Insights on MHM The Whole Journey Matters

Transcription

1 UNC Water & Health 2018 Side Event: Insights on MHM The Whole Journey Matters Product Market Research (India & Ethiopia) On-site Disposal Research (India & South Africa)

2 MHM Safe Disposal UNC Water & Health Conference October 2018 This work is supported in-part by a grant from the Bill & Melinda Gates Foundation through Duke University s Center for WaSH-AID. All opinions, conclusions, recommendations are those of the authors and do not reflect the views of the Foundation, Duke University, or the Center for WaSH-AID

3 MHM Safe Disposal Project Activities Develop on-site decentralized thermal treatment technology for safe disposal of MH waste UNC Water conf) Landscape of decentralized incineration appliances in India Literature review paper on MHM waste disposal (paper under review / IJERPH) Data collection on current menstrual practices and disposal in public spaces in India and South Africa (publish) Policy Brief & Recommendations for Safe Disposal in India Draft for Discussion

4 MHM Safe Disposal Project Partners

5 MHM Safe Disposal Project Survey Research Team Arundati Muralidharan (WaterAid / India) Alison Parker (Cranfield University / UK) Anju Toolaram (Cranfield University / UK) Kristin Ravndal (Cranfield University/UK) Sudha Ramalingam (PSG / India) Kavitha Karthik (PSG / India) Subhashini Ganesan (PSG / India) Shalini Trivedi (SEWA/ India) Varsha Thakkar (SEWA / India) Lungi Zuma (EWS / South Africa) Nokuthula Pearl Shange (EWS/ South Africa) Sithembile Khambule (EWS / South Africa) Myles Elledge (BMC / USA)

6 Rationale MHM in WASH MHM neglected issue in WASH Where MHM programming is present, MHM disposal often absent Menstruation is natural bodily function, waste streams require management just like management of urine and faeces Lack of appropriate and safe disposal mechanisms may lead to unhygienic MHM and additional environmental risks Quality toilet facilities with MHM considerations are potential driver for toilet use

7 Rationale for Innovation in On-site Management Context Use of reusable and disposal absorbents both require safe disposal Rapid increase of disposal pad use w/ rising education, income, mobility, product performance Disposable products often viewed as aspirational Solid waste management systems often not work well Disposal done poorly is public health and environmental risk Incinerators in public spaces often poorly functioning, with incomplete treatment and poor emission management Disposal into latrines and toilets creates blockage and increased O&M costs Manual scavenging and waste-pickers exposed to used MH absorbents

8 MHM with Safe Disposal Potential Impact: For women and girls, safe disposal: Facilitates mobility Supports work and school participation Promotes personal health Brings dignity, safety and privacy Builds confidence and reduces anxiety (particularly where taboos are strong)

9 MHM with Safe Disposal Potential Impact For the community, better MH absorbent disposal reduces: Environmental health risks of bacterial exposure Unsightly waste from littering in common spaces Risks of poorly managed incineration Exposures and anxiety for waste management workers Blockages in toilets, sewers and drains

10 MHM Disposal Pathways Draft for Discussion

11 Disposal Survey Observations

12 Draft for Discussion

13 Data from Public Spaces on MH Waste Streams In communities, schools, colleges, worksites, markets: Sanitation practices at public spaces Absorbent type and use patterns Absorbent disposal practices Type of disposal behaviour, in general Type of disposal practice, at given site Wrapped? Washed? Experience w/ on-site incineration Aspirational designs for menstrual waste disposal Perspectives on incineration Data collected in Ahmedabad, Coimbatore, Delhi, Durban

14 Sample from Varied Public Spaces Ahmedabad, n = 57 (SEWA) Factory Low-income community toilet block Public toilet in market area University housing and campus public toilets Delhi, n=35 (WaterAid) Metro toilet complexes Market toilets complexes Low-income community toilet complexes Coimbatore, n= 53 (PSG) Factory College and university dormitories & campus public toilets Low-income community public toilets Secondary schools Durban, n= 13 (EWS, Cranfield) Low-income community toilet block

