Tuesday, March 6, 2018

From taboo to empowerment through menstrual management and education

By Sarah Cowley

A 6 grader enjoys her study session at
Snor Kley Primary School, Kampong Thom.
© UNICEF Cambodia/2017/Bona Khoy

Kampong Thom, Cambodia, March 2018
– Females today have an estimated 450 periods during their lifetime, which amounts to six to seven years when combined. Yet awareness of menstrual hygiene management (MHM) is low in Cambodia and elsewhere because menstruation is considered a taboo subject unsuitable for open discussion. 


A lack of knowledge of MHM and poor access to facilities and services can negatively impact on women and girls’ education, health and equal participation in various aspects of society.

For instance, numerous studies have suggested links between poor menstrual hygiene and urinary or reproductive tract infections and other illnesses. 

Many school girls in Cambodia face insufficient access to adequate toilet and handwashing facilities to maintain their cleanliness and dignity; a lack of sanitary pads that offer comfort and protection to last the entire school day; and inadequate privacy to change and dispose of these sanitary products.

Menstruation, without such critical supplies and facilities, can cause girls to miss class or even eventually dropping out completely, depriving them of a basic right and their ability to reach their full potential in life and society. 

A Water Aid-UNICEF collaborative study undertaken in 2016 showed that insufficient knowledge about menstruation and MHM prevented girls from taking care of their health and caused them unnecessary fear and distress.

During the break, school girls in Snor Kley school apply
their good practices of hand washing they have learned from their class,
using water from school WASH facility.
© UNICEF Cambodia/2017/Bona Khoy


While female family members were found to be a source of information, teachers and peers were not.

To expedite girls’ equal right to an education, provided in a safe and clean environment, Snor Khley Primary School in Kampong Thom Province is implementing a number of inspired MHM initiatives to help schoolgirls manage their period hygienically and with dignity.

The school’s approach to MHM includes an education plan that engages both boys and girls in open discussions about MHM so their collective awareness can yield greater consideration and understanding among both genders.

Grade 6 girl students at Snor Kley Primary School,
Kampong Thom province, are being interviewed by UNICEF team.
All discussions were focused around the menstrual hygiene management 
at the school, bathroom facilities, privacy, hand washing, 
student support group and the impact that had on students, 
the impact of the Growth and Changes booklet for students, 
their families and the community.
© UNICEF Cambodia/2017/Bona Khoy


Additionally, the creation of hygienic on-site school facilities has enabled girls to better manage their period and concentrate more fully on their studies.

One of the school’s most perceptive interventions to date is compulsory learning of the Growth and Changes booklet.

Snor Khley Primary School Director Ms Heum Sokunthea recognizes the importance of teaching the book to both genders.

She said: “Students have a ‘life skills’ class where they speak about menstrual hygiene management and they learn with the Growth and Change booklet.”

Teacher Ms Doeurn Khim added: “Girls know more about the changes in their body and they can prepare and be cleaner. They are also aware in advance of their period and other body changes.”

Female students confirmed not many were taught at home about menstruation and said the book gives them and their families a better understanding – and importantly it reduces myths.

The impact of this learning on male students is also visible.

Male student of grade 6 in Snor Kley Primary School 
are also taking part in the interview.
© UNICEF Cambodia/2017/Bona Khoy


Ms Doeurn said: “Mocking and teasing has reduced and there has been a normalization of girls and their period. There has definitely been an attitude change with the boys.

The booklet was developed by the Ministry of Education, Youth and Sport (MoEYS) – in partnership with UNICEF, Columbia University and The United Nations Population Fund, (UNFPA) – to provide guidance to students about puberty and MHM in school.

Since 2014 and in cooperation with NGOs Rainwater Cambodia, Muslim Aid and BoRDA, UNICEF has supported the School Health Department at MoEYS to distribute nearly 150,000 copies of Growth and Changes to primary schools in 11 provinces.

It builds knowledge on menstruation, MHM and increased awareness about the physical and emotional changes girls undergo during puberty. To date, the book has benefitted over 122,000 students.

Specifically, the book explains how girls can maintain their hygiene during their period; how they can maintain a menstrual cycle calendar; how they can manage their first period, with details on misinformation; and it provides reassurance through detailing girls’ experiences of their menstrual cycle.

Complementary to MHM education, WASH facilities at the school have been developed to an   appropriate standard, with private and separate bathrooms and extensive modern hand-washing stations.

The respective boys and girls’ facilities are separated and each female toilet unit has an inside lock and full doors that provide complete privacy.

Girls are provided with single-use sanitary pads and these are disposed of by incineration to maintain standards of hygiene. Additionally, handwashing taps are positioned outside of all the classrooms.

Feedback about MHM intervention has been positive and it has been described by girl students as ‘comfortable and appropriate’ for their needs.

The school has also established a girls’ support group which has been operative for a number of years. Each year, a leader and four members from Grades 4, 5 and 6 are appointed to the counsel group.

This provides extra support to female classmates in regard to menstruation, MHM and female health and the group reports important comment back to teaching staff. Since the formation of this group school director Ms Heum said the dropout and absentee rate had reduced. 

“Girls can support each other through the counselling group. They can help each other, especially when they have their period,” she said.

One female student said: “If one girl has a headache, she cannot learn. We help her to get home and help her catch up on work later on. Now almost all girls come to school when they have their period.”

UNICEF is working with Governmental and NGO partners to advocate for MHM to be included in the minimum requirement guideline for Water, Sanitation and Hygiene in schools and Education Management Information System (EMIS), as well as the revised school health curriculum and the school health policy so Snor Khley School’s success can be replicated on a larger scale nationwide.

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