PRESENT for MHM

Every year, around 12.3 billion used-sanitary pads are dumped in landfills in India. Each non-organic sanitary pad is equivalent to four plastic bags, and its decomposing takes ~250-800 years. There are eco-sensitive solutions available, however, the uptake of these healthy, convenient, affordable, and environmentally sustainable solutions is challenging. Lack of awareness, embarrassment, limited social support, and impaired access to amenities are some of the reasons for poor uptake. It becomes even more complicated when girls and women are from socioeconomically disadvantaged communities.

 Menstrual hygiene management (MHM) is under-provisioned and under-researched, with the onus of obtaining information, products, supplies, and facilities, left largely to individuals. The current provision for MHM is largely disposable sanitary pads, that are not biodegradable and have high environmental costs. In addition, as they are not reusable, they must be purchased in large numbers throughout a person’s menstruating years, posing an economic challenge to people from low-income groups. Notably, a woman uses 5,000 -15,000 sanitary pads in her lifetime, an equivalent of 15,000 to 60,000 plastic bags.

 PRESENT for MHM aims to implement and evaluate a holistic solution to address these issues in eleven communities: three urban settlements and eight rural communities in Telangana and Haryana facing a range of deprivations. The three urban settlements include a notified slum, a non-notified slum, and a refugee settlement. The eight rural communities include four villages with adolescent health programs and four with non-adolescent health programs.

PRESENT for MHM aims to impact knowledge, attitudes, and behaviors related to menstruation at individual and community levels. This solution will use a mix of qualitative and quantitative methods to collect data and refine an intervention of informational sessions, community engagement, MHM materials, and prospective documentation of MHM practices and health. It will shed a holistic light on MHM, emphasizing personal convenience, and economic and ecological sustainability. The intervention will ensure gender inclusivity to underscore the understanding that MHM is not a concern of girls and women alone, but a matter of health and well-being pertinent to everyone and as a result bust the myths and misconceptions around menstruation leading to embarrassment and privacy issues.

Key expected outcomes from this solution are:

• Adoption of MHM practices for improved health, acceptability, convenience, affordability, and sustainability
• Increased awareness of ecological and economic sustainability in general
• Improved discourse on health and well-being in the communities
• Evidence for further work
• Advocacy for provision to promote healthy and sustainable MHM beyond the selected communities.

PRESENT for MHM allows making the smart choice for menstrual hygiene management (MHM) by developing, implementing, and evaluating a behavioral change intervention for socially disadvantaged girls and women. This solution has the following distinctions: i. It takes a holistic view of MHM, emphasizing personal health, convenience, economic and ecological sustainability. ii. All phases involve male and female participants, researchers, and facilitators. iii. The MHM intervention kits (comprising sustainable MHM options, including menstrual cups, and reusable cloth pads, as well as some supplies, such as soap and a steel container for cup sterilization after use, to support their use initially) are customized to participants’ needs and preferences rather than promoting a single practice for everyone.

We aim to establish a durable and environment-sensitive sustainable solution to MHM at an individual as well as community level. We will begin with exploring communities’ perceptions towards MHM and building rapport with the community members. This will be followed up with conducting informational sessions with the community members, along with providing them gynecological consultations and MHM kits. The learnings from these engagements will help the team formulate the model for expansion to other communities.

We believe that we will be able to engage with and influence behavioral changes across different generations through this intervention. This solution will help us: A. Understand perspectives and contemporary practices related to MHM in the selected underprivileged communities. B. Understand the awareness levels of menstruation, available menstrual hygiene products, attitudes towards discussing MHM, and practicing and supporting sustainable MHM among adolescents and adults of all genders in the project communities. C. Implement a three-pronged intervention on enabling sustainable MHM. This will include:

• Community engagement to build and improve the discourse on sustainable living and personal and environmental health, and MHM
• Information sessions on MHM for groups of girls, boys, men, and women
• Provision of an MHM kit to participating menstruators

We will evaluate the impact of the intervention on the participants and the communities and develop a toolkit for adaptation to other communities.

PRESENT for MHM will positively impact the lives of socially disadvantaged girls and women by improving their menstrual hygiene management, health, knowledge, and overall well-being, while fostering a supportive community environment and contributing to sustainability and environmental awareness overall. The solution will address 60,000 community members indirectly. Directly, 1600 girls and women will benefit from this study by receiving MHM kits. Around 2200 community members will participate in the survey planned, and 572 community members will participate in detailed discussions. During the following year, 3300 community members will attend the information sessions.

