Key messaging and dissemination around Menstrual Health Management (MHM)

4 Poster Track: Applied Research » 4 Health, safety and hygiene

Speaker: Monisha Ravi

Summary – for publication in conference brochure:

Menstrual health and hygiene is vital to the empowerment and well-being of women and girls. Currently, this discourse is centered around product provision, with little focus on structural and societal change. 

Discussions with women in low-income settlements in Tiruchirappalli Corporation and Periyanaicken Palayam and Narasimhanaicken Palayam town panchayats in Tamil Nadu, highlight the need to create an enabling environment to openly talk about menstruation and break the taboos. This poster presents the design of key-related messages and current initiatives in the project locations and sets a framework for an action plan to integrate MHM into schools and low-income settlements.

Introduction, methods, results and discussion:

The problem of MHM is multi-faceted, and the poster highlights the pressing need to address it in a holistic manner. MHM should be considered a socio-political issue and the key messaging and campaigns should focus on fighting the stigma rather than the provisioning of products. Girls are forced to keep their periods quiet and out of sight. This often leads to an unsystematic understanding of menarche and the life cycle knowledge on menstruation, while menstrual shame linking it with impurity enforces a culture of silence and secrecy.         

To understand further, studies were conducted on MHM related beliefs, myths, and practices in Tiruchirappalli Corporation and Periyanaicken Palayam and Narasimhanaicken Palayam town panchayats in Tamil Nadu, with a special focus on children from government schools and low-income settlements for systematically planned improvements. Focus group discussions and structured interviews were conducted with women from low-income settlements, and girls and teachers in government schools to understand their knowledge of MHM, common practices, parental support, and the attitude of men towards menstruation. Infrastructure assessment was undertaken in select schools and community toilets in both locations.

The study indicated that there are euphemisms associated with periods, and girls have no knowledge about the same till menarche. During menstruation girls prefer to skip school for fear of staining, which was reported as an ‘uncomfortable situation’. Restrictions and stigmatised customs such as isolation are still prevalent. Most girls and women are unaware of safe disposal methods. Though all the surveyed schools offered some basic information on MHM to girls, no schools involved MHM in their curriculum.

Based on the learnings, dissemination around MHM was designed with a focus on:

●  Breaking the silence, and challenging the shame and secrecy around menstruation         

●  Moving beyond taboos and myths to end associated stigma and discrimination;    

●  Providing life cycle knowledge on menstruation linking it to reproductive and sexual health;

●   Enabling women to make informed choices by ensuring access to various products and information about their safe usage and disposal; and

●    Ensuring infrastructure and systems are in place for the safe disposal of MH products.

Women spend several days menstruating within their lifetime, with evolving needs. Systematic interventions are being undertaken in project locations, to disseminate the identified key messages, while undertaking improvements in related infrastructure.

An action plan for MHM is being developed for both the cities. An initiative called ‘Ungal Thozhi’ (your friend) is a part of the action plan to incorporate MHM in health education for boys and girls and popularise the MHM value chain ‘Awareness, Access, Usage, and Disposal’ 

The efforts do not always mean large investment in hardware intervention but in many instances, it focusses on knowledge improvement. Efforts also include advocacy, building partnership and collaboration with Chief Medical Officers, Front Line Workers such as Accredited Social Health Activists (ASHA), Anganwadi Workers (AWW), Auxiliary nurse midwives (ANM), sanitation workers, school administrations, social mobilisation and capacity building of teachers, students, parents-teachers associations and local partners to bridge the gaps in this public health issue.


Conclusions and implications:

A comprehensive action plan is being prepared from the study learnings, that aids to conceptualise, organise and provide a range of intervention options depending on the social belief system and behavioural pattern that needs to be made available for scaling up and linking to policy actions. Training modules are being developed for teachers, sanitation workers, children in schools, and also communities in low-income communities pertaining to the full value chain of MHM.

There is a need to strengthen existing policy guidelines, as most schemes/programmes have a hardware focus in terms of toilet construction and sanitary napkin production and distribution. However, there is a need for a greater focus on awareness, access to product basket, hygienic use, and disposal.

Safe Menstrual waste disposal must be supported by the availability of infrastructure to handle the non-biodegradable MH waste which is a basic requirement to prevent pollution, rather than advocating only around shifting to reusable menstrual products.

Relevant references:

2015. Menstrual Hygiene Management - National Guidelines
2018. Scoping Study on Menstrual Hygiene Management – Periyanaicken-palayam and Narasimhanaicken-palayam.

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