1. DR KAMNA DATTA ASSOCIATE PROFESSOR, DR RML HOSPITAL
MENSTRUAL HYGIENE
DR KAMNA DATTA
ASSOCIATE PROFESSOR, DR RML HOSPITAL

2. Menstruation
52% of women worldwide are in reproductive age and most of them thus are menstruating monthly.
Still, the majority of them are not in conditions to take care of their menstruation in a hygienic manner or are impaired by it.
Menstruation is supposed to be invisible and silent.

3. Beliefs, Myths and Taboos
In some cultures, women and girls are told that
During their menstrual cycle they should not bathe (or they will become infertile)
Touch a cow (or it will become infertile)
Look in a mirror (or it will lose its brightness)
Touch a plant (or it will die)
‘Banishment’ to menstrual huts as they are given a rest period from the normal intensity of daily chores.

4. Challenges in Menstrual Awareness, hygiene
Education by parents about reproductive health, sexuality and related issues is often a no-go area leading to a low knowledge and understanding on these issue.
Lack of facilities and sanitary products

5. Menstrual hygiene Change pad atleast once a day.
Changing 6-8 hours is recommended.
During heavy menses, change every 3-4 hours.
Do not keep completely soaked.
Wash genital area after each use of toilet, also after urination.
Keep the area between the legs dry to prevent chaffing and soreness.

6. Health Risks of Poor Menstrual Hygiene Management
Poor protection and inadequate washing facilities may increase susceptibility to infection
In case of female genital cutting: blockage and build-up of blood clots is created behind the infibulated area: pain, additional infection risk
Risk of infection higher than normal during period as the blood forms a pathway into the uterus

7. Inappropriate hygiene practices
Certain practices are more likely to increase the risk of infection e.g. using unclean rags
Unclean sanitary pad materials (local infections/bacteria can travel up the vagina and enter uterine cavity)
Changing pads infrequently (skin irritation by wet pads)
Insertion of unclean material into vagina (easier infection , also of uterine cavity)
Using highly absorbent tampons during light blood loss or no menstruation (toxic shock syndrome, vaginal irritation)

8. Inappropriate hygiene practices
Wiping from back to front following urination or defecation (bacteria can travel easier into vagina)
Unprotected sex (increased risk of sexually transmitted diseases)
Unsafe disposal of used sanitary materials or blood (risk of infecting others with diseases)
Frequent douching (forcing liquid into vagina can introduce bacteria into uterine cavity)
Lack of hand-washing after changing a sanitary towel (can spread infections

9. Menstrual Hygiene Management:
It is critical that any programme aiming to support women or girls with sanitary protection materials involves them in the planning discussions and decisions about the options to be supported.
Disposable sanitary towels
In resource-poor settings often very expensive and hard to dispose of
Often difficulty of proper disposal (generates solid waste)
But reduce barriers of girls staying at school
However, Govt of India provides low cost sanitary pads.

10. Menstrual Hygiene Management:
Cloth or cloth pads
A sustainable sanitary option, but it must be hygienically washed and dried in the sunlight (natural steriliser)
But shame of drying the clothes outside, so often hide them in damp unhygienic places
Menstrual cup
New technology appropriate for poor women and girls
Cup made of medical silicone rubber that is inserted into the vagina to collect menstrual blood
Removed and emptied less frequently than sanitary pads
Needs to maintain a high standard of hygiene especially during insertion, removal and general cleaning

11. Menstrual Hygiene Management National Guidelines (December 2015)
Menstrual Hygiene Management (MHM) is an integral part of the Swachh Bharat Mission Guidelines (SBM-G)

12. Swachh Bharat Mission Guidelines
Every adolescent girl and woman, and their families, including men and adolescent boys, must have awareness, knowledge and information so that menstruation is understood and can be managed safely with confidence and dignity.
Every adolescent girl and woman must have easy access to sufficient, affordable and hygienic menstrual absorbents during menstruation.
Every adolescent school girl must have access to a separate toilet with private space for cleaning, washing. This includes access to adequate and sustained water supply and soap.
Every adolescent girl must have access to infrastructure for disposal of used menstrual absorbant, and should know how to use it.

13. Infrastructure for menstrual hygiene
Menstrual hygiene: e.g. lockable toilets, closed bin for sanitary item disposal, sink for hand washing and cleaning of clothes (both inside toilets)
Public toilet design should ensure safe and private entrance to women’s toilets, with ample lighting after evening hours.
Adequate water and space inside the toilet should be ensured for the women users to change napkins/cloth and to wash themselves.
Toilet cubicles may be provided with a shelf, hooks or niche to keep clothing and menstrual adsorbents dry.
Disposal bins with lids should be placed within the toilet, as the initial point of waste collection.
setting up incinerators in community toilets.

14. Sanitary napkins disposal
As per MHM guidelines, ‘Safe disposal’ means ensuring that the process of destruction of used and soiled materials is done without human contact and with minimal environmental pollution
‘Unsafe disposal’ means throwing used cloth into ponds, rivers, or in the fields exposes others in the area to decaying material and should be avoided.
If lack of opportunities, dispose secretly and easily: thus on defecation field, river or garbage dump
Blocking toilets/filling up pits

15. Unsafe
Safe
Common practices
Throw them unwrapped into fields, rooftops, etc.
Wrap them in paper/ plastic bag and throwing them outside
Drying, wrap in paper/plastic bag and throw in dustbins (mostly non-rural)
Burry them for de-composting
Throw them in latrine / toilets
Burn it (rural areas and peri-urban areas)
Use small scale incinerators (community or school level)
Municipal waste management / burning in health clinics (more urban)

