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Menstrual Hygiene Management in Emergencies

Menstrual Hygiene Management in Emergencies. Session 2 - The basics, myths, taboos, practicalities, cross-sectoral considerations. The world has around 7 billion people in it Of which approx 3.5 billion are female During any one month... ... approx 1.5-2 billion menstruate.

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Menstrual Hygiene Management in Emergencies

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  1. Menstrual Hygiene Management in Emergencies Session 2 - The basics, myths, taboos, practicalities, cross-sectoral considerations

  2. The world has around 7 billion people in it Of which approx 3.5 billion are female During any one month... ... approx 1.5-2 billion menstruate

  3. Physical process • Starts at menarche (~ age 10 to 19) • Ends at menopause (~ late forties-fifties) • 28 day cycle (21 to 35) • If egg not fertilised lining of uterus and blood are shed through vagina • Bleeding 2 to 7 days per month Basics MHM - M1 P: 24

  4. Practically what does this mean for women and girls?Practically what does this mean for women and girls... in an emergency context?

  5. What does this mean for women and girls? • Very taboo – women don’t often discuss with women, mothers don’t always discuss with daughters • Girls reaching onset of menstruation – scared, not know what to do • Myths, traditional practices – some can be dangerous / problematic • Cost / availability of sanitary materials/washing/drying/disposing • Need for water • Need for privacy • Poor hygiene practices • Girls don’t go to school / loose time from school • ... Implications MHM - M&T 1 Pp: 22-40 Pp: 213-236

  6. What does this mean for women and girls in an emergency context? • Lost old coping mechanisms • May not have access to usual sanitary materials • Living in a tent with fathers, brothers, uncles, strangers • May not have a gender segregated private location to bathe • May not have adequate volumes of water • May not have a container to soak or wash cloths • Where to dispose of soiled menstrual materials • Nowhere private to dry their cloths • ... Implications - emergencies MHM - M6 PP: 131

  7. Taboos and myths http://www.adweek.com/news/advertising-branding/straight-talk-menstruation-ad-thats-causing-quite-stir-147501

  8. Examples of restrictions on girls during their menstrual period in Afghanistan, India, Iran and Nepal Cultural and religious beliefs, norms and myths MHM - M&T 1 Pp: 25-29 Pp: 213-215

  9. Health and ‘menstrual hygiene’ • Limited / patchy documented evidence of link between menstrual hygiene and health • Except Toxic Shock Syndrome (rare condition) • Issues around insertion of unhygienic materials into vagina • Douching (forcing liquid into the vagina) - increased incidences Thrush & Bacterial Vaginosis • Use of damp cloths, or using a soiled cloth for too long – irritations Health & MH MHM - M&T 1 Pp: 32-37 Pp: 227-236

  10. Health and ‘menstrual hygiene’ • Vaginitis due to allergic reactions to sanitary products - women with sensitive skin • Risk of disease transmission from poor handling of menstrual blood – such as HIV, HepB (with ARVs – women with HIV menstruating) • Physiological stress – concern over smell, leaks, how to manage menstruation • May prevent engagement in schooling or other activities • Transactional sex to buy sanitary protection materials Impacts on schoolgirls MHM - M&T 1 Pp: 32-37 Pp: 227-236 Health & MH MHM - M&T 1 Pp: 32-37 Pp: 227-236 Health & MH MHM - M&T 1 Pp: 32-37 Pp: 227-236

  11. Health and ‘menstruation’ • Some risks possible of lower reproductive tract infections (RTIs) moving to be upper RTIs and possible to turn into Pelvic Inflammatory Diseases (PIDs) – due to increased penetrability of the cervical mucus and menstrual blood moving back into the uterus, including during sexual intercourse • Women who have had infibulation undertaken – can have blockages / clots and increased pain during menses • Men may make the decision on when the wife can seek health treatment – reluctance to discuss reproductive health issues Health & MH MHM - M&T 1 Pp: 32-37 Pp: 227-236 FGM MHM - T7 P: 331

  12. Health and ‘menstruation’ • Pre-menstrual syndrome (PMS) • Heavy and prolonged bleeding (Menorrhagia) • Pain, back aches, abdominal pains, cramps (Dysmenorrhoea) • Risk of transmitting HIV, HepB etc increases during sexual intercourse during menses (woman to man) • Risk of Bacterial Vaginosis and TrichomonasVaginalis can increase during menses Health & MH MHM - M&T 1 Pp: 32-37 Pp: 227-236

