Supporting the Rights of Girls and Women through Menstrual Hygiene Management (MHM) in the East Asia and Pacific Region Realities, Progress and Opportunities Joint initiative of the Education and Water, Sanitation and Hygiene (WASH) Programmes – UNICEF East Asia and Pacific Regional Office February 2016 Citation: Dutta, Devashish, Chander Badloe, Hyunjeong Lee and Sarah House, Supporting the Rights of Girls and Women Through Menstrual Hygiene Management (MHM) in the East Asia and Pacific Region: Realities, progress and opportunities, UNICEF East Asia and Pacific Regional Office (EAPRO), Bangkok, Thailand, 2016. Schoolgirl, Manufahu District, Timor-Leste Plan Indonesia’s WASH Supervisor explaining MHM Schoolgirls, Indonesia (WaterAid/T. Greenwood) to school teachers during MHM training in Nagekeo (UNICEF Indonesia et al., 2015) District (Plan International Indonesia) Teachers with the girls’ puberty/MHM book in Luang Schoolgirls, Solomon Islands (UNICEF Pacific/J. Alcock) 12–13 year old girls from Eastern Region, Prabang Province, Lao People’s Democratic Republic Mongolia, taking part in a focus group (Eau Laos Solidarité/S. Piper Pillitteri) discussion (UNICEF Mongolia/Surenjaviin) Contents Foreword . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Tables. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 6 Figures ................................................................................. 7 Acronyms .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Terminology. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 9 Acknowledgements.....................................................................10 1. Executive summary . .. .. .. .. .. .. .. .. .. .. .. .. 12 2. MHM – Establishing the realities and opportunities in the East Asia and Pacific (EAP) Region . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 19 2.1 Menstruation and menstrual hygiene management . .. .. .. .. .. .. .. .. .. .. 19 2.2 East Asia and Pacific region, adolescence and educational context . .. .. .. 20 2.2.1 Geographical scope and focus............................................ 20 2.2.2 Adolescents in the EAP region ............................................20 2.2.3 Education across the EAP region ......................................... 23 2.3 Purpose of establishing the status of MHM across the EAP region. .. .. .. 23 2.4 Methodologies ................................................................ 24 2.5 Limitations of this synthesis . .. .. .. .. .. .. .. .. .. .. 25 3. MHM in overview – global context . .. .. .. .. .. .. .. .. .. 26 3.1 Why considering MHM is important .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 3.2 Framework for research and understanding the factors which impact on MHM .... 29 3.3 MHM good practice framework and Theory of Change . .. .. .. .. .. .. .. .. .. 30 3.4 MHM and schools – the global context. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 34 3.4.1 MHM in the school environment .. ... ... ... ... ... ... ... ... ... ... ... ... ... 34 3.4.2 MHM in the curriculum .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 35 4. Snapshot of progress on MHM across the EAP region .. ... ... ... ... ... ... ... ... ... 38 5. Enabling environment related to MHM across the EAP region. .. .. .. .. 41 5.1 Overview of the enabling environment. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 41 5.2 Government leadership and commitment . .. .. .. .. .. .. .. .. .. .. .. .. .. 41 5.2.1 Government engagement and leadership at national level. .. .. .. .. .. .. 41 5.2.2 Policies, strategies and guidelines ........................................ 42 5.2.3 Government support to MHM-related activities implemented by other stakeholders . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 43 5.2.4 Government budgets supporting MHM ................................... 44 5.3 Coordination, cross-sectoral engagement and advocacy on MHM ................ 45 5.3.1 Cross-sectional engagement on MHM. .. .. .. .. .. .. .. .. .. .. .. .. 45 5.3.2 Partnerships with civil society organizations (CSOs) .. ... ... ... ... ... ... ... 46 5.3.3 Partnering with the private sector ........................................ 47 2 • Supporting the Rights of Girls and Women through Menstrual Hygiene Management (MHM) in the East Asia and Pacific Region 5.3.4 Development partner/donor engagement in MHM . 48 5.4 Formative research and learning. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 48 5.5 Monitoring and evaluation of factors relevant to MHM . .. .. .. .. .. .. .. .. .. 50 5.6 Sanitary protection material availability and use . .. .. .. .. .. .. 52 5.7 Teaching of MHM in schools. .. .. .. .. .. .. .. .. .. .. 