Limited access to clean water and adequate sanitation facilities, a common phenomenon in slums and rural communities, is associated with health issues, particularly for women during menstruation. Educational opportunities are often limited, and poverty remains pervasive, creating a cycle of impoverishment for socially disadvantaged communities. Basic healthcare is often inaccessible, and environmental challenges like poor waste disposal add to their woes. Through this solution, we intend to impact the communities in the following ways:

Improved MHM: By improving the community’s attitude towards MHM and providing menstrual hygiene kits, of a range of sustainable MHM products and some supplies, PRESENT for MHM will empower them to manage their menstruation more effectively and comfortably, reducing health risks.

Increased knowledge and community engagement: Girls and women will have improved knowledge about MHM, breaking down myths and misconceptions around menstruation, empowering them to make informed decisions about their menstrual health and adopting hygiene practices that are environmentally sustainable. The solution will foster a more supportive and informed community environment where discussions about menstruation are encouraged. The solution will also in turn, reduce the stigma surrounding menstruation and promote empathy and support from others in the community. By educating young girls, boys, and adults, the solution aims to initiate a behavioral change that will influence the current generation and future generations, leading to sustainable improvements in MHM practices.

Enhanced Dignity and Confidence: Access to proper menstrual hygiene products will enhance the dignity and self-confidence of menstruators, allowing them to participate in daily activities effectively, and to progress towards their aspirations.

Environmental Impact: Promoting sustainable MHM practices and providing environmentally sensitive menstrual hygiene kits will reduce the environmental impact associated with menstrual waste.

Improved Reproductive Health: Proper MHM practices will help reduce the risk of reproductive tract infections, which, if left untreated, can lead to complications such as infertility. By promoting better MHM, the solution aims to improve women’s reproductive health, reducing the risk of infertility and related issues. Proper MHM can help reduce the risk of maternal and neonatal health complications, contributing to the well-being of upcoming children and future generations in these communities.

Model for Expansion: By piloting and evaluating the intervention, the solution aims to create a model that can be replicated and scaled in other underserved communities, potentially impacting the lives of many more girls and women, and their communities, in the future.

The George Institute for Global Health (TGI) is a leading international health research institute focused on the world’s biggest health challenges. Our mission is to improve the health of millions of people worldwide. One of the three foci of TGI is to build healthier societies by harnessing the power of governments, markets and communities to improve population health. Our team at TGI possess expertise in areas such as public health, gender studies, community development, and reproductive health. The TGI office is located in the heart of Hyderabad Metropolitan City in Telangana and works closely with disadvantaged urban communities, and rural and tribal communities in several neighbouring districts. Our office in Delhi works with communities in urban areas in the National Capital Region, and rural and tribal communities in neighbouring states.

TGI has a Centre for Operational and Research Excellence (CORE), which provides high-quality expertise and robust operations, systems and processes to TGI’s research strategy. These systems at TGI make it the ideal place to execute this solution effectively. In addition, the team at TGI has adequate administrative, field and research staff, which is essential for implementing and sustaining MHM research and advocacy in the future. Our team at TGI have all the necessary processes and resources to design and implement robust monitoring and evaluation systems, which will allow us to assess the MHM intervention’s impact accurately. The research team specializes in qualitative research, focusing on community engagement and the development of interventions that are both practical and well-received by the people they serve. They firmly embrace a grassroots approach to their work. This data and community-driven approach can help refine and improve the solution over time.

TGI maintains an active field presence in Haryana and Telangana, cultivating and nurturing collaborative partnerships with local health departments and district administrations. Furthermore, TGI has established a strong presence within the communities it serves, allowing for a more grounded and comprehensive approach to its projects.

One noteworthy initiative within TGI is the Global Women's Health Program (GWHP). This project represents a natural extension of the pioneering Perspectives, practices, and environmental footprints related to menstrual hygiene among girls and women in India – a pilot study (PEnMen-pilot), which received funding and support from the GWHP as a pilot initiative, and directed its efforts towards the critical intersection of women's health and environmental concerns. TGI's dedication to planetary health is a fundamental tenet of its mission, and this project is emblematic of its commitment to this cause. This project will also have a home in the newly developed Planetary Health Program in TGI.

As an integral part of this ambitious study, TGI will have the opportunity to tap into a vast network of experts within and outside the organisation. This rich pool of expertise encompasses a wide range of disciplines and perspectives, providing invaluable insights and resources to ensure the project's success and advance the broader goals of TGI's planetary health focus.

