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‘Awareness building still key to improving menstrual hygiene management’

  • Published at 08:12 pm August 27th, 2019
Round Table
Rokeya Kabir, Chair of Menstrual Hygiene Management (MHM) Platform, centre, addresses the roundtable jointly organized by Dhaka Tribune and RedOrange Media and Communications at CIRDAP on July 16, August 27, 2019 Mahmud Hossain Opu

The meeting was facilitated by Imrul Hasan Khan, Director, Programmes and Operations, RedOrange Media and Communications

RedOrange Media and Communications and Dhaka Tribune jointly organized a consultative meeting, titled “Reflection on MHM Learning: National MHM Strategy.” Md Zahirul Islam, Additional Secretary of the Local Government Division under the Ministry of Local Government, Rural Development and Co-operatives, was present as the chief guest at the event, which was chaired by Rokeya Kabir, Chair of Menstrual Hygiene Management (MHM) Platform and Executive Director of BNPS.

The meeting was facilitated by Imrul Hasan Khan, Director, Programmes and Operations, RedOrange Media and Communications.

The meeting’s objective was to share information, opportunities and challenges of MHM among stakeholders in order to help formulate The National MHM Strategy.

Mahbuba Haque Kumkum, Programme Manager, Simavi

Based on Ritu Program’s findings, two topics stood out — education and wash. When dealing with menstruation, we needed an improved educational channel to disseminate correct scientific data. An obstacle to this is a mother taboo that claims that menstrual blood is polluted.

Breaking this one will remove 80% of all taboos. To that end, we needed to create a sustainable source for correct information in order to educate our youth. So we focused on educating schoolteachers and families as the primary source of information, producing effective results.  Furthermore, education officers should monitor how effectively teachers are educating students on sensitive issues, including but not limited to menstrual hygiene.

We also need to improve the school wash systems. We have tried to build awareness in this regard, and we felt that an information dissemination system to let the schools and community know about the budget for realizing MHM toilets should be developed between the local government and the school and community to produce the best results.

Nakib Rajib Ahmed, Head of Programmes, RedOrange Media and Communications

Lack of awareness is the root cause behind every taboo, misconception and social stigma around menstruation, and a significant aspect of the Ritu Program is building that awareness and advocacy around menstrual hygiene management on a national level.

Working on this, we have learned two major things. First, on a national level, using edutainment and infotainment involving mass and social media campaigns have a big impact in raising awareness.

We produced a 13-episode reality TV show, where we learned that if we can get the target audience directly involved, it gathers massive acceptance and credibility. If these people are talking about it publicly, then the taboo is broken to a large extent and people can start having a more positive outlook on menstruation.

The second most noteworthy learning comes from our journalist fellowship program, where we provided orientation to 90 journalists. It had a transformative effect on these journalists, and now they identify MHM as a significant aspect of women’s health, which has, in‌ ‌turn, inspired them to write extensive news reports on the topic.

Nakib Rajib Ahmed, Head of Programmes, RedOrange Media and Communications

Lack of awareness is the root cause behind every taboo, misconception and social stigma around menstruation, and a significant aspect of the Ritu Program is building that awareness and advocacy around menstrual hygiene management on a national level.

Working on this, we have learned two major things. First, on a national level, using edutainment and infotainment involving mass and social media campaigns have a big impact in raising awareness.

We produced a 13-episode reality TV show, where we learned that if we can get the target audience directly involved, it gathers massive acceptance and credibility. If these people are talking about it publicly, then the taboo is broken to a large extent and people can start having a more positive outlook on menstruation.

The second most noteworthy learning comes from our journalist fellowship program, where we provided orientation to 90 journalists. It had a transformative effect on these journalists, and now they identify MHM as a significant aspect of women’s health, which has, in‌ ‌turn, inspired them to write extensive news reports on the topic.

Mahjabeen Ahmed, WASH Specialist, UNICEF

National hygiene promotion strategy of Bangladesh has emphasized on menstrual hygiene. When national hygiene surveys are conducted, a number of indicators are included which paints a clear picture of the situation.

