Guidance On Menstrual Health And Hygiene

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Guidance onMenstrual Healthand Hygiene

March 2019First editionProgramme Division/WASH3 United Nations PlazaNew York, NY 10017 USAwww.unicef.org/washCommentaries represent the personal views of the authors and do not necessarily reflectthe positions of the United Nations Children’s Fund (UNICEF). The designations employedin this publication and the presentation of the material do not imply on the part of UNICEFthe expression of any opinion whatsoever concerning the legal status of any country orterritory, or of its authorities or the delimitations of its frontiers.Edited by Phil Poirier and designed by Noha HabaiebCover photo credits : UNICEF/UN0145564/SchermbruckerThis guidance is intended to be updated as new evidence and programme experiencesare generated. For more information on this publication or to share your experiences onmenstrual health and hygiene, please contact:Lizette Burgers, UNICEF Senior WASH Adviser, lburgers@unicef.orgPatty Alleman, UNICEF Senior Gender Adviser, palleman@unicef.org

Guidance onMenstrual Healthand Hygiene

ContentsAcknowledgementsAcronymsKey termsOverviewSection 1: Menstrual health and hygiene; a global opportunity1.1 An opportunity1.2 A global goal1.3. UNICEF’s commitmentResources for Section 1Section 2: Programme design2.1 Programming principles2.2 Supporting government leadership2.3 Analysing the situation2.4 Developing a theory of change2.5 Designing for scale2.6 Building the evidence base2.7 Assembling a UNICEF teamResources for Section 2Section 3: Core package of interventions3.1 Working through national systems3.2 Building skills and capacity3.3 Partnering with others467810121315161720212225293132343638394042

3.4 A framework for supporting MHHPillar 1: Social supportPillar 2: Knowledge and skillsPillar 3: Facilities and servicesPillar 4: Menstrual materials and suppliesSection 4: MHH for girls and women in vulnerable situations4.1 Reaching girls and women with disabilities4.2 Responding to humanitarian crises4.3 Transgender and non-binary personsResources for Section 4Section 5: Learning, monitoring, reporting and evaluation5.1 A global learning agenda5.2 Monitoring5.3 Reporting results within UNICEF5.4 EvaluationResources for Section 5Annex I: Key informantsAnnex II: Example MHH assessment checklistAnnex III: JMP core questions and indicators for SH in schools relevant to MHMTable 1: Ten critical determinants for assessing bottlenecks andbarriers to equitable outcomes for children28Table 2: Overview of menstrual materials5970Table 3: Sectoral contribution to MHH in emergenciesTable 4: Exemplar topics and research questions around MHM foradolescent girls76Table 5: MHM outcome measures that need standardised definitions7981Table 6: MHH in UNICEF’s Strategic Plan results framework5

Guidance on menstrual health and hygieneAcknowledgementsThe authors would like to sincerely thank all their key informants for the generosity insharing their time and knowledge with us during interviews, responding to informationand resource requests, and more broadly for their continued partnership with UNICEFon topics related to menstrual health and hygiene. Please refer to Annex I for a list of allcontributors.Contributors came from the following organisations and country contexts: Bill and Melinda Gates Foundation The Case for Her Columbia University Global Affairs Canada Johns Hopkins University Save the Children UNFPA UN Girls’ Education Initiative WaterAid WHO/UNICEF Joint Monitoring Programme for Drinking Water, Sanitation and Hygiene UNICEF Programme Division (Adolescent Development and Participation,Communication for Development, Disability, Education, Gender, Health, and WASH),Supply Division, Regional Offices (South Asia, Latin America and the Caribbean,Eastern and Southern Africa, West and Central Africa, Middle East and North Africa,and East Asia and the Pacific), and country offices (Indonesia, Ethiopia, Philippines,Bolivia, Zambia, Burkina Faso, and India).The authors would like to similarly extend sincere gratitude to the internal reviewers whoprovided comments on multiple drafts of this guidance: Jérémie Toubkiss (EvaluationOffice); Magdalene Matthews Ofori-kuma (Eastern and Southern Africa Regional Office);Jolly Ann Maulit, Charlotte Pram Nielsen, Yodit Sheido (West and Central Africa RegionalOffice); Cristina de Carvalho Eriksson, Ayuko Matsuhashi, Tamara Rusinow, Julia Stricker,and Megan Tucker (Programme Division). Special thanks to Frank Odhiambo (Chief ofWASH, UNICEF Tanzania) and Esenbek Turusbekov (Climate Change Specialist, UNICEFKyrgyzstan) for the additional case studies that they contributed during the review period.Thanks to Monica Serrano, knowledge management consultant with Programme Division(WASH) in NY, for her assistance in finalising the guidance.This guidance owes a debt of gratitude for the work done by many others, notably theguidance and manuals already produced by other organisations along with the review andsynthesis studies carried out by UNICEF and its partners at the national and regional level.This guidance was prepared by Leisa Gibson, consultant, and Brooke Yamakoshi, UNICEFWASH Specialist, with contributions and overall guidance from Lizette Burgers, SeniorWASH Adviser, and Patty Alleman, Senior Gender Adviser.6