16. Recommended options for disposal of different sanitary wastes (as per MHM Guidelines 2015)
Disposal into pit latrine
Deep burial
Composting
Pit burning
Incinerator
Used tissues, paper, cloth, cotton 
Less recomm-ended
Low cost/ locally made inclinators or Electric inclinators
Cotton napkins (reusable or commercial)
Electric inclinator
Commercial napkins with plastic and liners
Not possible
Bio-medical Waste Incinerator

17. Disposal of sanitary waste – Consumer level
The consumer shall wrap the sanitary waste using self-wrapping straps or keep the sanitary waste in leak-proof pouches provided by producer and dispose the same along with dry waste or keep the waste in separate bin provided at the time of door to door collection by local agency.
In case Producers does not provide wrapper or Pouch, the used sanitary waste should be wrapped in old newspaper and placed in dry-waste bin for collection by authorized waste picker

18. Producer level
Provide wrapping pouches OR Provide suitable self-wrapping (sealing straps) for the used sanitary waste so that the sanitation staff (Safai Karmachari) are not exposed to sanitary waste during handling.
Work with local agencies for achieving segregated collection and disposal of sanitary waste.
Indulge in providing mass education and awareness in proper handling and segregation and disposal of sanitary napkins.
Explore the possibility of using recyclable materials in their products.

19. By private agencies
Segregated sanitary waste can be disposed by Incineration through authorised common Biomedical Waste Treatment and Disposal Facilities
An authorised waste picker by local authorities (as per SWM Rules, 2016) can provide such services on commercial basis.
In small cities, the sanitary wastes can be composted if cotton/clothes are separated from the products. Other-wise, the sanitary waste will go along with dry waste for disposal.
In Class I cities sanitary waste can be landfilled.

20. At SPCBs/PCCs Level:
modular incinerators can be based on twin chamber incineration, Magnetic Pyrolysis Furnaces, plasma pyrolysis furnaces, electrically operated furnaces, Clay-pot (Matka incinerator) etc..

21. At ULB/Local Level
Send the segregated sanitary waste to available waste management options/incinerators for final disposal/incineration.
ULBs may also install a stand-alone common incinerator for disposal of sanitary waste and other wastes (such as STP/drain sludge).
Develop waste management systems at the local level and facilitate access to water, sanitation and waste disposal for women and girls, especially in rural areas.
ULBs must conduct the training sessions in schools and communities along with the key messages of Hygienic practices as per the MHM Guidelines.

22. At Villages/Panchayat Level:
may dispose used home-made sanitary napkins made of natural tissues/paper/cloth/cotton as well as re-usable commercial cotton napkins in small burial pits of more than 50 cm deep or into pit latrines.
In case of commercial sanitary napkins made with plastic and liners, low cost incinerators like Matka Incinerator kept in open areas (such as open backyard, open fields, terrace of the house, etc.).

23. Menstrual Hygiene Education
Counseling for adolescent girls, and special educational sessions around menstrual health and hygiene should be organized by qualified professionals as part of school education.
Promoting good practices for Menstrual Hygiene Management:
How to dispose of the cloth, pad, cotton
How to keep yourself clean during the period
How to manage the stomach pain from your period

24. Menstrual Hygiene Education
Community-wide approaches that include boys and men (Physical barriers are often connected to social barriers. Social barriers have to be overcome!)
Integrate Menstrual Hygiene Management into a wider hygiene promotion approach on Water, Sanitation and Hygiene including risks and good practices.
Similarly, menstrual health and hygiene awareness camps may be organized for women in the community, at local health centres, Anganwadis, etc. by qualified professionals.

25. Menstrual hygiene at workplace - Challenges
Inadequate toilet facilities.
Lack of facilities for washing or drying menstrual cloths.
Lack of facilities for disposing of sanitary pads or menstrual cloths.
Difficulty raising menstrual hygiene issues with male managers.
Managers often don’t understand the need for women and girls to be able to take additional time in the toilet or washroom to manage menstruation.
Difficulty concentrating on work due to menstrual cramps.
Lack of medicines or sanitary materials.
Cultural restrictions (such as menstruating women not being able to leave the house, wash their bodies, eat certain foods, cook or attend religious functions) have an impact on personal hygiene or the ability to engage in work-related activities.
Lack of opportunities or facilities to change, wash or clean sanitary cloths if travelling with work.

26. Ways to improve situation
The female staff could undertake an assessment of the offices from gender and menstrual hygiene perspectives.
A small female-only room could be constructed outside the back of the office for women to rest and sleep. This should have thick curtains and a lock on the door.
A toilet and shower room could be built at the back of the women’s room with a small walled compound, with a burning unit (mini incinerator or facility to have a small fire) and private drying line.

27. Good practices for employer
Provide separate water, sanitation and hygiene facilities for women and men.
Ensure that the facilities are kept clean at all times.
Provide facilities for the disposal of cloths and pads.
Ensure locks are fitted inside the toilet doors, and there is a light and water inside the toilets.
Have a discrete supply of sanitary pads and clean cloths available in an emergency for women or girls at work.
In larger work environments, employ a trained health professional who can be approached for pain relief or sanitary products when needed.
Include menstrual hygiene in staff employment policies, with an understanding that women and girls may need additional days of sickness to deal with menstrual hygiene complications.
Provide awareness-raising sessions on menstrual hygiene for all female staff by a health professional.

28. Good practices
Prepare well for time at work, taking in emergency cloths or sanitary pads and pain relief, in case menstruation starts unexpectedly.
Be supportive of other female colleagues who may need to spend more time visiting the bathroom, suffer from pre-menstrual syndrome, or have to take sickness days due to their menstrual cycles.
If a woman or girl stains her clothes, let her know.
Help your employer understand what would improve the working environment for women and girls in managing their menstruation.

29. THANK YOU