Menstrual Hygiene Day: WASH's role in menstrual hygiene management

On the heels of a pandemic which has heightened the levels of period poverty, advocates are pushing for menstrual health and hygiene, or MHH, to be better provided for. One way of doing that is making sure it’s better integrated into water, sanitation, and hygiene programming.

According to research, 500 million women, girls, and people who menstruate don’t have what they need to manage their menstrual cycles — access to WASH facilities, information, and sanitary products — and funding to rectify this is in short supply. During the COVID-19 pandemic, it is thought this number may have risen as supply chains were interrupted and access to public facilities was suspended.

In India, Akhila Sivadas, managing trustee and executive director of the Centre for Advocacy and Research, told of how sanitary products were excluded from the essential commodities list during the initial two month lockdown in 2020. “Not only were the shops closed, there was absolutely no supply of any absorbents and community toilets were shut,” she said.

When that first lockdown was lifted, Sivadas said women were “exploding” with anger over the indignity they’d been subjected to, and experiencing “self-revulsion” at not being able to keep themselves clean.

Advocates say the WASH sector plays a critical role in ensuring people worldwide can practice safe and dignified menstruation. And COVID-19 has brought “a big shake up,” Sivadas said.

“If we’re talking about Sustainable Development Goal 6.2 — access to sanitation for all — we’re talking about women and girls,” said Jose Mott, gender and social inclusion specialist at the Water for Women Fund, adding that the goal won’t be achieved if safe and dignified menstruation is treated as a peripheral issue in WASH programs. Other SDGs — such as those on education, equality, and poverty — could also be jeopardized.

For those implementing WASH programs, Mott said an important part is being able to think about where the MHH entry point is, be it by adding a gender lense in the designing of WASH infrastructure, and if working in schools, supporting an educational component.

The role of WASH infrastructure in MHH

All WASH projects must be gender-sensitive and inclusive, Silvia Devina, WASH and early childhood development adviser at Plan International Indonesia, said. That could mean considering separate facilities for males and females.

“If the toilet is not separated for boys and girls, the girls might have a high risk in other issues — for example sexual harassment,” Devina said. A 2018 survey by Plan in Indonesia revealed that 79% of students surveyed had never changed their sanitary pads in schools, in part because of the inconvenience of toilets, unlockable doors, and fear of being identified by their male peers.

Other gender-sensitive and inclusive solutions include implementing a handrail or ramp, installing locks, or providing a cabinet supplied with sanitary products.

Women, including women living with disabilities, can themselves identify the best solutions if they’re included in the project’s design phase, Devina said. Local rights organizations and women's groups can also help in ensuring activities are culturally and contextually appropriate, Mott said.

According to a learning brief by Water for Women, MHH interventions should not only consider cultural sensitivities, but the climate, availability, and source of water supply, as well as different physical settings.

Another element to consider is sanitary disposal. “It’s not enough to say ‘wrap up the napkin and put it somewhere.’ We have to resolve the issue,” Sivadas said, adding that there’s no point talking about sanitary products if that end of the value chain isn’t ready.

In the Plan study, a lack of adequate disposal was also listed as a reason girls didn’t change their sanitary pads in school.

Indian NGO Breaking the Silence suggests disposing of sanitary pads via compost pits or segregating the waste to be handed over to the waste collectors or sanitation workers. In Ethiopia, Kidame Mart — a social enterprise working with rural female entrepreneurs “to provide last mile distribution of consumer goods” — supplies locally made, reusable sanitation products.

Beyond the infrastructure

Aside from improving the physicality of WASH services to better cater for MHH, there are other ways it can be tackled.

For Mott, MHH needs to be integrated into national WASH policies. This can be done by engaging government officials as they’re developing sanitation and hygiene policies or plans. She recommended asking how they plan to integrate MHH needs and whether they are considering people living with disabilities too.

WfW’s brief states that, “working with government and DPOs [disabled persons' organizations] to ensure MHH is part of WASH plans and budgets leads to more sustainable results.”

Mott said there should also be an allocation of budget for MHH needs in COVID-19 responses and that mainstreaming it in other program areas can help ensure it gets the attention it needs. “In terms of good practice, it’s really having that twin track approach so it shouldn’t deflect from funding,” she said.

According to research, funding for MHH programming is “marginal” and not enough to address the gaps, although a specific deficit amount is hard to gage given that MHH is typically integrated into projects on WASH, gender inclusion, or education. The WASH sector also has a funding gap and is estimated to need $229 billion a year until 2030 to reach SDG 6.

All interviewees also spoke of the need to break down the stigma and taboo that surrounds menstruation.

The U.N. Human Rights Council’s resolution on the human right to safe drinking water and sanitation in fact calls for the stigma to be addressed through increased information, addressing of negative social norms, and access to hygienic products and gender-sensitive facilities.

Mott said a number of WfW’s partner projects address stigma by educating teachers and students, including boys, so they understand menstruation as a normal, healthy part of people’s lives. It’s important to look for the right opportunities for such discussions and knowing when to involve boys, she added.

Thrive Networks includes male leaders in its MHH training in Cambodia to help them better factor the needs of women, girls, and people who menstruate into their decision-making. In India, Sivadas explained that COVID-19 has given way to more open conversations on MHH in communities. “There has to be a very well chartered pathway of negotiation with the family, with men, with service providers, with policymakers because they just don’t seem to see the issue,” Sivadas said.

We start with knowledge and we end with sustainable disposal, but there are hundreds of things to negotiate in between, she added. COVID-19 has taught us that this must happen, she added.

Visit the WASH Works series for more coverage on water, sanitation, and hygiene — and importantly, how WASH efforts intersect with other development challenges. You can join the conversation using the hashtag #WASHWorks.