An exploratory study, PEnMen-pilot, was conducted on the perspectives, practices, preferences, and environmental impact related to MHM, in and around Hyderabad, the capital city of Telangana in India. The research team interacted with 128 participants, including key informants, interviewees, and focus group discussants. Four key informant interviews, six in-depth interviews, and 16 FGDs were conducted. The pilot study revealed partial or total miscomprehension and misinformation on menstruation and MHM options, difficulty accessing a variety of MHM products, and considerable stigma attached to menstruation and even discussion of menstruation and MHM, as barriers to healthy and sustainable MHM. The most frequently reported practices of post-use treatment and disposal of MHM products included dumping in open spaces, burying, open burning, or discarding in dustbins or open fields, all of which create considerable unsustainable waste. The pilot highlighted the imperative to promote MHM strategies that are healthy, acceptable, affordable, and sustainable. The environmental impact assessment conducted by our team, specifically a life-cycle assessment of commercial disposable sanitary pads, reusable cotton pads, and menstrual cups, also revealed that in a landfill disposal scenario (which is closest to the dumping, and occasional open burning characteristic of many places in India), total annual green house gas emissions, calculated as kg of carbon-dioxide equivalent, per menstruator would decrease from 8 to 4 if a switch were made from disposable pads to reusable pads, and from 8 to 1 if a switch were made from disposable pads to menstrual cups.

The proposed project is based on the learnings from the PEnMen pilot, and addresses the gaps in awareness, availability, affordability, and embarrassment that the pilot project illuminated.

Our solution takes a holistic view of MHM, emphasizing personal health, convenience, economic and ecological sustainability, and does not classify MHM narrowly as a biological phenomenon that needs to be addressed by females alone. In consideration of the heavy burden of stigma and embarrassment on any discourse and practice of MHM, all phases of our project involve male and female participants, researchers, and facilitators, to steadily work on opening up the discourse and influencing community change. The MHM intervention kits present a range of options to suit each menstruator needs and preferences at different times, rather than promoting a single practice for everyone at all times during menstruation.

The principal component of PRESENT for MHM is behavioral change. The innovation is not just providing MHM kits but changing attitudes, perceptions, and practices related to MHM in the target communities. Behavioural change, and a shift in community mindsets will make PRESENT for MHM sustainable. Though eco-sensitive solutions are available in the market, they are unlikely to be as effective unsupported by the social and economic components of PRESENT for MHM.

By involving community members in discussions and awareness campaigns, our solution takes a participatory and community-driven approach, which is innovative and sustainable. This innovation aligns with the global trend toward sustainable and eco-sensitive solutions, which are gaining increasing importance. If demonstrated to be successful, it has the potential to reduce environmental waste associated with MHM substantially.

While the core of PRESENT for MHM will stay the same, we expect to tailor site-specific implementation to local customs, cultural norms, and environmental factors. The flexibility of the specifics of the intervention will aid its application in different geographic settings, and also in diverse communities with different socioeconomic profiles.

One of the innovative aspects of our solution is its focus on catalysing broader positive impacts through improved attitudes and awareness. By engaging the community directly and involving them in the co-creation process, we are addressing MHM challenges and instilling a shift in mindset and cultural attitudes towards menstruation. This comprehensive approach is designed to trigger a ripple effect, fostering greater acceptance and openness on the subject and benefiting other populations as well. Our approach uses eco-sensitive materials and innovative manufacturing processes to create affordable, sustainable MHM kits. This makes our solution not only cost-effective but also environmentally responsible.

Our innovative approach can potentially change the market dynamics by promoting sustainable MHM practices and eco-sensitive products. By demonstrating the feasibility and benefits of such products, we aim to encourage wider adoption in the market, which could lead to a shift in the MHM industry towards more environmentally responsible solutions.

PRESENT for MHM largely focuses on the 6th sustainable development goals (SDGs) – Water and sanitation. The solution addresses achieving access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women, girls, and those in vulnerable situations.

Aligned with the United Nations Sustainable Development Goals (SDGs), our impact goals encompass several key areas. Firstly, we aspire to significantly reduce the prevalence of MHM-related health issues, such as urinary and reproductive tract infections, by advocating for and implementing safe and accessible menstrual hygiene practices. This includes proper waste disposal methods to prevent environmental contamination. We aim to measure this impact through indicators associated with SDG 6 (Clean Water and Sanitation).

In parallel, we are dedicated to economic empowerment and poverty reduction among women in these areas. By promoting reusable and sustainable menstrual hygiene products, we intend to reduce the financial burden on families and improve overall economic well-being. Additionally, we will foster community engagement and grassroots participation in designing and implementing MHM interventions. Lastly, our solution prioritises environmental sustainability, reducing the ecological footprint of disposable menstrual products. This supports SDG 12 (Responsible Consumption and Production) by promoting biodegradable or reusable materials.

