This dissertation examines the benefits of DMM by comparing water services in three informal settlements in Kisumu city, Kenya: two slums where DMM has been implemented, and one, a control, where it has not. In addition, the research examined how school-based hygiene interventions could be designed to improve safe water and hygiene knowledge in urban informal settlements. This study compared outcomes of two approaches to hygiene education, one which combined messages with participatory water testing; the second used hygiene messages alone.
Results of the DMM study showed that DMM implementation had lowered water cost and improved provider accountability. However, unhygienic water collection and handling practices on the part of the service users could contaminate drinking water that was clean at the delivery point, thus preventing the intended health outcomes of DMM from being realized. Results of the hygiene education intervention showed that one week after the inventions, hygiene knowledge among students who received the intervention that combined hygiene messages with participatory water testing was significantly improved. Evaluation of the intervention 12 months after implementation showed that the hygiene knowledge gained was sustained.
The research findings suggest that: i) regular monitoring of water quality at the kiosks is essential to ensure that the DMM model achieves intended health outcomes, ii) sanitation conditions at kiosk sites need to be regulated to meet minimum hygiene standards, and iii) customers need to be educated on safe water collection and storage practices. Finally, school-based hygiene education could be made more effective by including hands-on water testing by students. Making sustainable impact on health and wellbeing of slum residents requires not only building effective partnerships for water delivery, but also paying close attention to the other points of intervention within the water system.
Prenatal Care is an educational booklet written by Mary Mills West of the US Children’s Bureau and published by the US Government Printing Office in 1913. The Bureau distributed West’s booklets in response to their field studies on infant mortality, which found that lack of access to accurate health and hygiene information put women and infants at greater than normal risk of death or disease. In Prenatal Care, West offers advice on nutrition, exercise, and personal hygiene during pregnancy and describes the processes of labor and birth. Soon after publication, women all over the US requested copies of Prenatal Care. Millions of copies of Prenatal Care were distributed nationally between 1921 and 1928 as part of educational programs funded by the Sheppard-Towner Act, and the infant mortality rate declined during that period.
In 1902, editors of the medical journal Alkaloidal Clinic Wallace C. Abbott and William Francis Waugh published Sexual Hygiene, a book about normal sexual physiology and behavior in Chicago, Illinois. Though the book includes a collection of passages from other books, articles, speeches, and documents surrounding sexual physiology and behavior, it does not include text regarding sexual hygiene. Rather, the book contains a preface and twenty-eight chapters on topics including masturbation, incomplete or delayed intercourse, and impotence, meaning the inability for a female to achieve an orgasm or a male to achieve an erection. Though physicians and those who served as experts in the book used seemingly factual scientific evidence to back up their claims, later scientific understanding of male and female physiology disproved many of those assertions. Sexual Hygiene is an early US discussion of sex by medical authorities that provides examples of historical medical misconceptions about sexual practices, physiology, gender roles, and context for understanding reproductive medicine during the early 1900s.
In their 2014 article “A Comparison of the Menstruation and Education Experiences of Girls in Tanzania, Ghana, Cambodia, and Ethiopia,” hereafter “Comparison of Menstruation,” researchers Marni Sommer, T. Mokoah Nana Ackatia-Armah, Susan Connolly, and Dana Smiles examined various physical and social barriers impacting women’s management of menstrual health across Ghana, Cambodia, and Ethiopia. The authors examined barriers such as misinformation about menstruation and how schools limit girls’ ability to manage their menstrual cycles. They then compared their findings to a previous study led by Sommer on similar experiences shared by girls living in Tanzania. “Comparison of Menstruation” provides insight into the physical and social barriers to managing menstruation in low-resource contexts and serves as a precursor to the creation of educational resources intended to improve menstruation health management for women and girls.
On 5 April 2018, the documentary Period. End of Sentence. premiered at the Cleveland International Film Festival in Cleveland, Ohio. In the documentary, Rayka Zehtabchi, the director of the film, documents the stigma surrounding menstruation in India and follows a group of women in Kathikhera, a rural village in the Hapur district of India, as they manufacture and distribute sanitary pads. A group of high school students at Oakwood High School in Los Angeles, California, raised money to produce the documentary after one student was inspired by her visit to the United Nations Commission on the Status of Women in New York City, New York, which focused on the stigma surrounding menstruation in low-income countries. Period. End of Sentence. draws attention to the obstacles impeding proper menstrual health management in low-income contexts by documenting the women of Kathikhera’s journey to manufacture and sell sanitary pads.
In 2008, Celeste Mergens founded the organization Days for Girls to address obstacles impeding women’s and girls’ access to sustainable hygiene and health education by enlisting volunteers around the world to construct reusable menstrual hygiene products for girls in low-income countries. Mergens founded Days for Girls in the US in 2008 after learning that an orphanage she was working with in Kenya did not have resources for girls to manage their menstrual cycles. She provided those girls with reusable sanitary pads, and later that year, she decided to provide Days for Girls Kits, or DfG Kits, that volunteers from around the world made for women and girls in parts of the world lacking access to menstrual hygiene products. By 2012, Mergens launched chapters across the United States to allow volunteers to hand-sew the DfG Kits, and by 2019, the organization expanded to include chapters in Zimbabwe, Ghana, and Uganda. Days for Girls provides women and girls with education and resources necessary to manage menstruation, which can help reduce the instances of absenteeism for girls in schools and reduce the risk of contracting infectious diseases.
