Menstrual Hygiene and Hygiene-Waste Disposal Management of Adolescent Girls and Young Adult Women in Barishal Slum Area   Md. Sadequr Rahman1,[*], Hafsa Maliha Dola2   1 Associate Professor, Department of Sociology, University of Barishal, Barishal- 8254, Bangladesh.  2 MSS Student, Department of Sociology, University of Barishal, Bangladesh.

 

Keywords		Abstract
Adolescent girl, health seeking behavior, menstrual hygiene management, menstrual waste disposal, slums, young adult women.		Menstruation is a natural and very much essential biological process that experience by adolescent girls and women of reproductive working age. In the country of Bangladesh, menstruation often has surrounded by socio-cultural limitations and taboos that lead to adverse health outcomes for adolescent girls. The study has been carried out to investigate the knowledge, attitudes, practices, and experiences around menstruation and the barriers they face, disposing of menstrual products and the health seeking behavior during menstrual problems of adolescent girls and young adult women. This study focused on two major slums namely Vatar Khal Slum and Stadium Colony Slum in Barishal. The study has been conducted by mixed method containing with quantitative and qualitative research approaches. There are 110 sample used for survey. Besides 04 case studies, 03 key information interviews (KIIs), 02 focus group discussion (FGDs) have been chosen for in-depth study as qualitative method. Only 18.19% of the respondents have the knowledge about menstruation. Majority of the girls are found to use cloth during their menstrual period. They were suffering from health problems related to menstruation. Out of all only 30% of the girls consulted to the doctors about menstrual health problem. The findings of the study indicate the unhealthy practices of menstrual management are very highly prevalent that affect their reproductive health.

 

Introduction

Menstruation is a natural and essential biological process that experience by adolescent girls and women of reproductive working age. In the country of Bangladesh, menstruation often has surrounded by socio-cultural limitations and taboos that lead to negative health outcomes for adolescent girls. In spite of being natural process, menstruation consider impure and taboo in many societies, which prevent girls from properly receiving health education and information related to menstrual health. According to 2018 national hygiene survey, only 53% of adolescent school girls in Bangladesh had heard about menstruation before get their first period. Further, a study conducts among adolescent school girls in rural area of Bangladesh found that inadequate menstrual hygiene habits are associating with lower academic achievement. In Bangladesh, mothers and other female relatives are primary sources of information on menstruation but they often provide little information or misconceptions that affect adolescent girls' response to menstrual management. Unhealthy practices of menstrual management among adolescent girls are very highly prevalent that affect their maternal and reproductive health. In slum area, the cultural taboos surrounding menstruation further exacerbate the issue, with girls and women facing restrictions and stigma during their menstruation. 

 

Objectives of the Research

The objectives of the study on Menstrual Hygiene Management and hygiene waste disposal in slum are:

1. To investigate the knowledge, attitudes, practices, and experiences around menstruation and the barriers they face in accessing, using, and disposing of menstrual products.
2. To discover the lack of awareness and education about MHM practices.
3. To know the health seeking behavior during menstrual problems of adolescent girls and young adult women in the study area.
4. To reveal the safe and proper hygiene management and menstrual waste disposal methods

 

Research Question

1. What is the knowledge, attitudes, practices, and experiences around menstruation and the barriers they face in accessing, using, and disposing of menstrual products?
2. What is the lack of awareness and education about MHM practices?
3. How is the health seeking behavior during menstrual problems of adolescent girls and young adult women in the study area?
4. What are the safe and proper management or disposal methods of menstrual waste?

 

Literature Review

The literature review on menstrual hygiene management and hygiene waste disposal in slums of Bangladesh highlights several key findings:

 

Awareness and Practices:

Studies indicate a significant gap in knowledge and awareness regarding menstrual hygiene practices among women and adolescent girls in slum areas of Bangladesh. The reuse of unhygienic materials like rags during menstruation is common, leading to health risks such as infections and complications.

