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ACKNOWLEDGEMENTS This handbook has been developed in collaboration by Ruby Life and WoMena Uganda and is funded by Ruby Life. This handbook is based on WoMena Uganda’s tried and tested training curriculum which was developed using various menstrual health resources (published by WaterAid, International Federation of Red Cross and Red Crescent Societies and The Danish Family Planning Associations and was originally developed in collaboration with Reproductive Health Uganda and Menstrual Care Uganda). For this updated handbook we have also drawn upon the cumulative experience of WoMena, Ruby Life, Femme International, Cup Effect and Golden Girls in menstrual health and menstrual cup trainings and workshops across Uganda, Kenya and Tanzania. A special thanks goes to Golden Girls Foundation for their support in testing and prototyping this training package and for sharing with us their vast experience in menstrual cups training.
Any part of this handbook may be cited, copied, translated into other languages or adapted to meet local needs without prior permission from Ruby Life, provided that the source is clearly stated. It may not be used for commercial purposes unless written permission has been obtained from Ruby Life. Ruby Life would appreciate information on how and where this resource has been used. Please send details to contact@rubycup.com
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WELCOME TO THE “ME AND MY CUP: A GUIDE TO A HAPPY PERIOD” HANDBOOK Welcome to the “Me and My Cup: A Guide to a Happy Period” handbook! This handbook includes lots of useful information on menstrual health and safe and comfortable use of the menstrual cup. Through a Buy One Give One model and strategic partnerships, Ruby Life provides Ruby Cups and education on reproductive health and menstrual care to girls and women in various countries. We believe that access to information about menstruation and to dignified menstrual care products is a basic human right and we strive to make this a reality for everyone, everywhere! We work with partner organisations who have a wealth of experience and knowledge on how to most effectively implement menstrual cup interventions and deliver the needed information to make sure that girls, women and their communities can benefit from menstrual cups. Through this handbook we want to share this collective knowledge and experience with you and anyone who is thinking of delivering menstrual health and menstrual cup education. With this handbook, we invite you to join our global team of Champions of Menstruation. Menstruation is often a taboo subject, silenced and ignored. Many girls and women do not know what their period is when they first get it, and often lack the support from their community to talk openly about menstruation. Your role as a facilitator and champion is to address these issues head-on and to create a safe space for your participants to learn comfortably, feel confident to ask questions and learn to appreciate that we are all beautifully different, both in our bodies and in our menstrual experiences. Menstruation is a natural process that most girls and women go through and we want them to feel confident and happy during their periods!
Julie Weigaard Kjaer CEO & Cofounder
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INDEX ACKNOWLEDGEMENTS
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Welcome to the “Me and My Cup: A Guide to a Happy Period” Handbook
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HOW TO USE THIS HANDBOOK
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WHO IS THE TOOKIT FOR?
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Different age groups
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PARTS AND SESSIONS
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THE TOOLKIT EXPLAINED
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ICONS
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SUSIE AND LEYLA, YOUR CO-FACILITATORS
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YOUR ROLE AS A FACILITATOR
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GETTING READY FOR YOUR WORKSHOP
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RESOURCES FOR TRAINING
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Getting Started
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PART 1 – ME AND MY BODY
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Session 1.1 One word or feeling about menstruation
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Session 1.2 My First Period
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Session 1.3 My Period Journey
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Session 1.4 Understanding My Body
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Session 1.5 Understanding My Cycle
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Session 1.6 Tracking My Period 28
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Session 1.7 What, Where, When?
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Session 1.8 My Healthy Period
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Session 1.9 Myths & Facts
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Session 1.10 Menstrual Management Methods
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PART 2- ME AND MY MENSTRUAL CUP
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Session 2.1 My Menstrual Cup
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Session 2.2 Where Does the Cup Go?
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Session 2.3 Using My Cup
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Session 2.4 Hymens and Virginity
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Session 2.5 Keeping My Cup Clean
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Session 2.6 Who is The Cup For?
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Session 2.7 Recap on ‘One Word about Menstruation’
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ENERGIZERS
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PARTS AND SESSIONS
The Me and My Cup handbook will guide you as a facilitator on how to deliver a successful workshop on menstrual health management and on using the menstrual cup. It is a part of a toolkit comprised of flip charts to aid you with the workshop, a take-home booklet for participants and posters that can be left behind after the workshop to serve as reminders. This handbook is designed to be delivered in the order presented and the full workshop should take around one full day including breaks and time for activities. Dependent on the context you are delivering your workshop in, you might consider delivering it across a few days.
