High Poverty and low Educational Level (<30%)

In Bangladesh, women's and girls' participation in the society is limited during menstruation by cultural beliefs and social norms. All communication on menstruation and menstrual hygiene is a taboo. At the same time, society lacks awareness and knowledge about the biological and medical background of menstruation. In addition, poor sections of the population do not have access to affordable sanitary products.

Restricted Access to Sanitary and Hygiene Products

Moreover, limited access to clean water, proper sanitation, and sanitary pads makes it difficult for women to manage their menstruation hygienically. In Bangladesh, 97% of women do not use sanitary towels, but use cloths or rags made from old saris. A recent UNICEF survey in Bangladesh found that at least one in three women hide their menstrual lumps in dirty places, fail to change their towels regularly or wash them with soap or detergent after use. Only half of the women dry their rags in the open air in the sun - which is a prerequisite for killing dangerous bacteria and germs. This inadequate approach to menstrual hygiene leads to widespread vaginal and urinary tract infections.

Lack of Access to Health Care

A 2014 population survey in Bangladesh on health revealed that more than half of the women do not seek medical treatment until their husbands allow them to do so. Even if the husband gives his consent, one third of women cannot travel to a hospital or health centre on their own. Moreover, there are still considerable taboos and inhibitions about women's health problems in society. Women who suffer from vaginal infections therefore rarely receive medical treatment. In order to reduce and avoid such health risks, comprehensive information and education campaigns, especially among poorer and less educated families in Bangladesh's rural regions, are of fundamental importance. 

MHI Project 2

Educational initiative and establishment of a supply structure to promote menstrual hygiene in Banishanta, Bangladesh

The overall objective of the project was to improve the health care of poor women and girls in the project area through a sustainable supply of hygiene products and the dissemination of basic knowledge on menstrual hygiene.

The following points were implemented for this purpose:

1. Production and marketing of reusable sanitary towels

• A production facility with three sewing machines for the manufacture of inexpensive, reusable sanitary napkins was built. This facility was also equipped with a sterilisation machine to guarantee the hygiene requirements of the sanitary pads. A transport vehicle was also purchased to supply the women in remote villages with sanitary pads.
• In a 15-day training course, 13 women were trained as seamstresses for the production of cloth sanitary napkins. Together they developed two types of sanitary napkins, with a belt and a panty system depending on the women's preferences. After a test run with ten women, the sanitary pads were improved and adapted accordingly, based on the women's feedback. A total of 2,773 sanitary pads sets have been produced so far.
• Together with the group leaders and representatives of the schools, a sales and marketing system for the sanitary towels was developed after a market survey and implemented in such a way that the sanitary towels are affordable and, above all, accessible to poorer women and girls. 

2. Training and educational workshops to raise awareness

• Our partner organisation RUPSA carried out ten educational workshops on general menstrual hygiene, the safe and healthy use of reusable sanitary towels as well as their washing and waste management, and the education of schoolgirls in the new menstrual age in various villages. A total of 2,443 women and girls took part in these workshops.
• In 14 workshops at twelve schools and two colleges, the awareness of healthy menstrual hygiene was improved among approximately 2,100 female pupils and 80 female teachers.
• A total of 162 'yard sessions' on the topic of menstrual hygiene were conducted by 18 female group leaders. A total of 4,175 women and girls took part.

3. World Menstrual Hygiene Day on 28.05.2019

• At the annual World Menstrual Hygiene Day, which was held with the support of the MHI project with RUPSA, a rally and subsequent discussion with 200 participants from government circles and NGOs highlighted the importance of proper menstrual hygiene management for women's health.
• In the village of Kakrabunia, a rally and subsequent discussion was held with 90 participants.
• The Marti Mongal Secondary High School, with the support of the MHI project and RUPSA, organised a bicycle rally on this topic with 40 students.
• Seven daily newspapers reported about the events of the World Menstrual Hygiene Day, which were supported by our MHI project. 

4. Health Camps

• Three health camps were set up in the project area in which a gynaecologist treated women and girls who had health problems due to a lack of menstrual hygiene. According to a previous survey, about 30% of the women in the project area suffer from these circumstances. A total of 343 female patients were treated. 

Fazit

During the project period, our experience has shown that the overall demand for reusable bandages is lower than we expected before the project started. It was also found that most of the demand for reusable pads comes from schoolgirls in low-income groups in the city of Khulna, although we have made great efforts to get village women interested in our pads. RUPSA therefore wishes to continue the project, taking into account all the problems based on the experience of the last six months, with the following measures and action plan:

• the promotional activities for our DESHIPAD pads will continue, including online

• the production of the pads is adapted to the corresponding demand

• the subsidised price of the bandages will remain in place until the end of 2019, after which it will be gradually adjusted to cover operating and administrative costs

MHI Project 1

Education and pad supply for Banishanta

We conducted a first project to learn about possible obstacles and local factors of menstrual hygiene management. As part of the MHI initiative, menstrual sanitary products were provided to the target group women and girls for the first three months by ASCEND through the local partner RUPSA. A multi-pronged training program was included to ensure women's capacity building, knowledge exchange on hygiene education and bridge with the local stakeholders. Afterwards a self-reliant supply and storage mechanism was established in the locality to ensure availability of menstrual sanitary products. The first project focused on the village Banishanta with the total costs of about 834€, resulting in a per-capita-cost of 3,34€ per person. 

