HARDWARE AND SOFTWARE – WHAT REALLY MATTERED IN OUR MENSTRUAL HYGIENE PROGRAM

BY KIMBER HADDIX MCKAY, INNOVATION DIRECTOR, ADARA DEVELOPMENT

I was at a workshop recently with people working in the water, sanitation and hygiene (WASH) sector. I was reporting on Adara’s monitoring and evaluation work. What I was struck by at this workshop was the emphasis on ‘innovation’, by which people meant to indicate the technological or ‘hardware’ side of interventions. This is something by no means unique to the WASH sector but what it suggests to me as an anthropologist is the possibility that there is something comfortingly uncomplicated and un-messy about technology as a force of social change, in comparison with the relatively messy and often uncomfortable spectre of human to human interaction and relationships that we know play such a critical role in social change.

At a recent conference on menstrual hygiene management (MHM) in Kampala, Uganda, funded by some of the chief donors in the health sector there – Irish Aid, UNICEF, UN/Uganda, and World Vision – this interest was echoed in the focus on latrine facilities and on Makapads and Afripads, two locally made sanitary pad companies. But the results from some recent research we’ve undertaken in collaboration with Kiwoko Hospital in Uganda on MHM, challenges this assumption that we should put emphasis solely on the ‘hardware’ side, and demonstrates to us the importance to instead focus on the ‘software’ that we believe is critical to the success of an MHM program.

WHAT WORKS?

Based on the existing literature on MHM and interventions targeting it, we tested a series of hypotheses aimed at understanding the factors associated with missed school by girls who’d reached puberty in six schools in Central Uganda.

Three of the schools had received an intervention by the hospital, with financial support for the provision of MHM materials (pads), and health education counselling and support for a senior woman teacher. We found that while it was common among the 82 case studies to find mention of the significance of various kinds of WASH facilities, the relationships between the provision of pads, health counselling services to menstruating girls by a female teacher or health education provider, and the frequency of those counselling sessions were most strongly associated with girls attending school while menstruating. The non-intervention schools happened to have better WASH facilities than the interventions schools, but had poorer attendance during menstruation reported in the case studies collected at those schools.

WHAT TO MAKE OF IT ALL

The ethnographically rich case studies showed that there was no question that a holistic and multi-pronged approach is the best way forward for tackling the MHM problem in these schools. Even with relatively good WASH facilities in school in the form of functioning latrine blocks, the school attendance of girls in schools without the care, nurturing and support of a trained Senior Woman Teacher suffered.

Girls gave three main suggestions for things they felt were needed to improve their attendance during menstruation, and none of them was improved latrine block or privacy stations, as we expected. Instead, students focused on the availability of a head woman teacher to take the lead on providing them with pads and other products but also on leading programs that would change attitudes at school, focused on de-stigmatizing menstruation. In fact of all of the factors we studied, the one most strongly associated with attendance of menstruating girls was not only the existence of counselling for students about menstruation, but the frequency of those counselling sessions. The more frequently sessions were held, the better attendance was among the 82 adolescent students we studied.

Development professionals working in the innovation space would benefit from considering the ways in which innovation can be broadened beyond the technology field and the hardware components, and into other forces of social change. We need to bring into focus innovation that inspires the powerful forces of change in the charismatic leaders of communities and the social networks that connect them.

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