Menstrual Hygiene Management in Pakistan

Forum for sharing of experience related to hygiene promotion.

Menstrual Hygiene Management in Pakistan

Postby Saif_khan » 23 Dec 2010 06:20

Abstract
Menstruation, a natural process in women’s life needs special care from physical and psychological point of view. Negligence in menstrual hygiene can result in biological disorders for example different sorts of infections but unfortunately awareness concerning this area of life is not highlighted due to socio- cultural trends of our society. In present age menstrual hygiene needs more attention because of rapidly increasing active participation of females in different walks of life. It has become necessary to analyze their relevant problems and prepare different strategies for solution. These solutions should be in accordance with social norms and traditions. Problems during menarche, effects of menstruation on studies, proper use of hygiene products, hygiene practices during menarche and source of information for girls during menarche have been focused in this study. Menstrual hygiene promotion will be an indirect support to gender equality, national development, high literacy rate and MDGs accomplishment.
MENSTRUATION: SCIENTIFIC PERSPECTIVE
Menstruation is one of the most important stage in a women’s life it is a symptom of adolescence that is the beginning of adult hood, it signals the possibility of fertility.
Image
Mensturation Cycle
Timing of menarche is influenced by both genetic and environmental factors, especially nutritional status. Puberty in girls is the phase of transition from child to mature woman.
SOCIAL PERSPECTIVE
This is a natural process but due to illiteracy, ignorance about religious teachings, poverty, socio-cultural trends, negligence regarding psychological health and poor health facilities there’s not much discussion on this topic that results in negative. One of the main reasons behind the issue is that menstruation is considered in many societies including Pakistan a hidden and secret issue even in many societies this is not openly discussed between mother and daughter. In many cultures menstruation is being perceived as unclean and embarrassing and also believed that it must remain hidden in communication.
FINANCIAL PERSPECTIVE
Majority of girls in low-income countries cannot afford a monthly supply of feminine hygiene products. Women and girls in poor countries can’t afford sanitary pads or tampons, which would normally be changed around four times a day during menstruation for example in our rural areas females are used to use only one ordinary cloth for almost four days of their menstruation which is absolutely unhygienic.
LACK OF KNOWLEDGE
In schools there are no proper facilities for menstrual waste management; girls don’t know how to dispose it off properly especially in time of immediate need. 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.

