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Global Research Update #35

Hennegan et al., 2020: ‘I do what a woman should do’: a grounded theory study of women’s menstrual experiences at work in Mukono District, Uganda. A qualitative study was conducted amongst 35 women aged 18-49 in Mukono District, Uganda to explore working women’s menstrual experiences and the impact of menstruation on their work and health. Results: a conceptual map of the categories was identified as ‘being a responsible woman’. ‘Being responsible’ meant keeping menstruation secret, and the body clean, at all times. These gendered expectations meant that any difficulty managing menses represented a failure of womanhood, met with disgust and shame. Difficulties with menstrual pain and heavy bleeding were excepted from these expectations and perceived as requiring compassion. Menstrual products were expensive for most women, and many expressed concerns about the quality of cheaper brands. Workplace infrastructure, particularly unreliable water supply and cleanliness, was problematic for many women who resorted to travelling home or to other facilities to meet their needs. Menstruation presented a burden at work, causing some women to miss work and income, and many others to endure pain, discomfort and anxiety throughout their day.

Gruer et al., 2020: Guidance Note: Integrating Menstrual Hygiene Management (MHM)into Ebola Response. Menstrual Hygiene Management (MHM) is a fast-growing focus in the humanitarian response globally. Evidence of its relevance continues to grow particularly in the current Ebola virus disease (EVD) response. This guide aims to address frontline programme staff, programme supervisors and country-level staff, as well as donors’ agencies, and organisations in the planning and delivery of EVD outbreak response with attention to MHM. For patients and potentially infected women and girls, as well as the staff, knowledge of menstrual needs is essential. Trained response staff on the subject of needs of menstruating women and girls during an EVD outbreak must be present. The staff members must be able to clarify and contextualise the case definition of Ebola, specifically the difference between “explicable bleeding” (e.g. menstruation) vs. “inexplicable bleeding” (e.g. prenatal bleeding). Since “inexplicable bleeding” is a symptom of EVD, this has the potential to result in confusion around menstruation in the community. Community-level education and messaging about the difference between menstruation and “inexplicable bleeding” can help dissolve the confusion and fear about having EVD. The menstrual blood of confirmed and suspected patients’ needs to be handled properly because it is a potentially infectious bodily fluid. As a result, it is recommended that patients in treatment centres should be provided with single-use MHM products to reduce washing and drying. Previous studies have stressed the importance of the provision of menstrual materials, Female-Friendly Water, Sanitation, and Hygiene (WASH) facilities, and healthcare facilities with safe and private menstrual disposal; healthcare facilities, especially those caring for potential Ebola patients, should not be left out. When discharged from an Ebola Treatment Centre, women and girls should be briefed on what to expect with their menstruation during recovery. Also, providing discharged patients with culturally appropriate kits with menstrual materials would restore the materials they had to dispose of for fear of contamination. An essential part of this integration is to ensure the education does not further stigmatize menstruation and menstruating women and girls. Overall, collaboration and engagement across sectors with knowledge of MHM needs of women of girls in the EVD response will lead to the best possible outcome.

UNICEF, 2020: Guidance for Monitoring Menstrual Health and Hygiene (VERSION I). Menstrual Health and Hygiene (MHH) monitoring has been limited, in part, by a lack of validated measures and standardised monitoring guidance. The main goal of this guide is to support the development and/or improvement of MHH monitoring, by highlighting the basic principles (including ethical considerations) and example questions to monitor the various elements of MHH. The basic principles are based on three phases: planning, data collection, and data analysis and use. It aims to provide practical guidance rather than a comprehensive prescription to national governments that have taken an interest in tracking the MHH situation. The guide includes sample checklists of objectives and questions for MHH monitoring surveys for outside the home through national information systems, households, and programmes for both men and women. While these resources provide a great guideline for designing future monitoring programmes, the authors stress the importance of adapting these guidelines to the context and specific programmes aims. Also, they discuss the significant gaps highlighted when researching for this document including access to health care services, trans/non-binary bleeders, and menstrual management for people with various disabilities with plans to address it further in a future document.

Rossouw & Ross, 2020:  An Economic Assessment of Menstrual Hygiene Product Tax Cuts. Access to menstrual hygiene (MH) products is key to safe menstrual hygiene management that promotes dignity and health for women and girls all over the world. Globally, there is a movement to remove Value-Added Tax/General Sales Tax (VAT/GST) on MH products with the intention to increase their use through making them affordable. With funding from the Bill & Melinda Gates Foundation, this report evaluates the economic impact of MH product tax cuts with a focus on the implications for affordability, equity of access and use, and government revenue. Specifically, this study draws on information from Bangladesh, Kenya, Nigeria, and South Africa, four countries that experienced MH product tax cuts, comparing them with other countries to determine patterns and make global comparisons. MH products are significantly less affordable in low- and middle-income countries (LMICs) than in high-income countries (HICs). A cause of this may be the lack of competitiveness in the MH product market allowing manufacturers and retailers to absorb tax cuts in their profit margin resulting in higher prices and lower affordability. Because of the complexity of VAT/GST systems, removal does not necessarily result in a retail price reduction. Wealth, education, and urban residence, rather than price, are the most important determinants of MH product use in LMICs. Poor accessibility among vulnerable populations may have created a market for dangerous, chemically harmful products. The research concludes that removing VAT/GST alone will not sufficiently improve the affordability of MH products in order to increase use. Even if all VAT/GST tax cuts were passed on to consumers, the impact on price would still be relatively small. Some recommendations from this study include promoting local manufacturing of MH products to incentivize competition and offering targeted subsidies to support free or affordable distribution of MH products.

Kulczyk Foundation & Founder’s Pledge, 2020: A Bloody Problem: Period Poverty, Why We Need to End It and How to Do It. This report presents effective funding recommendations to address period poverty through Menstrual Health and Hygiene (MHH) programming as well as reviewing the current state of funding and solutions to ending period poverty. The main sources of funding for MHH programming are in-country government spending, bilateral aid, UN agencies, corporate social responsibility programmes and private philanthropists. High-income countries (HICs) programs are covered mainly by government funding, but most donor-funded programming happens in lower- and middle-income countries (LMICs). MHH is indirectly addressed through Water, Sanitation, and Hygiene (WASH), education, or sexual and reproductive health (SRH) programming. This overlap in programming makes the estimation in funding of MHH especially difficult. However, this report estimates that the figure ranges from USD$10 million to USD$100 million per year with around 500 million menstruators lacking access to complete MHH with a majority living in LMICs. Since the MHH field is so young there is a significant lack of existing evidence in the field on areas including effectiveness of different activities, the scale of the problem globally, and the harms caused by a lack of MHH. Additionally, the factors contributing to incomplete MHH are complex and vary significantly across different settings and individuals. The following showcases eight most cost-effective organisations that implement a range of interventions with built-in monitoring and evaluation activities. These organisations include Days for girls, Inua Dada Foundation, Irise International, Nepal Fertility Care Centre (NFCC), Population Services International (PSI), Sesame Workshop, Simavi, and WoMena with a combined funding gap of USD $10 million. Each of these organizations were highlighted because they carry out activities that address multiple components of MHH in LMICs as well as develop and scale sustainable programmes locally in collaborations with governments and markets.

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