Piloting an acceptable and feasible menstrual hygiene products disposal system in urban and rural schools in Bangladesh

Abstract

Background Access to washroom facilities and a place to dispose of menstrual waste are prerequisites for optimal menstrual hygiene management in schools. Like other low- and middle-income countries, Bangladeshi schools lack facilities for girls to change and dispose of their menstrual absorbents. We explored existing systems for disposing of menstrual absorbent wastes in urban and rural schools of Bangladesh and assessed the feasibility and acceptability of alternative disposal options. Methods We explored how girls dispose of their menstrual products, identified girls’ preferences and choices for a disposal system and piloted four disposal options in four different schools. We then implemented one preferred option in four additional schools. We explored girls’, teachers’, and janitors’ perspectives and evaluated the acceptability, feasibility, and potential for sustainability of the piloted disposal system. Results Barriers to optimal menstrual hygiene management included lack of functional toilets and private locations for changing menstrual products, and limited options for disposal. Girls, teachers, and janitors preferred and ranked the chute disposal system as their first choice, because it has large capacity (765 L), is relatively durable, requires less maintenance, and will take longer time to fill. During implementation of the chute disposal system in four schools, girls, teachers, and janitors reported positive changes in toilet cleanliness and menstrual products disposal resulting from the intervention. Conclusions The chute disposal system for menstrual products is a durable option that does not require frequent emptying or regular maintenance, and is accepted by schoolgirls and janitors alike, and can improve conditions for menstrual hygiene management in schools. However, regular supervision, motivation of girls to correctly dispose of their products, and a long-term maintenance and management plan for the system are necessary.

Drivers of menstrual material disposal and washing practices: A systematic review

“…availability of soap for washing [20,33,49,53,54,[56][57][58]60,61,63,64,66,67,73,77,90,91] and the availability of a physically functional disposal mechanism and/or service for used material [18,28,[31][32][33][34][35][36][37]42,[44][45][46][47][48]52,53,57,58,60,62,63,[66][67][68]71,76,77,82,83,86,90,91,…”

“…Social perceptions of appropriate infrastructure were driven by the presence or absence of a private/safe space for managing menstruation [28,34,36,37,39,40,[44][45][46]48,[51][52][53][54]57,60,63,64,[66][67][68][69]71,74,76,80,81,83,87,[89][90][91][92]96], the cleanliness and maintenance of the facility [25][26][27][28]31,33,36,37,40,43,44,46,48,53,57,63,…”

“…When using disposable materials, many menstruators wrapped their used menstrual materials in newspaper or polythene bags before disposal, so as to obscure their waste [24,25,32,40,41,43,47,54,60,63,69,74,77,79,81,83,85,97,99]. In addition, some cultures discouraged the use of open disposal, such as bins, due to fears of witchcraft and infertility [19,20,29,30,36,41,42,53,57,60,68,71,72,82,83,87,90,92,93,99], or due to beliefs it is a sin to throw (especially unwashed) materials into a bin [79].…”

“…Embarrassment and worry were direct results of being seen disposing or washing menstrual materials, and often lead to hiding of materials, and secretive behaviours [19,20,[25][26][27][28][33][34][35]37,40,44,[47][48][49]53,58,60,62,65,68,73,74,[76][77][78][79][80][81][83][84][85]92,97,99]. This worry was usually related to having ones' menstrual status exposed (meaning those around the menstruating individual are aware that they are currently experiencing their period).…”

Efficacy, Practicality, Intimal Health, and Sustainability of Menstrual Cups use among Undergraduate Medical Students: a cross-sectional study

“…(North and Oldham 2011; Smith et al 2020) Sustainability is a current concern and can be one of the criteria adopted by women during their decision-making. (Jahan et al 2020) Menstrual cups appear a sustainable, cost-effective, practical, and adequate choice compared to the most known methods. (Hennegan et al 2020) Despite these observations, the use and the preference of menstrual cups remain primarily unexplored.…”