What can existing data on water and sanitation tell us about menstrual hygiene management?
Libbet C. Loughnan, Rob Bain, Rosemary Rop, Marni Sommer, Tom Slaymaker
Half of the global population menstruate as part of their life cycle. This involves water, sanitation, and hygiene (WASH) needs that are often overlooked. Experience from the Millennium Development Goals shows that states focus on targets that are measured globally. Data and indicators on menstrual hygiene management (MHM) for women and girls can have a positive impact on raising awareness, national policy making, and in finding sustainable WASH sector solutions. With this paper, we explore the possible use of Joint Monitoring Programme for Water Supply and Sanitation estimates for representing women and girls’ unique WASH experience, through a focus on MHM. We reviewed definitions of MHM alongside indicators monitored by the JMP and calculated estimates for 18 case-study low- and middle-income countries. Consultation with a broad range of experts identified open defecation and handwashing indicators as the best proxy indicators for inadequate MHM. Globally around half a billion women (13 per cent) defecate in the open and likely lack privacy for MHM. Data on handwashing suggest that a lack of cleansing materials is a particular challenge for MHM. In six of 10 study countries with data, over three-quarters of women lacked handwashing facilities with water and soap. Further research is needed to establish the validity of various aspects of these proxies and to gain greater understanding of the principal WASH-related challenges and barriers faced by women. Nevertheless, it seems clear that interventions among communities with highest open defecation rates and lowest handwashing levels are needed to address barriers to MHM.Adukia, A. (2014) Sanitation and Education [pdf], Harvard University <http://scholar.harvard.edu/files/adukia/files/adukia_sanitation_and_education.pdf> [accessed 14 May 2014].
Aiello, A.E., Coulborn, R.M., Perez, V. and Larson, E.L. (2008) ‘Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis’, American Journal of Public Health 98(8): 1372–81 <http://dx.doi.org/10.2105/AJPH.2007.124610>.
Cairncross, S. and Valdmanis, V. (2006) ‘Water supply, sanitation, and hygiene promotion’, in D.T. Jamison, J.G. Breman, A.R. Measham, G. Alleyne, M. Claeson, D.B. Evans, P. Jha, A. Mills, and P. Musgrove (eds), Disease Control Priorities in Developing Countries, Chapter 41, Washington, DC: World Bank.
Columbia University and UNICEF (2016) ‘MHM in Ten’: Advancing the MHM Agenda in WASH in Schools Second Annual Meeting, UNICEF Programme Division.
Das, P., Baker, K.K., Dutta, A., Swain, T., Sahoo, S., Das, B.S., Panda, B., Nayak, A., Bara, M., Bilung, B., Mishra, P.R., Panigrahi, P., Cairncross, S. and Torondel, B. (2015) ‘Menstrual hygiene practices, WASH access and the risk of urogenital infection in women from Odisha, India’, PLoS ONE 10(6): e0130777 <http://dx.doi.org/10.1371/journal.pone.0130777>.
Freeman, M.C., Greene, L.E., Dreibelbis, R., Saboori, S., Muga, R., Brumback, B. and Rheingans, R. (2012) ‘Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial’, Tropical Medicine and International Health 17: 380–91 <http://dx.doi.org/10.1111/j.1365-3156.2011.02927.x>.
Hennegan, J. and Montgomery, P. (2016) ‘Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low and middle income countries? A systematic review’, PloS ONE 11(2): e0146985 <http://dx.doi.org/10.1371/journal.pone.0146985>.
House, S., Mahon, T. and Cavill, S. (2012) Menstrual Hygiene Matters: A Resource for Improving Menstrual Hygiene around the World, London: WaterAid.
Kayser, G.L., Moriarty, P., Fonseca, C. and Bartram, J. (2013) ‘Domestic water service delivery indicators and frameworks for monitoring, evaluation, policy and planning: A review’, International Journal of Environmental Research and Public Health 10: 4812–35 <http://dx.doi.org/10.3390/ijerph10104812>.
Loughnan, L., Ram, P. and Luyendijk, R. (2015) ‘Measurement of handwashing behaviour in multiple indicator cluster surveys and demographic and health surveys, 1985–2008’, Waterlines 34(4) <http://dx.doi.org/10.3362/1756-3488.2015.028>.
Luby, S.P., Agboatwalla, M., Feikin, D.R., Painter, J., Billhimer, W., Altaf, A. and Hoekstra, R.M. (2005) ‘Effect of handwashing on child health: a randomised controlled trial’, The Lancet 366(9481): 225–33 <http://dx.doi.org/10.1016/S0140-6736(05)66912-7>.
