Action for improved menstrual hygiene management

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3 years 4 months ago - 3 years 3 months ago #30 by lwilson

This discussion is initiated by Sridevi Adivi, Chief Coordinator for a water and sanitation project in Hyderabad, India on 11/10/2012.

Action for improved menstrual hygiene management in developing countries. A health promotion perspective.
Menstrual Hygiene Management (MHM) is a subject of ‘silence’, and discussion of the topic among women or even mother and daughter is very limited. Every culture has taboos attached to this biological cycle. On the occasion of the UNICEF's first ‘International Girls Day’, October 11th, we would like to open a discussion on the topic of menstrual hygiene management in developing countries.

Traditionally, women play the central role in fulfilling water needs of the family. Especially in developing countries, they fetch water from long distances in heavy containers impacting their health, expenditure, education and productivity. Girl children frequently absent themselves from school to assist their mothers to fetch water for the family. Women and girls often need to compromise on their own health by reducing the number of meals cooked or preferring raw food. Inadequate water forces them to forego their personal needs of water to compensate for domestic needs. Water, sanitation and hygiene have major impact on menstrual hygiene of women right from washing themselves to washing and drying cloth for repeated use. Lack of privacy (to use toilets) inhibits change of cloth or napkin for long hours and also proper drying of washed cloth. Insufficient water and lack of privacy causes infections and in many cases leads to infertility. Male members of the family are ignorant or insensitive to the needs of women worsening the situation. There have been hints of few hysterectomy surgeries caused by improper or insufficient facilities. Adolescent girls drop out from schools due to improper or lack of water and sanitation facilities in schools. Lack of education pushes them into the cycle of loss of productivity and poverty. Inadequate water and sanitation facilities have impact on physical and psychological health of adolescent girls and women. Governments are implementing sanitation campaigns but lack user friendly designs. Concerned departments are distributing sanitary napkins for the girl students but they do not ensure provision of water, sanitation and disposal facilities. So, these namesake schemes and negligent attitude to these basic needs of women affects public health at large and burdens the health expenditure of the family and country. It is imperative to generate more awareness on MHM among women and men in developing countries. Cost-effectiveness is also an important factor affecting the frequency of changing the napkins among the economically backward women. Some good practices and safe and reusable napkins have to be promoted or else disposal might also pose a major problem. Recommendations for provision of basic facilities for girls have to be put forth to governments. Girl students from the ages of 9 to 14 years should be educated on this subject in schools including the physical and biological changes.

From a health promotion perspective, what actions are needed for improved MHM in developing countries, and at what levels? How can health promotion ideas facilitate better MHM in relation to the abovementioned needs? Your suggestions and opinions on this subject are welcome.


Lianne Wilson
Last Edit: 3 years 3 months ago by lwilson.

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3 years 4 months ago - 3 years 4 months ago #31 by lwilson

The response was posted by Puspa Pant on 31/10/2012.

I am very much embarrassed to share the fact about my own country where women are considered as 'untouchable' for 50 days in a year during their menstruation periods. They live in isolation and in miserable conditions, in an impoverished hut/shed which merely provide any comfort. Every year some women succumb to death because of lack of safety and hygiene. This kind of tradition has deeply rooted where people from highly educated family also practice it to date.
more at en.wikipedia.org/wiki/Chhaupadi and blog.nyayahealth.org/2010/03/26/chhaupadi/


Lianne Wilson
Last Edit: 3 years 4 months ago by lwilson.

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3 years 4 months ago #32 by lwilson

The response was posted by Sri Adivi on 12/11/2012

This is true Puspa Pant and it is sad that not much is discussed about this issue. Despite health and education forwarding leaps and bounds, this is still a 'silent' subject. We have been brought up with this tradition and follow it blindly.

It is a pity that people are still not able to comment on this. I would like to know if you are working towards addressing this issue and if so please do share your experiences.


Lianne Wilson

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3 years 4 months ago - 3 years 4 months ago #33 by lwilson

The response was posted by Tanya Santina on 11/12/2012.

