The needs assessment found that there are high numbers of barriers to girls having safe menstrual hygiene in Bangladesh. These barriers can be categorised into three areas: poor access to adequate WASH facilities, a lack of knowledge of biological processes, and taboos restricting females’ behaviour during menstruation. In 2015 we started the four-year Ritu programme to tackle all those barriers. ‘Ritu’ is a Bangladeshi word for ‘menstruation cycle’. In Ritu we improve the menstrual health of women and girls, which allows them to increase their social and economic participation and thereby both directly and indirectly improves their health and wellbeing. The programme combines Sexual Reproductive Health Rights and Water, Sanitation and Hygiene interventions in schools and communities for a holistic approach to improving menstrual hygiene.

ROLE TNO – FULL BIODEGRADABLE PADS

The needs assessment showed that girls see sanitary pads as the best option for MHM, a view which is backed by their parents. Currently, 60% of menstruating girls is using sanitary pads. The programme needs to capitalise on the high levels of interest in pads and work with manufacturers to improve accessibility through addressing issues such as costing and quality.  As partner in the Ritu project TNO took the necessary actions to ensure that biodegradable sanitary napkins will become available in Bangladesh in 2018 so that the improvement of hygiene does not create an environmental disaster. The collaboration of TNO and the Dutch company Rodenburg Biopolymers since 2016 resulted in coming to a successful recipe for the industrial production of biodegradable thin foil at an affordable price. This foil is made of an innovative blend of potato starch and clay and can be used as water resistant ant-leakage layer in sanitary pads. Based on this business case analysis it is shown that biodegradable sanitary napkins can be sold for 0,05 US dollar per napkin which is equal to the current lowest price for which basic napkins are available in Bangladesh at the moment.

EVIDENCE BASED PROGRAMMING

Using a clustered randomized controlled trial the effectiveness of the Ritu-programme interventions is measured. There are two treatment groups, one receiving basic school level interventions and the other a combination of these interventions plus community level education for parents. A control group forms the third cluster where no interventions will take place. At the beginning of 2017 we conducted a baseline survey with 4046 girls from class 6 and 7 in 149 schools in Netrokona district. 40% live below poverty line of $1.25 a day and 80% has an income below $1.75 a day.

The basic intervention is school-based including a school campaign, realization of a good toilet and training 10 teachers per school and the headmaster on a curriculum. It is believed this is neces¬sary to create an understanding and a supportive environment for girls but also for teachers to be able to effectively teach these topics. In addition to the basic programme, schools in the treatment B group also include parents interventions; educational sessions for parents, take home kits containing visuals and information and health works are trained to provide correct infor¬mation on menstrual hygiene. The focus is on substituting existing taboos with factual information to change social norms related to menstruation and constructing good toilets.

The baseline data show that girls lack knowledge on menstrual health with 66% of girls, who have reached menarche, not knowing what menstruation was when it started. The girls lack an understand¬ing of the biological reasons for menstruation. The data also show the current condition of toilets in the schools and at home are insufficient with no bin, water or soap in toilets. Moreover, 75% of girls who have reached menarche, did not change their sanitary products in the school toilets indicating the inadequacy of current facilities.

INTERVENTIONS

The Ritu programme will stagger interventions to first improve conditions of in school toilets and then address knowledge, attitudes, and practices. We work on education an information sharing on menstrual hygiene in schools and at communities, improving toilets at schools, national mass media campaign on radio and TV and a targeted lobby strategy at policy makers. Achievements so far:

• At the moment 149 schools in Netrokona district are involved with 27,855 girls.
• 8,207 girls (grade 6-8) gained access to the better water and sanitation facilities in 40 schools and they are now coming to schools during their menstruation. During the school toilet visit by Simavi, the samples of used sanitary napkins are found in the disposal bins in the toilets.
• The school authorities are more attentive to the maintenance of the toilets at their schools. 11 schools already allocated budget for cleaning the toilets and appointed cleaners and 27 schools are preserving sanitary pads for emergency purpose
• Training of 191 teachers with menstrual hygiene curriculum
• 26 school campaigns took place with leaflets, interactive discussion
• Development of take home modules for parents, brothers, sisters and broader family which help to start the conversation
• We raised awareness at 400 mothers and fathers in community sessions
• A knowledge sharing Ritu-online platform on menstrual hygiene is developed and launched
• Development of 13 episodes’ serie TV reality show of which 1st episode is aired on national TV (BTV) which got thousands likes
• Organization of round table on International Menstrual Hygiene day

PARTNERS

The Ritu Programme is a joint initiative of Simavi, RedOrange, and TNO and is implemented in close collaboration with BNPS and DORP in Bangladesh. The programme is designed and implemented fol¬lowing an Evidence Based Programming approach. As part of this approach, we are working with the Impact Centre of the Erasmus University and Maastricht University to evaluate the programme. Ritu is funded by the Embassy of the Kingdom of The Netherlands in Dhaka with 3,4 million euro.