McMahon, S., Winch, P., Caruso, B., Obure, A., Ogutu, E., Ochari, I., McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.O., Ogutu, E.O., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head”: reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health and Human Rights 11: 1–10 <http://dx.doi.org/10.1186/1472-698X-11-7>.
Montgomery, P., Ryus, C.R., Dolan, C.S., Dopson, S. and Scott, L.M. (2012) ‘Sanitary pad interventions for girls’ education in Ghana: a pilot study’, PLoS One 7: e48274 <http://dx.doi.org/10.1371/journal.pone.0048274>.
National Sample Survey Office (2013) Housing Condition and Amenities in India – NSS 2012, Ministry of Statistics and Programme Implementation, Government of India.
Oster, E. and Thornton, R. (2011) ‘Menstruation, sanitary products, and school attendance: evidence from a randomized evaluation’, American Economic Journal: Applied Economics 3: 91–100 <http://dx.doi.org/10.1257/app.3.1.91>.
Patkar, A. (2012) Preparatory Input on MHM for End Group by Archana Patkar, WSSCC, JMP Equity and Non-Discrimination Working Group.
Rhee, V., Mullany, L.C., Khatry, S.K., Katz, J., Leclerq, S.C., Darmstadt, G.L. and Tielsch, J.M. (2008) ‘Maternal and birth attendant hand washing and neonatal mortality in southern Nepal’, Archives of Pediatrics & Adolescent Medicine 162(7): 603–8 <http://dx.doi.org/10.1001/archpedi.162.7.603>.
Sommer, M. (2010) ‘Putting “menstrual hygiene management” into the school water and sanitation agenda’, Waterlines 29(4): 268–78 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Sommer, M. and Caruso, B. (2015) ‘Menstrual hygiene management and WASH’, in J. Bartram (ed.), Routledge Handbook of Water and Health, pp. 522–30, Abingdon, UK: Routledge.
Sommer, M. and Sahin, M. (2013) ‘Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls’, American Journal of Public Health 103(9): 1556–9 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Sommer, M., Kjellén, M. and Pensulo, C. (2013) ‘Review paper: girls’ and women’s unmet needs for menstrual hygiene management (MHM): the interactions between MHM and sanitation systems in low-income countries’, Journal of Water, Sanitation and Hygiene for Development 3(3): 283–97 <http://dx.doi.org/10.2166/washdev.2013.101>.
Sommer, M., Cavil, S., House, S. and Ferron, S. (2014) ‘Violence, gender and WASH: spurring action on a complex, under-documented and sensitive topic’, Environment and Urbanization 27(1): 105–16 <http://dx.doi.org/10.1177/0956247814564528>.
Sommer, M., Sutherland, C. and Chandra-Mouli, V. (2015) ‘Putting menarche and girls into the global population health agenda’, Reproductive Health Journal 12: 24 <http://dx.doi.org/10.1186/s12978-015-0009-8>.
Sumpter, C. and Torondel, B. (2013) ‘A systematic review of the health and social effects of menstrual hygiene management’, PLoS One 8: e62004 <http://dx.doi.org/10.1371/journal.pone.0062004>.
UNFPA (2016) ‘Gender-biased sex selection’ [online] <www.unfpa.org/gender-biased-sex-selection> [accessed 14 May 2016].
United Nations (2015) Sustainable Development Goals <www.un.org/sustainabledevelopment/water-and-sanitation/> [accessed 14 May 2016].
Van Eijk, A.M., Sivakami, M., Thakkar, M.B., Bauman, A., Laserson, K.F., Coates, S. and Phillips-Howard, P.A. (2016) ‘Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis’, BMJ Open 6: e010290 <http://dx.doi.org/10.1136/bmjopen-2015-010290>.
Water Supply and Sanitation Collaborative Council (WSSCC) (2013) ‘Celebrating womanhood: how better menstrual hygiene management is the path to better health, dignity and business’, Geneva: WSSCC <http://wsscc.org/resources-feed/celebrating-womanhood-report-2013/> [accessed 14 May 2016].
WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation (2015) Progress on Sanitation and Drinking Water, 2015 Update and MDG Assessment, Geneva: WHO; New York: UNICEF.
