EFFECTIVENESS OF USER-FRIENDLY TOILETS AND PAD VENDING MACHINES FOR DIGNIFIED MENSTRUATION
MANJU BHATTA Behaviour Change Communication Officer Rural Village Water Resources Management Project, Phase III Project Support Unit, Amargadhi-5, Dadeldhura, Nepal
PAMELA WHITE Senior Manager, Natural Resources Management and Climate Home Office Coordinator and short term Gender Advisor in the project firstname.lastname@example.org
Sanitation facilities are very important, in order to support menstrual hygiene management in the home, at the school or office, and in other public places. To ensure the dignity of women and girls it is vital to allow them to use the toilet and tap during menstruation. However, women and girls are facing menstruation ‘malpractices’, and support to sanitation structures is needed to permit them to have a total sanitised and dignified life.
The Rural Village Water Resources Management Project (RVWRMP) operates with the Rural Municipalities of Sudurpaschim and Karnali Provinces, and has been promoting WASH activities for many years. These include menstrual hygiene management (MHM) activities at school and community level, and support for the construction of user-friendly sanitation facilities in schools. The Project has a target to support construction of 180 user-friendly toilet structures in schools within the project area. The Project also provides orientations and trainings on menstrual hygiene management and proper use of sanitary materials. Recently, the Nepali government conducted a dignified menstruation management (DMM) campaign throughout Nepal. At the local level, many Rural Municipalities (RMs) are conducting campaigns to destroy chhau-goths (where women are forced to stay during menstruation), raising awareness and convincing residents to make their RM a dignified menstruation-friendly RM. It is very difficult in many districts to break the taboos and traditional mind-set, but one method is via promotion of the Dignified Menstrual Management (DMM) directive at the local level, and delivering the message through schools and students.
The Project has given orientations to schools and supported them to construct sanitation structures, including toilets and taps, and sometimes incinerators. RVWRMP has also worked with the schools to conduct menstruation campaigns and supported the installation of sanitary pad vending machines in schools, where the sanitation structures are user-friendly. RVWRMP has provided support to construct user-friendly toilets, and the RM supports the school to ensure it is operational in the longer term.
Girls often express their concerns regarding poor access to sanitary materials, and their anxieties about attending school during menstruation - for practical reasons, fear of breaking taboos, and embarrassment. 15 schools have installed sanitary pad vending machines to date (all during the Nepali financial year 2076 – or 2019/2020 in the western calendar), in order to support the availability of sanitary pads for school girls. It is anticipated that by giving them access to sanitary materials at the school, there will be an increase in the attendance of girls at school during menstruation (a decrease in absenteeism).
The 15 vending machines as a part of the MHM-friendly toilet activities have been installed in schools in Bhageshwor RM (Dadeldhura), Naugad RM (Darchula), Api Himal RM (Darchula), Chhabis Pathibhera RM (Bajhang), Thalara RM (Bajhang), Talkot RM (Bajhang), Marma RM (Darchula), Masta RM (Bajhang), Bungal Municipality (Bajhang), and Kharpunaath RM (Humla), Dilashaini RM (Baitadi). The survey was conducted in the first seven RMs on this list. While the toilet was under construction the machines were installed in an office, or some schools installed it in a school room. However, now that the toilet construction is complete, the machine is connected in the toilet building. This study investigated the use of the vending machine and the changes the machine has provoked. In this connection, a total of 212 girls were interviewed by Support Organisation staff (Sanitation Health Promoters) contracted by the RMs with Project funding, regarding their feelings before and after the vending machine was installed. The survey involved girls of menstruating age in Grades 6-12, with approximately 30% of the girls in this group randomly selected in each school. In addition, teachers from the seven schools provided information on MHM activities in the school, operation of the vending machines, etc . All surveyed school head teachers send the information on the school status, using the given format with the school stamp, and the focal teacher in each school also supported collection of further other information.
