ME AND MY CUP: A GUIDE TO A HAPPY PERIOD. Menstrual Cup Workshop by Ruby Cup

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 Ugandaâ&#x20AC;&#x2122;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

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

INDEX ACKNOWLEDGEMENTS

Welcome to the “Me and My Cup: A Guide to a Happy Period” Handbook

HOW TO USE THIS HANDBOOK

WHO IS THE TOOKIT FOR?

Different age groups

PARTS AND SESSIONS

THE TOOLKIT EXPLAINED

ICONS

SUSIE AND LEYLA, YOUR CO-FACILITATORS

YOUR ROLE AS A FACILITATOR

GETTING READY FOR YOUR WORKSHOP

RESOURCES FOR TRAINING

Getting Started

PART 1 – ME AND MY BODY

Session 1.1 One word or feeling about menstruation

Session 1.2 My First Period

Session 1.3 My Period Journey

Session 1.4 Understanding My Body

Session 1.5 Understanding My Cycle

Session 1.6 Tracking My Period 28

Session 1.7 What, Where, When?

Session 1.8 My Healthy Period

Session 1.9 Myths & Facts

Session 1.10 Menstrual Management Methods

PART 2- ME AND MY MENSTRUAL CUP

Session 2.1 My Menstrual Cup

Session 2.2 Where Does the Cup Go?

Session 2.3 Using My Cup

Session 2.4 Hymens and Virginity

Session 2.5 Keeping My Cup Clean

Session 2.6 Who is The Cup For?

Session 2.7 Recap on ‘One Word about Menstruation’

ENERGIZERS

HOW TO USE THIS HANDBOOK 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 learning. If your group is larger than 30, we strongly recommend dividing them into smaller groups for separate workshops. If you are short on time, make sure to go through the most important sessions which are highlighted using the symbols explained below.

Distribution of menstrual cups should always be accompanied by provision of information and support to new menstrual cup users. We strongly recommend delivering all the highlighted sessions. There are also suggestions on additional exercises should you have extra time.

WHO IS THE TOOLKIT FOR?

on sex, sexual pleasure, and â&#x20AC;&#x2DC;safe daysâ&#x20AC;&#x2122; might not be appropriate for younger girls. Make sure to check the sexual education policies in your country to see what information you can give, for instance in schools!

Existing menstrual hygiene facilities

Before delivering your workshop, it is important to be aware of the existing facilities your participants have access to, to manage their periods. Conduct a simple facility assessment at the training site or in the community, and find out if it is a menstrual friendly environment. You can use this information to adapt the guidelines in your workshop if necessary, and to advocate for positive changes. Consider the following; 1. What is the main water source at the site? 2. Are there toilets/latrines at the site? 3. How many are using each toilet/latrine? 4. How is the privacy? Can the facilities be closed off, and are they lockable? 5. Are there separate facilities for women and men? 6. What is the source of light for the facilities? 7. Does the site have handwashing facilities? 8. Is there soap available for handwashing? 9. Do the facilities have toilet paper available or any material for wiping? 10. How often are the facilities cleaned and who cleans them?

This handbook, along with accompanied tools, is designed as a guide to facilitators to deliver a workshop to girls and women about their menstrual and reproductive health and how to manage their periods using a menstrual cup. The toolkit has been developed for the East African context, with research, evidence and consultations taken from this region. However, you are likely the one who knows your context the best! Feel free to adapt the content however you feel best Support structures to suit your participant group and your environment. No matter if your menstrual health workshop is a single activity or a part of a larger program, it is always important to think about sustainability and long-term support on the ground. Girls and women may need additional support when starting to use their menstrual Male and community involvement cup, and you might not be around at that time to Although the toolkit has been designed to target encourage them and answer questions. Explore and girls and women, including boys, men and the strengthen existing support structures on the ground, wider community in discussions on menstruation is build partnerships and involve the team on the ground important to enhance their understanding and to break as much as possible, to serve as support persons after menstrual stigma. Should you need any additional the workshop has been delivered. Think for instance information on how to include boys and men you are of teachers, school nurses, student prefects, parentsâ&#x20AC;&#x2122; welcome to contact us and we can put you in touch committees, health care providers, and community with one of our excellent partners. leaders.

