4 2 Overview of education and adolescence in South Asia 7 3 Overview of MHM services in school settings in South Asia 9 4 Enabling environment for MHM services in schools 16 5 Effective implementation of MHM services in schools 21 6 Sustainable MHM services in schools 28 7 Opportunities 32 References 35 Acronyms CBE Community based education; CFS Child-friendly schools; DISE District Information System for Education, India; EMIS Education Management Information System; GPE Global Partnership for Education; ILE International Learning Exchange; JMP Joint Monitoring Programme; KAP Knowledge, attitude, practice (and behaviour); MH Menstrual health; MHM Menstrual Hygiene Management; MHM-PA MHM Practitioners’ Alliance, Nepal; MoE Ministry of Education; MoH Ministry of Health; NGO Non-governmental organisation; O&M Operations and maintenance; P&G Procter and Gamble; ROSA Regional Office – South Asia (UNICEF); SACOSAN South Asian Conference on Sanitation; SB:SV Swachh Bharat: Swachh Vidyalaya, India; SDG(s) Sustainable Development Goal(s); SH&NSs School health and nutrition supervisors; SMC School management committees; SRH Sexual and reproductive health; UNICEF United Nations Children’s Fund; WASH Water supply, sanitation and hygiene; WHO World Health Organization; WinS WASH in schools; WSSCC Water Supply and Sanitation Collaborative Council. 1 Menstrual hygiene management in schools in South Asia Synthesis report Summary Progress Materials and their effective disposal Enabling environment Cloth remains most common, particularly in rural areas. There are many initiatives Several governments have started to integrate to promote locally made, reusable sanitary good menstrual hygiene management (MHM) materials. Brands of sanitary pads are widely practices into national norms, standards available across the region, but in many places or guidelines related to water, sanitation the supply chain is weak. and hygiene (WASH) in schools (WinS). Many national education, WASH and sexual Gaps and challenges reproductive health (SRH)-related policies and strategies recognise the importance of MHM in Enabling environment WinS. National government engagement and MHM-friendly WASH facilities leadership on MHM varies across the region. There are a number of activities at pilot scale, Significant progress has been made on rather than a comprehensive response. Few ensuring that separate toilets are available for countries monitor MHM in national monitoring girls and boys; and, in some cases, there are systems. Hard-to-reach women and girls face additional spaces for managing MHM. multiple MHM challenges in school, especially Accurate, age-appropriate, pragmatic those marginalised by geography, caste or information ethnicity, disability, disasters, and the ultra-poor. To address the lack of appropriate MHM MHM-friendly WASH facilities educational materials, efforts have been made Effective operation and maintenance (O&M) to improve teachers’ capacity and resources. of school WASH facilities remains a major Another approach encourages peer-to-peer challenge. Where facilities exist, they may not MHM learning. The use of IT and social media be MHM-friendly. In some countries, O&M is has helped accelerate outreach. chronically under-funded. Some of the greatest Social support MHM challenges relate to the lack of systems and supply chains for hygiene ‘software’. School management, teachers and parents are increasingly aware of the MHM needs of Accurate, age-appropriate, pragmatic girls and female staff. School-based health information and nutrition services or counselling services support girls to get advice on menstruation, A wide range of myths, taboos, norms and request painkillers or sanitary materials, or find traditional beliefs and practices around space to rest. menstruation persist across South Asia, affecting the ability of girls and women to manage their periods. Integrating MHM into the school curriculum remains a challenge, alongside teachers’ confidence to teach the subject. 2 Menstrual hygiene management in schools in South Asia Synthesis report Social support Information and communication platforms: Efforts to ensure MHM is included in the There is a need to build the capacity of curriculum are underway in several countries. parents, other relatives and the community MHM actors are also beginning to emphasise to ensure MHM in schools has traction and girls’ voices to challenge social norms around efforts are sustainable. menstruation and demand accountability for Materials and their effective disposal better facilities in schools. Widespread adoption of disposable sanitary Equity: Efforts aimed at ‘leaving no one pads varies, due to the cost and lack of behind’ are underway, including safer and disposal options in schools, which remains an more accessible school facilities, especially for underdeveloped aspect of most MHM services. girls with disabilities; however, this remains a A long-term view is needed across the entire gap. Reaching girls in remote or inaccessible service chain for supply and disposal. regions that lie beyond normal supply chains requires more attention. Opportunities Cross-sectoral integration and coordination: Regionally, there is a shift to consider menstrual health more broadly. This requires better cross-sector collaboration, particularly between WASH, health and education to build national convergence. Materials and supply chains: Wider engagement with the private sector may accelerate progress, including linking with waste management service providers and encouraging social responsibility among commercial pad suppliers around disposal. Quality programme design and monitoring: A better understanding of programme costs and outcomes to determine what programme elements can work at scale is needed. Sustainable Development Goals (SDGs) monitoring offers an opportunity to get an MHM indicator in national Education Management Information Systems (EMIS) and incentivise action. 3 Menstrual hygiene management in schools in South Asia Synthesis report 1. Background to the report Menstrual hygiene management – a definition The Joint Monitoring Programme (JMP) of WHO and UNICEF, has proposed the following definition of menstrual hygiene management (MHM): “Women and adolescent girls are using a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of used menstrual management materials. They understand the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort or fear.” There is increasing recognition that menstrual and WinS International Learning Exchange hygiene is a multi-sectoral issue that requires (ILE) platforms have played a significant role in integrated action particularly from the WASH, mobilising action on this critical issue. education, health, adolescents, protection and UNICEF and WaterAid are among the gender sectors. As the body of research on the organisations that have incorporated MH and importance of MH for girls expands, there is MHM into WinS programmes in order to help a growing interest in addressing it, especially girls and women overcome the associated through WASH in Schools (WinS) programmes. stigma and marginalisation. Integrating MHM Numerous studies have shown that the lack into WinS has the potential to empower of MHM-friendly facilities, information, MH students and teachers, and especially materials and social support for schoolgirls encourages girls and female teachers. The and female teachers is a barrier to their full importance of MHM at school has been participation in school and thus to quality acknowledged through the inclusion of related education. indicators in the monitoring guidance for WinS The South Asia region has been at the that relates to the Sustainable Development forefront of innovation in policy and practice Goal for education (SDG4) and various to ensure that WASH services, including national policies, guidance and plans. those in schools, pay attention to the needs of Significant experience of developing effective menstruating girls
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