A consolidated reply of experiences and examples shared by various members of the Solution Exchange Water Community
From Shweta Patnaik, WaterAid UK India Regional Office (East), Bhubaneswar
Posted 12 March 2010
I work with WaterAid India in the Eastern Regional Office. We are currently dealing with the issue of developing a communications strategy for Menstrual Hygiene Management (MHM) that could assist the Government and other institutions and civil society organizations working on the topic.
There are several problems in this area that are not adequately researched before institutions/agencies/organizations design their strategy and make products to address the perceived issues. The end result is that funds are spent on products and promotion, but there is no rigorous method of analyzing their effectiveness.
We are interested in developing a communications strategy on MHM that will follow the following steps:
- A baseline survey in the field to establish baseline indicators
- Development of clear communications objectives
- Use of appropriate modes of communication
- Development of suitable messages
- The testing of messages, modes and objectives in the field
- Refinement, if needed
- Implementation of the strategy
- Monitoring, evaluation and review of the strategy
Against this background, I would request members of the Water Community to share their knowledge/experience on the following:
- What processes have agencies followed to develop communications strategies for MHM? Are there examples of how these have helped in providing women with protection from diseases and improving quality of life?
- What strategies/approaches and materials have been developed for MHM communication?
- Are there any materials available that have effectively addressed the issue of “where male structures/myths come in or how are they strengthened”
- Suggestions on how to strengthen existing MHM communication strategies
Finally, we would also like the names and contact details of agencies that have developed materials or implemented communication strategies.
Your responses will help us to streamline our communications strategy for the MHM sector.
Responses were received, with thanks, from
1. Anna-Marie Guiney, UNICEF Country Office, Lalitpur , Nepal
2. Asit Sahu, Raincentre, Bhubaneswar
3. Dipak Roy, WASH Consultant, New Delhi
4. Prakash Nayak, CARE-India, New Delhi
5. S Vishwanath, Biome, Bangalore
6. Charulatha Banerjee and Runa Nath, Terres des Hommes, Kolkata
7. Gautam Choudhury, National Informatics Centre, Guwahati
8. Braja S. Mishra, School of Rural Management, KIIT University , Bhubaneswar
9. Surendra Kumar Yadav, Vikram University , Ujjain
Further contributions are welcome!
Summary of Responses
Summary of Responses
One of the fundamental gaps in menstrual hygiene management (MHM) is the lack of effective communications strategies and material. Most times, organizations rush in to produce material without a strategy in place, and the output is unusable. They need, therefore, to follow certain processes while developing a communications strategy so that the products they develop for MHM awareness serve the purpose; this can be informing adolescents and adults about hygienic practices, dispelling myths, reproductive health education and even basic information about human physiology.
An effective MHM communications strategy is built on sound baseline information. The Department of Home Science, Jaipur University , Rajasthan, surveyed 300 girls in 20 villages spread across four districts of Rajasthan in 2007-08 for UNICEF. They developed efficient qualitative and quantitative tools for the job and rigorously field-tested them. In Kathmandu , Nepal, UNICEF supported a session on MHM during a training of trainers programme. The trainers felt a handbook would be a useful training tool. UNICEF developed a small booklet on MHM, tested it in schools and elicited feedback from students and teachers. It also sent the publication to the government and other partners for inputs. Finally, it worked with two schools to lead community programmes on MHM. The programme was successful and the schools now raise money for buying sanitary napkins and are also putting together enough to install incinerators.
In another example, an individual worked with adolescent boys and girls to develop communication material under a project, Media Design for Communicating Reproductive Health Information to Rural Young People. She held 16 workshops attended by 545 youth, including 337 girls. While girls are aware of physical changes that come with growth, they have nowhere to go for information on menstruation or reproductive health. They drew basic images of their bodies that professional communicators used as the starting point for developing suitable messages. Additionally, she found interpersonal communication to be the most effective way of behaviour change.
This is borne out by the experience of the School of Rural Management , KIIT University , Bhubaneshwar, Orissa. They conducted a series of awareness programmes for women from self-help groups, that include a component on MHM. They surveyed the women after two years and found as many as 60 per cent still used the knowledge they had acquired on MHM.