We will work collaboratively with local organisations and volunteers to achieve these transformational impacts and leverage the core team's expertise at TGI. By combining community-driven solutions with best practices in MHM, we aim to improve the lives of countless women and girls, ensuring they lead healthier, more empowered, and environmentally responsible lives. Our approach is to create a model for comprehensive MHM solutions that can be adapted and scaled across various regions, creating positive change.

In the following year, we will impact eleven underprivileged communities in India: three urban settlements in Telangana and eight rural communities of Haryana facing a range of deprivation. The three urban settlements are - a notified slum, a non-notified slum, and a refugee settlement. The eight rural communities are four villages with adolescent health programs and four with non-adolescent health programs. We will collaborate with local schools and community organisations such as Good Universe for MHM awareness workshops. Conduct targeted awareness campaigns through community events. Currently, PRESENT for MHM is crowd-funded. To make PRESENT for MHM sustainable and scalable, the team will establish multiple revenue streams to reduce dependence on a single source.

Over the next few years, we will strive to extend the successes and lessons from PRESENT for MHM. While our core focus remains on disadvantaged communities, we will extend the interventions to the broader population, recognising that MHM awareness, access to information, and affordable, eco-sensitive products are essential for everyone.

In the next five years, the solution will also be extended to middle-income communities. Corporate Social Responsibilities (CSR) offices, governmental organisations and philanthropists will be contacted for scaling up in Hyderabad. To scale PRESENT for MHM, we will work towards creating mass behavioural awareness-raising and change approaches in the community.

Our solution ensures that girls and women in underprivileged communities have better ways to manage their menstrual hygiene. We will raise awareness of menstrual health and well-being and productivity. The knowledge gained will not only improve menstrual hygiene practices but contribute to environment sensitive living in general. After free consultation with a gynecologist, participating menstruators will receive special kits that contain materials and supplies they need to manage their periods. We will engage with the entire community to help them understand why this is important. We want to change how people think about and support menstrual health, and thereby community and planetary health. We believe that the inclusion of the whole of the community in our activities will accelerate the change we aspire to bring about. To this end, boys and men as well as girls and women will receive information on menstruation and support for healthy and sustainable MHM. The provision of the MHM kits will address the known barriers of lack of availability and affordability of MHM products that many disadvantaged communities face.

This is important because proper menstrual hygiene helps girls and women stay healthy and prevents infections or other problems. Having the materials and knowledge ensures they can go about their daily lives confidently and without embarrassment. This means better practices for future generations. We also do our bit for the environment by promoting sustainable, eco-sensitive menstrual hygiene practices. PRESENT for MHM aims to improve the lives of girls and women by giving them the tools and knowledge they need and changing how their communities think about this important issue.

Full-time

 Twenty-seven full-time personnel will be employed. Including:  22 field assistants, & five field supervisors to coordinate and monitor field activities.

Part-time

Five researchers from TGI are working part-time on this solution, including a statistician and a data manager. Additionally, three administrative/support staff from TGI, including finance, logistics, and grant management, will support the solution.

Contractual

Four consultants (researchers) from the NGO and two implementation managers from the NGO are employed.

 Others

 Furthermore, we hire vendors and healthcare professionals, including gynecologists. It also includes engaging distributors and sellers of menstrual hygiene management (MHM) products and supplies as required.

The team at TGI has been working on this solution for the past four years. However, TGI was established in India in the year 2007.

The team that has come together for this project has diverse expertise and experience. The team members have academic training and professional experience in health promotion and disease prevention, public policy and advocacy, epidemiology and clinical and community-based research, exploratory, ecological, and interventional, diverse research methods, and qualitative, quantitative, and documentary analysis. We have women and men in the team, across different age groups. Our partners in our communities have expertise and experience in community engagement and social work. Further, our consultants on this project bring scholarship in economics, environmental sciences, and development sector to the project.

The urban and rural communities in which this project is set to be implemented, face varying levels of deprivation, and have diverse needs, opportunities, strengths, and capabilities. Discrimination and disadvantage based on caste, religion, economic status, occupation, and linguistic minority membership are high in many of the communities that we work with. We will strive to engage with the communities in all phases of this project, ensuring that all voices are heard, and all inputs are considered in the design and execution of the project.

This project focuses on menstrual health as a core component of overall health (biological, environmental, and psychosocial) among menstruators, and a node to promote ecological (including environmental and psychosocial) health among non-menstruators. We anticipate that during this project, and following it, all persons whom the project touches will have numerous opportunities to reflect on their and their community’s well-being; and adopt strategies and engage in activities for improvements in health and well-being.

