Menstrual hygiene management in Fiji: Establishing an evidence base to address WASH challenges for girls in school, results from a formative study Pubblico

Abstract

Background: Menstrual hygiene management (MHM) has a strong impact on girls’ education in the developing world. However, evidence of the impact of MHM on the quality of life and education of women and girls in the Pacific is limited. In late 2015, following devastation from Tropical Cyclone Winston, UNICEF Pacific and the Ministry of Education, Heritage, and Arts in Fiji targeted MHM as an area of significance in addressing water and sanitation hygiene (WASH) in the school setting.

Objective: To promote gender equality and girls’ empowerment in schools, identify barriers to MHM, and increase access to MHM-friendly WASH facilities and sanitary resources.

Methodology: Researchers utilized in-depth interviews, focus group discussions, participatory learning activities, and WASH facility observations to examine knowledge, attitudes, and practices surrounding menstruation. Data were collected from 7 schools (2 urban, 3 rural and 2 peri-urban) in three educational sub-districts of Viti Levu from May to September, 2016. In total, 151 participants comprised of 75 girls, 42 boys, and 34 teachers openly shared their experiences, knowledge, and attitudes on menstruation, including recommendations for improving school WASH facilities and resources for MHM.

Results: The research provided a better understanding of girls’ experiences and needs surrounding menstruation in the school environment as well as insight into the cultural, social, and religious norms limiting girls’ ability to confidently manage menses. Many female study participants learned about menstruation prior to menarche; however, information varied based on socio-cultural norms. Study participants expressed an increased need for education on puberty and menstruation in schools. Girls and female teachers identified the challenges they encountered regarding adequate WASH facilities for MHM in school, including access to toilet paper, handwashing soap, and sanitary disposal bins. This research generated recommendations that include: teacher training, school-based management and operation of WASH facilities, and cross-sectoral collaboration for policy improvement.

Table of Contents

Table of Contents:

      I.         Introduction....................................................1

    II.         Literature Review.............................................1

a.  Menstrual hygiene management globally ................. 2

b.  Menstrual hygiene management in Fiji .....................3

c.  Fiji’s education sector ................................................3

d.  Coverage of WASH facilities in Fijian schools............ 4

e.  WASH in Schools Policy and Efforts ...........................5

  III.         Statement of Purpose ....................................... 6

 IV.         Justification.........................................................7

   V.         Methodology.......................................................8

a.  Inclusion and Exclusion criteria.................................. 8

b.  Ethical Considerations ................................................ 9

c.  Training....................................................................... 10

d.  Theoretical Framework................................................ 11

e.  School Selection............................................................11

f.   Recruitment..................................................................12

g.  Data collection and study tools .................................... 12

 VI.         Data Analysis........................................................15

VII.         Study findings ......................................................15

a.  Challenges...................................................................... 16

b.  Determinants..................................................................18

                 i.    Education and Culture context of MHM practices ............... 18

                 ii.    WASH facilities......................................................................19

c.     Voiced Impacts..................................................................................... 21

VIII.   Discussion.....................................................................................22

 IX.     References.......................................................................................24

 X.       Figure 1. Ecological framework for MHM research activities and themes........26

XI.     Appendix I: Research Note: Menstrual hygiene management in Fiji: Evidence-based policy recommendations to improve girls education in Fiji 27

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	Fiji menstrual hygiene WASH education MHM menstrual hygiene management
Committee Chair / Thesis Advisor	Freeman, Matthew, Emory University
Committee Members	Traven, Flavia, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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