This report follows the enquiry into the school absenteeism by adolescent girls due to problems associated with menstruation. As of today, there are 12668 Schools in the state out of which there are around 2820 high schools including around 1001 government schools, many of them where adolescent girls attend. The enquiry throws light into a very serious issue where adolescent girls are forced to stay back home during their menstrual periods. There are also health problems prevailing among girls such as reproductory tract infections, skin infections and urinary tract infections. One of the studies conducted by a scholar from Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum also proves this as significant where the self reported morbidity is about 61% of the girls. It is of the opinion that menstrual hygiene should be stressed in schools in our state as it is been implemented in to some extend in some Tamilnadu. Menstruation, even though a natural process, it has been dealt with secrecy even at home due to taboo associated. Many girls from poor families cannot afford sanitary pads where they use rags, usually torn from old saris that are washed quickly inside the latrine and reused several times. Many of our schools do not have spaces with privacy and toilets are not girl friendly with adequate water supply. Rags that are unclean and the fact that there is no adequate wash facilities in school result in absenteeism and prevalence of infections in these girls. All these would not only reduce the reproductory health of a generation but also their overall development. Doctors say that during the period, girls may have to change napkins every 5 – 6 hours to prevent infections i.e. an average of 15 – 20 napkins during a period (per month). The following are the recommendations for consideration.
Recommendations
1. Girl-friendly toilets: In those schools where adolescent girls are studying, clean toilets with good lighting, privacy, adequate ventilation and clean running water should be made available. Dr. Bency Josephs study from Achutha Menon Center points out that reproductory tract infections is closely associated with erratic or absence of water supply in school toilets leading to absenteeism. This can be easily averted by this recommendation. Regular maintenance and cleaning to keep the toilets in good condition is paramount.
2. Sensitisation for teachers: As teachers are expected to be in good contact with students, they are more likely to identify key issues pertaining to reproductive health of their students and aid in early detection of problems and prevention of morbidity. Sensitising teachers in such schools will enable girls to access to information and clarification of doubts as well as advice to good health. This may also improve rapport between student and teacher in such matters.
3. Supply of sanitary napkins in School: As sanitary napkins are advised and owing to fact being unaffordable, provisions can be made to provide them in the school in adequate numbers and at a lower cost. It is recommended that such napkins may be provided free of cost or highly subsidised to those girls coming from poor socio economic background. Coin operated Sanitary napkin vending machines are available and are used in schools in other parts of the country – Tamilnadu is an example. This will significantly bring down the reproductory, urinary and skin infections among girls. However, the quality of the napkins supplied has to be strictly ensured. Cost escalation / manufacturing cost and shortage of napkins have to be thought of.
4. Ensure adequate water supply: Adequate clean running water in toilets is essential to keep clean during this period. Schools should be directed to make this provision as feasible. Where government water supply is not available, well water can be preferred provided it is kept clean; a bore well can also be thought of as required. Overhead water storage is ideal for providing a continuous stream of water.
5. Waste disposal: Safe disposal of used sanitary napkins is essential. All schools are expected to have a waste management system and this could be modified as needed. Waste basket should be provided inside girls toilets for disposing off used napkin. Provision of an incinerator can be thought of while burial of waste is economical.
6. Regular visits from health department: Being this also related to health, cooperation of health department maybe beneficial if regular visits can be done by doctors or health workers (ANM or ASHA of NRHM) of the respective PHC / CHC.
Implimentation
Effective implementation of the school sanitation and hygiene program would require an inter-sectoral effort. Health department can contribute by taking the lead in guiding the program, conducting the sensitisation programs for teachers and parents and health checks. Where ever possible especially with private and aided schools, PTA shall take the initiative in mobilising required resources to improve the conditions also taking help from professional bodies such as IMA. However, for such non-government schools, a subsidy for infrastructure development may be provided. Small scale industries may be promoted through self help groups to manufacture napkins with strict quality checks. Purchase from large scale manufacture at competitive price could be considered to bridge the huge demand. This would help in seeing sanitary napkins not as a luxury good and rather a healthy practice.