WHAT TO KEEP IN MIND?

Different age groups

The content of this handbook is aimed for girls and women of all ages, however we recommend being aware of your context and your audience and to adapt the material where necessary. It is important that girls and women understand their bodies and are body positive. However, some information, such as

We encourage organizations from across different regions to use this toolkit and adapt the information however they feel necessary. We would love to hear from you if you do!

PARTS AND SESSIONS

WHAT TO KEEP IN MIND? The workshop is divided into two parts; Part 1: Me and My Body and Part 2: Me and My Cup. Within these parts there are different sessions to guide you through the workshop.

Part 1: Me and My Body The first part of the workshop focuses on menstruation generally, the female anatomy and the reproductive system. This part will help girls and women understand why and when changes to the female body occur and explain ways to manage their periods, so they feel confident and healthy during their period.

Part 2: Me and My Cup The second part of the handbook focuses on the menstrual cup. It will introduce the cup, how it is used and the benefits that come with using it. This part will also help to answer any questions on the challenges and misconceptions of using the cup. At the start of each session you will find an overview with information on how long each session takes, the objective of the session and the relevant materials and tools needed. This will help you prepare for the session.

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.

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. 9

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! Iâ&#x20AC;&#x2122;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.

Nice to meet you! My name is Leyla and I have been using a menstrual cup for a few years now. Iâ&#x20AC;&#x2122;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:

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.

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.

1111

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 â&#x20AC;&#x153;Me and My Cupâ&#x20AC;? Toolkit as well as a demonstration kit whenever available. You will need to gather these resources yourself before the workshop. 12

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

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.

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.

2. 3.

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.

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.

•

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.

• •

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:

• •

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?

• •

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.

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.

1.2

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.

Discuss the different stories and what they show about people’s perspectives on menstruation, using the above guiding questions.

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

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, â&#x20AC;&#x153;Susie, donâ&#x20AC;&#x2122;t worry! This is very normal. You have started your period, something that all women experience.â&#x20AC;? 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.

1.3

MY PERIOD JOURNEY 25 MINUTES FLIP CHART 2: MY PERIOD JOURNEY

Objective: To explain what happens to a womanâ&#x20AC;&#x2122;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. 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!

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.

UNDERSTANDING MY BODY Fallopian tubes

Uterus

Egg

ovary

Uterus wall

cervix CLITORIS

VAGINA

URETHRA VAGINA OPENING

EVERYONE´S BODY IS DIFFERENT

Anus

THE VULVA You are now going to explain the female genitalia. Participants may be less familiar with these words than the internal structure of the reproductive system which they may already have learnt about in school. Note that is important that girls and women understand their bodies and are body positive. However, information on sexual pleasure might not be appropriate for younger girls. Make sure you check the sexual education policies in your country to see what information you can give in schools.

I used to be worry about how I look. Now I know that everyone ´ s body is different. We are all beautiful in our own way!

CLITORIS URETHRA VAGINA OPENING

Anus

• The Vulva is the proper name for the area between your legs, where you have three openings. It is difficult to see unless you squat over a mirror. • The Urethra: this is the first opening, it is very small. This is where urine comes out. • The Vaginal Opening: this is the second opening, this is where menstrual blood comes out. • The Anus: this opening is towards the back where faeces come out. • The Clitoris: At the top, above the urethra is the clitoris. This is a small bump that is normally hidden under a small hood at the top of the vulva. The clitoris is the primary source of female sexual pleasure.

Now, point to the images on the bottom of the flip chart.

The three images give us an idea of how different vulva’s looks like. On the outside is the outer labia, this is the part between your legs where hair grows. Sometimes you can see the inner labia, like in the first image. Sometimes the outer labia completely cover the inner labia like in the last image, and sometimes it’s in-between. As you can see they are all very different from each other. That is because everyone’s body is different and no two vulvas are the same. If your labia are long or short, or you have lots of hair or almost none, it is very normal and it does not mean that anything is wrong.

