WASH Convention International Health Expo
As a member of the National Working Group on MHM in Pakistan, RMF Pakistan participated in the WASH Convention, a three-day International Health Expo that was held in Islamabad on October 5–7 2018. It was organized by the WSSCC (Water Supply & Sanitation Collaborative Council), which is the current chair of the MHM National Working Group.
The invited speakers were officials from the ministries of health and education from all four provinces of Punjab, Sindh, Balochistan, and Khyber Pakhtunkhwa (KPK). The one-day MHM conference on October 6 was composed of three sessions, titled “Mainstreaming MHM in Educational Institutions,” “Mainstreaming MHM in the Health Sector,” and “Social Media & Advocacy on MHM.”
Chairing the session
Mainstreaming MHM in Educational Institutions
In the first session of the conference, our Pakistan Girls’ Puberty Book was one of the key highlights. The book has been approved by the Sindh Ministry of Health as a supplementary reader in the middle school curriculum of girls-only schools. The discussion revolved around strategies for integrating the book into the system, and concluded on three recommendations: firstly, pages of the book need amendment to make them culturally sensitive; secondly, it should be translated into the Sindhi language; thirdly, it should introduce a guide for teachers, who, after training, would act as instruments for sharing the book with girls. To implement these recommendations, STEDA (Sindh Teachers Education Development Authority) will liaise with RMF, UNICEF, and WSSCC to make the necessary changes after consensus.
RMF Pakistan’s Rubina Mumtaz Magsi chaired the second session
Mainstreaming MHM in the Health Sector
RMF Pakistan chaired the second session of the conference. During this session, officials from the Ministry of Health of Balochistan announced that they, too, would endorse the book as a curriculum supplement. However, they also declared that the strategy for implementation of the book in Sindh could not be used in Balochistan due to cultural and geographical differences. Therefore, it was recommended that the most effective strategy for Balochistan should be determined before implementation. Officials from the health ministries submitted their reports on how MHM is being incorporated at the primary health level by Lady Health Visitors (LHVs) and community midwives.
MHM National Working Group
Social Media & Advocacy on MHM
The last session of the day took place in the afternoon. WSSCC announced that the MHM National Working Group had joined the Prime Minister’s “Green, Clean Pakistan” initiative, which will be launched on October 12, 2018. MHM has a role to play within this paradigm’s goals for sanitation. Hence, a discussion was held on how to create different opportunities and approaches to advocacy for MHM on a national scale. RMF Pakistan, which is the only research organization in the MHM National Working Group, has been invited to conduct research to evaluate the most effective methods of advocacy and behavior change strategies for MHM in both schools and communities. To address school advocacy, RMF Pakistan shared the idea of a quasi-experimental research methodology which could pilot several approaches simultaneously and allow researchers to compare results; this study could be done using RMF Pakistan’s puberty book as one of the tools of behavior change. Balochistan officials agreed to allow this pilot study to be conducted in the province. After detailed discussion, this idea was accepted, and RMF Pakistan requested to submit a concept note for the next MHM National Working Group meeting.
Sample excerpts from the Pakistan Girls’ Puberty Book
The modifications to make the Pakistan Girls’ Puberty Book more culturally sensitive are currently underway. This process is being handled by STEDA (Sindh Teachers Education Development Authority) in collaboration with UNICEF and RMF Pakistan. This process started in December 2018, and is approaching finalization.
- 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.