Managing menstruation effectively and with dignity can be challenging for girls and women in low and middle-income countries. Currently there is limited research on menstrual hygiene management (MHM) in the Pacific region. Unpublished information suggests that menstrual management is a challenge for many women and girls in the Pacific, and that it may also be a barrier to school participation and attendance, and to employment and income generation.

This study aimed to explore the challenges experienced by women and girls in managing their menstruation, and whether these challenges make it hard for them to equally participate in school and work and engage with their communities.

The study was undertaken in Fiji, the Solomon Islands and Papua New Guinea (PNG), in both urban and rural research sites.

Image: Solomon Islands data collection

In late 2016 and early 2017 focus group discussions were undertaken with adolescent girls (both in and out of school), women, and men. In-depth interviews were undertaken with marginalised girls and women, such as those living with a disability. Interviews were also held with people such as employers and vendors of menstrual hygiene products, health workers, religious and community leaders and teachers. We explored information, practices and challenges related to menstruation, and opportunities to enable menstruating girls and women to manage their menstruation more effectively and with dignity.

An observation checklist was completed at participating schools and workplaces (both formal and informal settings) to examine the extent to which WASH facilities are appropriate for menstruating girls and women. An assessment of the availability and cost of commercially available sanitary products in each site was also made.

Image: PNG data collection team

The cultural and ethnic diversity in each country, differing expressions of gender inequality and the vast geographic spread of communities should be acknowledged when interpreting the study findings. Some of the key research findings were:

• Adolescent girls and women, particularly in Solomon Islands and PNG, face a number of challenges that influence their ability to manage menstruation effectively and with dignity. 

• Many adolescent girls in Solomon Islands and PNG lack comprehensive knowledge about menstruation and are unprepared for menarche. This often results in feelings of shame and embarrassment. In contrast, adolescent girls and women in Fiji have reasonably good access to education and information about menstruation and its hygienic management, although gaps in knowledge exist.
• Common beliefs and attitudes around menstruation being “dirty” create needless stigma for menstruating women and girls. This stigma makes it more difficult to manage menstruation, contributes to some unwanted behavioural restrictions, and can negatively impact on emotional well being.
• A wide range of reputable sanitary products are available in urban areas in Fiji and PNG, but less so in rural areas. In Fiji and PNG, products were generally considered to be affordable for those with an income. In contrast in Solomon Islands, reputable sanitary products are prohibitively priced and much less available, particularly in rural areas.
• In all countries, girls and women with less access to money (such as the unemployed, or those on low income and adolescent girls reliant on parents) face affordability challenges and may rely on home-made solutions (of variable efficacy) to manage their menstruation. Women and girls commonly experience fear of leakage and staining, and are subsequently distracted from school or work. Those that are unable to effectively manage their bleeding may opt to disengage with community life, stay home from school, or miss work on days of heavy bleeding. 

• In Solomon Islands and PNG, WASH facilities in schools and workplaces (particularly informal work settings such as markets) are commonly inadequate to meet the needs of menstruating girls and women. When WASH facilities are inadequate some girls and women prefer to return home to change used materials- contributing to absenteeism from school and work. 
In comparison in Fiji, WASH facilities in schools, work and public places are generally of a high standard- yet often lack soap for handwashing, toilet paper or safe and discrete disposal options for sanitary materials.

Image: Solomon Islands data collection

Programming efforts directed toward improving MHM in Solomon Islands, PNG and Fiji would benefit from a comprehensive approach that considers the broad range of determinants of menstrual health. Our general recommendations from the research include:

• Strengthening puberty education and awareness, and challenging discriminatory beliefs/taboos where they exist;
• Improving availability, affordability, & access to quality commercial products and locally made alternatives, especially in schools/workplaces; and,
• Improving WASH facilities & standards to ensure that women-specific WASH needs are met, particularly options for safe disposal of soiled sanitary materials.

Image: Fiji data collection team

Critically, any initiatives should be underpinned by a human rights approach, and ensure that women’s and girls’ voices are central to decision making about any initiatives that impact on them.

This research was funded by the Australian Government Department of Foreign Affairs and Trade (DFAT), including its InnovationXchange. It was conducted by Burnet Institute and WaterAid Australia with support from the International Women’s Development Agency, and in partnership with local researchers, government, organisational and community stakeholders in country. The findings will guide development of DFAT funded MHM programs in the region.

Image: Solomon Islands shop survey

Timeline

May 2016 – December 2017