Adukia, A. (2014) Sanitation and Education [pdf], Harvard University <http://scholar.harvard.edu/files/adukia/files/adukia_sanitation_and_education.pdf> [accessed 14 May 2014].
Aiello, A.E., Coulborn, R.M., Perez, V. and Larson, E.L. (2008) ‘Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis’, American Journal of Public Health 98(8): 1372–81 <http://dx.doi.org/10.2105/AJPH.2007.124610>.
Cairncross, S. and Valdmanis, V. (2006) ‘Water supply, sanitation, and hygiene promotion’, in D.T. Jamison, J.G. Breman, A.R. Measham, G. Alleyne, M. Claeson, D.B. Evans, P. Jha, A. Mills, and P. Musgrove (eds), Disease Control Priorities in Developing Countries, Chapter 41, Washington, DC: World Bank.
Columbia University and UNICEF (2016) ‘MHM in Ten’: Advancing the MHM Agenda in WASH in Schools Second Annual Meeting, UNICEF Programme Division.
Das, P., Baker, K.K., Dutta, A., Swain, T., Sahoo, S., Das, B.S., Panda, B., Nayak, A., Bara, M., Bilung, B., Mishra, P.R., Panigrahi, P., Cairncross, S. and Torondel, B. (2015) ‘Menstrual hygiene practices, WASH access and the risk of urogenital infection in women from Odisha, India’, PLoS ONE 10(6): e0130777 <http://dx.doi.org/10.1371/journal.pone.0130777>.
Freeman, M.C., Greene, L.E., Dreibelbis, R., Saboori, S., Muga, R., Brumback, B. and Rheingans, R. (2012) ‘Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial’, Tropical Medicine and International Health 17: 380–91 <http://dx.doi.org/10.1111/j.1365-3156.2011.02927.x>.
Hennegan, J. and Montgomery, P. (2016) ‘Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low and middle income countries? A systematic review’, PloS ONE 11(2): e0146985 <http://dx.doi.org/10.1371/journal.pone.0146985>.
House, S., Mahon, T. and Cavill, S. (2012) Menstrual Hygiene Matters: A Resource for Improving Menstrual Hygiene around the World, London: WaterAid.
Kayser, G.L., Moriarty, P., Fonseca, C. and Bartram, J. (2013) ‘Domestic water service delivery indicators and frameworks for monitoring, evaluation, policy and planning: A review’, International Journal of Environmental Research and Public Health 10: 4812–35 <http://dx.doi.org/10.3390/ijerph10104812>.
Loughnan, L., Ram, P. and Luyendijk, R. (2015) ‘Measurement of handwashing behaviour in multiple indicator cluster surveys and demographic and health surveys, 1985–2008’, Waterlines 34(4) <http://dx.doi.org/10.3362/1756-3488.2015.028>.
Luby, S.P., Agboatwalla, M., Feikin, D.R., Painter, J., Billhimer, W., Altaf, A. and Hoekstra, R.M. (2005) ‘Effect of handwashing on child health: a randomised controlled trial’, The Lancet 366(9481): 225–33 <http://dx.doi.org/10.1016/S0140-6736(05)66912-7>.
McMahon, S., Winch, P., Caruso, B., Obure, A., Ogutu, E., Ochari, I., McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.O., Ogutu, E.O., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head”: reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health and Human Rights 11: 1–10 <http://dx.doi.org/10.1186/1472-698X-11-7>.
Montgomery, P., Ryus, C.R., Dolan, C.S., Dopson, S. and Scott, L.M. (2012) ‘Sanitary pad interventions for girls’ education in Ghana: a pilot study’, PLoS One 7: e48274 <http://dx.doi.org/10.1371/journal.pone.0048274>.
National Sample Survey Office (2013) Housing Condition and Amenities in India – NSS 2012, Ministry of Statistics and Programme Implementation, Government of India.
Oster, E. and Thornton, R. (2011) ‘Menstruation, sanitary products, and school attendance: evidence from a randomized evaluation’, American Economic Journal: Applied Economics 3: 91–100 <http://dx.doi.org/10.1257/app.3.1.91>.
Patkar, A. (2012) Preparatory Input on MHM for End Group by Archana Patkar, WSSCC, JMP Equity and Non-Discrimination Working Group.
Rhee, V., Mullany, L.C., Khatry, S.K., Katz, J., Leclerq, S.C., Darmstadt, G.L. and Tielsch, J.M. (2008) ‘Maternal and birth attendant hand washing and neonatal mortality in southern Nepal’, Archives of Pediatrics & Adolescent Medicine 162(7): 603–8 <http://dx.doi.org/10.1001/archpedi.162.7.603>.
