1. The secret world of Menstrual hygiene and management
Mita Gupta, Gender and Rights Unit, UNICEF HQ Social Norms Course, UNICEF/Penn
12 June 2012

2. The issue of ‘hardware’
Toilets
Sanitary Napkins
Lack of access
Not affordable
No doors, close to boys’ toilets – lack privacy
No means for disposal
No water source within or nearby

3. Factual and normative beliefs about menstruation
Menstrual blood is dangerous
Menstrual blood is dirty
Impurity
Religious beliefs
Silence, secrecy
The mythical belief that menstrual blood is dirty and toxic can be traced to the writings of the early Greeks and Romans (Allen & Fortino, 1983; Delaney et al., 1988; Knight, 1991)
Roman natural history books, myths abound about the potential of menstruating women turning wine sour, causing seeds to be sterile, (Mahoney, 1988). The woman was believed to be capable of destroying entire crops and wilting plants if she walked by them.
In Hindu socio-cultural practices woman abstained from worship and cooking and stayed away from her family, as her touch was considered impure during this period.
In Jewish tradition, a woman was ritually impure during menstruation and anyone or anything she touched was considered impure as well.
Western Europe reveals a similar history of taboos and beliefs against menstruating women. In Pre-modern Europe, for example, a woman in her menses was seen as capable of causing ‘meat to go bad, wine to turn sour, and bread dough to fall’ (Thuren, 1994: ).
In traditional Islam, a menstruating woman was considered vulnerable and polluted; therefore she could not pray, fast, or have sexual intercourse. 

4. The social norm of silence, secrecy
“That’s how it has always been”
“It is normally kept secret, you would not allow the other people to know this.”
Empirical expectation
Societal expectation to keep this hidden
Sanction: shame, embarrassment, disapproval, teasing
Normative expectation
Study carried out in Western Kenya (Nyanza Province) as part of the Sustaining and Scaling School Water, Sanitation and Hygiene Education Plus Community Impact (SWASH+) Project in schools in Nyanza Province,Kenya.
SWASH+ is an applied research project that seeks to identify, develop, and test approaches to school-based water, sanitation and hygiene in Nyanza Province, Kenya. The partners that form the SWASH+ consortium are CARE, Emory University, the Great Lakes University of Kisumu, the Government of Kenya, the Kenya Water for Health Organisation, and (formerly Water Partners International).
Method – in-depth interviews, FGDs, and observation.
Several girls noted a societal expectation to maintain secrecy about menstruation. It is something that should not be discussed.

5. Why does it matter?
Health consequences
Infections
Shame in seeking medical attention
Education impacts
Absence from school
Reluctance to participate
Inability to concentrate
Poor conditions of the toilets and lack of privacy and hygiene facilities resulted in girls’ absenteeism from school.
And even when in attendance, girls reportedly withdrew from school related activities –both within and outside the class.
An example of the impact:
A UNICEF report (2004) confirms that on average, in Kenya, 1 in 10 schoolgirls did not attend school during menstruation. This translates to a considerable 10 percent of the schoolgirls who missed school several days in a month.
It is estimated that girls living in sub-Saharan Africa could miss, on average, up to four days of school each month because they lack the basic necessity of sanitary protection as well as other resources needed to manage their periods. This in effect means that such girls could miss 10 to 20 percent of school days each month and consequently, each year (Hero, 2008; Protecting Futures, 2008). (Protecting Futures is a comprehensive care program which aims at bringing puberty education to schools in southern Africa among other health related activities)

6. Char Bramagacha Village
Community worker
Set up hygiene education groups
Approached women, men and a teacher of a non-formal school
Spoke with girls about menstrual hygiene and management
Also spoke with men and boys
As part of a hygiene promotion initiative under the SHEWAB (Sanitation, Hygiene Education and Water Supply in Bangladesh) programme, community workers were trained to address issues related to hygiene, especially, menstrual hygiene and management by speaking with girls in schools.
Most mothers do not speak to their daughters about menstruation.
Girls cannot afford sanitary napkins and use/re-use rags
Approached women and men in the community about hygiene education groups – this includes proper use of latrines, handwashing
and she approached Ms Farida Parvin, the teacher of an NGO-funded non-formal school about starting hygiene education classes with her students.

7. Key elements Entry point – talking about hygiene issues in general
Not just girls, but reference group
Making the private public
Spontaneous diffusion
Shift in empirical expectations; erosion of normative expectations

8. Some points to consider
Discussions with parents as key members of the reference group
Separate discussions with girls, boys, parents, teachers and then bring together common knowledge
Re-enactment of what girls face – teasing, bullying
making the private public
Commitment from schools to continue talking about puberty, reproductive health (incl. female teachers/mentors) sustainability
Discussions with parents as key members of the reference group – broached in context of value of ensuring daughters’ health and avoiding infection.

9. Some points to consider
Link to facilities/ ‘hardware’
Link with CLTS efforts – ensure consideration of needs of girls/women in terms of toilets
Speak with women’s groups, tailors, local manufacturers about local, low-cost options
Missing school remained an issue as girls had nowhere to change/wash their rags in school or to dispose of them.