Md. Abu Talha and Md. Zakiul Alam (2022) conducted a study on ‘Menstrual hygiene management practice among adolescent girls: an urban–rural comparative study in Rajshahi division, Bangladesh’. The aim of this study is to absorbent used for managing menstrual blood is a primary health concern. The reuse of cloths without maintaining proper hygiene may increase the risk of reproductive tract infections. The prevalence of using sanitary pads was 37.7%, significantly higher than previous studies conducted in Bangladesh. According to their study, among the cloth users, including sometimes sanitary pads and sometimes cloth users, 71.1% reused cloths for absorbing menstrual blood, and 97.7% washed those materials before reusing.

 

Socio-cultural Factors: 

Most. Ummay Hani Kulsum (2023) works on ‘Menstrual concepts, hygiene practices and health seeking behavior of adolescent girls in Bangladesh: A study on slum areas in Rajshahi’. The study findings reveal that adolescent girls have no idea about menarche before their menstruation that is why the majority of the adolescent girls get frightened during their menarche and become nervous about their situation. There are various misconceptions towards menstruation. Majority of the slum dwelling adolescent girls think that menstruation is a shameful issue.

 

Health Risks:

Muhammed Muazzam Hussain (2020) carried out a study on ‘Health Problems, Misconceptions and Challenges: Experiences of Slum Dweller Adolescent Girls in Bangladesh’. The study shows that the adolescent girls of slum areas face multiple health challenges including physical health problems, mental ill health, poverty etc. They suffer from different types of diseases (headache, fever, cough and cold, gastric ulcer, diarrhea, asthma and allergy, jaundice, skin diseases). The study also highlights some misconceptions on menstruation which added another dimension of health challenges that they face in their daily lives.

 

Access to Menstrual Products: 

Musabber Ali Chisty, Nawshin Afrose, Sheikh Mohiuddin Shahrujjaman (2020) work on ‘Urban women’s access to water and hygiene kits during menstruation in Dhaka city’. This study highlights that only 14.2% of respondents ever received any menstruation products for free for once or twice. More than 82% of the respondents never received any menstruation kit for free from any organization. There is no or limited program by government or nongovernment organizations support women with free menstruation and hygiene kits. Due to the high cost of menstruation and hygiene kits, most of the women from poor or middle-income families face difficulties using them.

 

Conceptual framework

The conceptual framework about menstrual hygiene management and hygiene waste disposal in slums focuses on understanding the complexities and challenges associated with addressing these issues in low-resource settings. Key components of this theoretical framework include:

 

Socio-cultural norms: Understanding the cultural beliefs, taboos, and stigmas surrounding menstruation that impact women's behaviors and access to hygienic practices.

 

Behavioral Change: Exploring strategies for promoting behavioral change and improving awareness about menstrual hygiene and waste disposal.

 

Health Implications: Highlighting the health risks associated with poor menstrual hygiene management, such as infections and reproductive health morbidities.

 

Environmental Impact: Examining the consequences of inadequate waste disposal practices on the environment and public health.

 

Policy and Infrastructure: Considering the role of policies, infrastructure, and                    community engagement in promoting effective menstrual hygiene management and waste disposal.

   

Figure-1: Conceptual framework

 

Theoretical framework

Sociology includes theoretical frameworks related to menstrual health and menstrual waste disposal:

 

Socio-Ecological Model (SEM): The “socio-ecological model” (the Ecology of Human Development) was developed by psychologist Urie Bronfenbrenner in the late 1970s. This framework examines the influence of menstrual health at five interdependent levels: individual, interpersonal, organizational, community, and public policy/structural factors. It recognizes that menstrual health is not limited to individual behaviors and provides a useful lens to critically examine the social and physical menstrual environment in schools.

 

Theory of Planned Behaviour (TPB):

This Planned Behavioural theoretical framework developed by Icek Ajzen (1991), was used to study the factors influencing menstrual waste disposal behavior in a study on school-going girls in rural areas of Gujarat, India. It considers three key factors: attitude, subjective norms, and perceived behavioral control, which significantly impact behavioral intentions and actual behavior.

Grounded Theory and Ethnographic Fieldwork by Glaser and Strauss (1967)

This approach applied in a study on knowledge and perceptions of menstrual hygiene management, helps to understand the social and cultural contexts that shape menstrual health practices and stigma around menstruation.