Sommer, M. (2010) ‘Putting “menstrual hygiene management” into the school water and sanitation agenda’, Waterlines 29(4): 268–78 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Sommer, M. and Caruso, B. (2015) ‘Menstrual hygiene management and WASH’, in J. Bartram (ed.), Routledge Handbook of Water and Health, pp. 522–30, Abingdon, UK: Routledge.
Sommer, M. and Sahin, M. (2013) ‘Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls’, American Journal of Public Health 103(9): 1556–9 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Sommer, M., Kjellén, M. and Pensulo, C. (2013) ‘Review paper: girls’ and women’s unmet needs for menstrual hygiene management (MHM): the interactions between MHM and sanitation systems in low-income countries’, Journal of Water, Sanitation and Hygiene for Development 3(3): 283–97 <http://dx.doi.org/10.2166/washdev.2013.101>.
Sommer, M., Cavil, S., House, S. and Ferron, S. (2014) ‘Violence, gender and WASH: spurring action on a complex, under-documented and sensitive topic’, Environment and Urbanization 27(1): 105–16 <http://dx.doi.org/10.1177/0956247814564528>.
Sommer, M., Sutherland, C. and Chandra-Mouli, V. (2015) ‘Putting menarche and girls into the global population health agenda’, Reproductive Health Journal 12: 24 <http://dx.doi.org/10.1186/s12978-015-0009-8>.
Sumpter, C. and Torondel, B. (2013) ‘A systematic review of the health and social effects of menstrual hygiene management’, PLoS One 8: e62004 <http://dx.doi.org/10.1371/journal.pone.0062004>.
UNFPA (2016) ‘Gender-biased sex selection’ [online] <www.unfpa.org/gender-biased-sex-selection> [accessed 14 May 2016].
United Nations (2015) Sustainable Development Goals <www.un.org/sustainabledevelopment/water-and-sanitation/> [accessed 14 May 2016].
Van Eijk, A.M., Sivakami, M., Thakkar, M.B., Bauman, A., Laserson, K.F., Coates, S. and Phillips-Howard, P.A. (2016) ‘Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis’, BMJ Open 6: e010290 <http://dx.doi.org/10.1136/bmjopen-2015-010290>.
Water Supply and Sanitation Collaborative Council (WSSCC) (2013) ‘Celebrating womanhood: how better menstrual hygiene management is the path to better health, dignity and business’, Geneva: WSSCC <http://wsscc.org/resources-feed/celebrating-womanhood-report-2013/> [accessed 14 May 2016].
WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation (2015) Progress on Sanitation and Drinking Water, 2015 Update and MDG Assessment, Geneva: WHO; New York: UNICEF.
Adukia, A. (2014) Sanitation and Education [pdf], Harvard University <http://scholar.harvard.edu/files/adukia/files/adukia_sanitation_and_education.pdf> [accessed 14 May 2014].
Aiello, A.E., Coulborn, R.M., Perez, V. and Larson, E.L. (2008) ‘Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis’, American Journal of Public Health 98(8): 1372–81 <http://dx.doi.org/10.2105/AJPH.2007.124610>.
Cairncross, S. and Valdmanis, V. (2006) ‘Water supply, sanitation, and hygiene promotion’, in D.T. Jamison, J.G. Breman, A.R. Measham, G. Alleyne, M. Claeson, D.B. Evans, P. Jha, A. Mills, and P. Musgrove (eds), Disease Control Priorities in Developing Countries, Chapter 41, Washington, DC: World Bank.
Columbia University and UNICEF (2016) ‘MHM in Ten’: Advancing the MHM Agenda in WASH in Schools Second Annual Meeting, UNICEF Programme Division.
Das, P., Baker, K.K., Dutta, A., Swain, T., Sahoo, S., Das, B.S., Panda, B., Nayak, A., Bara, M., Bilung, B., Mishra, P.R., Panigrahi, P., Cairncross, S. and Torondel, B. (2015) ‘Menstrual hygiene practices, WASH access and the risk of urogenital infection in women from Odisha, India’, PLoS ONE 10(6): e0130777 <http://dx.doi.org/10.1371/journal.pone.0130777>.