AcronymsCSEComprehensive sexuality educationDHSDemographic and health surveyFGDFocus group discussionFGM/CFemale genital mutilation/cuttingGAPGender Action PlanJMPWHO/UNICEF Joint Monitoring Programme for Drinking Water, Sanitation and HygieneMICSMultiple indicator cluster surveyMHMMenstrual hygiene managementMHHMenstrual health and hygieneNFINon-food itemWASHWater, sanitation and hygieneWinSWASH in schoolsSRHRSexual and reproductive health and rightsTOCTheory of changeUNICEFUnited Nations Children’s FundUNFPAUnited Nations Population Fund7

Guidance on menstrual health and hygieneKey termsMenstruation or menses is the natural bodily process of releasing blood and associatedmatter from the uterus through the vagina as part of the menstrual cycle.Menarche is the onset of menstruation, the time when a girl has her first menstrualperiod.Menstrual hygiene management (MHM) refers to management of hygiene associatedwith the menstrual process. WHO and UNICEF Joint Monitoring Programme (JMP) fordrinking water, sanitation, and hygiene has used the following definition of MHM: ‘Womenand adolescent girls are using a clean menstrual management material to absorb or collectmenstrual blood, that can be changed in privacy as often as necessary for the duration ofa menstrual period, using soap and water for washing the body as required, and havingaccess to safe and convenient facilities to dispose of used menstrual managementmaterials. They understand the basic facts linked to the menstrual cycle and how tomanage it with dignity and without discomfort or fear1.Menstrual health and hygiene (MHH) encompasses both MHM and the broadersystemic factors that link menstruation with health, well-being, gender equality, education,equity, empowerment, and rights. These systematic factors have been summarised byUNESCO as accurate and timely knowledge, available, safe, and affordable materials,informed and comfortable professionals, referral and access to health services, sanitationand washing facilities, positive social norms, safe and hygienic disposal and advocacy andpolicy.A menstruator is a person who menstruates and therefore has menstrual health andhygiene needs – including girls, women, transgender and non-binary persons. Throughoutthis guidance, the term ‘girls and women’ is used as a shorthand term to increasereadability and refers to all menstruators regardless of gender identity.Menstrual hygiene materials are the products used to catch menstrual flow, such aspads, cloths, tampons or cups.Menstrual supplies are other supportive items needed for MHH, such as body andlaundry soap, underwear and pain relief items.Menstrual facilities are those facilities most associated with a safe and dignifiedmenstruation, such as toilets and water infrastructure.Gender refers to the roles, behaviours, activities, and attributes that a given society at agiven time considers appropriate for men and women. These attributes, opportunities andrelationships are socially constructed and are learned through socialisation processes. Theyare context- and time-specific, and are changeable. Gender determines what is expected,1WHO/UNICEF (2012) Consultation on draft long list of goal, target and indicator options for future global monitoring of water, sanitation andhygiene. Available at f8