Monitoring and Indicators: Monitoring and evaluation will be carried out by regular inspections by the DEO, Health inspectors and reports from them and from the schools shall be submitted regularly to the department regarding status of infrastructure, attendance statistics with reason for absence from class etc in the provided data sheet to maintain uniformity in reporting during the evaluation period. Reported morbidity among students, status of school absenteesm due to menstrual problems, Improvements / comparisons between schools, percentage of teachers / schools sensitised to the issue, percentage of schools covered with infrastructure and availability of napkins etc can be of value as indicators for success of the program and evaluation.
Recommendations
1. Girl-friendly toilets: In those schools where adolescent girls are studying, clean toilets with good lighting, privacy, adequate ventilation and clean running water should be made available. Dr. Bency Josephs study from Achutha Menon Center points out that reproductory tract infections is closely associated with erratic or absence of water supply in school toilets leading to absenteeism. This can be easily averted by this recommendation. Regular maintenance and cleaning to keep the toilets in good condition is paramount.
2. Sensitisation for teachers: As teachers are expected to be in good contact with students, they are more likely to identify key issues pertaining to reproductive health of their students and aid in early detection of problems and prevention of morbidity. Sensitising teachers in such schools will enable girls to access to information and clarification of doubts as well as advice to good health. This may also improve rapport between student and teacher in such matters.
3. Supply of sanitary napkins in School: As sanitary napkins are advised and owing to fact being unaffordable, provisions can be made to provide them in the school in adequate numbers and at a lower cost. It is recommended that such napkins may be provided free of cost or highly subsidised to those girls coming from poor socio economic background. Coin operated Sanitary napkin vending machines are available and are used in schools in other parts of the country – Tamilnadu is an example. This will significantly bring down the reproductory, urinary and skin infections among girls. However, the quality of the napkins supplied has to be strictly ensured. Cost escalation / manufacturing cost and shortage of napkins have to be thought of.
4. Ensure adequate water supply: Adequate clean running water in toilets is essential to keep clean during this period. Schools should be directed to make this provision as feasible. Where government water supply is not available, well water can be preferred provided it is kept clean; a bore well can also be thought of as required. Overhead water storage is ideal for providing a continuous stream of water.
5. Waste disposal: Safe disposal of used sanitary napkins is essential. All schools are expected to have a waste management system and this could be modified as needed. Waste basket should be provided inside girls toilets for disposing off used napkin. Provision of an incinerator can be thought of while burial of waste is economical.
6. Regular visits from health department: Being this also related to health, cooperation of health department maybe beneficial if regular visits can be done by doctors or health workers (ANM or ASHA of NRHM) of the respective PHC / CHC.
Implimentation
Effective implementation of the school sanitation and hygiene program would require an inter-sectoral effort. Health department can contribute by taking the lead in guiding the program, conducting the sensitisation programs for teachers and parents and health checks. Where ever possible especially with private and aided schools, PTA shall take the initiative in mobilising required resources to improve the conditions also taking help from professional bodies such as IMA. However, for such non-government schools, a subsidy for infrastructure development may be provided. Small scale industries may be promoted through self help groups to manufacture napkins with strict quality checks. Purchase from large scale manufacture at competitive price could be considered to bridge the huge demand. This would help in seeing sanitary napkins not as a luxury good and rather a healthy practice.
Monitoring and Indicators: Monitoring and evaluation will be carried out by regular inspections by the DEO, Health inspectors and reports from them and from the schools shall be submitted regularly to the department regarding status of infrastructure, attendance statistics with reason for absence from class etc in the provided data sheet to maintain uniformity in reporting during the evaluation period. Reported morbidity among students, status of school absenteesm due to menstrual problems, Improvements / comparisons between schools, percentage of teachers / schools sensitised to the issue, percentage of schools covered with infrastructure and availability of napkins etc can be of value as indicators for success of the program and evaluation.
this really helps in my literature review......thanks
ReplyDelete