By Minhtam Tran, Education Intern, Menstrual Health Hub
Within the growing field of Menstrual Health & Hygiene (MHH), it is of the utmost importance to pool existing resources and evaluate the research that has already been produced. By utilizing lessons from other researchers and educational initiatives, we create space for continued progress and more success, as opposed to duplicating efforts and moving in circles.
This practice of learning from others to improve and advance female health is a core tenant of the Menstrual Health Hub. A crucial way that shared learnings are distributed is via events, events such as the UNICEF MHM Virtual Conference.
The MHM Virtual Conference is a yearly event that facilitates the global exchange of knowledge and learnings around MHH development interventions, which are historically delivered in WASH (Water Sanitation and Hygiene) in Schools (known as WinS) in low-to-middle income countries. Intended to foster greater collaboration and resource exchange, the virtual conference started in 2012 as a collaboration between UNICEF and Columbia University Mailman School of Public Health.
Starting in 2014, the conference had focused on the ‘MHM in Ten’, a set five of priorities to achieve in 10 years related to the integration of MHH into WinS, whereby: “In 2024, girls around the world are knowledgeable about and comfortable with their menstruation, and are able to manage their menses in school in a comfortable, safe and dignified way.”
The conference is set to have its 8th edition on May 21, 2020 (7am EST).
The focus of this year’s conference is innovation, highlighting novel ways to improve menstrual health programmatic interventions. Within UNICEF, innovation is a key area, with supplies, technology, financing, and programming making up their four pillars of innovation. When mapped onto MHH, products and services may be a key factor for innovation, however finding new ways to empower and educate are also crucial areas to progress in the field.
Over the years, one of the most important changes in the field of menstrual health and hygiene has been the change in focus. MHH is a relatively new field of research, and much of the early reports focused on formative research; that is, research that helped to establish the existence of the problem. As the amount of MHH research grew, so did proof of the need for increased MHM education, and the focus of MHH has turned towards innovative ways of designing and/or conducting educational initiatives.
Over the years, the MHM Virtual Conference has also grown rapidly; from around 230 participants (online and in-person) in 2012 to 1,300 participants in 2018. In this time, submissions for research projects have also increased, indicating the greater amount of work being done in the field as work in MHM becomes more robust.
This conference is important in making progress in menstrual health and hygiene because research, educational approaches, and interventions are key for establishing evidence-based information around what works around menstrual health and what doesn’t. And the sharing of this information across contexts through pathways such as the MHM Virtual Conference is essential to improving MHH worldwide.
Major lessons learned from previous MHM Virtual Conferences
The focus of the first conference in 2012 was on MHM (then a very new field of development research and WASH technical inquiry) interventions delivered through WinS programming. This included global research into the stigmatization of menstruation and working to establish a strong evidence base of empirical data collection and analysis around research interventions.
One of our favorite reports from this conference was the ‘National Context and Preliminary Findings in Cochabamba Department’ from Bolivia. This project was well-done because is really put girls’ experiences and voices at the center. At first, the researchers in the intervention tried to use focus groups to encourage conversations around the topic of menstruation, but found that many of the girls were too shy to share their experiences. To overcome this issue, the researchers developed simulated conversation through creating indirect opportunities for the girls to interact with the materials, such as through interactive games where they could express their concerns and ideas in alternative ways.
For example, the researchers had the girls draw what they considered to be their ideal bathroom. During this exercise the girls were able to critically think about their own experiences and creatively design and share what they thought might work better for them. This, as opposed to implementing solutions from the top-down, was a highly innovative way to co-create human-centered solutions to menstrual health and hygiene challenges.
The research team from UNICEF and Emory University expanded on this work. As detailed in the 2014 report, ‘Using Games to Research Menstrual Hygiene Management’, a board game was designed based on the socio-ecological model of public health. This model is predicated on the idea that several different frameworks influence public health issues, and specifically MHH.
The game was designed to elucidate the overall situation of MHM in school. For example, hypothetical scenarios were presented to students that detailed what they might do if there were no water accessible. By incorporating a game into data collection and research, it was much easier (and more fun!) to get increased participation from the girls.
The major lesson to take away from this work? To think critically about your audience and target population. In health research, quantitative measures are often taken, however with MHH, it can be difficult to fully quantify the situation. Creative, alternative and innovative approaches can (and should!) be used, when possible. This approach is seen in new monitoring frameworks, such as the 2020 Menstrual Practice Needs Scale (MPNS-36), which provides multidimensional framing of questions to help understand if the menstrual management and environment needs of the population at hand are being met.
Another piece of research from the MHM Virtual Conference we at the MH Hub regard highly is ‘Strategies for Inclusive MHM for Girls with Disabilities’, from Huru International. It should come as no surprise to anyone working in female and menstrual health that the work of the Menstrual Health Hub is incredibly intersectional and it is crucial when addressing challenges around MHH, we do not forget the people at the margins, the disabled, and other vulnerable populations.
Huru International published their work as part of the 2017 MHM virtual conference and in alignment with the ‘MHM in Ten’ five priorities, to “integrate MHM, and the capacity and resources to deliver inclusive MHM, into the education system”. Here Huru worked with the instructors at the primary school sites to develop an adaptable MHH curriculum for students that are deaf or hard of hearing, blind or visually impaired, as well as students with diverse sets of disabilities.
A major takeaway from this project is the importance of understanding of how to develop interventions, and more generally, research models based on the context in which they are meant to serve. It is’s essential to address the individual issues that different communities face. Another, more general lesson from this project is that interventions should always plan for flexibility in their approaches towards research and data collection. This project is a great example of a successful intervention that was not only flexibly designed but also had very strong community engagement and feedback loops built in. Research methodology can and should be adapted to fit the needs of the target population. Although the data being collected is the same (e.g. the state of WASH and MHM at the primary school sites), the technique in which it was recorded allowed for greater participation rates and increased the level of vulnerability students expressed in describing their experience with MHM.
What’s next for the MHM Virtual Conference?
So, what is there to look forward to at the 2020 MHM virtual conference? Well, for starters, we can expect to see a greater focus on the ways innovation can address the growing body of research around menstrual health and hygiene. We will see new research methodology, such as Dr. Julie Henngan’s MPNS-36, new practices in the area of disposal and waste management, and finance and capital mechanisms that have the power to shape markets for menstrual materials in previously underserved areas. Furthermore, there will be a presentation on the ways in which digital technology can be scaled to help young girls track their periods and learn about the changes in their bodies.