We will now discuss what happens in the reproductive system for menstruation to occur. 1. Once a girl has reached a critical stage in puberty (menarche), one of the ovaries releases a mature egg every month. This is called ovulation. Ovulation occurs once in each menstrual cycle. 2. Once the egg leaves the ovary, it enters the fallopian tubes and travels to the uterus. 3. Every month, the uterus wall thickens with blood and other nutrients to make it ready to carry a baby. 4. Pregnancy occurs when a single sperm fertilizes the egg while it is in one of the fallopian tubes. The fertilized egg travels to the uterus where it is implanted in the nutrient-rich lining of the uterus wall. It is at this point that a baby begins to grow. 5. If the egg does not meet with a sperm, the unfertilized egg leaves the body about 2 weeks later, passing through the cervix into the vagina, along with the lining of the uterus (which is not needed to support a foetus). This is menstruation, it is also called a ‘period’. 6. This lining is shed slowly, like a trickle. It does not pour like water from a tap.

1.5

UNDERSTANDING MY CYCLE IMPORTANT SESSION 20 MINUTES FLIP CHART 3: UNDERSTANDING MY BODY AND FLIP CHART 4: UNDERSTANDING MY CYCLE

Objective: To understand the menstrual cycle; not only the changes happening in the body but the feelings and emotions girls and women may experience in each phase. This can help them understand how they feel and why. Think about your age group during this session. For young girls, it might not be appropriate to talk about when they are more or less likely to become pregnant. If young girls ask about safe days, make sure they understand that there are no “safe days” especially as their cycle is still irregular. Adult women might be more interested in knowing which days they are likely to conceive.

THE MENSTRUAL CYCLE: • Most girls and women have a menstrual cycle of around 28 days with one period. After the 28 days the cycle starts again. • When monitoring your cycle, you count the first day of your period as the first day of your menstrual cycle. • The last day of your cycle is the day before your next period starts. • Normal cycles for women can be between 21 to 35 days and for younger girls, the cycle can range from 21 to 45 days, because their bodies are getting used to these big changes. • An average period is 3 – 7 days. If a period lasts much longer, for example 2 weeks, it is advised to see a doctor. • For most girls and women, the number of days that you bleed, or the length of the cycle, can vary by a few days each cycle. This is normal and and most girls and women will experience this at some point in their lives. Normal irregularities or changes in the menstrual cycle can be caused by factors such as stress, diet, weight loss or weight gain, and high levels of exercise. It can also be caused by some medicine and contraception. Avoiding stress and eating a healthy and balanced diet can contribute to a more regular period. • A missed period does not always mean there is a problem, especially if you have only recently started your periods. If a woman misses three periods in a row, she should go and see a doctor. The most common reason for this is pregnancy.

Go through the menstrual cycle step by step, starting with menstruation (day 1 on flip chart 4) and point to the relevant images of the reproductive system as you explain. Make sure your participants understand that it is a cycle and therefore has no beginning or end, but for simplicity we have put menstruation as the first phase.

THE MENSTRUAL CYCLE HAS 4 PHASES: 1. Menstruation: 3 – 7 days. You are unlikely to get pregnant during this time.

• Menstruation occurs because the egg which was released into the uterus was not fertilised during the last menstrual cycle. The uterus lining sheds along with the unfertilised egg, and comes out as menstrual blood. •Blood can be bright or light red, and may be brown in some women. •Periods can be light or heavy. Both are normal and it is also normal for the amount you bleed to change over time. •Heavy periods, or periods with blood clots (lumps) in them are very common and lots of girls and women experience this. •During your periods you might experience cramps, sore breasts, achy muscles and joints and you might feel more tired than usual.

2. Uterus wall starts to thicken again: It is possible to get pregnant at this time.

• After menstruating, a new uterus lining starts to build up to prepare for a fertilised egg to come. • During this time, you might feel more energetic and concentrated.