Key termsallowed and valued in a woman or a man in a given context. In most societies, thereare differences and inequalities between women and men in responsibilities assigned,activities undertaken, access to and control over resources, as well as decision-makingopportunities. Gender is part of the broader socio-cultural context, as are other importantcriteria for socio-cultural analysis such as class, race, poverty level, ethnic group, sexualorientation, age, etc2.Transgender (sometimes shortened to ‘trans’) is an umbrella term used to describea wide range of identities whose appearance and characteristics are perceived asgender atypical —including transsexual people and people who identify as third gender.Transgender women identify as women but were classified as males when they wereborn, transgender men identify as men but were classified female when they were born,while other trans people do not identify with the gender-binary at all3.Sex (biological sex) is defined as the physical and biological characteristics that distinguishmales and females, such as reproductive organs, chromosomes and hormones4.Intersex people are born with physical or biological sex characteristics, such as sexualanatomy, reproductive organs, hormonal patterns and/or chromosomal patterns, which donot fit the typical sex definitions of male or female. These characteristics may be apparentat birth or emerge later in life, often at puberty. Intersex people can have any sexualorientation and gender identity. UNICEF/UN0309028/Kokic2WHO (2011) Gender mainstreaming for health managers: a practical approach. Available at /glossary/en/.3UN Free & Equal Campaign (2018) Definitions. Available at https://www.unfe.org/definitions/4WHO (2011) Gender mainstreaming for health managers: a practical approach. Available at /glossary/en/9

Guidance on menstrual health and hygieneOverview10

OverviewThis guidance was developed for UNICEF WASH, Education, Health, and Genderspecialists or focal points in country offices who are working with their partners to developprogrammes related to menstrual health and hygiene (MHH).In recognition of the inherently broad programming considerations of MHH, this guidanceis also aimed at UNICEF colleagues from the cross-cutting clusters of Communications forDevelopment, Adolescent Development and Participation, and Disability. While it is writtenfrom the perspective of a UNICEF staff member, it may also be useful for colleagues fromother agencies who are working to advance menstrual health and hygiene at a national andsub-national level.This document is guided by the priorities laid out in UNICEF’s Strategy for WASH 20162030, Strategic Plan 2018-2021, and Gender Action Plan 2018-2021, and is intended toadvance the realisation of the targets contained therein. As such, it focuses on the processof designing and supporting programmes from the vantage point of UNICEF, rather thandetailed technical notes and descriptions of menstrual health and hygiene programmes.These detailed technical resources already exist and reference is made to them in eachrelevant section.This guidance is structured into five sections.Section 1: A global opportunityThis section explains the global interest in supporting MHH through development andhumanitarian programming under the SDGs.Section 2: Programme designThis section articulates the principles underpinning UNICEF’s MHH programmes andexplains the process to support government leadership, carry out a situation analysis,develop a theory of change, build an evidence base, estimate programme costs, andassemble a team.Section 3: Core package of interventionsThis section provides and describes a framework of essential MHH interventions thatare inclusive of all menstruators and which reach the most underserved, with a focus onworking through and strengthening national systems.Section 4: MHH for girls and women in vulnerable situationsThis section is not exhaustive but provides an overview of strategies to reach threespecific populations: girls and women with disabilities, girls and women in humanitarianaction, and transgender or non-binary menstruators.Section 5: Learning, monitoring, reporting and evaluationThis section provides an overview of the global monitoring and evaluation frameworks forMHH.11

Guidance on menstrual health and hygieneSection :Menstrual health and hygiene;a global opportunity12