Within its support to ensure the sustainability, UNICEF has suggested to include very important elements in the strategy: informing  girls on menstrual hygiene issues at early age before  menstruation starts, operation and maintenance of WASH facilities at schools and other institutions, emergency preparedness plan eg during natural disasters, reinforcement of public-private partnership, disposal methods at homes, schools and workplaces, community engagement for breaking taboos, making appropriate use of  technological advancements, development of appropriate and gender sensitive IEC/BCC materials, involvement of men as they have many important roles in the society such as father, husband, colleague, classmate and professionals and better knowledge management through dissemination of best practices of different stakeholders.

Dr Ikhtiar Uddin Khandaker, Head of Health Programme, Plan International Bangladesh

We have focused our SRHR efforts in hard to reach locations like coastal and hilly areas. We should continue to create partnerships with the union council. In our experience, it has produced better results since these councils have a budget allocated exclusively for SRHR; they even helped install toilets.

With regard to informing students about MHM, we suggest creating interactive and engaging channels apart from the standard curriculum. This allows students to feel more interested and helps them absorb the information better.

Md. Zahirul Islam, Additional Secretary, Local Government Division

The government is in the process of creating an MHM strategy through a working committee with me as its chairperson. In this meeting, we have already discussed the need for awareness, infrastructure, regulatory reform, availability of products and pads, and budget allocations, and I am certain these discussions will bear fruit.

Menstruation is a natural phenomenon and our people’s representatives, guardians, parents, teachers and religious authorities need to exercise an ideal social perspective toward it. To bring this about, we need an all-encompassing social movement with the Ritu Program as the pioneer behind it whose experience can prove invaluable to us.

I would request every institution to include madrasas whenever they are working to create MHM awareness in schools. Since madrasas are managed by the government, it is often easier to work with them than with schools. With Islam having specific guidelines related to menstruation, we need to work on sensitizing our religious leaders as well, thus removing religious obstacles currently predominant in society.

Private contributions outweigh government contribution in case of MHM because the government does not have sufficient resources to take a financial lead on this. The government will focus on vulnerable groups and be responsible for their development.

Lastly, I would like to point out that our communication regarding MHM has become primarily English-centric and I suggest that we make a comprehensive Bangla version available as well. This will help increase reach and is likely to produce far more effective results.

Mahfuj-ur Rahman, Equity and Rights Specialist at WaterAid Bangladesh

We have been working on a project called WASH in School since November 2016 with the aim to address WASH inequalities at secondary school and madrasas across the country. At the initial phase, the project encompasses approximately 350 secondary schools and madrasas from 76 upazilas in greater Rangpur, Sylhet and Dhaka division.

In our experience, infrastructure is crucial for MHM, that is why we tried to follow a gender-friendly inclusive model and it has seen significant development over the years. An integral part of it is an exclusive restroom reserved for MHM, primarily because although there are latrines in most schools, such restroom that allows changing sanitary pad is not available almost anywhere.

On disposal, the ministry circular states that every school needs to have a lidded bin exclusively for pad disposal. But carrying that bin away for further disposal becomes an issue. That is why we came up with a sustainable plan — the bin would house a pit behind it to collect pads. In about three years when the pit is filled to capacity, these pads will get incinerated. These restrooms are also equipped with washing and drying facilities of sanitary materials.

Md. Enamul Haque, Joint Secretary, Education Ministry

Under the Ministry of Education, we have 10,000 madrasas covering 100,000 students. There are plans for 1,800 more madrasa buildings, and according to our SDGs, each building should have at least two wash blocks.

MHM is often not in focus as a part of the fourth SDG and to address that, we should include the madrasa training centre in our strategy.

Md. Iqbal Hussain, Joint Secretary, Women and Children Affairs Ministry

It is an undeniable fact that MHM is still a taboo in our country. Last year, our ministry carried out a project to ensure adolescent girls’ menstrual health by producing and distributing sanitary napkins.

I was appointed as the project director, but after doing a little research, I notified the ministry that it would be difficult for me to carry out my responsibilities the project’s sensitive nature. Later, a woman was appointed in my place.