The workshop is designed to be held with groups of maximum 30 participants and we encourage smaller groups to enhance active participation and to maximise
THE TOOLKIT EXPLAINED This handbook has been designed to be used alongside the other resources provided as part of Me and My Cup Toolkit. The toolkit includes the following:
The Handbook This handbook will guide you through the different sessions and include all the information you need to conduct a successful workshop.
The Flip Charts For some sessions in this handbook there will be flip charts to accompany the workshop. The flip charts are there to aid you in explaining the different processes and help participants to visualise what you are explaining.
The Booklet The booklet can be distributed to participants and includes some take home information for them to refer to after the workshop is complete.
The Posters The poster will act as a reminder of the workshop and can be shared with the facility staff of where you are training. There are two different posters depending on your participants; girls and adolescents, and adult women. Both posters leave a space where you can write your own message and/or contact information.
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ICONS Throughout the handbook you will see these icons below, they will help you stay prepared and guide you through the different sessions.
VERY IMPORTANT: This symbol shows that this session is crucial and is essential to conduct a complete workshop. It should not be missed under any circumstances. TIME: This symbol indicates how long the session should take. ENERGIZERS: Throughout the handbook this symbol will indicate when it may be time to do an energiser with the participants. Energisers are ways to get participants moving and improve their concentration.
ACTIVITIES: This symbol indicates an interactive activity, where participants will need to be involved.
RESOURCES : This symbol reminds you of the tools and resources you need for each session of the workshop. TIPS FOR THE FACILITATOR: This symbol indicates that there is additional information for you as the facilitator, that provides you with helpful tips to make your workshop effective. EXTRA ACTIVITY/SUGGESTED ADAPTATIONS : This symbol is to help you adapt your workshop to your target audience and gives suggestions on extra activities should you have time. INFORMATION : This symbol indicates that this information should be given directly to the participants. We suggest reading through this information before sharing it with participants, so you fully understand the text and are able to inform participants fluently. 7
SUSIE AND LEYLA, YOUR CO-FACILITATORS Meet Susie and Leyla! They will be with you throughout the workshop, providing tips and helping participants relate to the information you are providing. Susie is a school girl who has recently started her period and is learning how to manage it. Leyla is a young woman who is more experienced when it comes to menstruation and a mentor to Susie. It may be a good idea to introduce participants to Susie and Leyla, explaining that they represent any girl or woman going through her periods.
Hi there! I’m Susie. I recently started my period, and am learning all about how to manage it. I wanna feel good and healthy during my periods so I can concentrate on my studies.
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Nice to meet you! My name is Leyla and I have been using a menstrual cup for a few years now. I’m here if you need tips on how to use your cup!
YOUR ROLE AS A FACILITATOR
AS A FACILITATOR, YOUR ROLE IS TO…
Many girls and women across the world are uninformed about menstruation; how it works, why it can cause pain and how best to manage their periods. Many may have misconceptions and myths surrounding menstruation that may endanger their well-being. As a facilitator you play a crucial role in dispelling these myths and providing accurate and appropriate information to help girls and women learn about their bodies and how to feel confident and healthy during their period. Therefore, it is important that you meet two main requirements:
1. Create and maintain a safe and open environment, where participants feel comfortable to share their experiences and are able to participate with no judgement. The environment should be inclusive. this also means taking into consideration participants with special needs , and speaking in a language everyone understands. 2. Facilitate discussions. It is important to remember that you may not always have all the answers and that is ok! Participants may know the answers, so before answering a question you can first ask the question back to the group. 3. Provide accurate information that is not influenced by personal beliefs. A facilitator should always remain neutral, objective, and fair. 4. Manage your participants. Your responsibility is to lead the workshop, encourage equal participation and keep the group on track. 5. Time management. This is crucial in earning and maintaining the group’s trust in you. It is also important that participants receive all of the information in the designated time. 6. Record relevant information. Note important information discussed in the sessions and display it where all participants can see it (such as on a flip chart or white/blackboard). Record the main idea or fact, not every word. 7. Encourage trust and engagement:
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You have used the menstrual cup yourself.
It is important to be able to speak from experience. If you are not someone who menstruates, or you have not had a chance to use the cup, ask someone who has used it to assist you with the sessions related to the menstrual cup.
