Menstrual Hygiene – The cycle of shame IT Menstrual Hygiene – The cycle of shame Fiona Ward WASH Section Bangladesh Country Office July 2013

Background information on Bangladesh Population of almost 150 million people (2011) The most densely populated country in the world (1015 people per square kilometre) Vulnerable to natural disasters, including cyclones, droughts, flooding and earthquakes Ranked 146th out of 187 in the HDI ranking 43% of the population living on less than US$ 1.25 per day Bangladesh is a predominantly Muslim country, conservative Predominantly rural (Urban: 23.3%) Recent trends: rapid urbanisation, working women and Middle income Status (2021) Positive examples of community mobilisation: BRAC, Micro-credit (Grameen bank), CATS and ORS

Menstrual Hygiene - why is it important? In some communities girls are removed from school to reduce the risk of girls being attacked on the way to or from school which would bring shame upon the family, if the girl becomes pregnant. There is a sense of shame bestowed upon the girl and her participation in various practices (Ramadan, consummation and preparation of particular food types) is restricted. Reduced attendance and attention rates in schools due to a lack of adequate and appropriate facilities. Reproductive tract infections due to unsafe menstrual hygiene management owing to a lack of information on what menstruation is, and how to manage it safely. The need to hide menstruation necessitates that girls and women must travel before dawn to waterbodies to wash, raising protection concerns.

The issues? Menstruation seen as being ‘unclean’ (Koran) - Shame associated with anything related to menstruation Shame is manifested through a silence on the topic – it is rarely discussed between mothers and daughters, or in school and the needs are ignored Lack of data Restricted movement of women and activities (excluded from society/communities/Ramadan –eating/preparing certain foods) Quite a variety of restrictions across the country Superstitions relating to genies and misfortune happening to men who come into contact with the blood Girls use old saris as - often not cleaned or dried properly leading to Reproductive / Urinary Tract Infections

Even more issues … Inadequate facilities in school for washing and drying properly and so girls miss out up to one week a month (quarter of their school time), contributes to increased drop out of girls from school (hard to catch up) Generally, poor access to adequate WASH facilities in schools – in secondary schools, mixed schools, high student ratios, facilities often not maintained or functioning Often girls sit all day with one pad Tense that there might be staining (reduced concentration) Most Secondary School Teachers are male – not discussed in class

To be a Social Norm or Not to be? Why is it a Social Norm and not a custom or Descriptive Norm? – Empirical Expectations: there is a belief that most people do not speak about the subject – Normative Expectations: there is a belief that you should not to speak about the subject, and to do so would incur shame (negative sanction) Extent of Pluralistic Ignorance?

Schema and Scripts? Good Mother: maintains the family’s honor, upholds the concept that menstruation is unclean, prioritizes the needs of her family above her daughter/s, expects her daughter to find out about menstruation through her own network, hides her own menstruation, continues on the tradition as her mother and grandmother did Good Daughter: does not seek advice on how to manage menstruation from her mother or seniors, manages her problems herself, hides her menstruation to not contaminate her father/brother/neighbor, does not bring attention to herself, does not taint the family honor, will get married and to have children and carry on the shame and the silence Good Teacher: does not pollute the class or the students with talk of unclean topics, directs the students to the relevant chapters in the books and maintains the sense of order in the community Menstruation: is ‘Unclean’, and should be hidden and managed independently, will be endured without complaint or attention.

Interventions to date? Historical interventions have predominantly concentrated upon one manifestation of the problem …. … Build build, build, build latrines and more latrines and even more latrines …. And even more latrines, some had water, others didn’t Some orientation on Menstrual Hygiene Little money or thought on how to maintain the faciliites

Possible future interventions using a Social Norms approach? National level discussion on whether it is even deemed to be an issue Five pilots where School led Total Sanitation is underway (in communities where it is successful) Surveys … to assess the Empirical and Normative Expectations, from this, the Pluralistic Ignorance Determine the Core Groups and conduct Values Deliberation sessions Development of a Community Action Plan Share the findings at a national level Piloting of the new menstrual hygiene management facilities and monitoring their effectiveness Conducting a review of the new WASH in School standards to assess the adequacy of the coverage of menstruation Cooperation with private sector to scale-up production of hygienic sanitary materials, as an income generation activity Investigation of more hygienic alternatives to rags and pads

Communication Strategy Develop a message to transition from the ‘Unclean’ association to one of ‘Celebration of Fertility’. Koran – sensitivity – reinterpretation. In addition, there is honor in cleanliness and taking care of your body, as outlined in the Koran and this could be endorsed by Imams and communicated during prayers. Adopt a Ready for the Change Champion symbol (visible by wearing a white bracelet or hat with the symbol, and the symbol would be from Bangla tradition) - to make change more evident. Power within girls and women Carry out additional training to the School Brigade to make them Champions in school Advocate for Positive Role Models to be identified and to become Mentors for young girls, (these mentors could also be entry points for other campaigns) Community Declaration through a Ready for the Change Celebration Radio shows for girls, together with medical and teaching representatives Village level discussions including at mosques and temples, with Ready for the Change Champions (Natural Leaders) Village theatre (paut shows)

Organized diffusion, not confusion At a national level Creation of an adolescent sister for Meena Inclusion of the issue in popular soap operas District competitions to reward the most ‘Ready for the Change’ village through agreed ways of classification Designation of high profile Ready for the Change Champions (successful females, as well as males and respected senior figures) Declaring a National Ready for the Change Day

New Schema and Scripts? Discussions … at different levels … revision of the scripts for the Girls and Mothers, wherein ….. Power within …. …. Proactivity and the demand for information and facilities – needs supported and expected For the Menstruation script, this could be transformed into something empowering, which makes girls special and something which needs to be supported for the benefit of the whole community. An alteration of the Bangladeshi citizen script: citizens of Bangladesh have strong communities, these communities support girls and boys to have access to adequate facilities and information to be able to maintain their hygiene and to be, and produce, healthy Bangladeshi citizens

Solved? The likely time-frame is significantly in excess of any standard donor-funded intervention ==> So, it is essential that …. The government of Bangladesh + key multi-sectoral actors (including UNICEF) + high level commitment + long term funding = sustainability Coordinate with other interventions e.g. child marriage and reproductive health

The likely time-frame is significantly in excess of any standard donor-funded intervention ==> So, it is essential that …. The government of Bangladesh + key multi-sectoral actors (including UNICEF) + high level commitment + long term funding = sustainability Coordinate with other interventions e.g. child marriage and reproductive health

Laws without morals Norms, and Legal Obedience are useless