We will select certain community members at each site to advise and join us in our work as co-researchers and co-implementers, ensuring that such selection is equitable and inclusive. Persons involved in the data collection and analysis will receive technical and social support for the development of their capacities and participate in documentation and dissemination in various fora.

At the organisational level, The George Institute for Global Health (TGI) has hosted workshops and meetings at various levels for their Justice, Equity and Dignity (JED) Initiative. The purpose of the JED initiative is to strategically guide the organisation to address racism, privilege, and power imbalance within. TGI has appointed an external agency to identify and improve JED within the organisation. Efforts are also made to ensure all the participants of the research projects, beneficiaries of the implementation activities, and processes of TGI align with the JED initiatives.

At TGI, we appreciate and leverage the many differences of a larger community, and we involve and reflect on our engagement with various communities we serve through partnerships and open innovation. TGI has a global presence, with offices in UK, India, Australia and China and numerous research partnerships in many African and Latin American countries.       

By enhancing menstrual hygiene management (MHM) and fostering holistic well-being, PRESENT for MHM aims to provide value to women and girls who are socially disadvantaged. The main goal of the initiative is to offer customized solutions with a focus on convenience, personal health, ecological well-being, and economic sustainability. Girls and women in poor communities, community leaders, researchers, and facilitators are the initiative's main beneficiaries.

As part of its goal, PRESENT for MHM provides a number of essential services. These services include workshops for community participation, examine MHM perceptions and practices in the neighbourhood, promoting understanding of MHM, sustainable living, and environmental and human health. The informational programs conducted through this project will support in dispelling stigmas associated with menstruation. This will be done by educating a variety of community groups. Most importantly, participants in the campaign receive customized MHM kits based on their individual needs and preferences. Gynaecological consultations as proposed in this project will deal with MHM-related health issues. The impact of the initiative on individuals and communities is measured through thorough reviews.

The value proposition is multifaceted. It improves MHM by giving people the tools they need to effectively manage menstrual hygiene, so enhancing their health and wellbeing. By involving community leaders and encouraging sustainable living, it aids in the development of the community. This strategy puts an emphasis on ecological sustainability, which lessens the harm that MHM practices cause to the environment and improves community well-being.

Various revenue methods can be taken into consideration in order to sustain this project. One main source of money for assistance can be grants and donations from international organizations, non-governmental organizations, or government agencies. While municipal governments might be involved to explore public-private partnerships, corporate sponsorship can offer financial support. Making and marketing eco-sensitive period hygiene products could be a part of a social entrepreneurship component. We have already taken a step towards the sustainability of this project, we have been able to gather a substantial amount of money through staff contribution campaigns and crowdsourcing, which has allowed us to carry out the project's pilot phase. Additionally, we have also gathered some small grants for this on-going project.

In summary, the PRESENT for MHM business model delivers value to beneficiaries in disadvantaged places by improving MHM, fostering community development, and minimizing environmental impact. Grant money, corporate sponsorship, public-private partnerships, and maybe a social entrepreneurship component are all possible sources of income.

Our initiative, "PRESENT for MHM," aims to promote sustainable menstrual hygiene management (MHM) among socially disadvantaged girls and women. It stands out by adopting a holistic approach, engaging both genders, and tailoring MHM intervention kits to participants' specific needs. This initiative targets individual and community-level change with a focus on the long-term impact.

To achieve financial sustainability, we propose the following strategies:

1. Philanthropic Funding: In the initial phase, we will seek philanthropic funding to set up and launch our programs.

2. Government Grants: We'll explore government grants and collaborations that align with our goals, tapping into funding opportunities focused on health, women's welfare, and community development.

3. Social Enterprise Model: Developing a social enterprise model is part of our long-term strategy. This model will generate revenue by selling specialized MHM products, with profits reinvested in our programs.

4. Corporate Partnerships: We'll establish partnerships with socially responsible corporations for co-funding, employee engagement, and CSR initiatives focused on MHM.

5. Community Contributions: Encouraging communities to invest in their well-being makes them stakeholders. They'll be invited to contribute financially to support MHM programs.

6. Grant Development and Fundraising: A dedicated team will identify and apply for grants from various sources to support our projects.

Monitoring and Evaluation: Regular impact assessments, financial audits, and feedback mechanisms will ensure program effectiveness and financial viability. We're committed to transparency and accountability.

By combining these strategies, we aim to achieve financial sustainability while delivering substantial and lasting benefits, focusing on improving menstrual hygiene among socially disadvantaged girls and women.