We have to acknowledge these realities when dealing with MHM.

Dr Bilkish Begum, Deputy Secretary, Health Services Division

Speaking of hygiene management, in the Health Ministry, women starting from the rank of deputy secretary all the way to peons do not have access to a toilet exclusively reserved for ladies. As a workaround, we use the library toilet and that too takes some effort. I hope this will be addressed in the near future.

Dr Mahbubur Rahman, Project Coordinator, EIU, icddr,b

In the national hygiene surveys of 2015 and 2018, hygiene product usage rates showed 85% of all women used cloth pads. In 2018, sanitary pad usage increased, bringing cloth pad usage to 73%. The usage of sanitary pads was most prevalent among adolescents.

In one research, we gave both cloth and sanitary pads to schools to determine preference patterns. Results showed a preference for both. The challenge with cloth pads was drying and washing while that of sanitary pads was the availability of proper disposal methods. Increased MHM awareness in schools also decreased absenteeism to an extent.

We need to orient girls and women on how to use these pads hygienically. We also need to focus on making these products as biodegradable as possible and help facilitate the pad disposal process.

Zobair Hasan, Director, DORP

We started bringing MHM to the forefront of discussion since 2014. Of the 11 directives issued in a 2015 circular, the first stated that there will be sufficient fund allocation for MHM. As in a few other cases, there is no exclusive budget allocation for MHM; it is fragmented over multiple allocations.

The 2019 Global Analysis and Assessment of Sanitation report states that 80% of the country’s health and sanitation costs are borne by families. The case is quite similar for schools as well. We look forward to seeing our government create a policy that will acknowledge our recommendations.

In our 17 SDGs, the fourth SDG states that women should have separate toilet facilities and we should work to achieve this goal by providing this facility all over the country. The SDG Planning Commission has allocated a budget which amounts to Tk1,186 per individual. Our local representatives need to be aware of this since the budget needs to be implemented in the grassroots.

Reaz Ahmad, Executive Editor, Dhaka Tribune

Objectively speaking, we need to acknowledge that we are not doing too badly as far as providing basic hygiene necessities are concerned. Comparatively, in many rural areas of India, women do not have access to proper toilets, let alone MHM facilities.

Almost 100% of our country has access to some form of hygiene facility. Putting the three stakeholders — our government, NGOs and charities account for 33% of the total health budget. That means 67% of our health expenditure is out of pocket, which is one of the highest in the world.

Since the ‘70s, we have been getting exceedingly better at health management even through natural disasters such as cyclones and floods. But, we need to prioritize on addressing how people slip back into poverty because they cannot cope with the high health budget.

The irrational levels of VAT applied to MHM products and ingredients only contribute to the problem. Removing these taxes will benefit not just women but future generations. Issues such as MHM and early marriage need to be addressed immediately, otherwise, we will not be able to begin reducing malnutrition and stunted growth for our future generations.

Nasrin Begum, Unite for Body Rights

We are working to incorporate MHM strategies in the NCTB curriculum. NCTB has announced that after 2020, the books up to 10th grade will include MHM and SRHR as a part of life-skill education.

We need to try to incorporate SRHR and MHM in the public and private teachers’ training institutions; only then can we have a major impact on a large group of adolescents. Lastly, we should develop a few web-based tools as part of the strategy in order to virtually connect to every adolescent in the country.

Alok Majumder, Country Coordinator, WAI, Simavi

MHM should not be simply about women since it affects reproductive health and thus our entire future generation.

According to a 2019 government report with survey data from 2013 and 2018, although 84% schools have latrines, only 22% have access to soap and water and only 13% has MHM systems in place.

Among these latrines in schools, 55% remain locked which needs to change. The previous survey showed 40% absenteeism and the current survey shows a 10% decrease, which is a sign of good progress.

Currently, the ratio for the number of students to toilets is 187 to 1, while our government’s target is to take this ratio to 50 to 1.

