Breaking the silence on menstrual hygiene in Bangladesh

Updated - Wednesday 20 February 2008

Apart from the most obvious purposes, women and adolescent girls in Bangladesh also use latrines for menstrual management– to clean and change menstrual towels. Most sanitation programmes are silent about this practical need and menstrual management tends to be ignored in latrine design and construction and excluded from hygiene education packages. Even reproductive health and preventive health programmes in developing countries often do not address this sensitive issue.

Poor women and girls in many countries cannot afford purpose made sanitary pads or napkins. Instead, the vast majority of women and girls in Bangladesh use rags known as ‘nekra’ - usually torn from old saris. Once used, these rags are washed quickly in a small clay pot called a ‘bodna’ or a plastic tub of water inside the latrine. The nekra are each used several times. There is no private place to change and clean the rags and often no safe water and soap to wash them properly. Because they feel ashamed of letting these rags be seen, women and girls seek well hidden places even in their homes to dry the rags. These places are often damp, dark and unhealthy.

This practice is responsible for a significant proportion of illness and infection associated with female reproductive health. Unclean rags can cause urinary and vaginal infection. Very often serious infections are left untreated. This is a common picture in urban slums and rural Bangladesh.

Overcoming initial shyness

During the design phase of a new large water and sanitation programme in 2002, it took WaterAid Bangladesh almost a year to break through initial shyness, felt even by their own female staff, to openly discuss the inclusion of menstrual hygiene management in the new DFID supported programme. A baseline survey in 2005 on beliefs and practices on menstrual hygiene and management in the slums in Dhaka was followed by a sharing and action workshop between male and female staff of WaterAid and partners.

After hearing about the shame, stress and health problems that this caused for women and girls, all participants became committed to addressing the problem. Female staff took responsibility for discussing the issue with adolescent girls and women in the villages, slums and schools. The discussion includes the use of flash cards and dolls to address problems and to give positive messages. It covers:

  • unhygienic practices
  • the negative health impacts
  • good hygiene practice; including how rags should be washed, dried and stored and proper disposal of sanitary napkin
  • how to make a low cost home-made sanitary napkin
  • how to use a napkin or pad – tribal women in one area of Bangladesh do not traditionally use anything and they required a demonstration
  • low cost household women friendly latrine (with wooden base for cleaning the rags)
  • counselling to overcoming cultural barriers and shyness.

In late 2005, partners started community discussions on menstrual hygiene. In the first year of the intervention, partners used existing materials from a partner organisation. In 2007, WaterAid developed a new set of materials (flash cards, pocket book, and doll) focusing on adolescent girls to overcome the limitation of existing materials.

Incorporate menstrual management in latrine design and construction

Today, the partners involved in Community-led Total Sanitation encourage the community to build women friendly latrines, which include additional space required for washing and drying napkins.

Women toilet

WaterAid provides financial support for construction of toilet blocks in public places such as markets, educational institutions and in urban slums. All these toilet blocks have separate toilet facilities for men and women. In the new design, the female toilet is one to two feet wider than the male toilet. The female toilet also includes a small raised platform to allow the washing of rags and also a hanger on which to dry them. There are also disposal facilities for used rags. The wider female latrine is not only helpful in allowing for changing and washing sanitary napkins; it also means that children can accompany mothers if required; and means that sick and disabled people can have someone to help them if they need it.

Initially, WaterAid Bangladesh supported the idea of having separate chambers in community toilet blocks for menstrual management. But women and girls said that they preferred the arrangement of facilities inside the latrine, instead.

The existence of women-friendly toilets in slums, rural markets and schools is a symbol of recognition of one of the important practical needs of women and girls and should trigger increased awareness and action in this International Year of Sanitation.

Adapted from a paper by Rokeya Ahmed, Poverty & Equity Adviser, and Kabita Yesmin, Programme Officer (Social Development), WaterAid Bangladesh, presented at the South Asia Sanitation & Hygiene practitioners’ workshop in Bangladesh from 29-31 January 2008, organized by BRAC, WaterAid and IRC International Water and Sanitation Centre, with support from WSSCC.

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