15 Absorbent Use Vast majority use single use disposable pads Older women use reusable cloth or single use cloth pads (AHM, Delhi) Convenient, comfortable, cost In households with multiple women, older women use cloth to save money (AHM) Reusable cloth used for 3-6mo Cloth pads disposed of after single use (Delhi, Coimbatore) Number of respondents Absorbant used around the city/at work Disposable pads Reusable cloths Durban Delhi Ahmedabad Coimbatore

16 Toilet Use During Menstruation Toilet use patterns remain largely unchanged during menses Availability of water, soap, privacy, dustbin availability and placement important during menstruation, especially for changing absorbent Washing of absorbent before disposal (AHM only) Public toilets: pay per use, timings can shape absorbent changing and disposal patterns On-site absorbent disposal (in dustbin) is common practice Discrete disposal a concern

17 Onsite Disposal Practices On-site disposal, common in public toilet spaces Dustbin most common Toilet floor or window ledge Flushing pads in toilet Burning (Coimbatore) Throw in municipal waste bin (Delhi slums) Steps taken with disposal Used menstrual absorbents wrapped in newspaper or plastic bag before disposing (stated, but practiced?) Placement of dustbin in toilet complex Washing used pads before disposing to reduce potential visible blood (AHM only)

18 Response: Absorbent Disposal Practice 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Durban Delhi Ahmedabad Coimbatore Throw in public waste bins without any wrapping Place in pit or fireplace for burning Burn off-site Throw in open forest / bush Throw in/flush down toilet bowl Bury Wrap in newspaper/bag/cloth and throw in public waste bin Place in waste bin for on-site incineration Throw in private household waste bin Throw in pond/lake/river/stream Throw into toilet cabin/ stall Other total

19 On-site Waste Management Collection on-site: Common dustbin in toilet complex Small dustbins in each toilet stall Waste collection centralized by cleaning personnel Issue of timely collection Caretakers lack protective clothing, dislike handling MH waste Caretakers responsible for batch-mode incineration operations

20 On-site Waste Management Improvements / Aspirations: Reduce contact with waste: Mechanical collection and handling Dustbins with lid and/or foot pedal Dustbins available in individual toilet stalls Reliable, female caretaker, dislike male caretaker Cabins with space, light, locking doors Water and soap for washing Paper for wrapping Thermal treatment (mixed response)

21 Thermal Treatment for Menstrual Waste Response to thermal treatment option: Coimbatore - very positive Delhi mixed AHM mixed (stronger social norms on burning) Durban positive Limited exposure to actual hardware or practice Exposure to incinerators not always positive Preference to have caretaker operate burning, after user exits Taboos, some beliefs that burning by user may cause infertility Better if someone else burns the absorbent, after exit Taboos, some believe it s a sin or black magic if waste seen

22 Preferred Option for MH Waste Disposal 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Durban Delhi Ahmedabad Coimbatore Dustbin (total) Incinerator Burial pit and incinerator Burial pit Something convenient Dumping in the pit Don't know Not responded

23 Is Burning Acceptable After User Exits 100% On-site Burning, After Exit 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Durban Delhi AHM CMB Yes No N/A

24 MH Waste Management & Facility Use 100% Does the presence of a disposal bin influence your decision to use this facility? 90% 80% 15 70% 60% 50% 40% Yes No 30% 20 20% 10% 0% Durban Delhi Ahmedabad Coimbatore

25 MH Waste Management & Facility Use 100% Are you more likely to use this facility if there is a private and well-managed disposal bin on site at this facility? 90% 80% 70% 17 60% 50% 40% Yes No 30% 20% 18 10% 0% Durban Delhi Ahmedabad Coimbatore

26 Safe & Sustainable MHM Disposal and treatment of menstrual waste cannot be addressed in isolation Information and support, availability and use of menstrual products impact waste load and disposal Developed by MH Alliance (New Delhi)