英国发展研究所-更年期：隐藏的WASH需求（英）-2023.8-23页_4mb

The Menopause: Hidden WASH Needs

This report examines the inadequate attention given to the Water, Sanitation, and Hygiene (WASH) needs of perimenopausal and menopausal women, a topic often overlooked despite significant physiological changes that impact health, dignity, and daily life. It argues for integrating these needs into WASH programming.

What is the Perimenopause and Menopause?

• Lifestages: Mark the end of reproductive capability; perimenopause is the transition phase, menopause occurs after 12 consecutive missed periods.
• Symptoms: Include hot flushes, night sweats, heavy irregular menstruation, incontinence, joint pain, and emotional impacts like anxiety and low self-esteem.
• Global Context: Women, especially in low- and middle-income countries (LMICs), often lack awareness, and issues like menstruation and incontinence are taboo.

Hidden WASH Needs

The report highlights previously-underaddressed WASH requirements linked to symptoms:

• Water Needs:
  • Increased bathing frequency due to heavy bleeding, incontinence, and sweating.
  • Challenges with water access, limited water quantity/safety, and the cost of purchasing water.
• Sanitation and Hygiene Needs:
  • Menstrual Health: Need for highly absorbent, reliable, and consistently available products and facilities for frequent changes, especially for managing unexpected heavy bleeding.
  • Incontinence: Need for private, accessible, and well-equipped toilets, hygiene management tools (pads, nighttime devices), and reduced-cost solutions due to leakage concerns.
  • Overall, demand for private, secure, and dignified sanitation facilities at all hours.

What the WASH Sector Can Do

• Programming Activities: Integrate perimenopause education into WASH initiatives, use participatory methods (feminist oral history, photovoice) to understand needs directly from affected women, assess local markets for menstrual products and infrastructure adaptations.
• Adaptations: Improve infrastructure with features like covered drains, accessible bathing/showering facilities (with handrails, seating), 24-hour community toilets with changing areas, and laundry facilities adaptable for people with disabilities.
• Capacity Building: Train WASH staff, health workers, and community leaders, focusing on user-friendly facilities and inclusive practices.

Recommendations

• Promote Dialogue: Talk openly about the (peri)menopause to reduce stigma and integrate its management into WASH programs at national and regional levels.
• Conduct Research: Map linguistic terms for local descriptions of these life stages and collect evidence on needs to inform programming.
• Foster Collaboration: Join forces with health sectors and civil society to address intersecting issues of gender, age, disability, and poverty.
• Develop Standards: Advocate for guidelines and monitoring frameworks for bathing, laundry, and sanitation facilities.
• Adapt Guidelines: Update existing sexual/reproductive health guidance for WASH professionals to include the perimenopause and menopause.