學校月經衛生管理建議事項

學校月經衛生管理建議事項

背景
隨著全球對學校月經問題的關注，人們努力制定一項十年計畫（2014-2024年），其中包含五個優先事項，以解決女童教育、健康、性別和月經的相關問題。

• 十年計畫中月經衛生管理（menstrual hygiene management，MHM）的五個優先事項，分述如下：

1. 優先事項1：為學校的月經衛生管理建立強大的跨部門實證基礎，以便對政策、資源分配和大規模規劃進行優先排序。
2. 優先事項2：制定並在學校宣傳月經衛生管理全球指南，其中包含在國家和地方各級適應、採用和實施的最低標準、指標和策略。
   • 政府（如印度、贊比亞、肯尼亞）、非政府組織和國際組織已經提出了針對學校並基於實證的指南，並針對水、環境衛生及個人衛生（water, sanitation, and hygiene，WASH）和月經衛生管理提出了具體建議。
   • 聯合國難民署的任務是為流離失所的女孩（和婦女）提供衛生用品，但並非專門針對教育部門。
   • 在2017年，27個聯合出版組織共同推出緊急情況工具包，建議提供衛生產品、女性友善廁所、向女孩提供月經衛生管理和青春期信息，以及在緊急情況下對已經開始有月經的女孩的學校教師進行宣傳。
3. 優先事項3：通過基於實證的綜合宣傳平台推動月經衛生管理在學校活動中的發展，該平台在各部門和各級政府制定政策、資金和行動。

• 一些合作夥伴關係為年輕人參與月經衛生管理對話創造了空間。例如，聯合國兒童基金會和巴基斯坦領導學院邀請女孩和男孩設計創新的月經衛生管理項目，作為16個國家的Generation Unlimited Youth Challenge（世代無限青少年挑戰）的一部分。

4. 優先事項4：將責任分配給指定的政府實體，以在學校提供月經衛生管理，包括充足的預算以及監測和評估 (M&E)；並向全球頻道和選民報告。

• 在阿富汗，第一夫人和兩位男部長在 2017 年Menstrual Hygiene Day（月經衛生日）的一次大型活動中公開談論月經話題。
• 在尼泊爾，總統最近在議會發表講話時指出，所有社區學校都將免費提供衛生棉。
• 在印度，旁遮普省地方政府承諾在 54,000 所學校擴大 月經衛生管理 計劃。
• 對於政府來說，重要的是通過監測和評估計畫，對於宣佈國家或省級免費或補貼衛生棉分發計畫的政府來說，重要的是在學校中建立適當的棄置機制。

5. 優先事項5：整合月經衛生管理以及將月經衛生管理納入教育系統的能力和資源。

• 尼泊爾將月經健康和衛生納入學校教育，由家庭福利部開發，在德國國際合作公司 (GIZ) 的支持下，正在不同地區進行試驗。

• 菲律賓：監測教育系統中的月經衛生管理政策

• 政策： 2016年，菲律賓教育部 (DepEd) 通過了《學校用水、環境衛生和個人衛生 (WASH) 綜合政策和指南》。該政策旨在「改善學生的個人衛生習慣，使他們能夠養成終生積極的個人衛生習慣和公共衛生習慣」，並規定「所有學校都應確保建立有效的經期衛生管理系統和支持機制」。
• 監測和報告以下月經衛生管理相關數據：

• 在廁所附近的個人洗手站定期供應肥皂和水；
• 月經衛生管理物品的棄置；
• 私人、安全、實用、男女分開的廁所；
• 替換生理用品的空間；
• 月經衛生管理相關資訊、教育與傳播（Information, Education and Communication，IEC）素材的可獲得性。