  13. Not related to menstruation but may use menstrual products • Fistula • Urinary incontinence • Faecal incontinence Fistula - can occur e.g.: • Young girls following protracted labour • Result of rape • Following pelvic operation Urinary incontinence – can occur e.g.: • Elderly • After child birth • Unlucky with urinary system functioning • One in three women expected to suffer from urinary incontinence in their lifetime Menstrual products however not ideal – as liquid volumes tend to be higher with incontinence Incontinence MHM - T7 P: 330

  14. Why should menstrual hygiene be considered in emergency contexts?

  15. Why MHM should be responded to in emergency contexts? • Hygiene - meeting adolescent girls’ and women’s hygiene needs • Protection – dangers for adolescent girls and women not provided with adequate safe facilities (GBV) and adequate sanitary materials (including transactional sex) • Dignity - crucial for girls and women to feel confident to engage in survival and other daily activities • Practicality for survival - girls and women may have to queue for long periods for life saving food, water or other provisions for essential needs • Education - can lead to girls missing school Adapted from Sommer, M (2011) Waterlines

  16. Cross-sectoral issue Cross-sectoral MHM - M2 Pp: 48-50

  17. Boys and men’s need for information on MHM? Boys and men MHM - M2 Pp: 56-59

  18. Should male staff be directly involved in discussing menstrual hygiene with women and girls affected by emergencies?

  19. Training staff, building confidence Training of UNHCR and partners on MHM, Uganda Getting started MHM - M2 & T6 Pp: 51-55 PP: 318-20

  20. Training staff, building confidence • Encourage talking about MHM – breaking the silence • Sharing information • Opportunities for male staff to also learn and build confidence in discussing MHM Training of UNHCR and partners on MHM, Uganda

  21. Menstrual Hygiene Matters A resource for improving menstrual hygiene around the world

  22. Team: Therese Mahon, Sue Cavill and Sarah House Contributors: Collaborative approach – inputs from individuals and organisations across the world - Reviewed by 21 experts including MSF - Co-published by 18 organisations Jointly funded by: UK Aid from the UK Department for International Development (DFID) under the SHARE Project and WaterAid

  23. Modules & Toolkits

  24. Module & Toolkit 1 – The basics • Why considering menstrual hygiene is important for all • What is menstruation? • Cultural and religious beliefs, social norms and myths on menstrual hygiene • Girls’ first experiences on menstruation • Girls’ experiences of menstrual hygiene in school and their impact • Health problems related to menstrual hygiene • How women and girls can keep themselves healthy during their menstrual period

  25. Module & Toolkit 6 - Menstrual hygiene management in emergencies • Getting started • Standards and guidelines on menstrual hygiene in emergencies • Practical menstrual hygiene interventions in emergencies __________________ • Specific examples relevant to emergencies also in other modules: • Module 3 – Re-usable pads made by women refugees in Dadaab Refugee camp , Kenya • Module 7 - MakaPads (made from Papyrus) made by women and men abducted by the Lords Resistance Army, Uganda

  26. Standards and guidelines relating to MHM in emergencies Sphere MHM - M6 Pp: 136-8 UNHCR MHM - M6 P: 139 Inter-Agency Network for Education in Emergencies – Gender responsive school sanitation, health & hygiene MHM - M6 Pp: 140-1

  27. Sphere Increasingly detailed mention of MHM from 2000, 2004, 2011 versions Focussed on: • Consulting users on selection and design • Privacy of latrines / toilets • Provision of private washing areas • Provision of sanitary materials • Availability of disposal mechanisms Gaps: • No mention of water in latrines • Could have been stronger on providing screening latrines and bathing units for privacy, increasing sizes of units • No family plastic washing basin included in priority NFIs, no mention of issues around only one basin for washing cloths and dishes

  28. Accessing the Menstrual Hygiene Matters manual • Free download (complete copy or by module, high and lower resolutions) from: www.wateraid.org/mhm

  29. UNICEF research into MHM in emergencies 2012 Hayden, T (2012) Menstrual Hygiene Management in Emergencies: Taking stock of support from UNICEF and partners Handout – summary of findings Handout (later) – FGD questions Full report on resource CD

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