Menstrual Hygiene Management (MHM) is one of the core issues that need proper policy attention to achieve at least two Sustainable Development Goals (SDGs), viz. healthy life and well-being (Goal 3) and access to water and sanitation for all (Goal 6)1. MHM is also related to school attendance and performance of the girl students (Goal 4), gender equality and empowerment of all women and girls (Goal 5), and full and productive employment for both men and women (Goal 8). The Government of Bangladesh (GoB) has identified the role of various ministries, divisions and agencies by goals and indicators and estimated costs of achieving the Goals where private corporate sector and non-government developmental organisations will take active part. However, available, accessible, acceptable and quality water, sanitation and hygiene facilities at schools are integral parts of MHM for girl students, but those are unfortunately neglected issues in Bangladesh due to a lack of MHM-friendly toilets in schools. Therefore, the goals and targets related to MHM for school-attending girls are unlikely to be achieved without adequate policy and budgetary attention.
If girls lack access to affordable, hygienic menstrual products, they often use old rags, cloths or other unhygienic materials. This can lead to reproductive tract infections (RTIs) and other health conditions. Decent MHM at schools promotes social inclusion and individual self-esteem, and it is an integral part of the quality and enjoyment of education. It hinges on school environment and infrastructure, which include access to menstrual hygiene materials, toilets and places to change, safe water and sanitation, and good hygiene practices like hand washing with soap. Otherwise, the school facilities are regarded as discriminatory against girls.
MHM Practices: According to the National Hygiene Baseline Survey 2014, 86 per cent of students use old cloths during menstruation. Besides around a quarter of female students do not go to school during menstruation and almost one third think that menstrual problems interfered with school performance. In rural areas, only 9 per cent of female students use disposal pads whereas 87 per cent of students use old cloth in their menstrual period, and 90 per cent of rural students store their menstrual cloth in a hidden place for repeated use. In urban areas, 21 per cent girl students use disposal pads whereas 76 per cent of students use old cloth, and 78 per cent of urban students store their menstrual cloth in a hidden place for repeated use.
MHM Facilities at School: According to the same survey, the average number of students per school toilet was 187, while the recommended number is 50 as per the Sector Development Plan (SDP) 2011-2025. In rural areas, less than half of the schools (43 per cent) had improved functional toilets that were open for girl students. Only 24 per cent of school toilets were found to be clean, about one-third (32 per cent) of schools had a hand washing location with available soap and water. In urban areas, 63 per cent had improved functional toilets that were open for girl students, while 47 per cent schools had a hand washing location with available soap and water. Baseline survey report of the RiTU project (2017) implemented by DORP in Netrakona district also displays similar findings. Poor management of toilets in educational institutions affects MHM of girl students, their attendance and educational performance. It again impacts negatively on human capital formation and the contribution of overwhelming majority of girls in economic and social development of the country.
Plan, Strategy and Budget for Decent MHM at Schools
The amount of budget required for decent MHM-friendly toilets and wash facilities in schools has not been specified in any of the governmental documents or circulars. The SDGs Financing Strategy 2017 has also not provided any clear guideline about the investment for wash in schools which would help girl students with decent MHM. Conversely, the 7th Five Year Plan (7FYP) 2016-2020 underscored the importance of ‘inclusive’ and separate toilets for girls with adequate facilities for sanitary pads and cleansing facilities. In addition in 2015, the Ministry of Education (MoE) instructed all secondary educational instructions to provide separate toilet for girls, with improved facilities including soap, water and waste bins; and appoint female teachers to educate girls on MHM.
Imperatives for National Budget
As per the directive of the SDP 2011-2025, budgetary allocation is a must to enable schools to construct new separate toilets for girl students and to maintain the toilet/student ratio at 1:50 instead of 1:187, which is indecent. A hand washing location along with available soap and water has to be established at every school so that girl students can use them. Regular operation and maintenance (O&M) is also necessary to that effect. It needs additional budget allocation for schools that do not have these facilities.
To implement the instruction of the MoE, the policy direction of the 7FYP and the pledges of the SDGs, a separate WASH budget is required at every secondary educational institution that meets the requirement of decent MHM. It will have to strictly maintain estimation of per capita basic minimum requirement of MHM facility at every secondary educational institution.
School Learning Improvement Plan (SLIP) has to be increased with dedicated budget of primary level WASH facilities along with O&M in line with the 4th Primary Education Development Programme (PEDP-IV).
A special programme is required for MHM at schools, especially for girls living in remote areas, viz. char, haor (wetland) and hilly areas, and those in vulnerable situations such as extremely poor and marginalised communities (e.g., ethnic minority, lower caste and underprivileged).
Budget should be allocated for raising awareness about the importance of MHM. It will improve personal hygiene practices of girl students.
National MHM strategy would play an important role in need specific budget allocation and utilisation. However Water, Sanitation and Hygiene Strategy 2014 is in place while MHM issue is not properly addressed.