Dr Kashfi Pandit
Menstruation is treated as a topic of impurity, unclean and surrounded by different taboos, myths and prejudices in developing countries. Restrictions, ignorance, lack of pre-menstrual knowledge makes the adolescent girls isolated from regular life, creating a negative impact on their psychology and this normal biological process is converted into a negative issue in their lives. Such negative phenomenon leads to life threatening reproductive tract infection that is very alarming to global health. In emergency crisis, where other basic needs are accounted with priority, menstrual hygiene management is often treated as a unimportant issue.
In Bangladesh, approximately 60% of the migrants in the current Rohingya crisis are women and girls. In fact, menstruation hygiene management (MHM) is not considered important enough for strategy and is not given priority in humanitarian aid, and therefore lacks a ‘home’ in any of the humanitarian approaches to crisis response. The objective of this review is to summarize, represent the current scenario of MHM in emergency contexts- i.e., the Rohingya issue in Bangladesh. This paper tries to find out the barriers and the root cause of problem. It also focuses on the level of knowledge and practice of adolescent girls in emergency crisis that helps in creating effective policies, guidelines, recommendations in the future through this paper, and menstrual needs is also addressed as part of humanitarian aid activities.
A descriptive cross sectional study was conducted for 6 months among 101 adolescent girls residing in Kutupalang Rohingya refugee camp. Purposive sampling was done and interview was conducted by using pre-tested close ended questionnaire with informed consent of the respondents. Qualitative analysis focus group discussion (FGD) was conducted with girls and they were selected randomly. Chi-square test, multiple logistic regression, co-relation and regression, standard deviation, cross tabs, mean, median, mode and others were used as the statistical tools to analyze the association and other statistical analysis.
Among 101 adolescent girls, the alarming news is- the level of “good” knowledge and practice among the respondents respectively was 21.7% and 19.8%. Only 27.6% of them had pre-menstrual knowledge. The mean age at menarche was 12 (+ 1.58) years. 82.8% of the girls reported that there were not enough MHM friendly facilities in the toilets of camp. Mothers were the major source of information (44%). 37% of the girls faced religious restrictions- besides this, restrictions in cattle touch, certain food taking, sleeping and eating with family members etc.
30% of the girls used disposable sanitary pad in camp whereas back home it was 26.7%. 46% used old cloths in camp but in their own homes 48% of them used old cloths. Only 17% disposed pads into dustbins. Only 24% of the girls sun dried their re-usable clothes, 45.3% of them kept in hidden and unhygienic spaces & 58.9% didn’t wash external genitalia on menstruating days. The knowledge and practice level was significantly associated with mother’s education level, family income, respondent’s education level p-value<0.05. So this paper’s findings may be helpful in developing new approaches to implement new field-level programs in emergency contexts like Rohingya crisis.
Results were also reinforced by focus group discussion (FGD) session. From FGD session, various barriers were highlighted that make their situation worse, such as- inadequate WASH facilities, lack of MHM materials and changing facilities, inadequate disposal system, lack of privacy in camps or informal settlements, confined & crowded place and non- supportive environment in camp, family and cultural beliefs, stigma, restrictions, fear of sexual violence.
There is a significant need for improved guidance across all relevant sectors for improving MHM response in emergency context, along with increased evidence on effective approaches for integrating MHM into existing responses. The enabling environment of the camp should be fosters improper MHM during menstruation and might cause severe reproductive infections and diseases. Therefore focus should be on promoting MHM friendly environment in the camp. However, despite some limitation, this study could be the initiating point in the future. As menstruation comes along with cultural & religious taboos, the MHM need represents a silent neccessity which becomes crucial in emergency context.
Dr. Kashfi Pandit is a Public Health Officerin an International NGO titled “Good Neighbors Bangladesh (GNB)