 

Ecological Systems Theory (EST): It also known as human ecology, is an ecological/ system framework developed in 1979 by Urie Bronfenbrenner (Harkonen, 2007). This framework draws attention to individual and environmental determinants of behavior at different levels of influence, emphasizing the need for intersectoral policies and programs to address menstrual health and hygiene issues.

These frameworks provide a comprehensive understanding of menstrual health and waste disposal by considering various sociological factors, including individual attitudes, social norms, environmental factors, and policy structures.

 

Methodology

The study design has been carried out a cross-sectional survey to gather information on the knowledge, attitudes, practices, and experiences of women and adolescent girls around menstruation and the barriers they face in accessing, using, and disposing of menstrual products in slums. Among the 12 city corporations in Bangladesh, Barishal City Corporation (RCC) was selected purposively as the study and from this city corporation two wards were selected. In Barisal City Corporation, there are around 137 slums with a population of 38,736. Among these 137 slums, this study focused on two major slums namely Vatar Khal Slum, Stadium Colony Slum. The slum areas under ward number 10 and ward number 11 are selected as the study areas.

                                                                                    

Figure 2: Vhatar khal Slum	Figure 3: Stadium Colony Slum

 

The respondents were adolescent girls and young adult women (married or unmarried) between the ages of 12 to 31. The sample size for the study was 125, and the sampling method used was purposive sampling. The method of the research is mixed method contain with quantitative and qualitative data. 110 samples were taken for quantitative (survey) method. 04 case studies were taken collecting from adolescent girls and young adult women. 03 KIIs were taken from parents, nurse and teacher. Besides, 02 FGDs with women and community members to facilitate discussions on shared experiences. Researchers select clusters (i.e., sections or blocks) within Barishal slums randomly, followed by random selection of households within each cluster. The study used manual data analysis methods to analyze the data. The data analysis involved descriptive statistics (percentage) to summarize the findings.

 

Findings of the Study

Socio-demographic characteristics of respondents

Table 1 represents the socio-demographic characteristics of respondents. Data show that out of 110 respondents, 12 to 16 years old girls are 27.7%, 17 to 21 years old girls are 31.82%, 22 to 26 years old girls are 27.27% and 27 to 31 years old women are 13.64%. That means adolescent girls are 59.09% and young adult women are 40.91%. Regarding educational qualification, the number of girls who have no formal education at all is 13.64%, while the number of girls who completed primary education is at 59.09%. The percentage of girls who completed secondary and higher secondary education is 23.64% and 3.63% respectively. No respondent who completed graduation is found. In terms of family income, 13.64% respondent's family monthly income is below 5000 BDT. About 63.64% respondent's family monthly income is between 5001-10000 BDT. About 18.18% respondent's family monthly income is between 10,000-15,000 BDT. 15,000-20,000 BDT household monthly income of respondents is only 4.54%. In terms of respondent's family size, small family size was 31.82% and large family size was 68.18%.

 

Table 1:  Socio-demographic characteristics of respondents

Age	Frequency	Percentage (%)
12-16	30	27.27
17-21	35	31.82
22-26	30	27.27
27-31	15	13.64
Total	110	100.00
Education Qualification
No formal education	15	13.64
Primary Education	65	59.09
Secondary Education	26	23.64
Higher Education	4	3.63
Total	110	100.00
Family’s Monthly Income (BDT)
Below 5000	15	13.64
5001-1000	70	63.64
10001-15000	20	18.18
15001-20000	5	4.54
Total	110	100.00
Family Size
Small (3)	35	31.82
Large (5+)	75	68.18
Total	110	100.00

(Source: Field survey, 2024)

 

Menstrual knowledge and Age at menstruation

Figure 2 shows that most of the girls have their first menstruation between the ages of 13 to 15 and it is 63.63%. About 31.81% of girls are between 15 and 18 years of age and 4.54% of girls had their first period between 10 and 12 years of age. None of the respondents were below 10 years of first menstruation.

             

Figure 1: Age at menstruation	Figure 3: Knowledge about this before menstruation

                                                (Source: Field survey, 2024)                   

 

The study finding shows that adolescent girl in the urban slum areas did not have any idea about menarche before their menstruation. Their family members did not give any idea respecting this matter. Figure 3 shows that 81.81% of the respondents did not know about this before their first menstruation.  Only 18.19% girls had idea about this.