Section 1: Menstrual Health and Hygiene; a global opportunity1.1 An opportunityMenstruation is a natural fact of life and a monthly occurrence for the 1.8 billion girls,women, transgender men and non-binary persons of reproductive age. Yet millions ofmenstruators5 across the world are denied the right to manage their monthly menstrualcycle in a dignified, healthy way.Gender inequality, discriminatory social norms, cultural taboos, poverty and lack of basicservices often cause girls’ and women’s menstrual health and hygiene needs to go unmet.Adolescent girls may face stigma, harassment and social exclusion during menstruation.Transgender men and non-binary persons who menstruate often face discrimination dueto their gender identity that prevents them from accessing the materials and facilitiesthat they need. All of this has far-reaching negative impacts on the lives of those whomenstruate: restricting their mobility, freedom and choices; affecting attendance andparticipation in school and community life; compromising their safety; and causing stress andanxiety. The challenges are particularly acute for girls and women in humanitarian crises6.The onset of menstruation coincides with new opportunities – and vulnerabilities – thatarise during adolescence. Menstrual health and hygiene interventions can be an entrypoint for other gender-transformative programmes during this period, like sexual andreproductive health education and life skills development. By strengthening self-efficacyand negotiating ability, MHH programmes can help girls build the skills to overcomeobstacles to their health, freedom and development, such as gender-based violence,child marriage and school dropout. Investments in adolescent girls’ well-being yield tripledividends: for those girls, for the women they will become, and for the next generation.What is menstrual health and hygiene?The term menstrual hygiene management (MHM) originated in the WASH sector. After decades of use,there is broad understanding and acknowledgement of this term. Importantly, there is also a definition andemerging attempts at measurement in the context of schools, through the WHO/UNICEF Joint MonitoringProgramme for Drinking Water, Sanitation, and Hygiene (JMP).In 2012, the JMP defined MHM as: “Women and adolescent girls are using a clean menstrualmanagement material to absorb or collect menstrual blood, that can be changed in privacy as often asnecessary for the duration of a menstrual period, using soap and water for washing the body as required,and having access to facilities to dispose of used menstrual management materials.”Menstrual health builds on this concept and encompasses the broader impacts of the psychological,socio-political and environmental factors that accompany menstruation on mental, physical, and emotionalhealth.By using the term menstrual health and hygiene in this guidance, we include both the factors includedin the JMP definition of MHM together with the broader systemic factors that link menstruation withUNICEF’s goals in health, well-being, education, equality and rights. These systematic factors have beensummarised by UNESCO as: accurate and timely knowledge; available, safe, and affordable materials;informed and comfortable professionals; referral and access to health services; sanitation and washingfacilities; positive social norms; safe and hygienic disposal; and advocacy and policy.5Throughout this guidance, the term ‘girls and women’ is often used as a stand in for all menstruators regardless of gender identity. Thisshorthand is used to increase readability. As part of UNICEF’s commitment to equality and human rights mandate, programmes should beinclusive of transgender and non-binary persons who have menstrual health and hygiene needs.6Sommer M., Caruso B.A., Sahin M., Calderon T., Cavill S., Mahon T., et al. (2016) ‘A Time for Global Action: Addressing Girls’ Menstrual HygieneManagement Needs in Schools’, in PLOS Medicine 13(2): e1001962. Available at https://doi.org/10.1371/journal.pmed.100196213

Guidance on menstrual health and hygieneMHH and human rightsInternational human rights law is a binding, and therefore enforceable, legalframework that defines the relationship between a state (the government) as‘duty-bearers’ of human rights and people living in that state as ‘rights-holders’.The Convention on the Rights of the Child (CRC), Convention on the Elimination ofAll Forms of Discrimination against Women (CEDAW), and the Convention on theRights of Persons with Disabilities (CRPD) are examples of international human rightstreaties that are particularly relevant to MHH.Understanding MHH within the context of human rights requires a holistic approachto women’s and girls’ human rights. The biological fact of menstruation, the necessityof managing menstruation, and society’s response to menstruation is linked withwomen’s and girls’ human rights and gender equality. Women and girls encounterdifficulties in managing hygiene during menstruation when they lack the enablingenvironment to do so. Notably when they have difficulty exercising their rightsto water, sanitation and education, they will likely have difficulty managing theirmenstruation. When women and girls cannot manage their menstrual hygiene, it cannegatively impact their rights, including the rights to education, work and health.Framing MHM in the context of human rights and gender equality may engage local,municipal, provincial and national government actors not typically attuned to MHMconcerns, and can support policy arguments for government action.Adapted from WASH United and Human Rights Watch (2016) Understanding menstrual hygiene andhuman rights. Available online at uman-rights-issue/14 UNICEF/UNI196036/Grile

