Menstrual Health

WHAT: Splash’s menstrual health (MH) program is designed so girls age 10 and above have access to girl-friendly sanitation facilities and education on puberty and menstrual health to prepare them to manage menstruation with dignity. We consider the unique experience of girls in school and tackle challenges related to sanitation infrastructure, social norms, education, and access to products.

FACILITIES WITH DIGNITY

Splash’s MH infrastructure approach improves access to girl-friendly sanitation facilities that are gender-segregated, clean, well-lit, ventilated, and equipped with water for personal hygiene, waste bins for product disposal, doors that lock to ensure privacy, and in-stall components such as stall hooks and shelves. 

TRAINING AND CURRICULUM

Splash works to foster self-efficacy, increase confidence and body literacy, and shift social norms through puberty and menstrual health education. Our MH curriculum, “Rosie’s World,” was contextualized through an intensive user-centered design approach. We deliver age-appropriate education to children in primary and secondary schools to normalize periods, reduce stigma, and address common misconceptions. We offer additional support to girls through training on the practicalities of managing menstruation and maintaining personal hygiene. 

SOCIAL ECOSYSTEM ENGAGEMENT

Splash complements these efforts through programs that leverage girls’ peers, older students, teachers, parents, and other critical stakeholders to drive normative change in their social ecosystem. We conduct education sessions for parents to build their self-efficacy to discuss puberty and menstruation with their children and with male students to motivate them to shift norms, reduce teasing, and become advocates for female peers. We also engage girls through a mentoring program, creating a safe space for girls to discuss their menstrual experiences with trusted older peers. 

WHY: Girls face a unique set of challenges that negatively influence their health, school attendance, self-efficacy, and well-being. Significant barriers to menstrual health persist. Girls do not consistently have access to education on puberty and menstrual health before the start of their menses. In addition, many do not have access to adequate sanitation facilities, sanitary products, or pain management methods to manage their menstruation at school. Splash's mission is for all children to be able to maintain their health, attend school, and reach their highest potential-something that many girls are currently unable to do because of lack of access to menstrual health management solutions. 

HOW: The Splash approach to menstrual health continues to evolve as more global stakeholders continue to recognize the impact that menstrual health can have on the life-course of the girl child. Splash is continuing to develop our menstrual health program; the current program focuses both on a standard package of hardware improvements and software interventions. Below outlines the current implementation standards:

HARDWARE

  • Girl-friendly sanitation facilities*
    • Strong, durable doors with locks accessible inside of the stall to ensure privacy
    • Adequate lighting within the stall and hallway of the toilet block
    • Water tap with small bucket within every toilet stall
    • Menstrual health-friendly trash/waste bin within every toilet stall (ideally with a lid on the waste bins

Component Specifications

Menstrual Hygiene Waste Bins 

  • Size: Small enough to fit in stalls, H- 12 inches, W- 8 inches, L- 8 inches
  • Materials recommendations: plastic
  • Color: red, black, dark grey
  • Accessories: Lid (removable), swivel lid (removable)
  • Placement location: in stall

Full Length Mirrors

  • Size: H- 4 ft., W- 1.5 ft.
  • Materials recommendations:
    • Shatter proof glass
    • Acrylic
    • Steel

  • Color: n/a

  • Accessories: framed/ protected

  • Placement location: In toilet block, discreetly located to reduce visibility from outside of the exterior door

Stall Shelves

  • Size: H-.25 inches, W-4 inches, L- 8 inches
  • Materials recommendations: metal, plastic, wood composite
  • Color: same color as stall walls, any color
  • Placement location: in-stall, accessibly from toilet

Under Investigation 

  • Incinerators- Splash is currently investigating the acceptability and feasibility of incinerators through a set of five trials at Splash schools in Kolkata, India. The environmental impact of menstrual hygiene product disposal is an important consideration for the Splash and will be critical in the design of our programmatic approach.

Sanitary products 

Currently, Splash does not provide sanitary products but the Behavior Change team plans to have conversations with school site administration to ensure there are free products available upon request to girls in case of emergencies during the school day.


*Intentionally excluded from the list of hardware interventions is a designated shower or changing room. Splash wants to ensure that girls can manage their menstruation within the toilet stall rather than needing to go to a separate designated room.

SOFTWARE

Menstrual Health Curriculum 

Abeba's/Ruby's World: A curriculum that follows a narrated story with various activities dispersed throughout in addition to some complementary activities for continued engagement post- training. The reading of the story can happen in the normal class context so long as safe COVID-19 protocols are in place and followed by each student and teacher present. 

  • Training of Trainers 
    • The training aims to build the capacities of trainers to deliver engaging and effective Menstrual Hygiene Management (MHM) sessions using the MHM Education Guide for Abeba's/ Ruby's World, to strengthen their confidence and address the sensitive issue of menstruation and menstrual hygiene. Trainers will then become agents of change, motivated to empower girls on this issue. 
    • A manageable group has 15-30 training participants. The training is suitable for all levels of MHM expertise, from experienced to inexperienced. We advise that trainers have some background in training others, as a teacher, trainer or peer educator. 
    • There have been good experiences in training teachers and leading students together, for example from a hygiene club. In such a case, ensure that students are actively engaged. It is also possible to have men as participants, yet men often face limitations in the practice session with girls and during the future implementation of the MHM Education Guide.
  • Gender Club Training
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Parent Program

Parental knowledge has long been recognized as a key barrier for improved MH practices for young girls. Splash would like to build out a parent-targeted MH intervention to increase parent knowledge, build self-efficacy, and address harmful norms and misconceptions that exist within communities and households. This program may include leveraging technology platforms such as SMS messaging and social media engagement.

