Women’s business: Inside SNV’s efforts to improve menstrual hygiene in Lao PDR

In many developing countries, a lack of knowledge around Menstrual Hygiene Management means women suffer not only health problems, but regular isolation from family, school and their communities. SNV's work in Menstrual Hygiene Management aims to help women better understand and manage their menstrual health, overcoming socio-cultural taboos, improving women's health and ensuring women and girls don't miss out on educational and productive opportunities as a result of menstruation.

SNV student researcher Liyen Chin recently undertook research into Women’s Menstrual Hygiene in Savannakhet. She talks about her research, her travels and why she wants to return to the field.

Liyen, you came back from a field trip in Southern Laos not long ago, what were your impressions?  Was it anything like you expected it when you boarded the plane back in Gothenburg?
It is tough being out there. I can’t speak any Lao, so most of the time I had to rely on an interpreter. That is a quite a challenge. You can’t express yourself and you don’t understand what people say to you. 
Beforehand, just knew I would probably go to places where people don’t have access to toilets or clean water. I tried to keep an open mind, but that also meant that it was a shock coming here. I thought that by coming from Asia originally and having done some trips to this region before, I would be prepared. But, culturally, Laos is still very different. Having had some previous field experience, I expected it to work the same; that I could just walk around and interview one household after another. I was wrong.

Why did you choose to work with WASH and gender?
I was first interested in WASH back in school, where I learnt that the WASH conditions for women in many countries are very poor. Some women can’t easily visit the toilet like I can, because of lacking toilets or cultural taboos for women. Men however, would just go outside and pee and poo everywhere, by the roadside for example. Women would instead hold and not relieve themselves the whole day. They are forced to wait until night-time, which increases the risk for sexual violence. Although this does not seem to be a problem in Laos, reading about these kinds of injustices for women regarding something so basic made me interested in WASH and gender aspects.

And how did you choose to do your research about menstruation?
I myself also had a lot of problems with menstruation and heavy bleedings, so I started to think: How do women in developing countries manage their menstruation? I started to read up on it, and it’s horrible. First thing, not all of them have access to menstrual pads. Instead, they would use anything they can get hold of, for example toilet paper. This is one of the reasons why girls do not go to school. I thought I had problems having cramps and not being able to sit through exams. But these girls just drop out of school, due to the lack of pads and clean functioning toilets. The shame that comes with menstruation also makes the girls afraid that the boys would see that they are menstruating. So my interest in menstruation is personal, but also academic.

Where does this lack of knowledge about Menstrual Hygiene in Laos come from?
There is a cultural taboo. Menstruation is something very personal and considered dirty and smelly. Women and girls feel ashamed about it. Often, mothers do not even talk to their daughters about it. They assume their daughters know about it from somewhere else, for example from school. But the school does not teach about it either. Some say they just know by themselves. I think they mean that they learn about it from observation. They see their mothers and sisters handling the days of menstrual bleeding in a certain way. Or they talk to their friends.

How was your work in the field?
It was fun; I learnt a lot about the field, the people and about myself. I also learned that the drinking out in the field was not manageable for me. The Lao people love beer. It was easier to find than water. People also drink a lot of beer for dinner. Since I was the foreigner of the group, they would always make sure that I had enough to drink. Sticky rice was a challenge as well, as well as the spicy food, intestines and the bugs on top of that. All this was quite alien to me in the beginning, but while I learnt to enjoy the food and drinks quickly, my tolerance level for alcohol has remained the same up until the end.

What did you exactly do in Savannakhet?
I interviewed menstruating women and girls about their knowledge and practice. I wanted to know what hinders good practice of hygiene in Laos: If the reasons are cultural, if it is the lack of education, or the lack of toilets, water and pads.

How do you find these women that you interviewed?
I visited villages and the district officials would contact the village head, who would in turn gather women. My requests got lost in translation quite a few times. Sometimes, when I asked for eight to ten women, about thirty turned up; small girls and also eighty-year-old grandmothers who had stopped menstruating for a long time. The young girls were shy and usually didn’t talk, unless I asked them directly. The old ladies were more comfortable sitting and talking.

Did you get the data you hoped for?
Yes! Among other things, I learnt that not everyone uses menstrual pads, even if they have access to them. Women think that the pads are not good for them. Modern menstrual pads absorb all the blood, which seems like only a small amount of blood is leaving the body. Believing what they see, they think that the rest stays inside and give them head and stomach aches. So they would rather not use menstrual pads and just wear a sinh (traditional Lao skirt)  and bleed out. They don’t go outside and stay inside the house.

So in rural areas some women don’t leave the house during their whole period?
Yes, but it really depends on the person. I also met strong ladies who did not care at all. I asked them if they are not afraid and they answer: No, all the women menstruate and know what it is! Then, there are those that actually use the pads, but go out and bury them in the forest, so that the pigs and dogs don’t dig them up.

That must take up a lot of time.
Yes. Some girls go out to the forest to bury the pads after every change. It also takes up a lot of time to change if you only wear the sinh.  The women told me that they usually change themselves three to five times per day; they have to return home, wash, change and then go back to work, if they even dare to go outside.

So, what do you think needs to be changed in Laos?
I think the single biggest thing is knowledge. Even if girls would have functioning toilets and pads, they would not know how use them. They are still too ashamed. They need to know: What is menstruation? How do you take care of yourself? What are facts and what are myths? There are so many of them: You shouldn’t drink cold water while you’re menstruating. You can’t wash your hair. You can’t eat papaya salad. You can’t eat pickled food. You can’t eat the Lao fish sauce. Introducing new knowledge is important, but culture is very deeply rooted in Laos and it takes a long time to change.

How would you approach that?
I’m actually sketching out a project right now. I would first work on including Menstruation and Hygiene in the school curriculum, but also train the teachers on how to approach the subject so they do not feel shy in teaching about menstruation. It is important the both boys and girls are taught and that male and female teachers are involved. Involving men and boys could show that menstruation is something acceptable, that you can talk about it. I believe that this together with the proper facilities would pave the way for better Menstrual Hygiene Management in schools.

Why can these topics not be taught at home? It is not possible to put every topic into the school curriculum.
The mothers usually do not know much more about menstruation than their daughters and if they do, they avoid sharing the information with them. But the mothers play a big part and knowledge has to be shared with them, too, since they could help to advise their daughters as well as improve their own practices.

Let’s talk about development in general. What’s your impression about the development world?
Development cannot be forced on anyone; the locals need to want it too. They also possess the knowledge in making any project more suitable and sustainable. Working with SNV I see the importance in cooperating with the local people. Sometimes you easily lose yourself in the work that you’re doing and you forget the bigger picture: Why am I doing this?

Why are you doing this?
I want to create better circumstances for the people in this world. We’re all humans. We do not choose where we’re born, but we’re born equally. It is unfair that some have good circumstances and some don’t. I want to improve that. People born in poor countries should have the same possibilities and choices as the rich ones.

You got a fresh impression of international development. How to do it right?
As mentioned, I think SNV’s approach, which is mainly about capacity building, is something that should be focused on. I also believe that it is not always that easy within the development business to say whether someone is doing it right or wrong. One approach that might work in one country may not work in another.

So you’d recommend other students to come here and do a similar internship?
Yes, definitely.

What are your plans now?
I will return to Lund to write my master’s thesis with the data I gathered here to finish my masters degree in June. Then I might come back to Laos. We’ll see. If I do return, I would definitely want to learn Lao. This is very crucial, to pick up the little and funny things as well as communicate better out in they field.