Section 1: Menstrual Health and Hygiene; a global opportunity1.2 A global goalMHH is important for the fulfilment of girls’ and women’s rights, a key objective of theSustainable Development Goals (SDGs). Women and girls’ access to MHH is a componentof gender-responsive WASH services; SDG 6.2 acknowledges the right to menstrual healthand hygiene, with the explicit aim to, “By 2030, achieve access to adequate and equitablesanitation and hygiene for all and end open defecation, paying special attention to theneeds of women and girls and those in vulnerable situations”. Without considering needsfor safe and dignified menstruation, the world cannot achieve the vision for sanitation andhygiene under Goal 6.Women and girls’ access to MHH is also central to achieving other SDGs. The lack ofbasic knowledge about puberty and menstruation may contribute to early and unwantedpregnancy; the stress and shame associated with menstruation can negatively affectmental health; and unhygienic sanitation products may make girls susceptible toreproductive tract infections – all affecting SDG health outcomes (Goal 3). Girls may beabsent or less attentive in school during menstruation due to a lack of WASH facilities orsupport from the school community, affecting education (Goal 4), or at work, affectingeconomic opportunities (Goal 8). Gender equality (Goal 5) cannot be achieved when taboosand myths prevent menstruating women and girls from full participation in society. Failureto develop markets for quality menstrual materials can impact on sustainable consumptionand production patterns (Goal 12).MHH in the SDGs3.7 “ universal4.1 “ all girls and5.1 “End all forms6.2 “ access to8.8 “ promote safe12.5 “ reduceaccess to sexualboys completeof discriminationadequate andand secure workingwaste generation ”and reproductivefree, equitable andagainst all womenequitable sanitationenvironments for allhealth-carequality primaryand girls ”and hygiene forworkers, includingservices ”and secondaryall and end openmigrant workers, indeveloping12.9 “Supporteducation ”5.5 “Ensuredefecation, payingparticular womencountries towomen’s fullspecial attentionmigrants ”strengthen their.4.5 “ eliminateand effectiveto the needsgender disparities inparticipation inof women andtowards moreeducation ”public life.”girls and thosesustainable patternsin vulnerableof consumption and4.7 “ all learners5.6 “Ensuresituations.”production”acquire theuniversal accessknowledge andto sexual andskills needed toreproductivepromote humanhealth ”capacity to moverights, genderequality ”4.a “Build andupgrade educationfacilities that arechild-, disability- andgender-sensitive ”15

Guidance on menstrual health and hygiene1.3 UNICEF’s commitmentUNICEF envisions a world where every girl can learn, play, and safeguard her own healthwithout experiencing stress, shame, or unnecessary barriers to information or supplies duringmenstruation. UNICEF’s support to menstrual health and hygiene is aimed at improvingoutcomes on education, health, and gender equality for girls and women. By comprehensivelyaddressing a range of factors - such as building self-efficacy, developing a positive policyand programme environment, effecting social change and increasing access to materialsand facilities - UNICEF will continue to support girls and women to have the confidence,knowledge, and skills to manage their menstruation safely, using appropriate materials andfacilities, at home and away from the household.Specifically, achieving these goals requires addressing four interrelated determinants; socialsupport, knowledge and skills, facilities and services, and materials and supplies – alongwith improvements in the enabling environment through appropriate policies, coordination,financing, capacity building, and monitoring in the education, health, and WASH sectors.Because of its transformational potential, MHH is one of UNICEF’s five interlinked prioritiesfor empowering adolescent girls in its Gender Action Plan 2018-2021, which accompaniesits broader Strategic Plan for the same period and is approved by the Executive Board.The Gender Action Plan is UNICEF’s commitment to achieving gender equality and girls’empowerment. The five priorities of the Gender Action Plan, implemented togetherand at scale, can dismantle some of the most stubborn barriers to gender equality andtransform the lives of adolescent girls – supporting them to become healthy, educated andempowered women, able to direct the course of their own lives. The priorities of the Planare monitored and reported on annually.16 UNICEF/UN0215383/Vishwanathan

Section 1: Menstrual Health and Hygiene; a global opportunityResources for Section 1Author, title and linkUNICEF Strategy for Water, Sanitationand Hygiene (2016-2030)UNICEF (2016)The Impact of Water, Sanitation andHygiene on Key Health and SocialOutcomes: Review of EvidenceUNICEF and SHARE Consortium (2016)UNICEF Strategic Plan, 2018-2021UNICEF (2017)UNICEF Gender Action Plan, 20182021UNICEF (2017)Global Partnership for EducationStrategic Plan,2016-2020GPE (2016)Programme Guidance for the SecondDecade: Programming with and forAdolescentsUNICEF (2018)RelevanceThis strategy guides UNICEF’s organisation-wide contribution toachieving SDG 6. It is designed to inform and support UNICEF’s coreplanning and strategy processes, and to guide the implementationof its programmes. It defines the principles to be applied to allUNICEF’s work and a menu of approaches and results areas to betailored to each country’s context.This evidence paper looks at 10 areas identified by SHARE andUNICEF on which WASH can plausibly have a strong impact:diarrhoea, nutrition, complementary food hygiene, femalepsychosocial stress, violence, maternal and newborn health,menstrual hygiene management, school attendance, oral vaccineperformance, and neglected tropical diseases. The paper indicateswhere evidence-based consensus is emerging or has beenestablished.UNICEF’s Strategic Plan, 2018-2021 highlights the organisation’s keygoals and activities, setting out the concrete results that UNICEFaims to achieve for children with its partners over a four-year period.The summary version outlines the organisational change strategiesand enablers envisioned by the Strategic Plan to achieve thoseresults, charting a course towards the attainment of the 2030 SDGsand a better future for every child.The Gender Action Plan specifies how UNICEF will promote genderequality across all of the organisation’s work at the global, regionaland country levels, in alignment with the UNICEF Strategic Plan.This is a five-year strategic plan that details the shared mission of thepartnership and the steps it will take to get it done. It captures GPE’svision, practical approach and dedication to partnership. At the globallevel gender equality is both a principle and the third strategic goaloutlined in the 2020 GPE strategy.This guidance document seeks to increase coherence, scale upresults and establish priorities and guiding principles for UNICEFprogrammes working with and for adolescents, in support of countryand regional offices. While the primary target audience of thisdocument is UNICEF staff, it also provides partners with an overviewof the strategic direction of UNICEF on the second decade of achild’s life.17

