Strengthen action on menstrual health for adolescent girls in the context of adequate water supply and sanitation and universal health coverage
World Health Organization (WHO)
(
United Nations / Multilateral body
)
#SDGAction51149
Description
Rationale:
1. A growing number of countries are developing policies and strategies on universal health coverage (UHC). Within this, WHO’s Department of Sexual and Reproductive Health and Research is working to ensure that the full range of sexual and reproductive health issues is addressed. This includes menstrual health.
2. There is growing interest and experience in addressing the menstrual health of adolescents, however this is still largely focused on informing and preparing adolescents for menarche, and for providing them with products.
3. In most countries, ministries of health are not really engaging in/contributing to menstrual health programmes. This means that case management of menstrual health problems in not really addressed.
Objectives:
1. To advocate with for the inclusion of menstrual health promotion, care, and support, and links to adequate water supply and sanitation, in the context of universal health coverage. While the initial focus will be on adolescents, this will extend overtime to the life course.
2. To work with partners to generate data and develop/update tools to promote menstrual health in the context of UHC and support countries in operationalizing it.
3. To support countries in using these tools to integrate menstrual health into UHC.
Proposed approaches:
In relation to objective 1: WHO will work with UNFPA and the Global Menstrual Health Collective to advocate for this.
In relation to objective 2: WHO will work with individuals and organizations involved in strengthening data on adolescent health, those involved in the case management of menstrual health problems and those involved in health systems strengthening work to synthesize available data, develop/update evidence-based case management tools, and set out approaches to integrate menstrual health into health and related systems.
In relation to objective 3: WHO will work with UNFPA and headquarters, regional office and country office levels to use opportunities to support country level decision making on UHC to include menstrual health.
In relation to objective 1: (i) A shared understanding in the UHC community about the importance of including SRH and specifically menstrual health within this. (ii) Awareness of WHO’s programme support tools.
In relation to objective 2: A set of programme support tools on integrating menstrual health in UHC.
In relation to objective 3: Support to 10 countries to integrate menstrual health in health systems.
Our vision is that women and girls and other people who menstruate, have access to information and education about it; to the menstrual products they need; water, sanitation, and disposal facilities; to competent and empathic care when needed; to live, study and work in an environment in which menstruation is seen as positive and healthy not something to be ashamed of; and to fully participate in work and social activities. Thirdly, to ensure that these activities are included in the relevant sectoral work plans and budgets, and their performance is measured.
UN agencies (UNFPA, UNICEF and UNESCO), Partnerships (Global Menstrual Health Collective), Academics (Mailman School of Public Health, Columbia University)
https://www.who.int/news/item/22-06-2022-who-statement-on-menstrual-hea…
Menstrual Health was not on the agenda of the International Conference on the Population and Development or the Millennium Declaration. Nor it is explicitly stated in the Sustainable Development Goals targets for goals 3, 5 or 6. However, it has been placed on the global health, education, human rights, and gender equality/equity agendas by grass-roots workers and activists from the global South, drawing attention to reports of women’s and girls’ experiences of shame and embarrassment, and the barriers they face in managing their period because they do not have the means to do so, with consequences for their life opportunities including their rights to education, work, water and sanitation, non-discrimination and gender equality – and ultimately to health.
WHO calls for three actions. Firstly, to recognize and frame menstruation as a health issue, not a hygiene issue – a health issue with physical, psychological, and social dimensions, and one that needs to be addressed in the perspective of a life course – from before menarche to after menopause. Secondly, to recognize that menstrual health means that women and girls and other people who menstruate, have access to information and education about it; to the menstrual products they need; water, sanitation, and disposal facilities; to competent and empathic care when needed; to live, study and work in an environment in which menstruation is seen as positive and healthy not something to be ashamed of; and to fully participate in work and social activities. Thirdly, to ensure that these activities are included in the relevant sectoral work plans and budgets, and their performance is measured.
WHO recognizes that several sectors have equally important roles to play in promoting and safeguarding Menstrual Health and is committed to stepping up its efforts to encourage health policymakers and programme managers to engage with these sectors to promote the rights of women, girls and other people who menstruate and meet their comprehensive menstrual health needs, especially in humanitarian contexts. WHO is also committed to breaking the silence and stigma associated with menstruation and to make schools, health facilities and other workplaces (including WHO’s workplaces), menstruation responsive.
Activists – including young people - and nongovernmental organizations have done much to place menstrual health on the agenda. A growing number of governments are taking action. Finally, a handful of countries have put in place laws and policies for medical leave when one is experiencing pain, discomfort and other symptoms and signs related to menstruation. These are useful steps, but governments could and should do more than improve access to menstrual products. They should make schools, workplaces and public institutions supportive of managing menstruation with comfort and dignity. More importantly, they should normalize menstruation and break the silence around it. Finally, in the context of what is happening in Ethiopia, Ukraine, and elsewhere, governments should include an attention to menstruation as part of a broader Sexual and Reproductive Health response in those who are displaced because of war or natural calamities.