Freeman, M.C., Greene, L.E., Dreibelbis, R., Saboori, S., Muga, R., Brumback, B. and Rheingans, R. (2012) ‘Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial’, Tropical Medicine and International Health 17: 380–91 <http://dx.doi.org/10.1111/j.1365-3156.2011.02927.x>.
Hennegan, J. and Montgomery, P. (2016) ‘Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low and middle income countries? A systematic review’, PloS ONE 11(2): e0146985 <http://dx.doi.org/10.1371/journal.pone.0146985>.
House, S., Mahon, T. and Cavill, S. (2012) Menstrual Hygiene Matters: A Resource for Improving Menstrual Hygiene around the World, London: WaterAid.
Kayser, G.L., Moriarty, P., Fonseca, C. and Bartram, J. (2013) ‘Domestic water service delivery indicators and frameworks for monitoring, evaluation, policy and planning: A review’, International Journal of Environmental Research and Public Health 10: 4812–35 <http://dx.doi.org/10.3390/ijerph10104812>.
Loughnan, L., Ram, P. and Luyendijk, R. (2015) ‘Measurement of handwashing behaviour in multiple indicator cluster surveys and demographic and health surveys, 1985–2008’, Waterlines 34(4) <http://dx.doi.org/10.3362/1756-3488.2015.028>.
Luby, S.P., Agboatwalla, M., Feikin, D.R., Painter, J., Billhimer, W., Altaf, A. and Hoekstra, R.M. (2005) ‘Effect of handwashing on child health: a randomised controlled trial’, The Lancet 366(9481): 225–33 <http://dx.doi.org/10.1016/S0140-6736(05)66912-7>.
McMahon, S., Winch, P., Caruso, B., Obure, A., Ogutu, E., Ochari, I., McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.O., Ogutu, E.O., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head”: reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health and Human Rights 11: 1–10 <http://dx.doi.org/10.1186/1472-698X-11-7>.
Montgomery, P., Ryus, C.R., Dolan, C.S., Dopson, S. and Scott, L.M. (2012) ‘Sanitary pad interventions for girls’ education in Ghana: a pilot study’, PLoS One 7: e48274 <http://dx.doi.org/10.1371/journal.pone.0048274>.
National Sample Survey Office (2013) Housing Condition and Amenities in India – NSS 2012, Ministry of Statistics and Programme Implementation, Government of India.
Oster, E. and Thornton, R. (2011) ‘Menstruation, sanitary products, and school attendance: evidence from a randomized evaluation’, American Economic Journal: Applied Economics 3: 91–100 <http://dx.doi.org/10.1257/app.3.1.91>.
Patkar, A. (2012) Preparatory Input on MHM for End Group by Archana Patkar, WSSCC, JMP Equity and Non-Discrimination Working Group.
Rhee, V., Mullany, L.C., Khatry, S.K., Katz, J., Leclerq, S.C., Darmstadt, G.L. and Tielsch, J.M. (2008) ‘Maternal and birth attendant hand washing and neonatal mortality in southern Nepal’, Archives of Pediatrics & Adolescent Medicine 162(7): 603–8 <http://dx.doi.org/10.1001/archpedi.162.7.603>.
Sommer, M. (2010) ‘Putting “menstrual hygiene management” into the school water and sanitation agenda’, Waterlines 29(4): 268–78 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Sommer, M. and Caruso, B. (2015) ‘Menstrual hygiene management and WASH’, in J. Bartram (ed.), Routledge Handbook of Water and Health, pp. 522–30, Abingdon, UK: Routledge.
Sommer, M. and Sahin, M. (2013) ‘Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls’, American Journal of Public Health 103(9): 1556–9 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Sommer, M., Kjellén, M. and Pensulo, C. (2013) ‘Review paper: girls’ and women’s unmet needs for menstrual hygiene management (MHM): the interactions between MHM and sanitation systems in low-income countries’, Journal of Water, Sanitation and Hygiene for Development 3(3): 283–97 <http://dx.doi.org/10.2166/washdev.2013.101>.
Sommer, M., Cavil, S., House, S. and Ferron, S. (2014) ‘Violence, gender and WASH: spurring action on a complex, under-documented and sensitive topic’, Environment and Urbanization 27(1): 105–16 <http://dx.doi.org/10.1177/0956247814564528>.
Sommer, M., Sutherland, C. and Chandra-Mouli, V. (2015) ‘Putting menarche and girls into the global population health agenda’, Reproductive Health Journal 12: 24 <http://dx.doi.org/10.1186/s12978-015-0009-8>.
