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Women, WASH and MHM

As 'World Toilet Day' just passed (a day which raises awareness of tackling the global sanitation crisis to achieve SDG 6), I thought it would be appropriate to explore the links between water, sanitation and hygiene (WASH) and gender. Despite the fact that North Africa's coverage of access to sanitation is at 90%, Sub-Saharan Africa (SSA) only has a 30% coverage (UN, 2014). It has been recognised that a lack of access to WASH facilities disproportionately affects the health of those who are menstruating (Corburn and Hildebrand, 2015). Today, I will look at how a lack in WASH facilities can facilitate 'period poverty' and how menstrual health management (MHM) can be improved. 

Period Poverty

I admittedly did not know about period poverty until a girl in my school started the 'Free Periods' campaign. I soon learned that period poverty is the lack of access to 'sanitary products, menstrual hygiene education, toilets, hand washing facilities, and, or, waste management' for financial reasons or otherwise (Global Citizen, 2019). In SSA countries like Kenya, it has been found that many girls and women can't afford appropriate sanitary products and instead use inadequate alternatives such as cloths or newspaper (Corburn and Hildebrand, 2015). School girls are particularly affected by this as they have a high risk of leaking through these unsuitable alternatives and being shamed at school by peers (Sommer, 2010). Socially, period poverty is also worsened by cultural norms and the taboo of perceiving periods as dirty (Abrahams et al, 2011). The lack of education about periods in schools, as well as at home with family members, can create a sense of shame and confusion around menstruation (Higgins, 2017). As a result of these factors, one in ten girls from SSA miss school while menstruating (UNESCO, 2014); in Kenya, around 3.5 million school days are missed by girls because of the lack of WASH facilities (Corburn and Hildebrand, 2015). In turn, period poverty becomes an obstacle to educational progression for girls and hinders their long-term 'capabilities and substantive freedoms' which is crucial for sustainable development (Sen, 1999). 

Figure 1: A photo from my A-Level Art project which looked at the taboo and shame behind periods

Menstrual Health Management: Hardware vs. Software Interventions

Interventions for period poverty, or MHM, can broadly be split into two components: hardware and software. Hardware interventions refer to physical infrastructures such as WASH facilities and sanitary products, whilst software interventions refer to the education around periods for women and men (Ssewanyana and Bitanihirwe, 2019). 

Hardware

Quite often, WASH facilities across SSA do not account for the needs that women have in relation to periods, such as the need for privacy and hence lockable doors, or the disposal of sanitary products (Crichton et al, 2013). This inadequate management of menstruation is integral to address the opportunities and well-being of school girls in particular; a study in Zambia found that it was girls (in grades 5-7, when girls usually start menstruating) who were the majority of drop-outs in schools without adequate WASH facilities (Agol and Harvey, 2018). Another study in Zambia found that the lack of provision of sanitary products in schools led to the use of unsuitable alternatives (Chinyama et al, 2019); this would leave them vulnerable to reproductive tract infections and skin irritations (Anjum et al, 2019). Ultimately, the adequate provision and access to menstrual products, as well as improved WASH infrastructures, are integral to targeting MHM (UNFPA, 2017). 

Software

Whilst the supply of sanitary products and improved WASH facilities will certainly contribute to MHM, this will arguably achieve little without a widespread education surrounding menstrual hygiene and the breakdown of socio-cultural norms. As discussed earlier, the taboo and stigma around periods has created a sense of shame around the topic, to the point where people feel to uncomfortable to talk about it in schools or even at home (Ssewanyana and Bitanihirwe, 2019). If menstrual heath education can be infiltrated through schools and families to increase awareness of how periods work, perhaps these taboos and stigmas can be broken down (Kirk and Sommer, 2006). It is especially important though that this education on periods is focused on both men and women so that men can understand the importance of women's menstrual needs (Tull, 2019).

What Can Be Done?

Ultimately, the lack of women who participate in the management of WASH facilities results in the menstrual needs of women being ignored. Hardware and software interventions to MHM will certainly help to alleviate period poverty, however, a greater number of women being involved in WASH management at a government or grassroots level will improve the effectiveness of these interventions (UN Water, 2006). For the future, I believe that the research on MHM should also look beyond how this issue affects school girls; an expansion of this to women at different stages of life and in different contexts would be more informative. It is also important for this expansion to look beyond women and consider transgender and non-binary individuals too, given that they are often overlooked in development narratives. 

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