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You feel comfortable talking openly about menstruation and the female body.
This is necessary so that you can carry out the workshop successfully, and so that your participants feel comfortable sharing with you and with each other. Not speaking openly about menstruation can risk enforcing existing stigma which can be harmful for girls and women.
Below are the different roles you play as a facilitator and some tips on how to keep your participants engaged.
TIPS FOR SUCCESSFUL FACILITATION 1. Do not be afraid to stop people from talking beyond individual time allocations. This can be difficult to do at first but with time you will develop confidence to interrupt people in a way that will not make them withdraw their participation. 2. A useful tip is using a page where you record issues that could be discussed later – the idea parking lot. 3. You may call “time outs” if the group is not adhering to time allocations or if a conflict is escalating.
Eye contact. Learn to write on a flip chart or white/ blackboard while maintaining eye contact with your participants. Check your body language to show the group that you are relaxed, comfortable, motivated, and confident. Be attentive. Check participants’ body language and level of participation, e.g. eye contact, yawning, leaning back, or whispering. Should you observe some of these signs, you can call for a break or an energizr. Call people by name. This builds trust as well as a personal relationship with your participants. You can also use name tags so everyone is able to address one another by name.
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RESOURCES FOR TRAINING
In order to support learning and allowing participants to visualize what you are explaining, we recommend using the flip charts included in the “Me and My Cup� Toolkit as well as a demonstration kit whenever available. You will need to gather these resources yourself before the workshop. 10
SCOPING OUT YOUR WORKSHOP SPACE It is important to think about the space you have available for your workshop and how you will use it. Think about how to arrange seating, if at all possible we recommend having your participants sit in a semi-circle, so they can see each other rather than in rows. Make sure your participants will have enough room to move around, especially for energisers, and that the venue has enough air and light so that your participants will not get tired. If you plan on delivering the workshop outdoors, think about adequate shade and have back up in case it rains. Remember that you are creating a safe space where your participants can share freely without being disturbed by noises or people who are not participating in the workshop. If you plan on using the flip charts provided in the toolkit, think about where and how you can hang them.
Please see check list below for all the materials you will need to prepare for your training, use it to make sure you are ready!
DEMONSTRATION KIT • • • • • • • • • • • • • • • • •
Menstrual cup(s) Reusable pad(s) Disposable pad(s) Pain killers (e.g. paracetamol and ibuprofen) Tampon(s) Tissue Cotton and gauze Basin Jerry can Small towel Soap Kitenge or other fabric Water bottle A metal container for boiling A food tin A glass jar with lid Stove, a pot/sauce pan for boiling
TRAINING MATERIALS • Printed or hand-drawn flip charts • Printed booklets for participants • Printed posters • Blank flip charts • Markers • Masking tape • Cut out flip chart attachments: 1. • 5A: Period tracker images 2. •6A: Reproductive system images • Questions & Concerns box • Pens and blank paper
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PART 1
ME AND MY BODY GETTING STARTED 20 MINUTES BLANK FLIP CHARTS AND MARKERS Objectives: To introduce the participants to the workshop and for you to get to know the group and the group to get to know each other.
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Introduce yourself to the participants and give some background to the workshop and why you feel this is important. You may also want to share any personal experiences of using the cup and your own interests in menstrual health.
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Ask the group: “What are your expectations from this workshop? What do you hope you will learn or take away from these sessions?”
Note down answers on a blank flip chart, inform participants which expectations will be met and which expectations you do not feel you will be able to fulfil or are not relevant to this workshop.
For successful and effective workshop, it is important that you are aware of your participants’ expectations for the workshop. The flip chart can be used throughout the workshop as a reference to ensure you have met their expectations at the end of the workshop. Depending on how well you know your participants and the size of the group, you may want to play a ‘name game’ or ask participants to share something about themselves as an introduction to the group.
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1.1
ONE WORD OR FEELING ABOUT MENSTRUATION 20 MINUTES BLANK FLIP CHARTS AND MARKERS
Objective: To help your participants explore their thoughts about menstruation, make them feel more comfortable discussing it and to introduce them to different opinions and attitudes regarding menstruation.
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Sometimes it’s difficult getting a group talking at the beginning, it may help to briefly tell them your personal story about menstruation e.g. something that has happened to you, a friend or a relative.
