Teams 4 U Menstrual Hygiene Management Changing Rooms Research Report - Kumi District, Uganda Proposal
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TEAMS4U
Teams 4 U
Menstrual Hygiene Management
Changing Rooms Research Report
Kumi District, Uganda Proposal
Charu Ravikumar
3rd Year Medical Student
University of Liverpool
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TEAMS4U
Changing Rooms Research Report
Aims
The aim of this report is to improve school attendance among girls by reviewing the
importance of menstrual hygiene provision and by identifying and providing the
best model of changing rooms for improved menstrual hygiene management in
schools across rural Uganda.
Why is menstrual hygiene provision important?
Additional to lack of basic services like toilets, sanitary products, changing rooms
and menstrual education; poverty, gender discrimination, cultural taboos, shame,
and fear can all cause menstrual health and hygiene needs to go unmet. This
negatively impacts students’ abilities to succeed and thrive within the school
environment.
In sub-Saharan Africa, education often presents as the key to a healthier life out of
poverty. Not only does poor school attainment diminish a girl’s economic potential
over her life course1, girls’ sexual and reproductive health outcomes and
population health outcomes are also impacted2. If all women had a secondary
education, child mortality would be halved, saving 3 million lives. Completing
primary school would reduce the number of child brides in sub-Saharan Africa and
South and West Asia from 3 million by half a million; completing secondary
education would reduce the number by 2 million3.
Following the announcement of free education in Uganda, enrolment almost
quadrupled. Yet about half of the girls who enrol in year one do not end up sitting
their primary school-leaving examinations. Girls have been found to drop out
particularly between the ages of 11-13; several studies have potentially linked this to
menarche4.
What is the current state of menstrual hygiene management in
Uganda?
It is reported that 83% of district primary schools across Kumi do not have changing
facilities and of the 91 government-funded primary schools in Kumi, many teachers
requested for changing facilities/rooms as girls absented themselves from schools
during their periods as they do not have anywhere to change their menstrual pads.
In a study published in 2016 in the rural district of Kamuli, Uganda; of the
participating 205 schoolgirls, 90.5% did not receive adequate MHM5.
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TEAMS4U
Listed below are the findings from another study published in 2016, conducted in
Wakiso district, Uganda, with 352 girls aged between 14-17 years.
▪ 18.7% reported having stained their clothes
▪ 19.7% reported missing at least 1 day of school, during their most recent
period
▪ school absence was reported to be 28% of period-days, compared with 7%
on non-period days6.
A very recent and possibly the most relevant study for this project, conducted in
November 2020 by the Ugandan Ministry of Education and Sports, involved 14
districts, has published the following findings about the ‘improvised changing
rooms’ in schools.
Graph 1 shows the percentage of ‘improvised changing rooms’ in schools in each
of the districts studied.
Percentage of 'improvised changing
rooms' by District
45
40
35
30
25
20
15
10
5
0
*
* data for Kumi district obtained from research done by Teams4U
Most schools that claimed to have ‘improvised changing rooms’ did not actually
contain necessities i.e., drying facilities, water, menstrual pads, disposable facilities7.
Kumi district was not included in the government study, which further indicates the
need for this research project.
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TEAMS4U
How has the COVID-19 pandemic impacted menstrual
hygiene management?
The current pandemic highlights and further exacerbates the menstruation-related
challenges many women and girls face around the world. The most affected are
the poorest and those most vulnerable to economic shock.
Girls with confirmed or suspected COVID-19 who are quarantined or isolated at
home may lack access to menstrual hygiene management supplies. Including
menstrual materials in care packages or in distributions of food would relieve this
strain. In scenarios where girls are using disposable materials, financial stress may
cause families to prioritise other needs such as food and bills rather than menstrual
materials. Encouraging the use of reusable materials would eliminate the recurrent
financial burden that COVID-19 has placed upon struggling families. School
closures have also meant that girls who usually access menstrual hygiene materials
through the education system are left without materials8. The government’s COVID-
19 relief programmes have largely been targeted at the 1.5 million people living in
urban areas as opposed to the 8 million Ugandans (19.7%) living below the poverty
line in rural areas9.