Target Audience

  • Parents of girls aged 10-18

Material/Creative Asset Need

  • Parent Reference Guide (Target audience: parents)
  • Creative Assets for Virtual Parent Support Group (WhatsApp, Telegram, or other communication platform) (Target audience: Parent)
  • Parent Support Group Facilitator Guide (Target audience: Teacher or School Administrator)

Content:

The parent  engagement materials and messages will closely link with Menstrual Health curriculum that students will be  reached at schools . It will also include helpful tips about how to talk to children about puberty, how to prepare girls for the onset of menstruation, how to support girls during menstruation, where to access hygiene products, and checklists to ensure that parents are providing comprehensive and accurate information to their children.

Objective: Target Behaviour/Normative Change 

  • Inform- target mis information/ lack of information
  • Persuade- present new viewpoints to change parents’ behaviour
  • Motivate- target lack of compelling reason to change behaviour/to be role models in supporting their daughters about puberty and menstruation

Delivery: 

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Peer Mentoring Program 

Through our formative research, beneficiary-level human-centered design sessions, and discussions with other MH stakeholders, it is clear that girls often seek menstrual health and puberty support from peers and older siblings. To leverage this natural source for support and information, Splash is designing a Peer Mentoring program that will be built into the Gender Club format that already exists in many schools. The program materials will include discussion guides, reference materials for peer mentors to refer to when their mentees come to them with questions, and activities for peer mentor groups to do together to continue to build trust.

Target Audience

  • Teacher
  • Older Female Student- Mentor 

Material/Creative Asset

  • Peer Mentoring Training Guide/Reference Materials
  • Peer Mentoring Checklist
  • Peer Mentoring Activity Sheets

Content:

  • The peer mentoring  materials and messages will closely link with Menstrual Health curriculum that students will be  reached at schools . It will also include helpful tips  about providing real life emotional support and advice ,  how to support girls  to  access and use products, maintain hygiene during menstruation , and how to  talk to parents about sensitive subjects. 

Objective: Target Behavior/Normative Change

  • Inform- emotional support and advices about puberty and menstruation
  • Persuade- present new viewpoints to change behavior
  • Motivate- target lack of compelling reason to change behavior

Delivery: 

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Boys Workshop

Given male peers are a critical source of social influence for girls, Splash includes boys in our menstrual health program by conducting a workshop with male students to better enable the creation of a supportive felt environment within schools. This workshop will target negative social norms and misconceptions that are perpetuated by male peers. After attending the workshop, boys will become agents of change in the discourse related to menstruation and puberty.

Target Audience:

  • Male Students
  • Male Teachers

Material/Creative Asset:

  • Workshop facilitator guide (target audience: teachers)
  • Workshop worksheet/discussion guide (target audience: male students)
  • Male Student Menstruation reference booklet (target audience: male students)

Content:

  • The importance of menstruation
  • Menstruation as a biological process
  • Common misconceptions and taboos around menstruation
  • Proper use of hygiene materials/products, including disposal
  • Menstrual cycle tracking
  • Empowerment

Objective: Target Behaviour/Normative Change 

  • Male and female students have free discussion on puberty and menstruation to create conducive environment
  • Male students support menstruating girls in the schools by adopting positive norms
  • Male students change the instances of teasing and shaming around puberty and menstruation

Delivery: 

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Event Days

  • Celebration of Menstrual Hygiene Day on May 28th  Splash encourages all schools to celebrate the event day by providing an agenda, but only facilitates the event at select schools depending on the number of volunteers and/or partners we have for implementing the activity. The Pad Drive will be conducted on Menstrual Hygiene Day (see below for more information on Pad Drives)

Pad Drive 

During the SMC meeting Splash staff will determine if a school is willing to allocate budget to purchasing an emergency pad stock for their students or if they would prefer to have Splash's support in conducting a pad drive, twice annually. The Pad Drive will take during the firs quarter/semester of school and again on Menstrual Hygiene Day, May 28th.

  • A “Pad Provision Commitment” will be included in the schools' Action Plans and will indicate if they will conduct a pad drive or allocate school budget for the purchase of pads. 

Digital Solutions 

Splash is digitizing our MH curriculum to reach girls, parents, and teachers through additional channels and reinforce positive menstrual health messaging outside of school. We will use these trainings to supplement in-person trainings, conduct refresher trainings, and continue learning and engagement when in-person education is not possible.

Digital Teacher Trainings

We have developed a Telegram/SMS program for focal teachers that will enable us to provide digital discussion groups and refresher trainings so they have the support needed to shift the social narrative and remain engaged in ensuring that every girl has access to quality menstrual health education.

Parent Support Groups

Parents are enrolled in virtual support groups to expand their knowledge and gain access to advice on discussing menstruation with kids. Engaging parents ensures that kids have access to supportive adults at home and in school, creating a positive cycle of reinforcement during a critical time in their adolescence.

Oky: Menstrual Health App (Kolkata only)

Splash has partnered with Oky, a mobile phone application designed by UNICEF, to support girls in managing their menstruation and reinforce messages that are disseminated through in-school activities. Splash will be the first partner to contextualize Oky for an Indian context, and we are eager to contribute our learnings from the contextualization of the app for this setting and to share best practices with implementers interested in expanding Oky to other regions throughout India.


WHEN: 

  • The software program (including the conversation with school administration about the need to stock emergency menstrual products) should be delivered at the same time as the training of teachers. It should be delivered by the Behavior Change team (whether Splash or the implementing partner) in the first year of implementation
  • The hardware should be installed at the same time as sanitation rehab or construction and should be managed by the Infrastructure team (including the water taps, buckets and waste bins)

If there is a need to deviate from the standard at any site, it must be approved in advance by Splash’s Director of Global WASH Infrastructure and/or Senior Global Lead for Menstrual Health