HIGH DROP OUT FROM SCHOOL AND POOR PERFORMANCE
Adolescent girls are often absent from school due to menstruation related issues. The accompanying abdominal cramps, headaches and fatigue, coupled with poor facilities and lack of counseling, all contribute to monthly absenteeism, which can be as high as 20%. It is often a first step to dropping out of school completely.
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Social Perspective
At school, girls are faced with poor facilities inadequate water for washing, lack of soap, no privacy and non-functioning or insufficient toilets. This reduces school attendance. It is important to realize that one out of two 13 year old girls will probably be menstruating. One in eight girls begins to menstruate (menarche) when she is 11 years or younger.
One of the reasons behind high drop out of girls from school in Asia is their difficulty in managing menstruation. The idea is that they don’t have decent sanitary products and so stay home during their periods and then get further and further behind and finally drop out.
The problem also affects the teachers’ performance the monthly menstruation period also creates obstacles for female teachers. They either report themselves sick or go home after lessons as fast as possible and do not have enough time to give extra attention to children who need it.
According to a study conducted in Nepal suggested that the main reason they stayed away was cramps nearly 44% of the girls cited cramping as the reason they couldn’t make it to school while they were menstruating.
One of the main reasons behind the issue is that menstruation is considered in many societies including Pakistan a hidden and secret issue even in many societies this is not openly discussed between mother and daughter. In many cultures menstruation is being perceived as unclean and embarrassing and also believed that it must remain hidden in communication.
Across the developing world, the lack of appropriate and adequate sanitation facilities prevent girls from attending school, particularly when they are menstruating. There is no private place to change and clean the rags and often no safe water and soap to wash them properly. A culture of shame and embarrassment forces them to seek for well hidden places even in their homes to dry the rags. These places are often damp, dark and unhealthy. This practice is responsible for a significant proportion of illness and infection associated with female reproductive health. Rags that are unclean cause urinary and vaginal infection. Very often serious infections are left untreated. This study was done in urban slum and rural Bangladesh but the same situation exists in rural area of Pakistan.
ENVIRONMENTAL DEGRADATION
The issue has major impacts on Environmental degradation. Environmental degradation refers to any impact on the natural environment which causes harm to plants, animals, soil structures, water quality, air quality, or aesthetic qualities. Menstrual waste means by-products of menstruation and menstrual management and includes items such as sanitary pads, tampons, human bodily excretions, product wrapping, and toilet paper. Composition of menstrual waste, the interaction of that waste with the natural environment (soil, water, and air) disturbs the environment.
Another report says that in developing countries, which frequently have poor waste management infrastructure, this type of waste will certainly produce larger problems. For this reason, encouraging menstrual hygiene in developing countries must be accompanied with calculated waste management strategies.
IN CASE OF IMMEDIATE NEED
In schools there are no proper facilities for menstrual waste management; girls don’t know how to dispose it off properly especially in time of immediate need. They don’t have proper feminine products for immediate use in out door especially in schools.
Keeping in view the importance of the issue different researches and studies done in it is important to have a look over few important previous researches.
PHYSICAL PROBLEMS
Physical structure of a female is more vulnerable to infections so the problems that a female have to face due to poor MH are here below;
1. Urinary tract infection,
2. Uterine infection
3. Irritation
4. Lechorea,
5. Discharge
6. Pelvic inflammatory diseases includes pains
PSYCHOLOGICAL PROBLEMS
1. Anxiety
2. Tension
DOMESTIC PROBLEMS
Medical expenses, lack of proper health facilities and less access to medication results in restlessness as well as in economic and financial crisis in a family.
DISTURBED RELATIONSHIP BETWEEN HUSBAND AND WIFE
There are following reasons behind the disturbed relationship;
1. Sexually transmitted infections from wife to husband
2. Effects on children due to mother’s weakness, carelessness or tension
3. Domestic work disturbs as a house wife can’t fulfill her responsibilities towards her house and family.
IRSP Iterventions for MHM
Integrated regional support program (IRSP) is a multi sector development organization working in the field of water & sanitation in different parts of country since last 2 decades. IRSP has partnership with World Bank, WaterAid, European commission, UNICEF, Oxfam and Government agencies to streamline the issues of water, sanitation and hygiene promotion in the country.
Keeping in view the importance of Menstrual Hygiene Managment, first need assessment survey was conducted on MHM in rural areas of Khyber Pukhtunkhwa (previously known as N.W.F.P) in 2010, it planned to initiate a project in four selected Union Councils of Mardan district in collaboration with WaterAid. After survey it is planned to begin with basic trainings in government girls' schools and in BHUs (Basic health units) on health and hygiene during menstruation. In order to convey the messages among students, teachers and lady health workers, IEC material has also been developed in form of booklets.
MHM during flood emergancy (2010)
In current flood emergancy, Females were using old and dirty clothes so, IRSP is not only providing sanitation pads, clothes and other sanitory products but also working to educate females on MHM in hygiene sessions so that they can manage it easily, in these sessions they learn to use sanitory clothes because due to their rural background they don’t know how to manage menstruation properly and this attitude has become more difficult and dangerous for them in existing situation. To satisfy their demand for sanitary products IRSP and WaterAid first MH kit distribution has been completed successfully on 6th, Nov 2010.
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MHM in Emergency Response
Another important issue was the issue of menstrual waste disposal during current emergency and in routine life also. Menstrual waste disposal was abselutly improper in camps and even in houses of flood affectees. They were used to throw openly or burn openly which is hazardous for environment. Improper disposal of used material can lead towards various kinds of infections so IRSP planned for advocacy campaign to address the issue of MHM.
Females from 12 to 50 years of age were in the beneficiaries but young and unmarried females were more focused because it was difficult for them to discuss their issues with anybody. 800 Menstrual hygiene kits have been designed with all relevant products and distributed.
To update the community’s knowledge on importance of menstrual health, hygiene and to educate the females about use of kit and proper MHM hygiene awareness sessions were conducted in 2, flood affected UCs.
UNICEF is working to ensure special protection according to Convention on the Rights of the Child and striving to establish children's rights as given in ethical principles and international standards of behavior towards children, for the most disadvantaged children; victims of war, disasters, extreme poverty, all forms of violence and exploitation and those with disabilities along with that it is promoting the equal rights of women and girls to support their full participation in the political, social, and economic development of their communities.
Last edited by Saif_khan on 18 Feb 2012 10:32, edited 3 times in total.
Saif Khan
Director, Technical & Development
Integrated Regional Support Program
Mardan Pakistan
www.irsp.org.pk
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Years of WASH Experience: 10
WASH Country Experience: Pakitan
WASH Work Experience: IRSP and its partners/donors Oxfam GB, UNICEF, UN Hab, Wateraid, WSP-SA