55 5.7.1 Integration of MHM in the curriculum . .. .. .. .. .. .. .. 55 5.7.2 Teaching of MHM in schools through extra-curricular activities.............. 58 5.8 Teacher training on MHM and guidance materials for teachers.................... 59 5.9 Availability of teaching and learning materials on MHM .. ... ... ... ... ... ... ... ... 61 5.9.1 Girls’ puberty/MHM books ............................................... 61 5.9.2 Boys’ puberty books ..................................................... 61 5.9.3 MHM integrated into teaching and learning materials on broader topics. .... 62 5.9.4 Other IEC materials on MHM .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 62 5.9.5 Online or other media materials . .. .. .. .. .. .. .. .. .. .. .. .. .. .. 64 6. MHM-related norms, beliefs, practices and implications across the EAP region .... 65 7. MHM in schools across the EAP region .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 7.1 Knowledge, skills and attitudes to menstruation and MHM ....................... 71 7.2 Current status of WASH facilities in schools ..................................... 73 7.3 Experiences of school environment and relationships ............................ 76 7.4 Recommendations made by girls, teachers or parents for improving the school environment .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 78 8. MHM in the community, in emergencies and in the workplace across the EAP region .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 80 8.1 Engagement of out-of-school children, the community and youth in MHM .. ... ... 80 8.2 Integration of MHM into emergency responses. .. .. .. .. .. .. .81 8.3 MHM in the workplace or as an income generating opportunity. .. .. .. .84 9. MHM for people in special circumstances, people with disabilities, or from minority, indigenous or marginalized communities across the EAP region . .. .. .. .86 10. UNICEF commitment and action on MHM across the EAP region . .. .. .. .. .. .. 90 11. Summary of progress, opportunities, gaps and challenges across the EAP region. 93 11.1 EAP – Regional level .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 93 11.2 Country – National policy level .................................................. 94 11.3 Country – Implementation level and experiences of girls and women ............. 95 12. Recommendations on the way forward across the EAP region. .. .. .. .. .. .. .. 96 12.1 Recommendations at EAP regional level ........................................ 96 12.2 Recommendations for countries. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 97 12.2.1 Recommendations – National policy level ............................... 97 12.2.2 Recommendations – Research, monitoring, evaluation and advocacy .. ... 99 12.2.3 Recommendations – Implementation level. .. .. .. .. .. .. .. .. .. 100 REALITIES, PROGRESS AND OPPORTUNITIES • 3 Annexes .............................................................................. 102 Annex I Terms of Reference. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 102 Annex II Contributors .............................................................104 Annex III Country MHM mapping questionnaire. .. .. .. .. .. .. ...108 Annex IV Global lessons on integrating MHM into the curriculum .. ... ... ... ... ... ... 118 Annex V Good practice in responding to MHM in emergencies . .. .. .. ...123 Annex VI School years/grades and ages across the EAP region.......................124 Annex VII Girls’ and women’s experiences related to MHM across the EAP region. .. 126 Annex VIII Government leadership, coordination and recognition of the importance of MHM in national policies, strategies and guidelines across the EAP region .. 133 Annex IX Formative research and other learning on MHM across the EAP region .. ... 138 Annex X MHM in the curriculum across the EAP region.............................145 Annex XI Teacher training relevant to MHM across the EAP region ...................153 Annex XII Teaching and learning materials with relevance to MHM across the EAP region .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 157 Annex XIII Availability of school WASH facilities across the EAP region.................162 Annex XIV Stakeholders pro-actively engaged in MHM in countries across the EAP region .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 169 Annex XV UNICEF engagement in MHM across the EAP region ......................184 Annex XVI Good practice case studies ...............................................187 GPCS1 Philippines – “Creating Connections” – Reaching adolescents in and out of school through incorporating MHM into adolescent sexual