Menstrual hygiene management (MHM) or menstrual health and hygiene (MHH) is the access to menstrual hygiene products to absorb or collect the flow of blood during menstruation, privacy to change the materials, and access to facilities to dispose of used menstrual management materials. It can also include the "broader systemic factors that link menstruation with health, well-being, gender equality, education, equity, empowerment, and rights". Menstrual hygiene management can be particularly challenging for girls and women in developing countries, where clean water and toilet facilities are often inadequate. Menstrual waste is largely ignored in schools in developing countries, despite it being a significant problem. Menstruation can be a barrier to education for many girls, as a lack of effective sanitary products restricts girls' involvement in educational and social activities.
Terminology An accepted definition of menstrual hygiene management (MHM) is:
"Women and adolescent girls use a clean material to absorb or collect menstrual blood, and this material can be changed in privacy as often as necessary for the duration of menstruation. MHM also includes using soap and water for washing the body as required; and having access to facilities to dispose of used menstrual management materials." The "value chain" related to menstrual hygiene management includes four aspects: awareness, access, use as well as waste management. The CLTS Knowledge Hub gives a definition that accounts for these four aspects as well as social and cultural factors: Menstrual hygiene management' is the way in which women and adolescent girls deal with their menstruation. (Good) MHM requires a minimum level of knowledge and awareness in women and adolescent girls to manage their menstruation effectively and hygienically by using a clean material to absorb or collect menstrual blood, by practicing good hygiene and personal care during their period, and by having access to facilities to wash or dispose of used menstrual management materials with dignity and in an environmentally responsible manner. MHM is not just about the management of the menstrual period but also the need to address societal beliefs and taboos surrounding the issue. Sufficient knowledge, guidance and support for girls and women in preparation for and during menstruation is also part of the definition. The term "menstrual health" is broader than menstrual hygiene. It encompasses both the menstrual hygiene management practices and the broader systemic factors that link menstruation with health, well-being, gender, education, equity, empowerment, and human rights (in particular the human right to water and sanitation). UNICEF now (since 2019) uses the term MHH for "menstrual health and hygiene". These systematic factors include accurate and timely knowledge, available, safe, and affordable materials, informed and comfortable professionals, referral and access to health services, sanitation and washing facilities, positive social norms, safe and hygienic disposal, and advocacy and policy.
History The oldest known records of menstrual hygiene products date to ancient Egypt, where people utilized softened papyrus as a means of absorbing menstrual blood. In resource-constrained Indigenous communities, organic materials were likely employed for this purpose. There is speculation that Vikings used bog moss. In the late 19th century, some suggest that menstruation was considered a form of illness. Doctor Edward Clark believed that attending school during menstruation could potentially delay the development of reproductive organs. In 1897, Johnson & Johnson added sanitary napkins to its price list following a suggestion from Joseph Brown Cook. Despite limited acceptance of this product, it was the first commercially available sanitary protection product for women in the United States. These sanitary napkins were advertised minimally and in small print to maintain a sense of 'modesty'. Sfag-Na-Kins, developed by the Sphagnum Moss Products Company, transformed sphagnum moss into sanitary napkins with the ability to absorb over 20 times their dry weight in fluids. In 1920, Johnson & Johnson introduced the discreetly named and plainly packaged Nupak brand, allowing women to make purchases inconspicuously. The success of Kotex napkins in 1921 can be attributed to extensive advertising in women's magazines and the use of cellucotton enclosed within a gauze sheath. In 1928, Johnson & Johnson introduced silent purchase coupons in magazine ads for MODESS sanitary napkins, providing women with a discreet means of acquiring products without engaging with salespeople. E.C. Haas filed a patent in 1931 for the Tampax tampons, featuring a paper-tube applicator. Tampons had initially been used in medical practice to control bleeding in deep wounds. In 1957, Mary Davidson Kenner presented a patent for an adjustable sanitary belt designed to secure the pad, prevent menstrual blood leakage, and avoid stains. However, Kenner, a black woman, faced systemic barriers. The popularity of belted sanitary napkins waned in the early 1980s with the advent of adhesive strips positioned on the bottom of sanitary pads, facilitating attachment to underwear linings. Since then, menstrual products have undergone substantial transformations, evolving to be more ergonomic, thinner, and incorporating diverse materials to enhance absorption.
Challenges
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