What are the different changing room models?
In the 2020 Study carried out by the Ugandan Ministry of Education and Sports,
interviews suggested that the schoolgirls had a concern that even if changing
facilities were built, there may be reasons that these facilities may not be fully
utilised; these reasons included “the likelihood of boys laughing at the girls, “limited
privacy” and “unfavourable location” of the changing rooms. The girls further
shared that it would be embarrassing to enter such rooms as everybody would
know that you are on your period. The girls suggested that concealing the
changing room facility would allow for more privacy7.
ActionAid has built ‘safe spaces’ in nine schools in Rwanda. These are rooms run by
a matron in a building separate to the school, “equipped with a toilet, shower,
menstrual products, spare clothes and a private space to change and rest.” This
facility has allowed girls to feel comfortable when they start their period and they
do not have to leave school for lack of facilities10.
An intervention in Burkina Faso to improve the attendance of primary school-aged
girls by way of menstrual hygiene management has highlighted valuable
information that has been considered and implemented in the proposed changing
room design.
Across the 118 schools involved in this project, the percentage of girls who said they
felt comfortable managing their menstruation at school went from 65.5% in July
2014 to 89.0% in May 2016.
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TEAMS4U
Images 1 and 2 show changing rooms
built in Burkina Faso11
Proposed changing room
Table 1 and Table 2 provide recommendations on characteristics for a good
changing room based on available research. However, a baseline assessment will
be conducted in-situ to determine the needs and wants of the local community,
therefore these recommendations may be subject to change.
Table 1 indicates the essential characteristics that would be required when building
a changing room and reasons for requiring them.
Essential Characteristic Reason
Washing facilities- i.e., water Reusable pads can be washed and dried
supply/bucket/soap/drying
rack
Adequate lighting Inadequate lighting would deter girls from wanting to use it.
Shuttered windows provide both light and privacy
Regular cleaning of rooms The overwhelming reason for failed facilities is lack of
upkeep
Drainage Prevent build-up of stagnant water, enable easy bathing
and cleaning of facility
Cupboard Store sanitary napkins
Pest control regulation Stop bat/other pest infestations, preventing use of rooms
Lock Provides privacy
Hook Hanging clothes whilst changing
5TEAMS4U
Table 2 indicates characteristics that would be preferable when building a
changing room but are not fundamentally essential
Preferred Characteristic Reason
Attached to girls’ latrine Ensures privacy and dignity, they will be less exposed to
block and away from boys’ teasing if the boys don’t know they have gone to use the
latrine changing room
It is not a latrine stall Odours would make it less likely that girls would want to use
it
Mirror Girls can check for stained clothing
Location is not too remote May make girls feel unsafe and less likely to use rooms
Torch Can be used when dark outside to walk to the rooms if the
path is remote
These changing rooms have the potential to be life changing for so many girls,
however this can only be true if they are fully utilised. For this, it is so important that
girls receive adequate education on menstrual health and menstrual hygiene
management.
It has also been found that when boys are educated on the topic, girls are less likely
to be teased and embarrassed, and so they are more likely to stay in school.
Images 3 and 4
show the
proposed
design for the Images 5 show the proposed
changing rooms floor plan for the changing
rooms
6TEAMS4U
In order to evaluate effectiveness of the changing rooms, it is important to collect
data on the attitudes and views towards menstruation and menstrual hygiene
management before and after changing rooms and educated have been
implemented.
Baseline Assessment questions to ask female students:
1. Do you feel that your education is affected by your periods?
2. How many days do you miss on average per period?
3. What are the reasons for not going to school on your period?
4. Do you feel you know enough about periods?
5. Do you feel comfortable managing your periods when at school?
6. a. What are the difficulties you face when on your period?
6. b. What would ease these difficulties?