3. Ovulation: 1 day. Fertile window: Approximately 7 days. Most likely to get pregnant.

•The fertile window is the approximately 7 days where ovulation could occur. •Ovulation is when an egg is released from the ovaries. It stays alive for 24 hours only. Sperm can live inside the body for 3 - 5 days, so it is possible to get pregnant during the fertile window. •Ovulation usually occurs 14 days before the start of your next period. • Ovulation day can vary and may not fall on the same day in each cycle. •Because there is so much variation regarding when you ovulate between cycles, the 8 – 19th days of cycle are when you can potentially become pregnant. Remember that if your periods are irregular, it is difficult to predict when you will ovulate. Your menstrual cycle can also change if you are stressed, sick, lose or gain weight, so relying on “safe days” may not be an effective way to avoid getting pregnant. •During ovulation, you’ll probably have more discharge than usual, egg-white like discharge, and you can feel more emotional.

4.Fertilised/unfertilised egg arrives in the uterus:

Less likely to become pregnant. This is the part of your cycle where you might experience PMS (premenstrual syndrome) indicating that your period is starting soon. During this time, you might feel more tired than usual, and you might experience mood swings, such as feeling more sad, emotional, or irritated than usual. You might feel bloated, have sensitive breasts, and get pimples. This is all due to hormonal changes and is completely normal. Your participants need all their focus for the next session - how about an energizer?

1.6

TRACKING MY PERIOD IMPORTANT SESSION 30 MINUTES FLIP CHART 4: UNDERSTANDING MY CYCLE, FLIP CHART 5: MY PERIOD TRACKER AND FLIP CHART 5A ATTACHMENTS

Objective: To help your participants to learn how to track their cycles and predict their periods. This session can take time but will help girls and women be better prepared for their periods in the future. To be able to manage your periods well it is useful to monitor your cycle, so that you know when your next period will start and you can be prepared. Otherwise you may get your period when you do not have your menstrual method with you. There are several options that can be used separately or in combination to monitor your cycle and predict your next period:

• Cycle beads (homemade) • Cycle calendars (homemade) • Smartphone apps • Keeping an eye out for the body signs that menstruation is coming

Take participants through how to track their periods, using the calendar on the flip chart. You can use Leyla as an example (see exercise on the next page):

PERIOD TRACKING ICONS Period days Possible ovulation days PMS Feeling happy Feeling Tired Feeling emotional or sensitive 26

MENSTRUAL IRREGULARITIES: Many girls and women are concerned about menstrual irregularities. In order to reduce feelings of shame and concern, it is important for them to know that menstrual patterns vary greatly. However, some irregularities may be causes for concern. It is important that girls and women with unexplained irregularities seek advice from a health care provider.

Leyla’s periods are now stable, her menstrual cycle is 28 days and her period lasts five days. 1. Start by counting 1 to 5 on the calendar (starting from the first day on the calendar – which is day 29) and put a period day icon on each of the days to represent Leyla’s period. 2. Ask your participants whether they know when her next period will start? Count 28 days ahead from the first day of Leyla’s first period and ask your participants to count with you. The 29th day will be Leyla’s next period - mark those with the period days icons again. 3. Ask your participants if they know when Leyla is likely to ovulate? Explain that the day of ovulation can vary, but it will usually be 14 days before your next period. Count backwards from Leyla’s second period, along with the participants. Place ovulation icon on the 14th day as well as the days before and after. 4. Ask your participants when Leyla is likely to feel tired during her cycle? Replace one of the period day icon with the tired icon as this will likely happen during her period. 5. Ask your participants when in the cycle she is likely to feel happy and energised? Place the correct icon somewhere between end of period and ovulation. 6. Ask your participants when Leyla might experience premenstrual syndrome such as mood swings? Place PMS icon just before next period starts. 7. Ask your participants when she is likely to feel emotional and sensitive? Place emotional icon around ovulation. 8. Remind your participants that irregular periods are common in the first one or two years of menstruation, making it harder to predict your periods. Most girls and women will experience irregular bleeding at least once in their life.