Practitioners and NGOs have developed several publications in Oriya on MHM. These include:
- Ashore Eva Joanna Swarthy, Adolescence and Reproductive Health, published first published in 2003 by the Orissa Voluntary Health Association, Bhubaneswar
- Jeunthi Daktara Nahanti, the Oriya version of Where there is no Doctor, considered to be one of the most accessible and widely used community health books in the world
- Jeunthi Mahilanka Pain Daktara Nahanti, the Oriya version of Where women have no doctors, published by DanT B, Bhubaneswar and Hesperian Foundation
Terres Des Homes, with its partner Prayas has set up hygiene committees in some schools in the Andamans. These committees inform children about health and hygiene, including MHM. They conducted a baseline survey that revealed the large widespread misconceptions concerning menstruation. While girls are very curious and anxious to know about menstruation, they felt boys need to be told as well to change male attitudes. However, they conduct separate sessions for boys and girls. They present information on myths, but leave it up to the individual to decide a course of action. They use models to explain human anatomy and grassroots comics to help children express themselves.
The most effective way of addressing male structures and myths is to include boys and men in MHM workshops. However, as talk about sex is taboo in most parts of India , the facilitating agency has to conduct separate sessions for men/boys and women/girls to give them the freedom to talk. Even though interpersonal communications is a slow and expensive way to impart information, most organizations have found it to be the only way to make a lasting change in hygiene behaviour. Their strategies underline the strength of youth as change agents; increasingly, adults have to listen to their children on matters of reproductive health and MHM.
Terre des Hommes Foundation (TdH) improves menstrual hygiene management in schools by innovative communcation strategies, Little Andaman and Baratang (from Charulatha Banerjee and Runa Nath, Terres des Hommes, Kolkata)
TdH has been providing information on menstrual hygiene to school hygiene committees. This includes use of illustrated flip charts and moving models. Communication tools like comics to help children express themselves and also communicate messages simply on other hygiene issues have also been used during this process. The process revealed that communication on the issue needs to be directed not only at girls and boys but also at teachers and parents. Read more.
Awareness Programme leads to better menstrual hygiene management, Bhubaneswar (from Braja S. Mishra, School of Rural Management, KIIT University, Bhubaneswar)
KIIT University conducted a series of awareness raising programmes on menstrual hygiene management. Following this programme it was observed that 60 per cent of the girls and women maintained reasonable levels of hygiene during menstruation period. Few started using sanitary napkins and a majority used washed and clean cotton cloth (mostly from used sarees or dhotis). As a result of the initiative menstruation related taboos had also come down.
Training on menstrual hygiene inproves menstrual hygiene management in schools, Nepal (from Anna-Marie Guiney, UNICEF Country Office, Lalitpur, Nepal)
UNICEF supported a specific session on menstrual hygiene management with NGO trainers in Nepal. A booklet for girls in schools on dealing with menstruation was also developed. The campaign was successful as the schools committed to challenge the taboos and improving facilities for menstruating girls in their schools. The schools now collect funds from the childclubs for sanitary pads and are investing in incinerators for sanitary pad disposal. Read more.
Describes UNICEF’s booklet on Menstrual Hygiene Management which will serve as a self reference and support women in providing factual information about menstruation
Interview with Mariya John Fernandes from Wateraid who speaks on menstrual hygiene management; the video is in Hindi
Paper presented by Mariya John Fernandes on menstrual hygiene management in Madhya Pradesh and Chhattisgarh
Discusses how sanitation programmes and latrine design are silent about women and adolescent girls’ need to clean and change menstrual towels and menstrual management
Brief on a training programme for women/adolescent girls in a Tsunami affected village in Kanyakumari on personal hygiene and production of low cost sanitary napkins
Highlights the issue of what adolescent girls/women require to manage their menstrual needs, in terms of materials, education and facilities for management and disposal.
