Menstrual Hygiene Management: Lessons from Cambodia

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By: Marni Sommer, Executive Director, Grow & Know, Inc.; Susie Connolly, Team Leader for Cambodia, Grow & Know, Inc.

The onset of menstruation indicates the passage from girlhood to womanhood in societies around the world. In many low-income countries, the physical and cultural implications of menarche can impact a girl’s participation in school. In Cambodia, many schools lack adequate water and sanitation facilities for girls to manage their monthly menses with privacy and dignity. Existing facilities may lack a sufficient water supply for washing of hands or clothes, and toilet stalls frequently lack a private place to dispose of used sanitary pads or cloths.

Although the Cambodian school curriculum includes reproductive health, adolescent girls report that many teachers are too shy to cover the topics in detail. In addition, large mixed-gender classes often discourage girls from asking sensitive questions. Menstruation remains a taboo and secretive topic, with numerous girls reporting not having received guidance from mothers or other elder women prior to their first menstrual bleeding. As a result, many girls report being surprised or scared by their first period, with some worrying they had a serious illness. However, as we have seen, girls are also eager to learn, and many girls would stay late, after research sessions had ended, to learn more about menstruation and menstrual hygiene management. Their questions were primarily about the normality of their menstrual cycles, the physical and emotional symptoms around monthly menses, and cultural restrictions related to menstruation.

After their first period, many Cambodian girls report asking their mother or a trusted woman for advice. Many adult women provided guidance that focused on traditional beliefs around menstruation, but did not include adequate information on the experience of menses and how to manage monthly menses comfortably in school. The traditional beliefs mothers conveyed reflected local cultural values, such as beliefs around how to prevent menstrual cramps. Traditionally, Cambodian girls used to practice “chul malop,” in which a girl, upon reaching menarche, stays inside the home to learn about her new womanly status in the community. Although girls reported that this tradition was no longer formally practiced, many girls said that they sometimes missed class due to menstrual cramps, or if they forgot to bring (or did not have adequate) menstrual supplies.

Gathering the perspectives of girls themselves is critical to identifying the menstrual hygiene management needs they may be facing in school, along with the guidance they are lacking around the topic of menses and puberty. One part of the solution is the Cambodia girl’s puberty book developed with adolescent girls, and approved by the Cambodia Ministry of Education in 2012. Copies of the Cambodia girl’s puberty book are now being distributed to 10-14 year olds, with the pdf file available online as a free resource.

To read more in the WASH and Women’s Health blog series coordinated by WASH Advocates, click here, or, to learn more about WASH Advocates, visit their website.