MON

MY PERIOD TRACKER TUE

29 30

WED

THU

FRI

SAT

SUN

20 21

22 23

27 28 29 30

Flip Chart 5

This is an example for 28 day cycle. If time, repeat the exercise with a 21-day cycle

1.7

WHAT, WHERE, WHEN? 20 MINUTES FLIP CHART 6: WHAT, WHEN, WHERE? FLIP CHART 6 ATTACHMENTS

Objective: Here you will test whether the participants have understood the menstrual cycle. This exercise can also be used as a recap, for instance if you decide to split the workshop into two days. Remember, because the menstrual cycle is a cycle there is no beginning or end. Therefore, it does not matter where the participants place the first card, as long as it follows the correct order.

Divide your participants into groups and give each group a print-out of the Flip chart 6A reproductive system attachments. • Tell them that they have 10 minutes to discuss with their group which order they think the pieces should go on the flip chart. • Once the time is up, ask someone from the first group to come and place the first card on the flip chart, and to explain what is happening. • Ask the other participants if they agree with the choice. If not, ask another group to come and place the card in the correct position on the flip chart. Continue until all the cards have been placed correctly on the flip chart.

KEY MESSAGES

• • • •

It is normal for everyone’s cycles to be different from each other’s and even vary between cycles. Most girls reach menarche between 11 and 16 years of age. A menstrual cycle normally lasts 28 days, but it is normal to range from 21 to 35 days (or longer if the girl has just reached menarche). Menstrual blood is the uterus wall shedding. This is because an egg was not fertilised this month so it is not needed.

Like me, many girls do not know what is happening when they have their first period. Now I want everyone to know that it is a normal and natural thing!

CORRECT ORDER

The lining of the uterus sheds and comes out through the vagina, this is menstruation.

While the egg is developing, the lining of the uterus is getting thick and soft.

1 4

The egg is released by the ovary, this is ovulation.

2 3

The egg travels to the uterus.

1.8

MY HEALTHY PERIOD IMPORTANT SESSION 30 MINUTES FLIP CHART 7: MY HEALTHY PERIOD. WATER BOTTLE, SOAP, BASIN, SMALL TOWEL, LARGE TOWEL/BLANKET, PAINKILLERS.

Objective: To advise your participants on how to stay healthy, happy and hygienic during their periods. As previously mentioned, most girls and women have around 450 periods in their lifetimes! Therefore, it is important that we feel good during those days, and that our periods do not hold us back. Unfortunately, this time in our cycle can sometimes be dreadful, some of us experience period pains, some feel dirty on their periods, and others feel stressed if they are not prepared. This session gives tips on how to feel good during our periods. Ask your participants how they stay healthy, happy and clean during their periods? Note the answers on a flip chart. With the aid of Flip chart 7, explain that there are three main ways of feeling good during our periods: Being prepared, staying healthy and clean and managing period pain we may experience. Demonstrate visually wherever possible.

Being prepared Being prepared for your period can help to avoid stress and help to be in a better position to manage it. Tracking your period, for instance by using a calendar, helps you predict when your next period will start. If you know your period is about to start, you can make sure you have your preferred menstrual method with you wherever you go, along with what you use to keep hygienic and managing period pain.

Staying healthy and clean It is always good to maintain a good level of hygiene, as it reduces the risk of getting sick and helps us stay healthy. It is particularly important during your period, as bacteria (the germs that cause infection) love to stay in places that are warm and moist and where there is blood. The following are good ways to stay clean during our periods:

Safe and clean menstrual management method Make sure you change your menstrual management method frequently and that you follow the hygienic guidelines to keep it safe and clean.

Keep vaginal area clean Wash the vaginal area at least once daily during periods. Wash the outside (the vulva) with clean water, but avoid using soap!. Do not wash or insert any liquids inside the vagina. Discharge inside the vagina cleanse it naturally and soap will wash away the good bacteria that protects your vagina. Wipe from front to back after using the latrine, so that no germs are transferred from the anus to the vagina, which may cause infections.