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Ask the group to think for a minute about one word or a feeling that describes menstruation to them. Explain that we can have a range of feelings about our periods. Some of them are negative and others are positive. Ask a volunteer to start and then ask each participant to share their word, write these words onto the flipchart. If your participants cannot think of a word, give them an example: “For me, I when I hear the word menstruation, I think about blood.” Divide participants into small groups (5-10 people) to explore one of the following questions:
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Are the words consistent across the group? Did the same words or feelings come up again and again? Was there anything surprising? 2. Is this how you wanted to feel about menstruation? How would you rather feel about your period?
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Comment on each feeling that has been ticked, starting with the most common – acknowledge these feelings, empathise, and add comments where relevant (see suggestions in box below). It’s time to wrap up this session – acknowledge that all these feelings are very common, and part of today’s workshop is to give you the knowledge, understanding, attitude and methods to turn these negative feelings into positive ones!
There will be a recap at the end of the workshop where you will go over the words on the flip chart again and see if people still feel the same about menstruation.
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SUGGESTED RESPONSES FOR PARTICIPANT ANSWERS TO ONE WORD ON MENSTRUATION • Embarrassing: Yes, it can be really embarrassing, especially if you leak and get blood on your clothes. It is very personal, and you might feel embarrassed talking about it to other people. But, be encouraged, most women you know go through menstruation. Also, there are options available to help avoid embarrassing leaks, which we will explain later. • Disgusting/shameful: You might feel like it is disgusting or shameful if other people have told you that, or if you didn’t know that it is a normal process that most girls and women go through. In fact, there is nothing to be ashamed about and menstruation is completely natural. You could instead think of it in a positive way, even beautiful and precious, a symbol of your womanhood and fertility. • Dirty: Period blood is not much different from normal blood. It is no dirtier than anything else you do in the bathroom. You wash your hands and life goes on. You as a person are not dirty! • Worrying: Periods certainly can be very worrying, especially if you don’t know what is happening to you, or you have been told things that are not true. Also, if you are trying to keep it a secret, or if you don’t have what you need to manage the flow, it can mean you miss school or work, or you can’t do the things you normally do. • Annoying: Yes, it can be annoying, especially if it comes and you are not prepared. If you have to walk long distances, pads/cotton/knickers/cloths can rub and get itchy. If you have to be somewhere for a long time, it can make you anxious. • Natural & womanly: Indeed, it is natural. Most healthy women have a menstrual cycle. It’s a part of the way we are made to be. • Normal or OK: Some of you said, ‘OK’: a kind of balance of annoying but manageable. That’s really encouraging and says that you are not worried or held back by your periods. You can manage them! • Blessed: Sometimes women feel blessed to get their period. Getting your period means your body is working as it should, and you are able to have children in the future.
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MY FIRST PERIOD 25 MINUTES FLIP CHART 1: MY FIRST PERIOD, BLANK FLIP CHARTS AND MARKERS
Objective: To get thinking about how some girls can experience menarche (their first period) and discuss how we can prepare girls well for it.
This is a good time to introduce participants to Susie and Leyla who are the main characters in the toolkit. The story is about Susie and her first period; however, it is also a story many girls and women can relate to. See what happened during Susie’s first period.
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Discuss the different stories and what they show about people’s perspectives on menstruation, using the above guiding questions.
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© 2018 Ruby Life.
Discuss the story with the participants and ask the following questions. Note the responses down on a flipchart:
1. Why was Susie’s first period a scary experience? 2. Why do you think Susie preferred to tell Leyla about her bleeding rather than her mother? 3. Do you think that Susie’s experiences are common? 4. What could have been done to prepare Susie better? Should you have less time, ask a participant to read Susie´s story aloud to the group, instead of making them to come up with their own story. The full story is on the next page
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Here is the full story: I first got my period when I was 12 years old, it was a scary experience. In the morning I started feeling pain in my stomach, but the bleeding did not start until I was already at school. During class my friend noticed that I had stained my skirt, and I realised that some boys were whispering and laughing at me. I could not concentrate in class because I felt embarrassed and the pain was too much. I did not understand where the bleeding was coming from and I was worried that something bad had happened to me. After class I talked to my two best friends but they also did not know what was happening to me, but they helped me cover the stain. When I came home I did not know who to talk to, I did not feel like I could talk to my mum. I was still very worried and did not know what was happening to me. I changed my clothes and hoped the bleeding had stopped. That evening I saw my friend and neighbour Leyla in her garden and I decided to tell her about what had happened. After listening to me she said, “Susie, don’t worry! This is very normal. You have started your period, something that all women experience.� She then told me everything about periods, what is happening in the body and how I can manage it. She even showed me different materials I could use, explained how they worked, and how I could reduce the pain. I felt so much better, and the next day in school I did not feel embarrassed or scared anymore and was happy to participate in class. I am lucky to have a friend like Leyla. I wish someone had told me about periods earlier so that I could have been more prepared.