Sumpter, C. and Torondel, B. (2013) ‘A systematic review of the health and social effects of menstrual hygiene management’, PLoS One 8: e62004 <http://dx.doi.org/10.1371/journal.pone.0062004>.
UNFPA (2016) ‘Gender-biased sex selection’ [online] <www.unfpa.org/gender-biased-sex-selection> [accessed 14 May 2016].
United Nations (2015) Sustainable Development Goals <www.un.org/sustainabledevelopment/water-and-sanitation/> [accessed 14 May 2016].
Van Eijk, A.M., Sivakami, M., Thakkar, M.B., Bauman, A., Laserson, K.F., Coates, S. and Phillips-Howard, P.A. (2016) ‘Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis’, BMJ Open 6: e010290 <http://dx.doi.org/10.1136/bmjopen-2015-010290>.
Water Supply and Sanitation Collaborative Council (WSSCC) (2013) ‘Celebrating womanhood: how better menstrual hygiene management is the path to better health, dignity and business’, Geneva: WSSCC <http://wsscc.org/resources-feed/celebrating-womanhood-report-2013/> [accessed 14 May 2016].
WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation (2015) Progress on Sanitation and Drinking Water, 2015 Update and MDG Assessment, Geneva: WHO; New York: UNICEF.
Adukia, A. (2014) Sanitation and Education [pdf], Harvard University <http://scholar.harvard.edu/files/adukia/files/adukia_sanitation_and_education.pdf> [accessed 14 May 2014].
Aiello, A.E., Coulborn, R.M., Perez, V. and Larson, E.L. (2008) ‘Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis’, American Journal of Public Health 98(8): 1372–81 <http://dx.doi.org/10.2105/AJPH.2007.124610>.
Cairncross, S. and Valdmanis, V. (2006) ‘Water supply, sanitation, and hygiene promotion’, in D.T. Jamison, J.G. Breman, A.R. Measham, G. Alleyne, M. Claeson, D.B. Evans, P. Jha, A. Mills, and P. Musgrove (eds), Disease Control Priorities in Developing Countries, Chapter 41, Washington, DC: World Bank.
Columbia University and UNICEF (2016) ‘MHM in Ten’: Advancing the MHM Agenda in WASH in Schools Second Annual Meeting, UNICEF Programme Division.
Das, P., Baker, K.K., Dutta, A., Swain, T., Sahoo, S., Das, B.S., Panda, B., Nayak, A., Bara, M., Bilung, B., Mishra, P.R., Panigrahi, P., Cairncross, S. and Torondel, B. (2015) ‘Menstrual hygiene practices, WASH access and the risk of urogenital infection in women from Odisha, India’, PLoS ONE 10(6): e0130777 <http://dx.doi.org/10.1371/journal.pone.0130777>.
Freeman, M.C., Greene, L.E., Dreibelbis, R., Saboori, S., Muga, R., Brumback, B. and Rheingans, R. (2012) ‘Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial’, Tropical Medicine and International Health 17: 380–91 <http://dx.doi.org/10.1111/j.1365-3156.2011.02927.x>.
Hennegan, J. and Montgomery, P. (2016) ‘Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low and middle income countries? A systematic review’, PloS ONE 11(2): e0146985 <http://dx.doi.org/10.1371/journal.pone.0146985>.
House, S., Mahon, T. and Cavill, S. (2012) Menstrual Hygiene Matters: A Resource for Improving Menstrual Hygiene around the World, London: WaterAid.
Kayser, G.L., Moriarty, P., Fonseca, C. and Bartram, J. (2013) ‘Domestic water service delivery indicators and frameworks for monitoring, evaluation, policy and planning: A review’, International Journal of Environmental Research and Public Health 10: 4812–35 <http://dx.doi.org/10.3390/ijerph10104812>.
Loughnan, L., Ram, P. and Luyendijk, R. (2015) ‘Measurement of handwashing behaviour in multiple indicator cluster surveys and demographic and health surveys, 1985–2008’, Waterlines 34(4) <http://dx.doi.org/10.3362/1756-3488.2015.028>.
Luby, S.P., Agboatwalla, M., Feikin, D.R., Painter, J., Billhimer, W., Altaf, A. and Hoekstra, R.M. (2005) ‘Effect of handwashing on child health: a randomised controlled trial’, The Lancet 366(9481): 225–33 <http://dx.doi.org/10.1016/S0140-6736(05)66912-7>.
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