Clean and dry underwear If you wear underwear, make sure that they are clean and dry to prevent the growth of bacteria.

Never share your menstrual management method It is yours and yours alone. Sharing a method increases risk of passing on infection and diseases to others.

Wash hands Itâ&#x20AC;&#x2122;s very important to have clean hands, it will stop you from passing germs on to other people or yourself. Keeping your nails short keeps them cleaner. Remember to wash your hands before and after changing your menstrual management method.

Demonstrate the following nine handwashing steps. Ask for volunteers to demonstrate as well. ok!

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.

Put a large towel or blanket on the floor and demonstrate ways to stretch during your period. Ask for volunteers to demonstrate as well.

HEAD-TO-KNEE FORWARD BEND: Start on the floor in a seated position, with one leg straight and the other knee bent outward to a 90-degree angle and the foot pressed into the inner thigh of the straight leg. Grab the left shin or foot, inhale, align the hips, and lengthen the torso over the straight leg. Exhale, fold forward slowly from the hip, looking forward, bringing your chin towards the straight leg, flex the left foot, pulling your toes back towards you. Stay for 5 to 8 breaths.

BACKWARD BEND (CAMEL POSE): Kneel on the floor with the knees hipsdistant apart. Turn your thighs inward slightly and press your shins and feet firmly into the floor. Place the base of your palms on your lower back, fingers down. Inhale, expand your chest, bringing your shoulders back and down. Exhale, push the hips forward and expand/lift the chest as you lengthen the front of the body and arch back. Keep your hands on the back of your hips (or on the back of the heels). Stay for 5 to 8 breaths.

KNOWING THE DIFFERENCE BETWEEN MENSTRUAL CRAMPS AND INFECTIONS Menstrual cramps are caused by the muscles of the uterus contracting to push out the lining of the uterus. Menstrual cramps, headaches and joint/back pain are all very normal during your period. If you have other types of pain, like pain inside the vagina, it could be a sign of infection. Infections may cause rash, itching, swelling, redness or soreness in the vaginal area or experienced during sexual intercourse. Infection may cause increased amount of vaginal discharge or change in colour and smell. You may also get pain while urinating if you have an infection. If you experience any of these symptoms you should seek medical care. Could it be lunch time? Take a break!

1.9

MYTHS & FACTS 20 MINUTES BLANK FLIPCHART AND MARKERS

Objective: There are often many different myths and misconceptions that go around about menstruation. Some of these myths can be restrictive or even harmful to girls and women. This session should debunk some of the local myths and help the participants to think critically about what they hear about menstruation. Most likely you are the one who knows your context the best. Although examples of myths are provided below, try to provide examples you know exist in the community. Before you start, make sure that everyone understands what a myth means.

• Ask your participants what are some of the things that people say about menstruation in your

• • •

community? Which ones do you think are true and/or false?. • Give an example of a myth from your community, or something that you have heard about menstruation that you now know is not true. Ask the participants if they have other examples, even if they are not sure if they are facts or myths. Read out a few statements about menstruation. Ask participants if they think the statements are myths or facts (true or false). Ask them to move to one side of the room if they think it is a myth and a different side if they think it is a fact. This is a silent game! Ask a few volunteers to explain why they think it is a myth, or why they think it is a fact. Listen to both sides and then conclude by telling them if the statement was a myth or a fact (explain why, if it has not already been done by a participant). Then move on to the next one… Conclude by emphasizing that menstruation is a normal and natural process, we should think critically about what we hear about menstruation in our communities and cultures and that it is our responsibility to dispel some of the harmful myths that exist about menstruation. If it is not possible for participants to move around, you can ask them to stand up/sit down, or put their hands up/down depending on if they think the statement is a myth or a fact.

Menstruation is something that most girls and women go through. It should not be a taboo!

EXAMPLES OF MYTHS AND FACTS STATEMENT A girl is unclean when she has her period

MYTH. No, there is nothing unclean about having your period. Especially if you have a way to catch the blood, and the chance to wash your hands and bathe.

