WASH in Schools: Empowers Girls’ Education

To provide an opportunity for sharing menstrual hygiene management (MHM) research
and practice, and to enable joint discussion on the way forward, Columbia University’s Mailman School of Public Health, New York, United States, and the United Nations Children's Fund (UNICEF) co-hosted the MHM in Schools Virtual Conference on September 27 2012. The conference highlighted "outstanding efforts to tackle the MHM challenges schoolgirls face, a topic that until recently was considered too secretive and taboo to address in most contexts." [As defined here, MHM involves: using a clean material, which can be changed in privacy, to absorb or collect menstrual blood; using soap and water for washing the body as required; and having access to facilities to dispose of used menstrual management materials.]

The MHM in Schools Virtual Conference was attended by more than 200 online participants, plus 30 in-person attendees, including water, sanitation and hygiene (WASH) and MHM experts, global health and education experts, and UNICEF country offices currently implementing MHM-related activities. Through online (WebEx) presentations, 13 UNICEF country offices shared their MHM practices.

"The WASH in Schools programmes have a fundamental role in creating school environments that make it easier for girls and female teachers to manage menstrual hygiene. As emphasized in discussions during the [MHM] in Schools Virtual Conference, these programmes should assure that girls’ experiences in school are more comfortable and conducive to learning by providing appropriate facilities and enriched hygiene promotion activities that include MHM topics."

Four research teams from UNICEF and the Center for Global Safe Water at Emory University are studying (in 2012 and 2013) MHM barriers in Rwanda, Bolivia, the Philippines, and Sierra Leone through examining the web of social and environmental contexts, interpersonal dynamics, and individual-level circumstances and, at the societal level, exploring factors relevant to current public policy, local traditions, cultural beliefs, and social norms, as well as environmental qualities of school water and sanitation facilities and the availability of MHM resources such as sanitary napkins. They are using: discussions; a desk review of literature and policy; observation of resources; in-depth interviews with girls, their teachers, and school administrators; and focus group discussions with groups of girls, boys, and mothers.

A session on approaches to addressing MHM for girls included discussion of water and sanitation facility interventions, the development of pragmatic guidance materials on puberty for girls, the production of local sanitary materials, and some policy-focused interventions. "Specific recommendations for action suggested during this session include:

• Develop guidelines for minimum standards on implementing, monitoring and evaluating menstrual hygiene management in development contexts.
• Provide factual and pragmatic MHM guidance that girls can access privately and that is not dependent on teachers, given the predominance of male teachers in many schools and existing disciplinary dynamics of many teacher-student relationships.
• Integrate sensitivity training on menstrual hygiene management into teacher training curricula.
• Identify simple design innovations to efficiently and effectively enhance MHM facilities in schools for girls and female teachers. These designs may include privacy screens, full-length mirrors, dustbins for disposal, incinerators, buckets of water inside latrines or toilet stalls, and doors with locks on stalls.
• Establish peer clubs focused on MHM and other activities, including mentoring by female teachers and older girls, to support and encourage girls in school.
• Explore the sustainability of new sanitary protection products under development in various countries, including how such products can be profitable and disposed of in an environmentally safe manner."

The conference document conclusions emphasise multi-sectoral involvement to address needs of girl students and female teachers, including: the water and sanitation community; researchers and practitioners focused on behavioural change and social norms to assure appropriateness of design and uptake and usage of MHM-adapted facilities; and the education community, both in schools and at the policy level. According to the document, the collaborators should work with available evidence to identify knowledge gaps for effective response and focus on activities that can go to scale, as well as foster involvement of surrounding communities to create and enabling environment for girls. The value of collaborative approaches between academics, practitioners, and global organisations was also recognised.

The three recommendations identified are the following:

"Recommendation One: Document current [MHM] practices and the barriers girls face....Strengthen the evidence base...to understand the relation between inadequate MHM programmes and girls’ school performance and attendance. Conduct research that enables individual countries to better understand the MHM-related barriers facing girls and female teachers.... Consolidate and share experiences on the most efficient and cost-effective interventions.

Recommendation Two: Develop guidelines for integration of a minimum package for [MHM] into existing WASH in Schools programmes. Guidelines may include policy guidance on implementation, facility designs, and monitoring and evaluation of MHM programmes.

Recommendation Three: Engage with national governments from the very beginning when initiating [MHM] activities to ensure buy-in and additional support for multi-sectoral involvement.... It is necessary to explore additional avenues and expand existing programmes... to reach girls and communities. Such activities should include MHM guidance and encourage girls’ self-efficacy and confidence.... Moreover, communities should be aware of the barriers to [MHM] that girls face in school, as well as their role in enabling girls to successfully manage menses in school and at home."