• 肯尼亞：擴大教育系統中月經衛生管理的政策和實施

• 政策：衛生部和教育部審視了國家學校衛生政策。修訂後的政策對月經衛生管理做出了強有力的聲明，並主張「月經衛生管理是學校衛生政策的關鍵要素，對尊嚴、性別平等以及婦女和女孩的人權非常重要。該政策承認，在月經衛生管理方面遇到挑戰的婦女和女孩，也會對生活的多個範疇產生負面影響；這些範疇與婦女和女孩的人權有關，尤其是健康權、工作權和受教育權，以及性別平等。」學校衛生政策概述了明確的行動要點、指標和目標，以在肯尼亞的學校實現全面的月經衛生管理。肯尼亞還制定了月經衛生管理政策，2017 年，肯尼亞總統簽署了2017年第17號《基礎教育修正案》，其中規定，政府應「向在公立基礎教育機構註冊和入學且已達到青春期的每位女童免費提供充足和優質的衛生棉，並提供一種安全和環保的衛生棉棄置機制。」
• 執行：自2017年以來，肯尼亞對教育系統進行了審視，以採用因材施教的課程。肯尼亞教育部、衛生部和月經衛生管理利益相關者制定了「月經衛生管理教師手冊」，作為向小學學習者培訓和提供月經衛生管理課程的參考書。肯尼亞課程開發研究所正在審查該手冊，以便將其用於培訓教師。此外，衛生部、教育部和水與衛生部已經審視了「學校用水、環境衛生和個人衛生基礎設施標準」，並納入了月經衛生管理的重要組成部分。本書就如何在學校建設學校用水、環境衛生和個人衛生友善設施，特別是女性友善廁所提供了指導。書中包含建築平面圖、工程規格清單、工程進度表、以達成月經衛生管理友善設施標準的廁所的用水、環境衛生和個人衛生要求。政府一直通過公共服務、青年和性別事務部等，向公立小學的目標女孩分發免費衛生棉。教育部有一筆款項，用於在學校尚未收到衛生棉托運時為女學生購買緊急衛生棉。資金將發送給各學校的校長。

具體作法

• 建議提供衛生產品、女性友善廁所、向女孩提供月經衛生管理和青春期信息，以及在緊急情況下對有已經開始有月經年齡的女孩的學校的教師進行宣傳；
• 所有社區學校都將免費提供衛生棉；
• 改善學習者的個人衛生習慣，使他們能夠養成終生積極的個人衛生習慣和公共衛生習慣；
• 所有學校都應確保建立有效的經期衛生管理系統和支持機制；
• 在廁所附近的個人洗手站定期供應肥皂和水；
• 月經衛生管理物品的棄置；
• 私人、安全、實用、男女分開的廁所；
• 替換生理用品的空間；
• 月經衛生管理相關資訊、教育與傳播（Information, Education and Communication，IEC）素材的可獲得性。

參考文獻：
Sommer, M., Caruso, B. A., Torondel, B., Warren, E. C., Yamakoshi, B., Haver, J., ... & Phillips-Howard, P. A. (2021). Menstrual hygiene management in schools: midway progress update on the “MHM in Ten” 2014–2024 global agenda. Health Research Policy and Systems, 19(1), 1-14.

Menstrual hygiene management in schools: midway progress update on the “MHM in Ten” 2014–2024 global agenda

Background
As interest grew globally on the issue of menstruation in schools, an effort was undertaken to develop a ten-year agenda (2014–2024) with five corresponding priorities that address the intersection of girls’ education, health, gender and menstruation.

• Five priorities of the MHM in Ten Agenda

• Priority 1: Build a strong cross-sectoral evidence base for MHM in schools for prioritization of policies, resource allocation, and programming at scale.
• Priority 2: Develop and disseminate global guidelines for MHM in schools with minimum standards, indicators, and illustrative strategies for adaptation, adoption, and implementation at national and subnational levels.

• School-specific evidence-based guidelines have emerged from governments (e.g. India, Zambia, Kenya), NGOs and international organizations

with specific recommendations for WASH and MHM.

• UNHCR has a mandate to provide sanitary products for displaced girls (and women), although not specific to the education sector.
• The MHM in Emergencies Toolkit, launched in 2017 with 27 co-publishing organizations, recommends the provision of sanitary products, female-friendly toilets, the provision of MHM and puberty information to girls, and the sensitization of teachers at schools with girls of menstruating age in emergency settings.

• Priority 3: Advance MHM in schools activities through a comprehensive evidence-based advocacy platform that generates policies, funding, and action across sectors and at all levels of government.

• Some partnerships have served to create spaces for young people to partake in the MHM conversation. For example, UNICEF and the School of Leadership in Pakistan invited girls and boys to design innovative MHM projects as part of the 16-country Generation Unlimited Youth Challenge.

• Priority 4: Allocate responsibility to designated government entities for the provision of MHM in school, including adequate budget and monitoring and evaluation (M&E); and the reporting to global channels and constituents.