7. Do you feel you have sufficient facilities and materials to manage your periods?
8. Would you feel comfortable using a changing facility in school?
9. What may prevent you from using a changing room, if provided?
10. What would you want included in a changing room?
Questions to be asked after the changing rooms have been implemented?
1. How have your studies and attitudes to school changed?
2. Do you feel more comfortable going to school on your periods?
3. Has girls’ attendance changed, if so by how much?
4. Do you use the changing rooms?
5. Have the changing rooms been maintained well?
6. Are there any factors that stop you from using the changing rooms?
7. What would you change about the changing room facility?
8. Has the water source been reliable?
Evaluating the success of this pilot will help to know how best to facilitate schools to
meet the need for changing facilities in the future.
7TEAMS4U
Bibliography
1. Sommer, M., Caruso, B.A., Sahin, M., Calderon, T., Cavill, S., Mahon, T. and Phillips-Howard,
P.A. (2016). A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management
Needs in Schools. PLOS Medicine, 13(2), p.e1001962.
2. Tull, K. (2019). Period poverty impact on the economic empowerment of women. [online] .
Available at:
https://assets.publishing.service.gov.uk/media/5c6e87b8ed915d4a32cf063a/period.pdf
3. New UNESCO data proves education transforms development. (n.d.). [online] . Available
at: https://en.unesco.org/gem-report/sites/default/files/PR_Ed_transforms_En.pdf.
4. www.unicef.org. (n.d.). UNICEF and partners support Karamoja schoolchildren to make
sanitary pads. [online] Available at: https://www.unicef.org/uganda/stories/unicef-and-
partners-support-karamoja-schoolchildren-make-sanitary-pads [Accessed 20 Aug. 2021].
5. Hennegan, J., Dolan, C., Wu, M., Scott, L. and Montgomery, P. (2016). Measuring the
prevalence and impact of poor menstrual hygiene management: a quantitative survey of
schoolgirls in rural Uganda. BMJ Open, 6(12), p.e012596.
6. Miiro, G., Rutakumwa, R., Nakiyingi-Miiro, J., Nakuya, K., Musoke, S., Namakula, J., Francis,
S., Torondel, B., Gibson, L.J., Ross, D.A. and Weiss, H.A. (2018). Menstrual health and school
absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study. BMC
women’s health, [online] 18(1), p.4. Available at:
https://www.ncbi.nlm.nih.gov/pubmed/29298699.
7. Kalembe, S. and Emojong, P. (2020). SITUATION ANALYSIS STUDY ON MENSTRUAL HYGIENE
MANAGEMENT (MHM) IN 14 DISTRICTS OF UGANDA: MINISTRY OF EDUCATION AND SPORTS
(MOES). [online] . Available at: https://www.ungei.org/sites/default/files/2021-
02/Situational-Analysis-Study-on-MHM-in-Uganda-2020-eng.pdf [Accessed 20 Aug. 2021].
8. Yamakoshi, B. (2020). Mitigating the impacts of COVID-19 and menstrual health and
hygiene. [online] UNICEF. Available at: https://www.unicef.org/media/95496/file/UNICEF-
Brief-Mitigating-the-impacts-of-COVID-19-on-menstrual-health-and-hygiene.pdf.
9. Development Initiatives. (n.d.). Socioeconomic impact of Covid-19 in Uganda: How has
the government allocated public expenditure for FY2020/21? [online] Available at:
https://devinit.org/resources/socioeconomic-impact-of-covid-19-in-uganda/ [Accessed 21
Aug. 2021].
10. ActionAid UK. (n.d.). Periods and girls’ education. [online] Available at:
https://www.actionaid.org.uk/our-work/period-poverty/periods-and-girls-education.
11. Kabore, I., Ilboudo, Nikiema, L., Debus, J. and Mcintosh, C. (2017). Menstrual hygiene
management to improve the attendance of primary school-aged girls in Central North,
Burkina Faso. [online] . Available at: https://wedc-
knowledge.lboro.ac.uk/resources/conference/40/Kabore-2637.pdf.
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