Re: Menstrual Hygiene Management in Pakistan

Postby CelesteofThrive » 08 Mar 2011 17:08

Thank you for highlighting this important issue. Days for Girls is addressing this need with quality washable feminine hygiene kits and accompanying distribution discussions. For patterns, samples and kits as well as team partnership to get kits into the hands of those that need them, go to http://www.ProjectThrive.org and click on Days for Girls.
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Re: Menstrual Hygiene Management in Pakistan

Postby JKMakowka » 09 Mar 2011 07:39

Dear Saif

Thanks for sharing this, we are also working on hygiene promotion in KPK and would like to focus more on this issue. Could you share the contents of your female hygiene kits and also the IEC material you developed?

Thank you very much.
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Re: Menstrual Hygiene Management in Pakistan

Postby Saif_khan » 09 Mar 2011 09:07

Dear JKMakowka,
Thanks for your post.

The following items were part of the menstrual hygiene kit which was distributed among the flood affected women in district Nowshehra:

1. Sanitary Cloth 5 Meters,
2. 1 Dettol Bottle,
3. Washing Powder 1 Kg Bonus Surf,
4. 4 Dettol Soap for Hand Washing,
5. 4 Laundry Soaps,
6. 3 Under wares,

In these items the sanitary cloth was used instead of pads which is according to the context and culture of the area. The sanitary cloth is placed in the underwear which can be washed and reused. There is a specific method of how to tie the cloth and underwear which is used by local women. To reuse the sanitary cloth the other accessories like washing powder, Dettol soap and laundry soap were provided to the women with appropriate knowledge and hygiene session by our staff.
We have also developed some IEC material with support of Water Aid to address the menstrual hygiene issues which I can post to you if you provide me your postal address.
Please feel free to contact me on; saif@irsp.org.pk
Saif Khan
Director, Technical & Development
Integrated Regional Support Program
Mardan Pakistan
www.irsp.org.pk
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Years of WASH Experience: 10
WASH Country Experience: Pakitan
WASH Work Experience: IRSP and its partners/donors Oxfam GB, UNICEF, UN Hab, Wateraid, WSP-SA

Re: Menstrual Hygiene Management in Pakistan

Postby Saif_khan » 07 Oct 2011 03:53

Thanks
Saif Khan
Director, Technical & Development
Integrated Regional Support Program
Mardan Pakistan
www.irsp.org.pk
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Re: Menstrual Hygiene Management in Pakistan

Postby lisalis » 12 Jan 2012 10:31

I am a little concerned that the article is using the term "transgender" instead of the identity marker used by the people in Pakistan use to refer to themselves. I do not know if the folks there have a problem with it or not though. Otherwise I'd make a big stink because there are important cultural differences that the term "transgender" could make invisible, in my own, perhaps not so fully informed opinion.
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Re: Menstrual Hygiene Management in Pakistan

Postby stakhan » 12 Jan 2012 13:14

Dear Saif

Thanks for sharing this, we are also working on hygiene promotion in Bangladesh and would like to focus more on this issue.

Thank you very much.

Regards
Shah Tasadduque Ali khan
Executive Director,PHRAS.
Email:stakhan1973@yahoo.com
web:www.phrasbd.page4.me
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Re: Menstrual Hygiene Management in Pakistan

Postby Saif_khan » 13 Jan 2012 04:46

Dear Shah,
Thanks for your comments. We have also developed some IEC material for improving menstrual hygiene management and got help from WaterAid India while developing these material. You can see the Pictorial MHM Manual on the following link:
http://irsp.org.pk/EC/MHM-EC.pdf

A permission is required from us if you want to reproduce the same material.
Saif Khan
Director, Technical & Development
Integrated Regional Support Program
Mardan Pakistan
www.irsp.org.pk
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Re: Menstrual Hygiene Management in Pakistan

Postby Hina » 07 Feb 2012 09:59

Really informative, I am planning to propose a study on Menstrual hygiene management in context of nomadic women for my organization in district Mardan, Please share any relevant info if you have. My email is hina@irsp.org.pk

With Regards,
Hina Israr
Gender Specialist
I R S P - Pakistan
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