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MY PERIOD JOURNEY 25 MINUTES FLIP CHART 2: MY PERIOD JOURNEY
Objective: To explain what happens to a woman’s body as she grows up and the changes over time. With the help of the flip chart, explain to participants the different stages the female body goes through and the changes involved. Importantly, your participants should understand that our bodies change throughout our lives, and so do our periods! Baby: As a baby girl, you are born with millions of tiny eggs inside you, these eggs will be released over your lifetime through menstruation, and some may mature to a foetus. Adolescent: During puberty, once you have matured, you will begin her periods. Usually this happens between 9 and 16 years old. Woman: Over the next few years your periods will become more regular. Menstruation normally lasts between 3 and 7 days and the menstrual cycle between 21 and 35 days. During the first few years of menstruation your cycle could be as long as 45 days though, this is not unusual. Š 2018 Ruby Life
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Pregnancy: During a pregnancy, your periods will stop for a while. This is usually the first sign that you are pregnant if you have been having sex. Your periods will usually start again a few months after giving birth. Menopause: When you reach a certain age, usually around 45 to 50, your ovaries will stop releasing eggs and your periods will stop. This is called the menopause. During your lifetime you will probably have about 450 periods!
Now is a good time for a break. Take 15 minutes!
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1.4
UNDERSTANDING MY BODY IMPORTANT SESSION 20 MINUTES FLIP CHART 3: UNDERSTANDING MY BODY
Objective: To explore the functions of the different parts of the female reproductive system and how they relate to menstruation. You’ll start with some basics to make sure all your participants are at the same level and understand where in the body menstruation happens. Point at the relevant parts on the flip chart as you explain.
Use words for body parts that you know your participants are familiar with. We have given you alternative words. Use the local language if you can !
THE FEMALE REPRODUCTIVE SYSTEM: • The ovaries are where the eggs (ovum) are stored. • The fallopian tubes (uterine tubes) carry the egg from the ovaries to the uterus. • The uterus (womb) is an organ inside our lower stomach, when a woman is pregnant it expands to hold the growing baby. • The uterus wall (eundometrium) is the lining of the wall of the uterus. It becomes thicker over the course of the menstrual cycle until it sheds through the vagina. This is menstruation. The wall of the uterus becomes thicker every month until it sheds again. • The cervix is the bottom of the uterus. It has an extendable opening through which menstrual blood and babies leave the uterus. This is also the hole through which sperm enters to fertilise the egg. • The vagina is the muscular canal where a baby is pushed out, where a penis enters during sex, and where menstrual blood comes out of your body.
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UNDERSTANDING MY BODY Fallopian tubes
Uterus
Egg
ovary
Uterus wall
cervix CLITORIS
VAGINA
URETHRA VAGINA OPENING
EVERYONE´S BODY IS DIFFERENT
Anus
© 2018 Ruby Life.
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MANAGING PERIOD PAIN Many girls and women experience period pain or discomfort right before and/or during their periods. Most common are menstrual cramps in the lower abdomen (stomach). Other common discomforts are bloating, headache, back pain and leg discomfort.
HEAT Roll a warm water bottle or place a warm towel on the lower abdomen (stomach) and lower back to relieve cramps.
RELAX It is normal to have less energy during your periods. Rest when you can, and think about positive things that make you happy or distract you.
DRINK WATER It is important to drink enough water during your period. This will keep you hydrated and avoid headaches and bloating.
STAYING ACTIVE Stretching and doing physical exercise to reduce menstrual cramps and bloating.
PAINKILLERS Taking painkillers can be an effective way of managing period pains when nothing else works. They can ease cramps or stomach pain, headaches and lower-back pain. It is important to follow the instructions, and not to take more than recommended amount. Painkillers do not cause cancer or infertility.
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