Has done some pioneering work in Rajasthan on communication for menstrual hygiene using local material in a very innovative way
Saraswati Swain, Orissa
Cuttack-based gynaecologist, Dr. Saraswati Swain has done extensive work on menstrual hygiene practices among adolescent girls
Has done significant work on women's health and issues of menstrual hygiene management among girls and women in Orissa
In Andhra Pradesh and on the Andaman Islands, Terre des Hommes is supporting health and access to water and sanitation projects, including menstrual hygiene management
Has worked through school hygiene committees on the island of Little Andaman and Baratang on the issues of menstrual hygiene management
Supports the government in developing and implementing a range of replicable models for sanitation and has developed a manual on Menstrual Hygiene Management
From Sunetra Lala, Research Associate
Total Sanitation Campaign, New Delhi
Department of Drinking Water Supply, (Rajiv Gandhi National Drinking Water Mission), Ministry of Rural Development, Govt. of India, 9th Floor, Paryavarn Bhawan, CGO Complex, Lodhi Road, New Delhi 110003; Tel: +91-11-24361043; Fax: +91-11-24364113; email@example.com; http://ddws.gov.in/tsc_index.htm
It has recommended activities on MHM particularly under the School Sanitation and Hygiene Education (SSHE) as part of its programme
National Rural Health Mission (NRHM), New Delhi
Ministry of Health and Family Welfare, 244-A Nirman Bhawan, Maulana Azad Marg, New Delhi; Tel: +91-11-23061195; http://www.mohfw.nic.in/NRHM.htm
Recommends including MHM activities under this programme as part of efforts towards family health and hygiene focussing on women and adolescent girls
Hindustan Latex Family Planning Promotion Trust (HLFPPT), Noida
B-11, Sector-59, Noida 201301 Uttar Pradesh; Tel: +91-120-4231060-62; Fax: +91-120-4231065
Implements programmes to encourage healthy behaviour particularly MHM and to increase access to health products at affordable prices like low cost sanitary napkins
Through interactive communication, it seeks to encourage action and empower young women to share their knowledge on menstrual hygiene with others in the community
Online museum based in the United States containing detailed information about menstrual hygiene management
Contains an interesting comic that was developed on the issue of menstrual hygiene by Terre des Hommes Foundation
Provides suggestions and feedback on the booklet based on members experiences and expertise on the content and approach and on integrating MHM with the TSC or NRHM
Responses in Full
Anna-Marie Guiney, UNICEF Country Office, Lalitpur , Nepal
First of all, congratulations on getting the ball moving on this very important and often neglected issue in the WASH sector. We piloted an MHM campaign/communications programme in Nepal in January this year in our efforts to put increased emphasis on the subject, especially through our school WASH programme. In answer to your question:
During a training of trainers programme in August 2009 on gender-friendly sanitation facilities, UNICEF supported a specific session on menstrual hygiene management which NGO trainers are now using in schools while promoting hygiene and sanitation. During this training, the trainers gave us their feedback as to what would be most useful as a communication tool.
From this, we developed a very short booklet for girls in schools on dealing with their menstruation. We then tested this in schools and got feedback from students, teachers and community members. Then we sent the booklet to government counterparts and other partners in the sector for their feedback. Based on a combined effort, we then asked 2 schools for their interest to lead a school campaign through their surrounding communities, handing out the leaflets and holding banners they made themselves about MHM. This campaign was very successful mostly because the 2 schools had already had training on MHM, the school showed commitment to challenging negative taboos and improving facilities and materials for menstruating girls and female teachers in their schools. The 2 schools now collect funds from the childclubs for sanitary pads and are investing in incinerators for sanitary pad disposal. Last month, teachers in the schools told me that they have noticed a higher attendance of girls during their menstruation as a result of the campaign and awareness raising activities.
The most important thing we have learned during this process is that it is so important to see what the practical needs are, the problems and how, locally, people can solve their own problems. For example, one school is making their own disposable sanitary pads as this is the most affordable and convenient way while the other school is purchasing more modern sanitary pads as they are the easiest for them. It is also very important to pre-test your materials so you can see where there might be gaps and suggestions for improvement. Also, very importantly, men and boys must be involved. They were so great at promoting MHM during the campaign and it is crucial they also understand the taboos, health issues etc. so they can support their wives, daughters, sisters and fellow students more positively.
I hope this was helpful in some way and please so send me your email address as I can send our booklet and others I came across when developing the booklet here.
Asit Sahu, Raincentre, Bhubaneswar
I hope you find the following article useful. The same is also available at:
UNICEF's Booklet on Menstrual Hygiene Management Released
UNICEF developed the guidance booklet on Menstrual Hygiene Management which will serve as a self reference and support girls and women in providing basic factual information about menstruation and its hygienic management will also clarify some of the myths and taboos centered on this issue.
A short advocacy film has also been developed that focuses on the importance of menstrual hygiene and low cost sanitary napkin production units.
Sharing her experience and the convenience low cost sanitary napkins has provided her, Mohana, a 8th standard student from Nemelli Village, Kanchipuram District of Tamil Nadu said “ Earlier we did not know how to manage and were forced to go back home if our periods started in school. Now, we have to just keep an extra napkin in our school bag and thus are prepared anytime”
Impressed with the low cost sanitary napkin production and the vending machine installed in schools on an experimental basis, Mukherjee saw its huge relevance in tribal society and schools.
“I was so impressed by the way in which such interventions helped in building confidence and safeguarding the dignity of young women and adolescent girls”, he said.
With 2008 being the International Year of Sanitation (IYS), the Total Sanitation Campaign of the Government of India acquires added importance.
The focus on menstrual hygiene management is an essential part of promoting hygiene and sanitation amongst adolescent girls and women who constitute approximately 45 per cent of the total female population.