Shila (pseudonym), from vhatar khal slum, 16 years old and a school going girl (from case study) said that, “I had my first period at the age of 12. I had no idea about menstruation before. I thought I had been bitten by an insect after seeing blood during my first period. When I told my mother about this after the period, she gave a rough idea about it. My mother told me to keep the matter a secret and forbade me to roam outside during this time”.

Coherent to this study there is a previous study which demonstrate that majority of that study population, teenage girls, did not know about menarche before their own experiences. Among adolescents, 81.6% communicated with their mothers followed by sisters, relatives and friends after experiencing menarche, while 59.9% reported that it was mothers who first commenced interaction with them. More than half (51.7%) stated that they felt shy during interaction with their mothers after menarche (Onia et al., 2022).

Moni Begum (pseudonym), parent of a respondent (from KII) said “I did not give my daughter any idea about menstruation before. I used to tell my keeps the menstruation issue a secret from the male family members”.

 

5.1.4 Menstrual hygiene management practices

Table 2 presents that the highest 48.18% of adolescent girls used new cloth only to manage their menstrual blood. About 28.18% used old cloth. 23.64% girls used Sanitary Napkin. When asked the reason behind using cloth, 42.86% girls answered that cloth is easy to use. 19.05% of girls use cloth because it is easy to reuse. On the other hand, 38.09% girls use clothes due to lack of money. That is, out of 110 respondents, 84 are cloth users and 31 of them are old cloth users. The respondents were asked about the period of use of these cloths, most of the girls replied that they used new cloths every month. That means 62% girls used new clothes every month during menstruation.  Rest 38% girls were using one cloth for 2 to 6 months.

One of the respondents (from case study) said, “I used cotton cloth during menstruation. I had been using this since my first menstruation. The cloth is very easy to use and reuse. My mother told me to use this. I changed 2 times a day and use this cloth once. There are different cotton cloths which have used before and after that I used it as my menstrual cloth. I used it for three months. My mother once told me about the reuse of this cloths and I did it every month. I never use pad. Sometimes I told my mother to buy some pads but my family can’t afford sanitary napkin”.

Table 2 again represents the frequency of changing absorbents of the respondents. About 15.45% of girls changed menstrual blood absorbent pads/cloths one time per day, but most girls about 70% changed two times per day. Only 14.55% girls changed menstrual cloth or pad three times per day. 72.73% of slum girls used soap and 27.27% of them used detergent to clean menstrual cloth. Most girls were using closed and shaded places to dry menstrual cloths. A significant portion (77.27%) girls are using closed and shaded areas. Only 22.82% girls were able to use open sunny places to dry their menstrual cloths. 

A respondent's mother (from KII) said, “we have a lot of sun on the roof of the house. Clothes can be left to dry.  But these menstrual clothes of girls cannot be allowed to dry.  It is not good for people to see. These things should be covered as much as possible by shame”.

But when a nurse (from KII) was asked the same question, she replied “If menstrual clothes are kept in the shade, germs grow very quickly, so these clothes should be dried in the strong sun because bacteria cannot grow at high temperatures”.

 

Table 2: Menstrual hygiene management practices

Products used during menstruation	Frequency	Percentage (%)
Sanitary Napkin	26	23.64
New Cloth	53	48.18
Old Cloths	31	28.18
Total	110	100.00
Reasons for using cloths
Easy to use	36	42.86
Easy to reuse	16	19.05
Lack of money	32	38.09
Total	84	100.00
Period of use of cloths
Use new cloths per month	52	62
2-6 months	32	38
Total	84	100.00
Frequency of changing absorbent
One time per day	17	15.45
Two time per day	77	70
Three time per day	16	14.55
Total	110	100.00
Menstrual Cloth cleaning ingredients
Soap	80	72.73
Detergent	30	27.27
Total	110	100.00
Drying place of menstrual cloth
Open sunny place	24	21.82
Keeping in bed/other cloths	1	0.91
Close and shaded places	85	77.27
Total	110	100.00

(Source: Field survey, 2024)

 

There is a Focus Group Discussion (FGD) has been conducted with married 4 participants, this FGD focus on the knowledge about menstruation, hygiene practices during menstruation, and menstruation waste disposal. In this group discussion everyone brings up their problems. According to them, if they had known about this before menstruation, they could have handled it better. They all use cloth during menstruation because they cannot afford pads. Since everyone here is married, they all stop their period for 3 months so that their baby is not conceived. Many have menstrual related problems but cannot see a doctor due to lack of money.

