Living with menstruation is more than pads and toilets

Dr Erin Hunter, lecturer in Global Health at the University of Sydney, was a key contributor to UNICEF’s Guidance for Monitoring Menstrual Health and Hygiene. The guide provides an evidence-based approach to assessing the effectiveness of programs developed to help girls and women address their menstrual needs.

Increasingly, attention has turned to improving conditions for menstruating girls and women across the world. In November, Scotland became the first country in the world to offer free universal access to sanitary products. Efforts by women in India to make low-cost and biodegradable sanitary pads was turned into an Academy Award-winning documentary, Period. End of Sentence.

“We are beginning to see more funds directed to addressing the menstrual needs of adolescent girls. It’s a cause that is becoming more popular. The increased interest is very welcome but we need to keep pace with assessing what is working and what isn’t working,” Dr Hunter said.

“Menstrual health and hygiene research and programs in low- and middle-income countries have often focused narrowly on access to menstrual pads and toilets. Important psychosocial aspects of girls’ and women’s menstrual experiences, as well as menstrual symptoms and pain, have been overlooked. This guide aims to ensure the whole menstrual experience is considered when assessing needs and the effectiveness of a program.”

UNICEF has identified four pillars that are necessary to ensure adolescent girls can confidently manage their menstrual cycle: social support, knowledge and skills, facilities and services, and materials.

It’s simplistic to think that by just providing pads and toilets, we’ve addressed all needs related to menstruation.

Dr Erin Hunter
Dr Erin Hunter (right) with collaborators at the icddr,b in Bangladesh

Dr Erin Hunter (right) with colleagues at the icddr,b in Bangladesh

“It’s important we consider the social environment, the knowledge and skills girls need, and their own confidence to manage their periods,” Dr Hunter said.

“We need to move away from seeing this as a hygienic crisis, because if we only measure the distribution of pads or the presence of a toilet that is where the focus will remain. But what use is a pad if girls aren’t also confident in using and disposing of it?

“If a girl is confident in her abilities and has the necessary support, she experiences less stress and anxiety when attending to her menstrual needs. Importantly, she’ll be less likely to avoid going to school when she is menstruating.”

The UNICEF guide is based in part on work Dr Hunter and her collaborators at icddr,b did in schools in Bangladesh to develop an instrument to evaluate the self-efficacy of girls to address their menstrual needs. The need to ensure girls in Bangladesh can comfortably and confidently manage their menstrual needs is particularly acute because of the impact it has on their schooling. According to the 2014 Bangladesh National Hygiene Survey, 40 percent of Bangladeshi schoolgirls missed school an average of 2 to 3 days per month during menstruation.

To ensure girls and women are able to participate in society fully in schooling and employment we need girls to be able to do all the things required to address their menstrual needs.

Dr Erin Hunter

“Positive social norms regarding menstruation are key, along with access to a variety of menstrual materials like pads, cups, and cloth, access to clean and private spaces to wash and facilities for waste disposal, support from trusted others, and strong body literacy,” Dr Hunter said.

The University of Sydney is a partner of UNICEF.

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