Guidance on menstrual health and hygieneMenstrual Hygiene Matters: A resourcefor improving menstrual hygiene aroundthe worldSHARE & WaterAid (2012)Modules and ToolkitsTraining GuideAn Opportunity to Address MenstrualHealth and Gendre Equity: A GlobalMenstrual Health Landscape AnalysisFSG (2016)Menstrual hygiene managementin schools in South Asia: SynthesisreportUNICEF & WaterAid (2017)Menstrual Health Management in Eastand Southern Africa: A Review PaperUNFPA (2018)Supporting the Rights of Girls andWomen through Menstrual HygieneManagement in the East Asia andPacific Region: Realities, Progress andOpportunitiesUNICEF (2016)18This comprehensive resource brings together accurate,straightforward, non-judgmental knowledge and practice onmenstrual hygiene programming from around the world toencourage the development of comprehensive and context-specificapproaches to menstrual hygiene. It presents comprehensive andpractical guidance on what is already being implemented in differentcontexts to encourage replication. The resource is divided intomodules, each with its own toolkit, focusing on various aspects ofmenstrual hygiene. It was written by Sarah House, Therese Mahon,and Sue Cavill.This report gives a concise overview of 1) the state of the evidencelinking menstrual health to health, education, and equality outcomes;2) a brief landscape of the menstrual health sector, including areasof progress and existing gaps; and 3) conclusions and perspectiveson opportunities for working in menstrual health. The report wasprepared with support from the Bill & Melinda Gates Foundation. Itis the result of a review of over 150 peer-reviewed articles and greyliterature, interviews with 37 global experts, 70-plus interviews withexperts and practitioners in India, Kenya, and Ethiopia, and a reviewof relevant programming focused on menstruation, MHM, andsexual and reproductive health and rights.This report details the status of MHM in schools in South Asia.Progress and gaps are identified in achieving sustainable andinclusive MHM services at scale, and the report draws togetheropportunities for further promoting and mainstreaming MHM inschools across South Asia.The findings are presented in an overall report, a summary, and 8country specific reports.This review provides an overview of MHM policies and programmesin the Eastern and Southern Africa region, with a focus on education,school and community-based sexuality education, WASH, sexualand reproductive health, workplace support and humanitarianprogramming, as well as opening up the discussion regardingmarginalized groups of women and girls such as disabled, prisonersand transgender men. It addresses barriers and enablers forscalability of MHM programmes such as knowledge, attitudes, andcultural perceptions, availability of menstrual products and supplies andsanitation facilities as well as policy.A comprehensive overview and analysis of the experiences of girlsand women, to establish the current status of MHM programmingand action across the East Asia and the Pacific region. The reviewnot only focuses on the school context linked to WASH in Schoolsprogramming, but also explores MHM in relation to out-of-school youth,as well as MHM at community level, in humanitarian contexts and inthe workplace.The findings are presented in two documents:(1) A regional synthesis report titled “Realities, Progress andOpportunities”(2) An implementation guidance note with selected good practicestitled “Regional Good Practice Guidance Note”

Section 1: Menstrual Health and Hygiene; a global opp

menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of used menstrual management materials. They understand

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