 

Menstrual Waste Disposal

Respondents were asked separately how they dispose of used menstrual cloths after use. From the table 1 we knew that 94 girls used cloth whereas from the table 3 we can see that after using these clothes, 88.09% girls threw these clothes in the river for disposal. Only 11.91% of the respondent used clothes are buried in the ground after use. From the table 1, 26 girls use pads. And after using these sanitary pads, about 23.08% girls throw them in the dustbin for disposal. And the remaining 76.92% of respondents used sanitary pad strip in the river after using these pads.

Nipa (pseudonym) 22 years old and married from Stadium slum (from case study) said, “I had my first menstruation at the age of 15. I used cloths during menstruation. I threw my menstrual cloth in the river. As I used cloth and reuse it so I washed my menstrual cloth in the river. When cloths are damaged or torn, we throw the cloths in the river”. 

 

Table 3: Percentage distribution of Menstrual Waste Disposal

Menstrual cloth disposed after use	Frequency	Percentage (%)
Throw away in the river	74	88.09
Buried	10	11.91
Throw away outside of the house	0	0
Total	84	100.00
Sanitary Napkins disposed after use
In the dustbin	6	23.08
In the river	20	76.92
Total	26	100.00

(Source: Field survey, 2024)

Nasima Khanom (pseudonym) a teacher (KII). She uses sanitary pad during menstruation. She has not had any physical problems related to menstruation till now.  Throw the menstrual waste in the dustbin and always be aware of it.

 

Health problems related to menstruation

When we come to know about health problems, it is found in figure 4 that about 90.90% of girls have menstrual health problems. Only 9.1% of girls do not suffer from any health problems. When asked whether they have consulted a doctor for those with menstrual health problems, 70% of girls responded that they had seen doctor for their problem (figure-5).  However, 30% of girls could not see any doctor due to lack of money.

 

Figure 4: Having menstrual health problem	Figure 5: Consult doctor about menstrual health problem

(Source: Field survey, 2024)

 

The most common problems among them are abdominal pain, fatigue and muscle spasms in leg.  70% of girls are suffering from these health problems.  But when asked to a nurse, she said that it is normal for all girls to have lower abdominal pain, fatigue and headache. 

One of the respondents (from case study) said, “I don't have any problem related to menstruation but I have severe lower abdominal pain during menstruation and it gets better after 1 day”.

There is about 10% of girls have irregularity of menstruation, 5% of girls have less bleeding and 5% of girls have excessive bleeding. However, 10% of girls get sores due to using clothes. Almost most of the married girls are stopping their periods by taking various medicines and injections.

Another respondent (from case study) said that, “After marriage I stopped menstruating to prevent conception.  For almost 1 year I did not menstruate due to discontinuation. Apart from this, I do not have any problems related to menstruation, but during menstruation, there is severe lower abdominal pain and less bleeding”.

 

 

Table 4: Facing different types of menstrual health problem

Menstrual Health problem	Frequency	Percentage (%)
Lower abdominal pain / Fatigue / Muscle spasms in leg	70	70
Irregularity of menstruation	10	10
Less bleeding	5	5
Excessive bleeding	5	5
Others (ribs are sore due to use of cloth)	10	10
Total	100	100.00

(Source: Field survey, 2024)

 

Awareness and Practices:

Figure 6 shows that 90.90% of girls have never been distributed pads by any organization.  The remaining 9.1% girls received pads from some organizations. Figure 7 show that individually 86.36% girls have taken awareness steps in managing hygiene management. But 13.64% of girls have not taken any steps. 

