12 November 2015

Improving menstrual hygiene management in schools

@UNICEF Mongolia/2012/Brian Sokol
Menstrual hygiene remains a taboo in many settings, with poor knowledge and misconceptions as great a challenge aswell as access to adequate facilities.
In recent years, a solid global body of evidence has revealed the discriminatory nature of many school environments, with menstruating girls unable to adequately manage their monthly menses with safety, dignity and privacy. In recognition of the positive impact on girls’ education, initiatives around the world are addressing adolescent girls’ menstrual hygiene management (MHM) needs in coordination with ongoing efforts to improve water, sanitation and hygiene (WASH) facilities and services in schools.

Since March 2014 the Canadian Department of Foreign Affairs, Trade and Development (DFATD) has been funding the project ‘WASH in Schools for Girls: Advocacy and Capacity Building for MHM through WASH in Schools Programmes (Wins4Girls Project)’. Phase I of the project involved the development and delivery of a web-based course to strengthen capacity of national research partners, WASH practitioners and policymakers to carry out rigorous research on MHM. In August 2015, 44 participants from 14 countries (Afghanistan, Bolivia, Burkina Faso, Eritrea, Ghana, India, Indonesia, Kyrgyzstan, Mongolia, Nepal, Niger, Nigeria, Pakistan and Zambia) graduated from the WinS4Girls E-Course. With technical support from Emory University and UNICEF, national MHM working groups from each of the 14 countries are currently conducting MHM research in schools. The results will inform the development of interventions to improve WASH in Schools (WinS) for girls.

To document the successes, challenges and lessons learned during the research undertaken in Mongolia, Jeff Sinden (UNICEF Consultant) spoke with Robin Ward (WASH Consultant) from UNICEF’s Mongolia Country Office. 

What was the focus of the WinS4Girls research in Mongolia? Why was this focus chosen?
The major goals of this study were to explore MHM experiences of Mongolian schoolgirls in order to highlight good MHM practices and also identify the challenges and barriers girls face. Furthermore, a goal was to establish common themes arising for school girls throughout the country and also to compare and contrast the relative challenges and barriers experienced by schoolgirls from very different contexts. The study involved both urban areas and rural boarding schools where some children of semi-nomadic herding families stay for up to nine months in dormitories. Some dormitories have outdoor latrines, which combined with extremely cold winter temperatures, which can make practicing proper sanitation and hygiene difficult in some cases.

Prior to the WinS4Girls project, there was no formative research or study on MHM in Mongolia. The results of our literature review were pretty bare. It is our hope that research results will provide us with the evidence needed to inform future policies and programmes.

How was the research conducted?
The research was implemented by the Center for Social Work Excellence, a Mongolian NGO, under the guidance of UNICEF and a technical working group including key stakeholders such as the Ministry of Education, Culture and Science and the Ministry of Health and Sport. Intensive support was provided by Emory University, who visited Mongolia twice during the project. During one of the visits, Anna Ellis, Emory’s MHM Research Manager, supported the training of 11 researchers over eight days: five days were spent in the classroom, two days were used for field-testing the draft tools and the final day was used for debriefing.

Following ethical clearance from the National University of Mongolia, data collection was conducted at 11 schools over three weeks using small satellite teams. The 11 sampled schools included three in the capital, Ulaanbaatar, four in provincial capital towns and four in rural areas. Research activities included focus group discussions with girls, mothers and boys, in-depth interviews with girls, key informant interviews with teachers and principals, and school and dormitory observations.

What were the major findings?
Field data collection activities were completed in May 2015 with data analysis now almost completed at the end of October 2015. The final report is in drafting stage and should be finalized by end of November 2015. The second phase of this project will start in November 2015 with wide dissemination of research findings and development and piloting of evidence informed and audience appropriate MHM guidance materials based on the research findings.

Generally, and positively, female research participants were very open to discussing MHM and provided some good recommendations for improving the situation where needed. Preliminary findings have raised some encouraging attitudes and openness.

Preliminary findings also suggest that a number of common barriers exist for all schoolgirls in Mongolia, including a lack of adequate access to satisfactory WASH facilities and a lack of knowledge and education on MHM. However, these barriers appear to be greater for rural and dormitory school-girls who may lack access to regular showers and face difficulties in in using toilets at night due a lack of lights and the fact that some schools lock the dorm door. These rural and dormitory school girls also seem to experience more significant barriers in terms of access to MHM Materials sometimes due to a lack of money and they may also lack traditional support systems from family due to their more isolated living conditions.

