Periods Don’t Stop for Pandemics – Neither Will Our Efforts to Bring Safe Menstrual Hygiene to Women and Girls

Periods don’t stop for pandemics. Every day, more than 300 million women and girls menstruate. Being able to manage their menstruation safely, hygienically, and with confidence and dignity is critical not just for their health and education, but also for economic development and overall gender equality. Millions of women and girls were already struggling to meet their menstrual needs before the current crisis, with an internalized sense of shame often linked to this natural process.

The coronavirus pandemic (COVID-19) highlights, or even exacerbates, persisting challenges related to menstruation:

●        Lack of access to water, sanitation and hygiene (WASH) infrastructure

Millions of women and girls lack access to household-level water and sanitation facilities and do not have a private space to change and dispose of menstrual materials. And poor WASH infrastructure in health care facilities affects not only patients, but also female health workers, who make up a large portion of this workforce globally.

●        Disrupted access to products

With the discontinuation of subsidized schemes, such as free distribution of menstrual hygiene products in schools and health care centers, many women and girls no longer have access to these supplies. Financial stress from the pandemic’s economic impact causes families to prioritize other basic needs. And disrupted supply chains increase prices of commercial products, making them unaffordable for too many. 

●        Lack of access to education to address stigma and taboos

Schools, community centers, and other touchpoints where girls and women can typically access critical information about menstruation – as a natural process that is neither shameful nor polluting – are closed due to the pandemic.  For those without computers or internet access, other sources of information are almost nonexistent.  Consequently, period stigma and taboos persist, and can undermine adolescent girls’ confidence at a key stage of development.  There is also limited availability of routine health services amid the COVID-19 response.

Menstrual health and hygiene (MHH) needs to be included in COVID-19 emergency response interventions and policies across sectors, including health, education, WASH, and gender.

As part of the WASH response to COVID-19, there are ample opportunities to continue this work.  Partnerships are on the rise with the private sector or charitable organizations to provide soap, as frequent handwashing is one of the primary methods for mitigating the spread of COVID-19;  in some cases, these have been accompanied by increased procurement and sales of menstrual hygiene supplies to reach girls and women at home.   Handwashing campaigns can also include messages to dispel stigma around MHH. The pandemic is driving efforts to develop WASH infrastructure, which provides an opportunity to ensure that MHH measures are incorporated from the beginning.

At the World Bank, we continue to work to improve menstrual health and hygiene for women and girls across the world, as demonstrated in these recent examples from our operations:

Tajikistan

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The Rural Water Supply and Sanitation project supports a WASH-in-School program and behavior change campaign to improve hygiene. It will also establish mechanisms to operate and maintain WASH facilities and finance delivery of soap, toilet paper, and cleaning materials. The WASH-in-School program will also finance construction of safe, gender-separated sanitation facilities and the development of menstrual education materials.  A high-level roundtable with the Ministry of Education, the Ministry of Health, and UNICEF convened in November 2019 to develop a policy brief on WASH in Schools, which also addresses MHH. The Ministry of Education conferred a high-level endorsement for the use of WASH materials in schools after their approval by the Academic Council. Working with partners, the project plans to support the replication of this approach beyond the 150 project-funded schools. 

Mozambique

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In Mozambique, the upper primary school completion rate in rural areas is just 14 percent for males and 8 percent for females, severely limiting livelihood opportunities.  Few schools have adequate sanitation facilities, and those that do are poorly maintained and unsuitable for MHH.  The Urban Sanitation Project is responding with a sanitation marketing and hygiene promotion campaign emphasizing the improvement of menstrual hygiene for girls and women. It will finance construction of 78 sanitation facilities, 68 for schools and 10 for markets in the two project cities. Standard designs include handwashing facilities, accessibility for people with disabilities, and MHH amenities. To maximize the impact in schools, MHH and hygiene promotion activities, including training for teachers and pupils, will be conducted. These approaches will inform future interventions in schools across the country.

Eswatini

^{_{Photo: Evolving Communications/The Global Financing Facility Flickr CC}}

A water and sanitation project in Eswatini found evidence that a lack of adequate school sanitation and hygiene facilities equipped for MHH increases the school drop-out rates for girls. The project is promoting design approaches to ensure that sanitation and hygiene facilities are constructed in schools to meet the needs of women and girls. This includes gender-separated facilities with door locks, lighting, disposal bins, and handwashing stations with soap and water. Behavior changes and hygiene promotion campaigns incorporating MHH will be undertaken, targeting students, teachers, parents and the larger community.

Solomon Islands

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In the Solomon Islands, gender inequality and gender-based violence are high, access to clean water is limited, and open defecation is prevalent, posing special health and security issues for females, particularly during menstruation.  An urban water and sanitation project is providing clean water sources in homes in underserved areas, improving sanitation services, and developing campaigns to change behaviors linked to sanitation, hygiene, menstrual hygiene management, and solid waste management.  It will coordinate with the Community Access and Urban Services Access project in targeting and implementing awareness campaigns. At least 10,000 people are expected to gain knowledge of the benefits of improved sanitation, hygiene, and MHH behaviors by 2027, with a significant share in informal settlements. 

Tanzania

^{_{Photo: Jonathan Seni/World Bank}}

The Sustainable Rural Water Supply and Sanitation Program in Tanzania, launched in 2019, is helping improve access to sanitation and promote hygiene practices at school.  Under the program, the Ministry of Education, Science and Technology will train male and female teachers on menstrual hygiene management at school once COVID-19 social distancing restrictions are lifted. The program will also support construction or rehabilitation of school WASH facilities (gender-separated and accessible child-friendly toilets with MHH facilities, water supply systems, and handwashing facilities), as well as campaigns to promote handwashing and MHH.  The ministry is working closely with the local NGO Sanitation and Water Action (SAWA) and the Tanzanian chapter of the Water Supply and Sanitation Collaborative Council (WSSCC), an UN-hosted organization.  The program will operate in 86 rural districts in 17 of the country’s 26 regions.

The  Global Water Security & Sanitation Partnership (GWSP), a multi-donor Trust Fund housed within World Bank’s Water Global Practice, prioritizes inclusion as one of its key themes, supports analytical work to build the evidence base, and works alongside Bank operations in bringing safe menstrual hygiene to women and girls.