Figure 6: Taken sanitary napkins from any organization	Figure 7: Taken any individually awareness steps in managing MHM

 

On the other hands figure-8 shows that, 81.81% people have never received any kind of help from any organization or government agency. Only 18.19% girls have received help for taking awareness step in managing hygiene management.

    

Figure 8: Help taking any organizational/ governmental awareness steps in managing MHM. (Source: Field survey, 2024)

Discussion

Knowledge and misconception on menstruation

The results of the survey reveal that adolescent girls have no idea about menstruation before menstruation, which is why most adolescent girls get scared during their period and become nervous about their condition. So, it is very important to inform adolescent girls about menstruation earlier, share their real experience about it, so that they can easily accept the menstrual situation and manage it very carefully without any hesitation. There are many misconceptions about menstruation. Most of the slum girls feel that menstruation is a shameful thing and should be kept secret from the male members of the family.   Their grandmothers have said that they have not disclosed the matter.  Besides, they think that during menses they should not leave the house especially in the evening and if they do go out, they should come out with things such as garlic and iron.

 

Hygiene practices during menstruation

The findings reveal that the practices and management of menstrual hygiene in slum areas of Barishal are not up to the mark. Adolescent girls and young adult women cut up their used cotton cloths and use them during menstruation and throw them away after use but many keep them for reuse. They use these clothes until they are torn. They find this cloth easy to use as it is reusable. But most of the slum families cannot afford to buy pads. There are many people who have never used pads and they think cloth is better than pads because they have never experienced using pads. According to many, pads cannot be reused. On the other hand, those who used pads also used cloth at the beginning of their periods. Later they started using pads. Girls clean their menstrual clothes with soap and detergent in the river. But they face lack of privacy while cleaning. Some of them in school are ashamed to tell teachers when they are menstruating and because of this they avoid going to school during menstruation. Regular changing sanitary materials is a prerequisite for maintaining good menstrual hygiene management. Although there is no hard and fast rule of changing sanitary materials during menstruation, it depends mostly on blood flow, varying from person to person. Some of those who are married stop their menstruating, so they don't have to buy menstrual products. But girls are more inclined towards using clothes for menstruation.  Due to lack of money, they can’t tell their family to buy pads.   According to those who are educated, they want to use pads but cannot due to shortage of money.

 

Menstrual Waste Disposal

Menstrual waste management in slum is a significant challenge due to the lack of proper infrastructure and facilities for disposal. The most commonly used menstrual products in urban slums are, cloth, old cloth and sanitary pads but the disposal of these used products is often neglected, leading to improper disposal and negative impacts on the users, the sanitation systems, and the environment. The lack of a proper place to dispose of menstrual hygiene materials is a serious issue that badly affects the life of adolescent girls and young adult women living in slum The majority of women and girls who use pads report disposing of them by throwing them alongside garbage in river, while some users put pads in plastic bags or wrap them in newspaper before throwing them away. The study found that girls throw their menstrual waste into the Kirtankhola River adjacent to the slum.   When they asked the reason for this, it was found that there was no waste disposal system in their slums. To address this issue, there is a need for proper infrastructure and facilities for menstrual waste disposal, as well as education and awareness campaigns to promote proper disposal practices. Additionally, there is a need for policies and guidelines for menstrual waste disposal to be developed and implemented, and for collective advocacy by the development sector, health agencies, and citizens to raise voices about the importance of menstrual health and hygiene.

 

Health seeking behavior in context of menstruation related health problems

Health seeking behavior in the context of menstruation-related health problems in slums is a critical issue that affects the well-being of women and adolescent girls living in these communities. The study highlights the challenges faced by these individuals in managing their menstruation due to limited access to clean water, sanitation facilities, and hygienic menstrual products. The study found that most women and girls experienced lower abdominal pain, fatigue and muscle spasms in leg during menstruation. Pain in lower abdomen and muscle spasms in leg started about 3/4 days before menstruation. Later this pain lasts till 2/3 days after menstruation.  Lower abdominal pain is almost common among adolescent girls in the slums, but married women also have the same problem but with a slight pattern change. Besides, many have irregular periods. Menstruation is not happening on time every month, some have excessive bleeding and some have less bleeding. Most of these problems are for married girls. Adolescents do not have many problems other than normal menstrual cramps. Among those who use cloth, some girls get sores between the legs due to the use of cloth. The biggest problem that is happening here is that married girls were stopping their periods for months and some even for years. They were stopping their periods by taking various pills and injections to prevent conception. As a result, they are having trouble conceiving a baby later, the body is getting fat, problems are appearing in the uterus. Some also see doctors for these problems. Some were seeing doctors for all these problems but due to lack of money they were unable to get proper treatment. Some were stopping their periods because of the sores. The lack of proper disposal of menstrual waste leads women and girls to resort to unsafe practices and contributing to environmental pollution and health risks. There is also lack of awareness and education about menstrual health and hygiene, which leads to misconceptions and poor practices among women and girls in slum.