Students and toilet facilities available in the surveyed schools
In the surveyed schools there were a total of 27 female and 128 male teachers, who were teaching 1816 female students and 1445 male students. Where the female students and teachers are at menstruation age, every day at least some must be having their period, therefore it is very important that the school has a menstruation-friendly toilet. All the schools have toilet blocks (sometimes more than one) but not all toilet stalls are well maintained, and there is often no privacy for girls. A menstruation-friendly toilet is defined has having a lockable door, a bin to dispose of sanitary pads (and a system for emptying it) or an incinerator, and space to wash and change clothes in privacy. All schools surveyed had a separate toilet for teachers, and separate toilet stalls for girls and boys. During field observations, we found the teachers’ cabins were always clean and well-maintained, but the student toilets were often not in proper use, nor maintained in a clean state. The surveyed schools have 30 toilet blocks altogether (including the teachers’ toilets), of which 16 are girls’ toilets, with 14 stalls; and 16 are boys’ toilets, with 29 stalls. Some schools have not ensured that toilets are suitable for use during menstruation. Toilets may be available, but are not menstruation-friendly, and this is proving a big deterrent for girls to attend school during their period.
How was menstrual hygiene maintained before installation of the vending machine?
Many of the persons interviewed were hesitant to discuss their personal behaviour, or how they maintain hygiene during menstruation. Adolescent girls feel particularly uneasy to speak openly. We asked the question “what did you do when you were menstruating at school, before the machine was installed?” The answer was varied, because in rural areas different materials are used to maintain personal hygiene. Lack of accessibility to sanitation materials for menstruation still causes many girls to leave the classroom and feel hesitant to attend school at all. The data shows answers to what they did before the vending machine was installed.
The data shows that prior to the vending machine installation, only three of the interviewed girls bought sanitary pads, if they experienced menstruation during school time. The others faced very difficult choices: 68 girls left the class; 108 girls stayed sitting in the classroom, experiencing fear, hesitation and panic; and 33 girls used the dirty cloths that were available at the school. Earlier, the girls reported that there was no coordination committee in the school, nor any MHM group, and they did not feel that they could discuss their problems about menstruation with their teachers.
We then asked a question about how the students are feeling now, after installation of the pad vending machine. The responses were overwhelmingly positive (these responses were given free form, so some have been grouped into the main answers when they covered a similar topic, and some girls gave more than one answer). The only concern mentioned was due to problems with electricity supply to the machine.
The result shows that the female students feel comfortable, and are happy to continue to study during their menstrual period. Following installation of the vending machine, the schools have formed MHM committees, and distributed pad vending machine cards to girls. All schools have a nominated person to check on the availability of pads in the machine. Some schools have not had sufficient cards, so they have appointed a focal teacher - if anybody wants a sanitary pad, they can request one from the focal teacher. The girls report that they can now continue their studies without fear and hesitation, and they are coming to school during menstruation with a happy mood.
The students noted their concern that if there would be any problem with the vending machine, such as irregular electricity supply and other technical problems, or availability of pads for re-stocking, they will face the previous problems again. They requested training in maintenance of vending machines, and collection of funds to ensure sustainable supply of pads. At present, four schools have a maintenance fund for repairs, while three do not.
One other potential risk of the vending machines, is that there could be an increase in environmental pollution in the rural municipalities, if there is inappropriate disposal of used pads. Of the schools surveyed, five have installed an incinerator, one is using a dustbin for disposal of used pads, and the seventh had not yet defined a disposal method. All these systems rely on appropriate handling. While burning the pads is not necessarily the best method of disposal (burial is ideal), in rural areas without rubbish collection or quality landfill, an organised system of burning runs the least risk of solid waste pollution. If pads are not disposed of appropriately, there is likely to be a backlash from the community. This will require follow-up by the Project.
Another option supported by RVWRMP is locally sewn, reusable sanitary pads. They are probably not as absorbent as commercial disposable pads, but are affordable and have less pollution risk. To date the vending machines have been dispensing commercial, disposable sanitary pads. However, Project staff are also investigating the possibility to reload them with locally produced, re-usable pads.
What are the effects on girls’ education and general awareness on MHM, after increasing MHM education, and having an MHM-friendly sanitation structure constructed in the school?