• In Afghanistan, the First Lady and two male ministers spoke openly about the topic of menstruation at a large event on MH Day in 2017.
• In Nepal, the President recently noted in a speech to Parliament that sanitary pads would be made available free of cost in all community schools.
• In India, the subnational Government of Punjab committed to scale-up MHM initiatives in 54,000 schools.
• It will be important for governments to adopt monitoring and evaluation plans, and for those announcing national or provincial free or subsidized sanitary pad distribution programmes to create adequate disposal mechanisms in schools.

• Priority 5: Integrate MHM and the capacity and resources to deliver inclusive MHM into the education system.

• For instance, Nepal’s Integrating Menstrual Health and Hygiene in School Education, developed by the Family Welfare Division, is being piloted in different districts, supported by the German Corporation for International Cooperation GmbH (GIZ).

• The Philippines: monitoring an MHM policy in the education system

• The Policy: In 2016, the Philippines Department of Education (DepEd) passed the Comprehensive Policy and Guidelines on Water, Sanitation and Hygiene (WASH) in Schools (DepEd Order No. 10). The policy aims to “improve hygiene and sanitation practices among the learners to enable them to develop life-long positive hygiene and sanitation behaviors,” and decrees that “a system and support mechanisms for effective menstrual hygiene management shall be ensured in all schools.”
• The following MHM related data are being monitored and reported:

• regular supply of soap and water in individual handwashing stations near toilets;
• disposal of MHM materials;
• private, secure, functional, gender segregated toilets;
• resting space for MHM;
• availability of MHM related IEC materials.

• Kenya: expanding policy and implementation of MHM in the education system

• The Policy: The Ministries of Health and of Education reviewed the National School Health Policy. The revised policy has strong statements on MHM and asserts that “MHM is a crucial element of the School Health Policy, being important for dignity, gender equality and the human rights of women and girls. Tis policy recognizes that women and girls who experience challenges with MHM will also experience negative effects on multiple areas of life; relevant to the human rights of women and girls, including in particular the rights to health, work and education, as well as gender equality”. The school health policy outlines clear action points, indicators and objectives to achieve comprehensive MHM across schools in Kenya. Kenya has also developed an MHM Policy, and a strategy to provide direction on how to implement MHM activities in Kenya and to promote integration of MHM and collaboration of all sector actors is also underway. In 2017 the President of Kenya signed the Basic Education Amendment Act No. 17 of 2017 which states that the government shall “provide free sufficient and quality sanitary towels to every girl child registered and enrolled in a public basic education institution who has reached puberty and provide a safe and environmentally sound mechanism for disposal of the sanitary towels.”
• Implementation: Since 2017, Kenya has reviewed the education system in order to adopt a competency-based curriculum. The Ministry of Education, Ministry of Health and MHM stakeholders in Kenya developed the ’Menstrual Hygiene Management Teachers’ Handbook’ as a reference book for training and delivering MHM sessions to learners in primary schools. The Handbook is under review by the Kenya Institute of Curriculum Development so that it can be used to train teachers. In addition, the Ministry of Health, Ministry of Education and Ministry of Water and Sanitation have reviewed the ‘Standards for WASH infrastructure in schools’ and incorporated a strong component of MHM. Tis book provides guidance on how to construct WASH friendly facilities in schools, and in particular female friendly toilets. The book includes architectural plans, bill of quantities, schedules of work and WASH requirements for toilets that meet standards as MHM friendly. The government, through the State Department of Gender at the Ministry of Public Service, Youth and Gender Affairs has been distributing free sanitary pads to targeted girls in public primary schools. The Ministry of Education has a vote head that is used for among other things, the purchase of emergency sanitary pads for school girls for when the school has not received their consignment of sanitary pads. The funds are sent to the headteachers of the various schools. In addition, the Ministry of Education in Kenya is reviewing the National Education Management Information System to include MHM indicators, and has allocated funds to public schools for school infrastructure development. These have been used to construct WASH facilities in schools.

Methods

• The provision of sanitary products, female-friendly toilets, the provision of MHM and puberty information to girls, and the sensitization of teachers at schools with girls of menstruating age in emergency settings;
• Sanitary pads would be made available free of cost in all community schools;
• Improve hygiene and sanitation practices among the learners to enable them to develop life-long positive hygiene and sanitation behaviors;
• A system and support mechanisms for effective menstrual hygiene management shall be ensured in all schools;
• Regular supply of soap and water in individual handwashing stations near toilets;
• Disposal of MHM materials;
• Private, secure, functional, gender segregated toilets;
• Resting space for MHM;
• Availability of MHM related IEC materials.