School of Public Health, University of Alberta, 3-309 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
School of Public Health, University of Alberta, 3-309 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
J Adolesc. 2019 Oct;76:152-161. doi: 10.1016/j.adolescence.2019.07.008. Epub 2019 Sep 2.
Despite the growing attention to the relationship between menstruation and girls schooling, there remain many challenges to addressing the issue. Current interventions, which mostly focus on developing WASH infrastructure and sanitary hygiene management products, while necessary, may not be sufficient. This paper aimed to identify the root causes of poorly maintained WASH infrastructure, and understand the deeply embedded socio-cultural values around menstrual hygiene management that need to be addressed in order to provide truly supportive school environments for menstruating girls.
Qualitative data were collected in rural and urban sites in three provinces in Pakistan using participatory activities with 312 girls aged 16-19 years, observations of 7 School WASH facilities, 42 key informant interviews and a document review.
Three key themes emerged from our data: (1) a poorly maintained, girls-unfriendly School WASH infrastructure was a result of gender-insensitive design, a cultural devaluation of toilet cleaners and inadequate governing practices; (2) the design of WASH facilities did not align with traditionally-determined modes of disposal of rag-pads, the most common used absorbents; (3) traditional menstrual management practices situate girls in an 'alternate space' characterised by withdrawal from many daily routines. These three socio-culturally determined practices interacted in a complex manner, often leading to interrupted class engagement and attendance.
To be truly effective, current menstrual hygiene management strategies need to address the root causes of poor WASH infrastructure and ensure facility design is sensitive to the gendered and deeply embedded local socio-cultural values and beliefs around menstrual hygiene management.
尽管人们越来越关注月经与女孩上学之间的关系，但在解决这个问题上仍存在许多挑战。目前的干预措施主要集中在发展 WASH 基础设施和个人卫生管理产品上，虽然这些措施是必要的，但可能还不够。本文旨在确定 WASH 基础设施维护不善的根本原因，并了解在为经期女孩提供真正支持性的学校环境方面需要解决的与月经卫生管理有关的深层次社会文化价值观。
在巴基斯坦三个省份的农村和城市地区，使用 312 名 16-19 岁女孩参与的活动、对 7 个学校 WASH 设施的观察、42 次关键知情人访谈和文件审查，收集了定性数据。
我们的数据显示出三个关键主题：（1）设计上不考虑性别因素、对厕所清洁人员的文化贬低以及管理不善，导致 WASH 基础设施维护不善且不适合女孩使用；（2）WASH 设施的设计与传统上确定的布垫处理模式不一致，而布垫是最常用的吸收剂；（3）传统的月经管理实践将女孩置于一个以“替代空间”为特征的环境中，这个环境的特点是女孩会退出许多日常活动。这三个由社会文化决定的实践以复杂的方式相互作用，经常导致课堂参与和出勤率中断。
要真正有效，当前的月经卫生管理策略需要解决 WASH 基础设施不良的根本原因，并确保设施设计对性别和根深蒂固的当地社会文化价值观和月经卫生管理观念敏感。
