Getting serious about sanitation and menstruation

May 27, 2015


Hope Randall
Communications Officer, DefeatDD

For the purpose of our DefeatDD Initiative - which is, of course, to defeat diarrheal disease - we focus interventions that support child health through the age of five. As such, we don't talk about menstrual hygiene a lot, but that doesn't mean we're not huge supporters! Given our shared emphasis on sanitation, integrated efforts, and making a stink about taboo topics, we find ourselves in friendly and familiar territory.


We sat down with Nancy Muller, Senior Program Officer for the Devices & Tools program at PATH, to learn more about PATH's work in menstrual hygiene and how these investments can improve child health, too.


How did you first become involved with the issue of menstrual hygiene?

In 2006, I was en route to Seattle from Uganda. I was traveling with our very own Sara Tifft, director of Sayana Press Pilot Introduction and Research project at PATH, who asked me what I thought low-income girls in Africa did when they had their periods. I felt like the bottom of the plane had dropped out! I had never thought about it. I became a bit obsessed with understanding how girls and women manage their periods, especially if they live in rural areas. My first passion was medical waste management, which was great preparation for my work in menstrual hygiene management.


We are currently conducting a review and landscape of menstrual cups to identify design and user challenges; develop design concepts to address barriers around cost, use, and cleaning; and contribute to the dialogue on improved menstrual hygiene (MH) products by publishing our work.

Nancy Muller gives an overview about menstrual hygiene and possible solutions that can make an impact in low-resource settings.


Why menstrual cups, as opposed to pads or tampons or reusable cloths?

We think there is a need for many improved product choices. Menstrual cups sidestep many challenges associated with other menstrual hygiene products in low resource settings. For example, pads, which have to be purchased every month, may not be either available or affordable. And in poor areas, where women may not have underwear, it is tricky to keep a disposable or reusable cloth pad in place.


Menstrual cups hold up to 12 hours of menstrual fluid and also help eliminate waste by lasting up to 10 years. Disposal bins are not available in the majority of bathrooms or latrines in low resource areas, and discarded MH products may end up clogging toilet pipes, filling pit latrines, or collecting along roadsides and in rivers. They become added environmental hazards where children live and play and eat and drink. 


Importantly, menstrual cups are discreet, can prevent leaking, and eliminate odor: features that are important to women.

Photo credit: Wendy Stone.


Have you encountered any resistance from women about using menstrual cups?

I have to say that I was not a proponent of menstrual cups originally. I didn't think there would be a high level of acceptability in traditional, rural areas, but a study done among low-income women in rural Bihar, India, completely opened my mind. Half of the 480 women who had been using rags and who were then given a cup, used it; many kept using it beyond the study. That's pretty telling! It speaks volumes to the headaches that women go through just to manage their periods. Considering what women are doing currently, it's easy to see why a menstrual cup would be appealing.


And it sounds like these investments in menstrual hygiene stand to benefit many other issues, too, including child health.   


I think WASH in schools programs are one of the most practical examples of this. From what I have experienced in traveling and living abroad, girls have potentially a 10 (or more) hour school day. How do you manage a period during that time? It's hard to begin to even imagine what you would do with a used cloth. Latrines along with a private space to wash hands and cloths (or other MH products) are essential for girls managing their periods, and also providing an opportunity to encourage good personal hygiene and handwashing behaviors.


We've also learned how important it is to consider MH if sanitation systems are going to be properly utilized. In India, even women with access to sanitation facilities washed their cloths in the river - because they weren't allowed to use the facilities due to the taboo of menstrual blood! Innovative “dry” toilets, which use little or no water, also pose a challenge in the Indian cultural context, which puts a high priority on cleansing with water. Programs seeking to tackle the health and environmental impacts of poor sanitation must incorporate culturally-appropriate MH solutions as well, or their full potential won't be realized. India currently has a great opportunity to consider the potential for MH solutions within the context of its national Swachh Bharat (Clean India) sanitation campaign.


What is the one message you'd like to share with other advocates as they commemorate Menstrual Hygiene Day?


It's so hard to say just one thing, but the bottom line is that the shame around menstruation just has to go. There wouldn't be life without menstruation! So why should a period hold girls and women back? If we're serious about equity and girls' and women's empowerment, we need to be serious about their right to manage menstruation safely, effectively, affordably, and with dignity.


For more information:

-          Learn more about PATH's work in menstrual hygiene management.

-          Find social media resources on the Menstrual Hygiene Day website.