Lizette Burgers stressed “From the age of around 12 and until she reaches the menopause somewhere in her 40’s, every girl and woman has to deal with it. Overall, she spends approximately 2,100 days menstruating which is equivalent to almost six years of her life. So, there is no question that girls and women need to be equipped with proper information on how to handle this issue best for their health and dignity.”
Dipak Roy, WASH Consultant, New Delhi
Ms Lakshmi Murthy has done some pioneering work in Rajasthan ( Udaipur ) on communication for menstrual hygiene using local material and it is very innovative. Please see the website: www.vikalpdesign.com for detailed references to the work done by Ms Murthy. Although the material was developed in Hindi, I am positive it can be adapted in Oriya (provided Ms Murthy is willing, of course).
There has been one KAP study carried out by New Concept Information Systems on MH among adolescent girls in Koraput district for UNICEF, Orissa office in Sept 2007 (unpublished). Although the sample size was small (55 girls), the findings are indicative of the demand for information and guidance in this area even in remote Koraput:
"The study findings revealed that there is demand among adolescent girls in both the schools and women in non-tribal village for low cost sanitary napkins. In the tribal village as the literacy levels and standard of living were very low, buying and using sanitary napkins was considered a luxury. The study also revealed that in the areas where there was demand for napkins, affordability on regular basis was an issue due to high price." (Extract from Exec Summary).
Another detailed study has been carried out by the Home Science Department of Jaipur University for UNICEF, Rajasthan office in 2007-08 in 20 villages of 4 districts of Rajasthan with a larger sample size (300 girls). You might be able to get more details of this study from UNICEF, Jaipur office. The tools (quantitative and qualitative) developed for this study might be of use to you as guides, since they had been rigorously pre-tested in the field.
There is a reputed (Cuttack-based) gynecologist Dr Saraswati Swain, who had done some very good work on menstrual hygiene practices among adolescent girls quite some time back (in late 90’s!!! ) in Orissa. She has huge experience in women's health and she also has her own NGO. You can consider contacting her for guidance, if she is available (contact tel: 06712344203). You can also get in touch with Ms Biraj Sarangi (firstname.lastname@example.org /Cell: 97781 66709), who is currently with CARE Orissa, and who had worked with Dr Swain on this exploratory study carried out by UNICEF, Bhubaneswar office in 1997.
There is another interesting website on the subject- "The Museum of Menstruation and Women's Health: www.mum.org ". You can consider visiting the site at least for purely esoteric interest.
There are at least two good guide books on the subject available:
- One was developed by UNICEF India Country Office in 2008. (UNICEF, Bhubaneswar office might have a copy of this document.) This booklet was released jointly by UNICEF and DDWS on March 8th 2008.
- Johnson & Johnson has developed a fairly smart and informative booklet which they are using to introduce their sanitary napkins in the Indian market. They are working with some NGOs in the field also. They have a good communication plan, but is understandably focused on and directed at promoting their own branded product. (There could be others, too e.g. Proctor and Gamble have also launched a campaign to popularise use of sanitary napkins in selected districts of Rajasthan in partnership with NRHM, GoR)
Prakash Nayak, CARE-India, New Delhi
Thank you for initiating a timely discussion on Menstrual Hygiene Management (MHM) where the Central Government is thinking on scale up the India’s first comprehensive scheme costing Rs 4,500 crore aimed at improving nutrition and skills of 8.5 crore adolescent girls.
The scheme, called Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (SABLA), under the Women And Child Development Ministry aims to provide food, health and develop vocational skill of girls in the age group of 11-18 years, 30 per cent of whom are malnourished.
Regarding the materials developed, I have documented few while writing a book on adolescent health in Oriya language in 2003. Hope this will bring help formulate a comprehensive communication strategy. The resources are:
- “Kaishora Evam Jouna Swasthya” – Adolescence and Reproductive Health under Swasthya Bichitra Series published first published in 2003 by Orissa Voluntary Health Association, Bhubaneswar written by Nihar Ranjan Patra, Dr. Samita Mohanty & Prakash Nayak under the technical guidance of Dr. R. N. Roth.
- “Jeunthi Daktara Nahanti” – the Oriya version of “Where there is no Doctor”
- “Jeunthi Mahilanka Pain Daktara Nahanti” – the Oriya version of “Where women have no doctors” published by DanT B, Bhubaneswar and Hesperian Foundation. Hesperian is a non-profit publisher of books and newsletters for community-based health care. Their first book, Where There Is No Doctor, is considered to be one of the most accessible and widely used community health books in the world.