In fact, magical solutions for this dilemma unfortunately do not exist. Nevertheless, any initiation should first begin with us, health promoters. But the major question remains: how to intervene? In your paper, you have addressed a combination of problems under the title MHM in developing countries, which in my opinion can be zoomed specifically for each country since major differences are found by country, culture and ethnic group.
According to the abundant existing literature about the above subject 1,2,3,4,5,6,7 the actual situation of some developing countries is not harsh as you cited. For instance, in Lebanon, all apartments are equipped with at least one bathroom with sufficient water supply for the actual demand. According to Santina and collaborators’ study6, although all participants (100%) used disposable sanitary products, only 40.4% of adolescent girls changed sanitary pads every 3 to 4 hours; 66.9% did not shower in the first three days of menstruation and activity restrictions included physical (70.3%) and social (18.2%) activity, diet (35.5%), and school attendance (41.4%). This is surprising in view of the educational background of the parents which was in 33% of the cases, a university level.
In light of the above, the problem might be more related to social conceptions and cultural beliefs than to the availability of economic resources for the adolescents. Therefore, I don’t think that educational campaigns in schools would solely give the desired results since adolescent girls do not in fact attend frequently their classes.
Finally, regarding your second question, it is imperative that interventions be conducted on the micro level focusing primarily on adolescent girls, their mothers and last but not least, community leaders.

References
1-El-Gilany, A., Khalil, A., & Shady, I. (2004).KAP of adolescent schoolgirls about menstruation in Mansoura, Egypt.Bulletin of High Institute of Public Health, 34,377–96.
2-Lee, L. K., Chen, P. C. Y., Lee, K. K., & Kaur, J. (2006). Menstruation among adolescent girls in Malaysia : a cross-sectional school survey. Singapore medicine journal, 47,869-874.
3-Moawed, S. (2001). Indigenous practices of Saudi girls in Riyadh during their menstrual period. Eastern Mediterranean Health Journal, 7, 197-203.
4-Poureslami, M., & Osati-Ashtiani, F. (2002). Attitudes of female adolescents about dysmenorrhea and menstrual hygiene in Tehran suburbs.Archives of Iranian Medicine, 5,219-224.
5-Santina, T., Wehbe, N. & Ziadeh, F. (2012). Exploring dysmenorrhea and menstrual experiences among Lebanese female adolescents. Eastern mediterranean health journal, 8(8),857-63.
6-Santina, et al. (submitted). Beliefs and practices relating to menstrual hygiene in adolescent girls in Lebanon.


Lianne Wilson
Last Edit: 3 years 4 months ago by lwilson.

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3 years 4 months ago - 3 years 4 months ago #34 by lwilson

The response was posted by Tanya Santina 24/01/2014.

Dear Colleagues, it is always a pleasure to benefit from your page to advance research on menstrual hygiene.
Sri Adivi, apart from taboos, sociocultural environment and beliefs that prevent better menstrual hygiene in developing countries (in particular), there are three major gaps that we, as health promoters, must deal with.
The first is the lack of consensus on the definition of “menstrual hygiene.” This expression is used “so often for so many reasons by all kinds of people” and highlights a conceptual confusion regarding healthy and unhealthy behaviours related to menstrual hygiene. According to a recent systematic review and meta-analysis, this confusion is due, in large part, to the wide range of definitions of menstrual hygiene in the literature and a lack of precision in the names of the optimal hygienic materials (tampons, disposable and reusable cloth menstrual pads made from old and new material, etc.), their ideal conditions of use, how often they are changed and how a woman should shower during her menstrual period.
My question to my colleagues is the following: How might we convince people to change their beliefs and behaviours related to menstrual hygiene if we have yet to identify the conceptual content of the expression “menstrual hygiene?”
In my opinion, it would be wise to work first on a clear definition of this expression in order to share the same scientific language and same scientific culture.


Lianne Wilson
Last Edit: 3 years 4 months ago by lwilson.

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3 years 4 months ago #35 by lwilson

The response was posted by Sam Philipps 05/02/2013.

I think this is just too much for Nepal women. First time that I have heard such practice. No wonder Nepal has a high mortality rate due to malpractices they do to citizens. Isn't it unfair to call them impure when in fact menstruation means they are capable to bear a child? I'm not being biased, I'm a man as well but how about men who buy generic viagra to help them cure erectile dysfunction?


Lianne Wilson

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