Pakistan: UNICEF Implementing Partner for Menstrual Hygiene Management (MHM) Research

MHM Research Presented at SACOSAN 7: April 10 and 12, 2018

April 12, 2018

Afshan Bhatti and Deanna Boulard

RMF Pakistan's Afshan Bhatti at SACOSAN 7

RMF Pakistan's Afshan Bhatti at SACOSAN 7

RMF Pakistan’s Research


RMF Pakistan has a rich history of maternal, child, and adolescent health research in Pakistan, funded by CIHR, USAID, DFID, and UNICEF. Our team specializes in women’s reproductive health, with a focus on facilitating access to services and abolishing inequities in policy, design, and delivery of services. In partnership with the government of Pakistan, University of Alberta, Columbia University, and the University of Sheffield, RMF has nearly a decade of experience and a proven track record implementing programs in Pakistan’s remote, rural, and insecure areas.

Afshan Bhatti presenting at SACOSAN 7 April 10

Afshan Bhatti presenting at SACOSAN 7 April 10

Path to an Equal World

Mainstreaming MHM in Education and Health

On April 10, 2018, RMF Pakistan Program Manager Afshan Bhatti presented some of our team’s findings at the seventh South Asian Conference on Sanitation (SACOSAN 7). SACOSAN is a government-led convention held every two years in one of the member countries (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka). The main goals of this regional convention are to promote increased commitment, shared learning, and accelerated progress in sanitation and hygiene.

The topic of Afshan’s presentation was “Path to an Equal World: Mainstreaming MHM in Education and Health.” She emphasized that menstrual hygiene management (MHM) is a fundamental human right and essential to achieving equality for women in any field. Additionally, girls from rural and urban communities need to have a voice in development of policies and plans. Afshan’s presentation was based on her research with RMF, including the recommendations provided by girls for mainstreaming MHM in health and education. She concluded that every girl and woman should be allowed to access accurate and pragmatic information on MHM to enable them to exercise choice.

Afshan Bhatti

Afshan Bhatti"s presentation during the session on Sociology of Sanitation

Sociology of Sanitation

Exploring Pervasive Socio-Cultural Understandings

Afshan spoke again on April 12, 2018, presenting a paper in the session on Sociology of Sanitation. The topic of her presentation was “How can we leave the traditions of our fathers and forefathers? – Exploring Pervasive Socio-Cultural Understandings of Menstrual Hygiene Management Practices in Pakistan.” This presentation focused on the socio-cultural practices surrounding menarche and menstruation in Pakistan and their harmful effects in women’s lives. Afshan explained many of the existing practices and structures around menstruation in rural Pakistan, such as the avoidance of water, use of rag pads, and unavailability of quality WASH facilities, as well as the underlying belief systems which perpetuate these. She argued that in order to achieve equity in the field of sanitation, we must be sensitive towards these beliefs, working with girls and women in the community to dispel harmful practices through educational programs and policies.

As part of the research project, a Pakistan Girls’ Puberty Book is being developed to provide girls with accurate, practical information on puberty. The book is currently at the provincial ministries for approval as a supplementary reader.

  • To describe local cultural understandings and meanings of menarche in urban and rural Pakistan through the use of ethnographic observations, interviews, and participatory activities with adolescent young women and the adults who play key roles in the lives of school-aged young women.
  • To explore, through comparative case studies of young women’s lives, the ways in which local cultural meanings about menarche and menstruation interact with sanitary technology, school design, and peer group relations, creating intolerable menstrual-related stigma that leads to young women dropping out of school.
  • To utilize adolescent young women’s own recommendations for improving the pubertal and menstrual management-related guidance adolescent girls receive through the development of a girls’ puberty book in Pakistan.

The intersections between menarche and education in Pakistan are still poorly understood. Nonetheless, existing reports suggest the dominance of male students in middle and high schools, and the absence of other “girl friendly” supports in the schooling environment are causes, e.g. water is rarely available in rural schools in Pakistan, with 75% of hand pumps and 28% of latrines being non-functional. Furthermore, female students lack separate, private latrines, and they often are attacked, sexually harassed, or shamed when waiting to use lavatory services, posing yet another barrier to school attendance. Female students may also have difficulty accessing sanitary materials owing to their high cost, especially if male family members make most major household purchases, as is the case in the majority of households in Pakistan. Given that menarche may be jeopardizing young women’s schooling and health in Pakistan, it is both timely and important to better understand the relationship between menstruation, education, and health for young Pakistani women, and to improve pubertal transitions.