Other than these, there are plenty of resources developed in Oriya language by Dr. Shashimani Panda/OMRAH, Dr. Saraswati Swain/NIHARD and many other NGO on the issue.
Charulatha Banerjee and Runa Nath, Terres des Hommes, Kolkata
Terre des Hommes Foundation, Lausanne , has been working in conjunction with the National Rural Health Mission (NRHM) through its partner PRAYAS on the island of Little Andaman and Baratang for the past 2 years. Through school hygiene committees in every school, children receive information on health and hygiene. Information on menstrual hygiene is also a part of the package.
A recently conducted baseline appraisal on knowledge attitudes and practices on life skills and health amongst adolescents further confirmed our impressions that misconceptions abound and are perpetuated with regard to menstruation.
We share a few lessons from this and other experiences:
- Girls are very curious and anxious to know – and we also tell them – about menstruation and why it is a difficult time for women. But we need to inform boys also if male attitudes on the issue have to change. These sessions of course are best conducted separate for both sexes.
- The information we provide extends beyond hygiene – there are many age old practices related to menstruation linked to observation of religious rites which often become sensitive to address. In this case we prefer to take an approach that presents the information but leaves the girl to make the decision – we are clear to point out what is harmful but do not become judgmental.
- Use of illustrated flip charts and moving models like the Champa kit developed by CINI and Thoughtshop Foundation help to understand the human anatomy better.
- We have used communication tools like grassroots comics to help children express themselves and also communicate messages simply on other hygiene issues. We will now extend this to the topic of menstrual hygiene through a workshop in May 2010. We were both part of a comics development workshop in a previous association with CINI-ASHA and we would like to draw attention to a very interesting comic that was developed then on the issue of menstruation which is now available on the World Comics site at this link: http://www.worldcomicsindia.com/westbengal03.htm.
Communication on the issue needs to be directed not only at girls and boys but also at teachers and parents. We have had instances of male teachers coming to us for information on how they can be of help to girls in classes 6-8. They do not all possess correct information and struggle to come to terms with their own biases in their own homes but know that they have to try. We need to include them in any communication plan on the issue.
We thank the query poser for raising this issue and will be glad to hear more after the strategy paper is developed and implemented.
Gautam Choudhury, National Informatics Centre, Guwahati
Thanks for initiating the discussion on 'Menstrual Hygiene Management (MHM)'. I think health education about this sensitive issue is of much use in the schools especially in the rural areas. The urban girls seems to be more privileged with better economic means to buy sanitary napkins and learning from their mothers with a more modern outlook.
While on a field visit to a school nearby during ‘3rd Annual Forum’ for the Water Community under the Solution Exchange Programme, UNICEF, at Kolkata, I could notice a sign board written in Bangla indicating the do’s and don’t’s during the menstrual cycle inside the girls toilet. A covered dustbin was also kept for disposal of used napkins there. I think this was initiated by Wateraid.
I am glad to find that materials are also available in Oriya as well. I am not sure whether similar material is available in Assamese or not. However, if I get some materials and necessary permission, I will be glad to do the translation into Assamese.
Braja S. Mishra, School of Rural Management, KIIT University , Bhubaneswar
Initiating a discussion on MHM is very useful for all concerned who work in the areas of rural health and sanitation. I have some experience of being part of creating awareness amongst the women about MHM in the Nilagiri sub-division of Balasore district, Odisha. My experience says, apart from the use of any amount of IEC materials, 'word of mouth' has a tremendous effect! In each of the awareness generation programmes (of 4-day & 2-day duration) for women, there used to be a couple of sessions on personal health and hygiene. Under this, MHM used to remain a major component. The programmes were meant for SHG leaders.
We did a sample survey after two years of conducting a series of programmes and found that because of the awareness programmes more than 60 % of women and girls maintained reasonable level of hygiene during menstruation period. Few started using sanitary napkin and majority used washed and clean cotton cloth (mostly from the used saree or dhoti). While cleaning and drying the cloth under the sun, they took enough care that the cloth remained sterilized to a great extent.
Besides, the menstruation related taboos had also come down substantially. Women take it as a normal hygienic practice and make necessary preparation for rainy season- that they preserve sufficient number of clean cloth pieces in a hygienic manner. It was some five years back we did this survey. I believe, by this time the situation must have improved.
Surendra Kumar Yadav, Vikram University , Ujjain
If intervention through education and face-to-face interaction by educated women to all rural women is made about the issues of MHM, then it shall be certainly effective. Women are preferred because rural women due to shyness may not clear all the doubts and things with a male educator.
As far as quality of water is concerned, it is more important rather then quantity, when used in washing during menstruation.
Many thanks to all who contributed to this query!
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