Unsuprisingly, given Mongolia’s widely accepted technically challenging rural conditions for developing WASH infrastructure, the study found large disparities in the quality of WASH facilities between urban schools, which have indoor flushing toilets, and rural village schools, which generally have outdoor unimproved open pit latrines. The schools in provincial capital towns had a mixture of indoor flushing toilets and outdoor latrines. Hygiene can be problematic in rural schools due to water scarcity and lack of bathing facilities, with some girls using wet wipes to clean themselves.

What recommendations have emerged from the research?
Based on the research results, there are a number of preliminary recommendations that would help to improve the MHM situation in Mongolia. First, the sector should prioritize dormitories and rural village schools for improvements in WASH and MHM facilities. To improve knowledge around MHM, school health curricula or extra-curricular modules should be developed, starting from the sixth grade. There needs to be clearer guidance on the roles and responsibilities of parents and schools in providing sanitary napkins for girls. Finally, support systems for girls could be strengthened by working with the parents and host families of dormitory girls.

A number of recommendations also emerged directly from girls and others involved in the research, such as encouraging peer support from older girls through clubs, and producing handbooks on MHM not only for girls but also for parents.

How have you engaged with the government during the planning and implementation of the research? Is the government likely to take up the research recommendations?
The project was introduced to the Ministry of Education, Culture and Science and the Ministry of Health and Sports in 2014 and their endorsement was received. The Ministry of Education, Culture and Science were particularly supportive of the research and provided supporting letters to all of the identified research schools. Officials from both ministries are members of the project working group. A meeting will be held in November 2015 to discuss research results with the working group.

The government recently approved ‘Norms and requirements for WASH in schools, dormitories and kindergartens’, which addresses a number of specific requirements for adolescent girls. While the norms are not yet fully implemented, the government is committed to working towards them and is currently developing a mid-term action plan. We hope to use the research results to further build on this momentum, ensuring that girls’ specific needs are given the attention they deserve. We are confident that the government will take ownership of the research findings.

What were the main challenges in planning and implementing the research?
A major challenge faced was that no prior research or study had been undertaken on the subject MHM, so even familiarizing with the technical language and finding appropriate translations into Mongolian language was a challenge. A big success in this area was that now there are ten researchers trained on qualitative research methods, specifically in MHM research by Emory University who flew in for two intensive training weeks at key moments during the research process.
Another major challenge was of logistical nature. There were large distances between schools (up to 1,500km) and short timeframe of 3 to 4 weeks for field data collection before the end of the school year and start of exam period. To successfully complete the field data collection, multiple satellite teams were deployed to collect data simultaneously at 11 schools staggered over three consecutive weeks.

Has anything surprised you during the planning and implementation of the research?
The volume of data generated was huge and took a lot of work to transcribe, translate and analyse thoroughly. Emory University’s assistance in data analysis was crucial in getting the work done on time.

There were a number of surprises uncovered by the researchers. An interesting finding was that the age girls experience menarche is decreasing in some cases, leaving both girls and mothers unprepared.

What are some of the next steps planned?
We will widely disseminate the research findings and recommendations, including through online sessions for national and sub-national education and school staff.

The results will be used to develop and pilot evidence-based materials for girls and other audiences, including exploration of online resources and modalities. We will also use the results to continue to support the government to
operationalize the ‘Norms and requirements for WASH in schools, dormitories and kindergartens’. As per the preliminary recommendations, we should advocate for the prioritization of dormitories and rural schools in this regard. Finally, we consider conducting exploratory follow-up research to further understand the unique challenges of rural and dormitory girls.

What advice do you have for other UNICEF country offices interested in undertaking similar work?
I think it is important to give the planning and implementation of this type of research the time it needs and deserves, and would encourage other country offices not to rush it. Many of the steps, including ethical clearance and data transcription, took longer than we anticipated.

Fully engage with your Ministry of Education from the outset of planning the research as they are likely to be supportive as in this case in Mongolia. Find a strong research partner and ensure collaboration between national and international partners in the research process, especially if it is the first time conducting such a study in your country. Before finalizing your methodology, take time to consider your country’s context and environment, particularly in terms of the education and school environment. This will help you in defining your sampling approach and enable you to explore contextual issues specific to your country and may open up areas for further follow on research.

During data collection, proper planning and preparation is essential. We found it very useful to prepare a research package for each school, including support letters from UNICEF and the government, and a copy of the ethical clearance document. Preliminary visits to the schools, prior to the research, are necessary to plan activities and collect the required number of participants, especially for focus group discussions. Even something as seemingly simple as the functionality of audio recorders needs to be checked carefully to ensure a successful research visit. 


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