Insights in the first project

The project was planned with a multi-pronged behavioral and awareness raising communication approach for managing menstrual hygiene leading to women capacity building, knowledge exchange on hygiene education and bridge with the local stakeholders.

As menstruation is a neglected topic, women and girls in the project area do not speak about the topic and are not involved in decision-making – for example, household decisions to build a toilet or spend money on sanitary pads. The result is a lack of facilities and services, e.g. a lack of separate toilets for girls at schools. It also results in a lack of social support and the culture of fear, shame, embarrassment and silence, completing the circle of neglect. This pilot initiative is targeted to break the ultimate circle of the silence through awareness raising, capacity building and knowledge exchange on menstrual hygiene management.

In West Banishanta Village, menstruation taboos lead to serious restrictions on the daily activities of menstruating women and girls; in many, the stigma means that they cannot discuss menstrual hygiene freely. To improve the women's and girls' lives, ASCEND (and RUPSA) planned to break the silence and dispel the stigma and shame by engaging with communities through participatory channels such as community theater, schools, religious interactions, and interactive training.

Due to the stigma and silence surrounding this issue, women and girls, as well as men and boys, often know very little about menstruation and menstrual hygiene. To address this critical gap, ASCEND (and RUPSA) intended to promote menstrual hygiene education through community platforms such as schools, communities, as well as in healthcare facilities. The targeted audiences could range from local government officials, traditional leaders, and community health workers who can help to reinforce important messages on menstrual hygiene throughout the community.

In West Banishanta, women and girls do not have access to quality and hygienic menstrual hygiene products. With this project, ASCEND wanted to ensure the availability, affordability, and range of menstrual hygiene products by partnering with the NGO RUPSA, social enterprises, and the local stakeholders. After the pilot phase, ASCEND intended to provide seed funding through the partner organization in Bangladesh to help establish menstrual sanitary store, including purchasing the materials needed to produce sanitary pads, and stocking the store with basic menstrual hygienic supplies.

Women and girls require safe, private sanitation facilities at home, at school and at work so that they can discreetly and comfortably go to the bathroom and/or change their menstrual hygiene materials. Key aspects targeted to address through this project include:

• access to water and/or hand washing in or near the facility;

• ability to lock the latrine from the inside;

• discreet disposal (i.e. trash cans, trash chutes, etc.);

• a place to hang reusable menstrual pads to dry. 

Acquisition costs

Our project partner RUPSA rented premises centrally located in the project area for the production plant and purchased sewing machines and other equipment from the nearest town of Khulna. Various tools and equipment were purchased to furnish and equip the manufacturing plant, in addition to the equipment for the workstations.

Training 

As part of the initiative, local women were trained as tailors in the production of sanitary pads. The training, in which 17 women participated, was accompanied by the partner organisation RUPSA. During the training, the participants were educated in the production of reusable sanitary pads and instructed in the operation of the tailoring machines. 

Production of Sanitary Pads

A total of 2,773 sets of pads were made by the trained seamstresses. Of these, 60% were padding sets and 40% were bandages with a belt system. The production costs included the depreciation of the equipment, rent, and running costs of the production facility as well as the salaries of all the seamstresses and one manager.

Transport and Distribution of Sanitary Pads

A transport and distribution system was integrated into the production centre to supply even remote locations with the pads produced. For this purpose, an electric delivery bicycle common in the area was converted and equipped with a superstructure to ensure hygienic and weather-independent transport of bandages and other hygiene articles.  

Workshops and Awareness Rising Campaigns

During the project period, events were held to inform and train women and pupils in menstrual hygiene, also at secondary schools and at the college in Dacope. The organisation and implementation of the information campaigns in the communities was 18% cheaper than expected, since local contacts enabled discounts to be obtained for the event rooms.

Health Camps

In the course of the project, three health camps for the prevention and treatment of gynaecological diseases were organised in different locations within the project area, for which an external gynaecologist was hired. The entire implementation of the health camps was carried out as a direct aid measure and was fully financed by ASCEND within the project.

Personnel Costs in Bangladesh

To ensure the successful implementation of the project, six project officers were employed and three volunteers were added to the project team for support. These include a project manager, a financial accountant, a trainer, a driver for the distribution of the produced pads, two local people to build a distribution network, and three master tailors to train local tailors.

Service Charges

Ancillary costs incurred in the course of the project include administrative costs and costs for consumables, transport costs for textile waste and materials, and costs for information, education and communication materials (IEC).