SDGS & Targets
Goal 3
Ensure healthy lives and promote well-being for all at all ages
3.1
3.1.1
Maternal mortality ratio
3.1.2
Proportion of births attended by skilled health personnel
3.2
3.2.1
Under-five mortality rate
3.2.2
Neonatal mortality rate
3.3
By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
3.3.1
Number of new HIV infections per 1,000 uninfected population, by sex, age and key populations
3.3.2
Tuberculosis incidence per 100,000 population
3.3.3
Malaria incidence per 1,000 population
3.3.4
Hepatitis B incidence per 100,000 population
3.3.5
Number of people requiring interventions against neglected tropical diseases
3.4
3.4.1
Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease
3.4.2
Suicide mortality rate
3.5
Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
3.5.1
Coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for substance use disorders
3.5.2
Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol
3.6
3.6.1
Death rate due to road traffic injuries
3.7
By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes
3.7.1
Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods
3.7.2
Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group
3.8
Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all
3.8.1
Coverage of essential health services
3.8.2
Proportion of population with large household expenditures on health as a share of total household expenditure or income
3.9
3.9.1
Mortality rate attributed to household and ambient air pollution
3.9.2
Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene (exposure to unsafe Water, Sanitation and Hygiene for All (WASH) services)
3.9.3
Mortality rate attributed to unintentional poisoning
3.a
3.a.1
Age-standardized prevalence of current tobacco use among persons aged 15 years and older
3.b
Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all
3.b.1
Proportion of the target population covered by all vaccines included in their national programme
3.b.2
3.b.3
Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis
3.c
3.c.1
Health worker density and distribution
3.d
Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks
3.d.1
International Health Regulations (IHR) capacity and health emergency preparedness
3.d.2
Percentage of bloodstream infections due to selected antimicrobial-resistant organisms
Goal 5
Achieve gender equality and empower all women and girls
5.1
End all forms of discrimination against all women and girls everywhere
5.1.1
Whether or not legal frameworks are in place to promote, enforce and monitor equality and non‑discrimination on the basis of sex
5.2
5.2.1
Proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months, by form of violence and by age
5.2.2
Proportion of women and girls aged 15 years and older subjected to sexual violence by persons other than an intimate partner in the previous 12 months, by age and place of occurrence
5.3
5.3.1
Proportion of women aged 20-24 years who were married or in a union before age 15 and before age 18
5.3.2
Proportion of girls and women aged 15-49 years who have undergone female genital mutilation/cutting, by age
5.4
Recognize and value unpaid care and domestic work through the provision of public services, infrastructure and social protection policies and the promotion of shared responsibility within the household and the family as nationally appropriate
5.4.1
Proportion of time spent on unpaid domestic and care work, by sex, age and location
5.5
Ensure women’s full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic and public life
5.5.1
Proportion of seats held by women in (a) national parliaments and (b) local governments
5.5.2
Proportion of women in managerial positions
5.6
Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences
5.6.1
Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care
5.6.2
Number of countries with laws and regulations that guarantee full and equal access to women and men aged 15 years and older to sexual and reproductive health care, information and education
5.a
Undertake reforms to give women equal rights to economic resources, as well as access to ownership and control over land and other forms of property, financial services, inheritance and natural resources, in accordance with national laws
5.a.1
(a) Proportion of total agricultural population with ownership or secure rights over agricultural land, by sex; and (b) share of women among owners or rights-bearers of agricultural land, by type of tenure
5.a.2
Proportion of countries where the legal framework (including customary law) guarantees women’s equal rights to land ownership and/or control
5.b
5.b.1
Proportion of individuals who own a mobile telephone, by sex
5.c
Adopt and strengthen sound policies and enforceable legislation for the promotion of gender equality and the empowerment of all women and girls at all levels
5.c.1
Proportion of countries with systems to track and make public allocations for gender equality and women’s empowerment
Goal 6
Ensure availability and sustainable management of water and sanitation for all
6.1
By 2030, achieve universal and equitable access to safe and affordable drinking water for all
6.1.1
Proportion of population using safely managed drinking water services
6.2
By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations
6.2.1
Proportion of population using (a) safely managed sanitation services and (b) a hand-washing facility with soap and water
6.3
By 2030, improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse globally
6.3.1
Proportion of domestic and industrial wastewater flows safely treated
6.3.2
Proportion of bodies of water with good ambient water quality
6.4
6.4.1
Change in water-use efficiency over time
6.4.2
Level of water stress: freshwater withdrawal as a proportion of available freshwater resources
6.5
By 2030, implement integrated water resources management at all levels, including through transboundary cooperation as appropriate
6.5.1
Degree of integrated water resources management
6.5.2
Proportion of transboundary basin area with an operational arrangement for water cooperation
6.6
6.6.1
Change in the extent of water-related ecosystems over time
6.a
6.a.1
Amount of water- and sanitation-related official development assistance that is part of a government-coordinated spending plan
6.b
Support and strengthen the participation of local communities in improving water and sanitation management
6.b.1
Proportion of local administrative units with established and operational policies and procedures for participation of local communities in water and sanitation management
SDG 14 targets covered
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The intended outputs of this work are Ministries of Health in countries, and national/international nongovernment organizations. The outputs are meant to be used to improve the menstrual health of adolescent girls and young women.
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Contact Information
Venkatraman, Dr