Exploring MHM with Dr Belen Torondel

Menstrual Hygiene Day aims to highlight challenges and solutions that women and girls face around menstruation. For this year's Menstrual Hygiene Day, we interviewed Dr Belen Torondel, Assistant Professor at LSHTM and SHARE's new Capacity Development Manager, who specialises in menstrual hygiene research. She tells us about her work in different contexts, and what we can all do to improve MHM. 

This year’s theme for Menstrual Hygiene Day is “Education and Menstruation”. How important do you feel education is for menstruation?

Menstruation and education are very interlinked topics in several ways. Firstly, without information about menstruation (mainly coming from education at school, at home or other community settings),  it is very complicated to maintain a healthy and comfortable life once you start menstruating. The second connection is that menstruation can act as a barrier for adolescent girls to attend and participate to schools.  It is known that in many settings, menstruation is linked with girls dropping out of school as this physiological change is viewed in many countries as a moment when a girl enters adulthood and is ready for marriage or for other social and family responsibilities.

Tell us about your research relating to MHM.

I am involved in different MHM projects that try to better understand the connection between having poor MHM practices and health and school attendance. When I talk about MHM practices, I try to explore and study all of the different aspects related to menstruation practices such as the type of menstrual absorbent used, frequency of absorbent change, body hygiene practices, and ways of managing reusable material (washing, drying and storing practices) in addition to understanding the environments that facilitate good menstrual hygiene practices, such as adequate WASH facilities that offer comfort and privacy.

The research projects that I am conducting in India are trying to measure the link between these practices and different urogenital infections such as bacterial vaginosis, candida infections and urinary tract infections. To do this research, I collaborate with another researcher, Dr. Padma Das from Asian Institute of Public Health (AIPH), who has a very good hospital and community support in Odisha to run this type of study. We focus in women over 18 as we found that it is complicated to do this type of study among younger girls due to the intrusive nature of getting the health diagnostic.

Regarding my research projects that focus on understanding the link between MHM and school attendance, there are 2 projects that are run in Gambia and Uganda. In both studies, we are first trying to understand the levels of school absenteeism and relationship with menstruation, and also our aim is to test different interventions that can improve this situation.

Why are you passionate about researching MHM?

I think this topic is very important for all women around the world. It has been a taboo for many cultures, and this silence and mystery surrounding the topic has not helped women around the world to maintain a healthy and comfortable menstrual life. Women coming from poor settings who have more social and religious restrictions, have been the ones suffering more from this issue. Their needs and their preferences have not been asked and also listened to in many places which is sometimes due to feeling ashamed to share their experiences with their families and community. Working in the sanitation sector for all these years, I can see that lots of sanitation facilities have not been designed to take into account women’s needs either because they have not been asked what they need or because in many settings women don’t participate much in the houses decision making process.

What led you to do this work?

I started getting interested in this topic when I was working with my late colleague Jeroen Ensink in another project that was seeking to find why some latrines fill quicker than others. We were sampling latrines in rural Tanzania and sometimes I needed to use the latrine, or I had my period, and I really struggled to manage it there. The walls of the latrine were made out of some type of leaves, they did not have a roof, and everyone could see that I was inside. I also could not find water or other cleansing materials. I always thought: how do women manage their menstruations in these settings? Then I started to search literature about the topic to see if there were studies in the WASH sector that try to better understand menstruation. I could not find much.  I wanted to understand the link between poor MHM practice and health and social impacts. Together with my colleague Colin Sumpter we did a systematic review about this topic.

How has SHARE supported your research?

SHARE started funding the systematic review that I mentioned previously. They were very interested in the topic, and funded our time to do the review. Later, I was invited by SHARE to present the results at the Water Forum in Marseille, in Delhi and also at LSHTM.

Additionally, SHARE opened a call for proposals to study Women and Sanitation issues in India. I applied to this call with some colleagues from different international institutions as well as with partners from Odisha (AIPH). I was leading the area related to menstruation and health. After we finished the first project, SHARE funded an extension of the first project to explore other reproductive health infections in more detail. This research led to a new project that was funded by WSSCC to explore further infections related to reusable menstrual absorbent material.

How does “Education and Menstruation” relate to your research?

Education is a common topic for all my projects, because girls and women who are not informed and ready for managing their menstruations are going to be more likely to suffer from health-related infections or to have diminishing attendance and participation at school. In all the projects, we try to understand how education links to MHM and also how maintaining good MHM links to improving girls’ education.

What is your experience working with research participants in contexts where MHM is a sensitive/tabooed topic?

I think you really need to spend time understanding the context of a new study place before starting any research related to this topic.

The secret is also to work with good partners that have experience in the sector (at least working with adolescents, or working in issues related to reproductive health). This is very useful and helps in knowing how to approach the study participants and how to design adequate tools for conducting our research.

Another important thing to consider is that, as this is a sensitive topic, we normally recruit women researchers to conduct the girls/women interviews as well as to collect the samples for health diagnosis. We know that it is very important to involve boys and men in this type of research, but they can participate in different ways. We also try to understand their perceptions and knowledge about this topic and invite them to stakeholders workshops that aim to discuss challenges and solutions of menstruation for girls and women in the community.

What do you think the key gaps are in the field of MHM research?

In general, we need much more research in this topic. We have recently seen more publications in the last few years as it is becoming a hot topic, but not much research has been conducted in the past 20 years which means that there are still a lot of gaps.

We need more evidence of various MHM practices as well as more knowledge about its relationship with school absenteeism and health for different settings. We don’t have much evidence of interventions that aim to improve MHM and had an impact in health or school attendance. We also lack a standard definition for what is considered “good” MHM. We need to improve how to measure school attendance, school performance and health outcomes (reproductive health and psychosocial health).

What are your recommendations for what non-academic researchers, practitioners or the general public can do to promote improved menstrual hygiene management?

It’s crucial to talk about the topic, to share with other males colleagues and with parents and friends and families. Break the taboo! And work with adolescent girls to help them to have a great menstrual lives without restriction and with support without taboos. Empower them to change their lives and the lives around them!

It’s also important to pressure your societies and countries to remove the luxury tax that menstrual products are charged. Try to find creative and inclusive solutions for everyone that has a different reality but has the same needs as you have!

Is there anything else that you would like to add about MHM and Education?

We still have a long way to go, and we need to go together. I also would like to say that menstruation is a beautiful event in our lives; we are so concentrated in pointing out all the problems associated with it that we forget the great things that menstruation provides in our lives, and working into this dimension is also important. Thanks! And have a good menstrual life!

Want to find out more about SHARE's work on MHM? Check out our policy brief.