Md. Abdur Rauf, Joint Secretary, Policy Support Branch, Local Government Division

The National Hygiene Promotion Strategy 2012, the first legal document on MHM, first saw the inclusion of MHM in Bangladesh. One of the 10 strategies mentioned in it was the Behaviour and Social Change Communication (BSCC) strategy and its primary focus was personal hygiene including menstrual hygiene.

Previously we did not have any data on the state of menstrual hygiene. So in 2014, we conducted a survey under the local government in collaboration with icddr,b and Water Aid. 

The results showed that 86% of all women use cloth pads and over 30% are not aware of MHM until it happens to them. However, our most recent survey data, which is yet to be published, shows that the percentage of women using cloth pads has dropped by 13%.

In 2018, we had met at Sonargaon hotel to observe the Menstrual Hygiene Management Day where we witnessed a rather strong demand for the creation of a legal instrument for MHM. After prolonged deliberations, we now have created a guideline that will help develop the National MHM Strategy.

Fazal Mahmud, Manager, Marketing, Square Toiletries Ltd

Before going to our recommendations, I would like to thank Bangladesh government and NBR for their care for female hygiene and declaring SRO to withdraw supplementary duty. However, we believe that this caring attitude will be reflected further to remove Custom Duty on Raw Materials; some of the major raw materials, such as Airlaid, PE Film, SAP etc. still have a CD of 25%, 10% and 10% respectively. Also, if the prevailing 15% VAT is removed from production stage, it would help companies to offer lower priced sanitary napkin.

From Square Toiletries Limited, we are trying to make our napkins more environment-friendly. To do that, we need significant assistance from our government, particularly because the necessary raw materials will have to be imported. India launched a biodegradable sanitary pad in March 2018 which costs only Rs 2.5 since it is heavily subsidized by the Indian government. It would be good if our government adopts similar practices and extend its assistance to produce and promote such environment friendly solution across the country. 

On the topic of ensuring availability and disposing sanitary napkin, we have a few initiatives in place. One such initiative is educating around 100,000 students annually and making sure their parents are notified of this MHM awareness program. Availability of pads in educational institutes or working places is an infrastructural issue and lack of eagerness is also there; even though we are pursuing to build a channel to keep products available at these places, a government order would bring more pace to ensure access of sanitary napkin for every girl.

Mahiul Kadir, Executive Director, Hope for the Poorest

If we divide the girls and women relevant for MHM into three broad categories — we have those who have no knowledge regarding menstruation, the ones who are aware but do not have the resources to acquire necessary pads, and ones who are exercise MHM in an ideal manner. 

A secondary target group would then be parents and siblings with teachers and leader groups as part of the community. The tertiary group would consist of the media which can focus on creating a link between policymakers and beneficiaries. Then there are organizations like the MHM Platform that addresses such issues, and lastly, there are cultural and social activists that can help create an enabling environment.

Furthermore, we need an intervention from the government so that we can have a separate and exclusive entity to address MHM issues.

Prof Dr Md Abdul Mannan, Director (Secondary), Directorate of Secondary and Higher Education

The curriculum that was developed in 2011 for pre-primary to Class XII included assessment strategies and teaching-learning approaches. But we have not been able to transition from a result-based education to a learning-based one  because we could not implement the continuous assessment mentioned in the curriculum.

Over the years, we have witnessed much development from a makeshift latrine to a toilet and now we have requirements for a wash block. But in order to achieve the fourth SDG, we are in dire need of continuous assessment.

Mushfiqua Zaman Satiar, Senior Policy Adviser, SRHR and Gender, The Embassy of the Kingdom of the Netherlands

The Ritu Program had a target of creating an MHM policy and it is evident through this dialogue that the initiative is already underway. Through our research projects, we have noticed how girls drop out due to MHM issues. This drop out leads to early marriage and that, in turn, leads to early pregnancy which proves detrimental for them in the long run. These limitations are restraining the women in our society from keeping up with men in terms of progress and development.

Unfortunately, the project outline stated that we are to start with HSC students, whereas girls in Class IV often experience menstruation. So we believe girls should be made aware at a much earlier age. We should also focus on alleviating the shock that accompanies experiencing menstruation for the first time.