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Vivian Hoffman studies women's sanitation impact in developing countries

Environmental and social impacts for women deriving from menstrual sanitation practices

Under a two-year grant from the Bill & Melinda Gates ­Foundation, Dr. Hoffman is investigating “Menstrual Management and Sanitation Systems” in developing countries.

Expanding and improving access to sanitation services is recognized as a critical challenge to improving global public health, although debate continues about which sanitation strategy is most appropriate under which conditions. One aspect of sanitation that has received relatively little attention to date is women’s menstrual management. This project will take stock of current knowledge about women’s menstrual management practices and how these practices interact with sanitation systems through a comprehensive literature review and key informant interviews. The size of the potential global market for menstrual management products (MMPs), and the overlap of this market with various sanitation systems, will be estimated through analysis of secondary data on demography and global sanitation coverage. The knowledge base on women’s menstrual management and, in particular, the interaction of these behaviors with sanitation systems, is expected to be thin. To address this gap, detailed case studies will be conducted in three locations, each chosen to represent a promising sanitation system. In each site, focus group discussions and household surveys will be conducted to collect information on menstrual management and waste disposal practices. Interviews with system personnel and direct observation of waste disposed of through the sanitation system will be conducted to characterize the impact of menstrual waste on the system. Both to understand women’s needs for menstrual solutions and project future demand for MMPs, women in each case study site will be offered the opportunity to test and then purchase alternative products. Data collected through this exercise will be used to develop predictions about the evolution of market demand for MMPs and assess welfare impacts of access to these products, including time savings, mobility, workforce participation and school attendance.

Update, June 2012

Two study sites have been selected: Durban, South Africa was chosen for the diversity of sanitation systems serving the urban and peri-urban poor. Informal settlements in Durban are served by communal toilet and shower facilities, while urine-diverting dry toilets have been installed in peri-urban areas. More traditional systems of pit latrines and private flush toilets are also present in rural areas and government-provided housing. The Durban site affords us the opportunity to study how women’s menstrual management practices and disposal of products interact with each of the sanitation systems represented.

The second site is a rural area in the Indian state of Bihar. Bihar is among the poorest and least developed of India’s states. Data from our baseline survey shows that use of purchased disposable menstrual products in this setting is currently very low. However due to both private sector and government promotion of menstrual products, the use of disposable pads is expected to increase rapidly in the future. In this setting, we are studying how experience with disposable menstrual products affects women’s demand for an alternative, reusable product, the menstrual cup.