 

Conclusion

Adolescent girls and young adult women in urban slums of Barishal city face significant challenges in managing their menstruation due to limited access to clean water, sanitation facilities, and hygienic menstrual products. The lack of proper infrastructure and disposal mechanisms contributes to unhygienic practices and health risks. The improper disposal of menstrual waste, including throwing used menstrual products rivers, poses environmental pollution and health risks. The disposal practices are often grounded in concerns about exposing menstrual blood, shame, and perceived physical harm to others. Socio-cultural taboos and stigma surrounding menstruation in Bangladesh contribute to poor menstrual hygiene practices and health-seeking behaviors among women and girls in slum communities. The high cost and limited availability of commercial menstrual products force women and girls to use alternatives like cloth, with only a small percentage following recommended cleaning and drying practices. Unhygienic practices can lead to menstrual infections and other health issues. There is a critical need for education and awareness campaigns to promote proper hygiene practices and to bring about changes in existing health-seeking behaviors among urban slum women and adolescent girls. Improving access to menstrual hygiene products and implementing effective waste management strategies are essential to ensure the health and well-being of individuals in these communities. In conclusion, addressing the challenges in menstrual hygiene management and hygiene waste disposal in slums of Barishal requires a comprehensive approach that includes improving access to promoting proper hygiene practices, raising awareness about menstrual health, and implementing effective waste management strategies.

 

Recommendations

1. Education and Awareness Campaigns: Implement comprehensive education and awareness campaigns targeting women and adolescent girls in slums to promote proper menstrual hygiene practices. This should include information on the importance of using hygienic menstrual products, proper disposal methods, and the risks associated with unhygienic practices.
2. Access to Menstrual Hygiene Products: Improve access to affordable and hygienic menstrual hygiene products, such as sanitary pads, in slum areas. This can be achieved through subsidized distribution programs and initiatives that provide free or low-cost menstrual products to women and girls in need.
3. Infrastructure Development: Enhance sanitation facilities in slums by providing proper waste disposal mechanisms. Establish separate containers for the disposal of menstrual waste to prevent environmental pollution and health risks associated with improper disposal practices.
4. Community Engagement: Engage with community members, local authorities, and stakeholders to raise awareness about menstrual hygiene management and waste disposal. Encourage community participation in developing sustainable solutions and promoting a culture of openness and support around menstrual health.
5. Health Services and Support: Ensure access to reproductive health services and support for women and girls in slums, including information on menstrual health, hygiene, and the prevention of menstrual infections. Provide training for healthcare providers on addressing menstrual health issues and promoting proper hygiene practices.

 

Acknowledgements

The researchers are grateful to data collectors including the authors for their participation of data collection process. We remain also grateful to all of the respondents (Adolescent girls and young adult women of Vatar khal and Stadium colony in Barishal slum area) those who share their experiences and valuable suggestions regarding menstrual hygiene management and hygiene waste disposal to conduct this study. 

 

Funding

The researchers did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors to conduct the study.

 

Declarations of Interest 

The authors declare that there is no conflict of interests regarding the publication of this paper.

 

 

 

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Nowreen, Sara, Chowdhury, Md, Arif, Tarin, Nusrat, Jahan, Hasan, Md Robiul & Zaman,  Rashed Uz (2022). A participatory SWOT analysis on water, sanitation, and hygiene   management of disabled females in Dhaka slums of Bangladesh. Journal of Water,      Sanitation and Hygiene for Development, 12(7), pp.542-554.

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