Sanitation structures are very important for good education in school. They can maintain the quality of education and a healthy environment. If girls feel safe and supported, they will continue studying during their menstrual period. The survey found that during the three months after installation of the vending machines, there was a marked increase in school attendance by girls during their menstrual period. Janhit Secondary school (Naugad RM) reported that there was increase by 81% in girls’ attendance, and in Khandeshory Secondary school (Api Himal RM) there was an 80-85% increase reported. Thalara Secondary school (Thalara RM) reported a 51% increase; and Durga Bhawani Secondary school (Talkot RM) reported a 37% increase in the girls attendance during the three months after installation. The three other schools have not yet reported whether there have been changes. We will follow up during the next step of monitoring in the new academic year. Students can also deliver important messages on health and sanitation education, learned at school, to their home and community. Five of the schools have begun to provide training on MHM to the Child Clubs. 24% of the surveyed students reported they had not received MHM training, but 31% said they had received training from a teacher, and 45% from RVWRMP. All but one school has implemented a DMM campaign within the school. The schools are developing the system to deliver the MHM and sanitation messages, and starting to think about sustainability of the sanitation structure in schools, including user-friendly toilets, vending machines, water supply schemes and other total sanitation components, which were described in the ‘Three Star’ model school rating. All the surveyed schools have formulated a WASH plan and mobilised their WASH committee and child clubs to work towards the standards outlined in the Three Star school ratings. Awareness campaigns alone are not sufficient - schools need to work as well on infrastructure development, and sustainable operation and maintenance. Many schools have toilets, but the structures are often not well designed or functioning for the access and use of children, women and people with disabilities, and there is often a lack of maintenance. There is a high demand from students in the surveyed schools for sustainability of all sanitation structures. The students were asked what would be the most important issues for improving MHM at their school in the future. They most important responses were as shown in the table below. The responses indicate that the Project supported activities are appropriate.
Best practices after installing the vending machine
RVWRMP has supported the schools and RMs to raise awareness on dignified menstruation management, total sanitation and hygienic behaviour change activities in the working area. The Project continues to conduct activities on menstruation hygiene and total sanitation at community and school level. The local level elected representatives are very supportive of these behaviour change activities, and the RMs have allocated the budget for installation of the vending machines in schools. The schools have followed the following practices:
All schools have implemented a WASH Plan.
The surveyed schools have started very good practices to maintain sanitation and hygiene in the school premises and to share messages.
All schools have appointed a focal teacher and are working on MHM and sanitation and hygiene with the child clubs.
Orientation on behaviour change and dignified menstruation. The schools are also involving the boys in MHM, in order to break the silence on MHM.
Schools have mobilised the Child clubs, in order to achieve the Three Star model school indicator rating in the school.
Girls’ attendance rates are increasing to a varying degree (between 37-85 % reported) during the three months after installation of the vending machines. This is a good indicator of improvements in girl's attendance, and we will continue to monitor this at intervals of 3-6 months.
Schools have started to provide menstrual hygiene education and constructed incinerators for pad disposal. At the minimum, they are managing pad disposal, via dustbins with lids.
Some schools have started to collect maintenance funds for repair and reloading pads in the machine.
In conclusion, the study found positive changes in the girls’ attendance as a result of improving toilets, installing pad vending machines and raising awareness. The attendance was compared before and after the installation of the sanitary pad vending machine in the school, and attendance improved after the machine was installed. As per the study findings, the vending machines are used properly, and the girls have easier access to sanitary pads, while being able to maintain privacy. Girls also became more open to share experiences on their menstrual period with female teachers.
Reference : Data collection Support by : Jeewan Dhami (SHP) - Api Himal RM Darchula Nandi Thagunna(SHP) - Marma RM - Darchula Gyenendra Dhami ( SHP) - Naugad RM - Darchula Ammara Upadhyaya ( SHP) Talkot - Bajhang Sarada Khadka, Manju Giri (SHP ) Thalara - Bajhang Basanti Bhandari (SHP) Chhabish Pathivera RM - Bajhang Kalawati Mall (SHP) Bhageswor RM - Dadeldhura