Integrating Menstrual Hygiene Considerations into Sanergy Education Outreach and Toilet Design

Candace Girod

ABSTRACT
Schools in urban informal settlements (slums) of low-income countries often lack adequate sanitation
facilities [1]. This issue is exacerbated for girls post menarche because they must also manage their
menstrual flow while attending school [2]. Gender inclusive toilet designs and education on menstruation
and puberty can help to address this problem [9]. Improved knowledge and understanding of menstrual
hygiene and increased access to adequate sanitation facilities can lead to better educational outcomes,
which contribute to better health and economic outcomes as well [7, 8, 10]. Sanergy, a for-profit
enterprise operating in Mukuru, an informal settlement in Nairobi, Kenya currently reaches 38 private
schools in Mukuru with ‘Fresh Life Toilets’ (FLTs). Sanergy provides improved sanitation, and WASH
education. To date, Sanergy has not addressed needs specific to girls’ menstruation, but is exploring ways
to engage the issue. Through key informant interviews and focus group discussions, I will collaborate
with Sanergy to assess the extent of problems associated with menstrual hygiene in schools. I will then
produce a plan to address these problems and develop a menstrual hygiene curriculum to be used in
schools with FLTs.

BACKGROUND
The average home in an informal settlement consists of one room that functions as a bedroom, living
room, and in some cases, a kitchen [3]. Because these settlements are unauthorized, there are very few
resources provided by the Kenyan government [4]. Overcrowding, poverty, and unemployment are
constant challenges [3]. Access to water is limited, such that women often must walk as many as 15
kilometers per day to transport water for their homes [5]. Access to private toilets is also limited, such that
residents must pay to use public facilities, or they practice open defecation [2].

Sanergy is a for-profit company that constructs modular urine diverting dry toilets (UDDTs) called,
“Fresh Life Toilets” (FLTs) that are sold to franchised operators who charge a small fee for their use.
Sanergy collects the waste from these toilets and treats it at a central location through a heating process
that produces energy as a by-product. Treated solids are sold as fertilizer to Kenyan farmers, and the
energy by-products are sold to the national power grid [12, 13]. FLTs have been shown to improve
hygiene and sanitation in the immediate area around the toilets both for those who use them and for those
who do not [1].

Over the last year, Sanergy introduced their toilet franchise model into schools in Mukuru, where
sanitation and hygiene is problematic, especially for menstruating girls [2]. In most settings, women and
girls are not consulted when decisions are made about water, sanitation and hygiene facilities [6]. As a
result, toilets often lack the necessary facilities to make them convenient for women’s use, such as
provisions for privacy, disposal facilities, and proper lighting [3]. Girls may also have inadequate access
to water for washing soiled hands or clothing [7]. The creation of spaces where girls feel comfortable to
take care of their menstrual needs, and the enhancement of knowledge and understanding of puberty and
menstruation have been shown to improve concentration, confidence and participation in school [8].
Menstrual hygiene and puberty education decreases shame, stigma, and negative body image, which can
contribute to decreased sexual risk taking, and increased schooling [8, 9]. These behaviors have been
shown to benefit the economic and educational potential of girls and their future children [10, 11].

OBJECTIVES AND AIMS

Sanergy’s primary objective is to provide people in informal settlements with access to hygienic and safe
sanitation facilities [12].
As part of the Sanergy team, my aims are to:
1) Assess knowledge, attitudes, and practices of school girls using FLTs
 2) Assess whether or not girls using FLTs are able to properly manage their menstrual period
3) Advise Sanergy on gender inclusive FLT design and gender inclusive operations
4) Improve existing WASH curriculum by adding menstrual hygiene specific information

Methods
As outlined in UNICEF’s handbook, WASH in Schools: Empowering Girls’ Education, I will work with
Sanergy to identify six schools in Mukuru with FLTs where I will conduct key informant interviews with
administrators, focus group discussions with girls (grades 6-8), and structured facility observations.

Key Informant Interviews: One key informant interview will be conducted at each school with a head
teacher or administrator to gather information on menstrual education and provision of supplies (Aims 1,
2 and 4).

Focus Group Discussions: One focus group discussion will be conducted at each school with 6-10 post-
menarcheal girls to explore girls’ experiences of managing their menses at school and using the FLTs (
Aims 1, 2, 3 and 4).

Observations: One structured observation will be conducted at each school to assess the adequacy of toilet
facilities in terms of cleanliness, function, lighting and privacy.

REFERENCES
1) Esper, H., London, T., & Kanchwala, Y. (2013). Improved Sanitation and Its Impact on Children:
An Exploration of Sanergy. Impact Case Study No. 2. Ann Arbor: The William Davidson
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2) Bartlett, S. (2003). Water, sanitation and urban children: the need to go beyond “improved”
provision. Environment and Urbanization, 15(2), 57-70.
3) Crichton, J., Okal, J., Kabiru, C. W., & Zulu, E. M. (2013). Emotional and psychosocial aspects
of menstrual poverty in resource-poor settings: a qualitative study of the experiences of
adolescent girls in an informal settlement in Nairobi. Health care for women
international, 34(10), 891-916.
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of Mukuru in Kenya. Retrieved February 27, 2015 From http://www.diva-
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in the slums of Nairobi, Kenya. Wagadu: A Journal of Transnational Women's and Gender
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WEDC. Leicestershire, UK. Retrieved February 27, 2015 from
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8) 13Montgomery, P. et al. (2012). Sanitary pad interventions for girls' education in Ghana: A pilot
study. PloS One, 7(10).
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health impact of girls’ experiences of menstruation and schooling in Tanzania. Journal of
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10) 3Biran, A., et al. (2012). Background paper on measuring WASH and food hygiene practices -
definition of goals to be tackled post 2015 by the Joint Monitoring Programme. London School of
Hygiene and Tropical Medicine, Dept. of Public Health and Policy: London, UK.
11) Sumpter, C., Torondel, B. (2013). A systematic review of the health and social effects of
menstrual hygiene management. PloS One, 8(4).
12) Sanergy Model. From the Sanergy website. Retrieved February 27, 2015 from http://saner.gy/our-
work/the-sanergy-model
13) Our Approach. From the Sanergy website. Retrieved February 27, 2015 from
http://saner.gy/ourapproach