It is okay for girls and women to cook food for others while on their periods

FACT. Yes, menstruation is natural and there are no restrictions regarding what girls and women can do on their periods as long as they are not in too much pain. As long as you keep proper hygiene and have clean hands, it is okay to cook food during your period and it is also fine for other people to eat the food.

If someone sees your menstrual cloth â&#x20AC;&#x201C; you will become cursed

MYTH. No, there is nothing magical about menstruation â&#x20AC;&#x201C; it is only natural. Nothing will happen to you if someone sees your menstrual management method, but for hygienic reasons you should store it safely.

Period blood is dangerous to men

MYTH. No, there is nothing special about period blood, and nothing happens when men come in to contact with it.

A woman can get pregnant if she has sex during her period

FACT. Yes, a sperm can live inside you for up to 5 days. If you have sex towards the end of your period, and you have a short menstrual cycle (and therefore an early ovulation) you could actually get pregnant.

MYTH OR FACT

1.10

MENSTRUAL MANAGEMENT METHODS 20 MINUTES DEMONSTRATION BAG

Objective: To introduce participants to the existence of difference menstruation management methods. Some of these materials may not be available or affordable in your setting but it may be useful for participants to understand what else is out there. Demonstration: • Place the methods on a table. • Ask for three volunteers to come up one at a time and find the method they used for their first period. Ask them to talk about their experience with it, and show how they used it. • Now go through all the other methods on the table concluding with the menstrual cup. For each method explain how it is used and the advantages and disadvantages of the method (see below). If you have time, this is also a good opportunity to ask participants to share their first experience of menstruation!

MENSTRUAL MANAGEMENT MATERIAL LIST CLEAN PIECES OF CLOTH: Girls can use pieces of cloth to fit into and wrap around the underwear. These pieces of cloth must be clean. They must be washed thoroughly and hung in a sunny place to dry. They should not be shared.

TOILET TISSUE: Place a thick, long wad of toilet tissue in underwear However, toilet tissue can be rough and can irritate the skin. It also may not be sufficient to absorb the blood.

DISPOSABLE PADS/SANITARY TOWELS: These are designed to fit the panty area. They have strips of tape that keep them attached to the panties. Disposable pads need to be disposed of, for example by throwing them down a pit latrine, in a bin or incinerator after use.

REUSABLE PADS: Reusable pads are often made with absorbent material and lined with plastic to minimize spill of menstrual blood. Reusable pads are made of multiple layers of cloth to absorb the menstrual blood and can be washed and reused for up to a year. They must be washed thoroughly and hung in a sunny place to dry.

TAMPONS: Small, compressed cotton objects, formed into solid, tube-like shapes, which are pushed up into the vagina during menstruation. The cotton softens as it absorbs the menstrual blood. Attached to the tampon is a strong, soft cotton string, which hangs out of the vagina. Pulling this string removes the tampon. A girl must always wash her hands before and after inserting a tampon. Tampons need to be changed often, it could cause infection if left in. One should never leave a tampon in for more than eight hours.

MENSTRUAL CUPS: Flexible, bell-shaped cup worn inside the vagina during menstruation to collect menstrual blood. It is normally made of medical grade silicone and can be washed and reused for up to 10 years dependent on brand. The cup needs to be emptied every 4-12 hours.

You are about to start delving into the menstrual cup business! How about doing a little dance first and getting your participants moving?

PART 2

ME AND MY CUP

This is a good time to tell participants why you are personally interested in the cup and share your experience with the cup if you have used one yourself!

2.1

MY MENSTRUAL CUP IMPORTANT SESSION 15 MINUTES FLIP CHART 8: WHAT IS A MENSTRUAL CUP?, QUESTIONS & CONCERNS BOX, PENS AND PAPERS FOR PARTICIPANTS, A MENSTRUAL CUP FOR DEMONSTRATION

Objective: To give your participants an idea of what a menstrual cup is and why using a menstrual cup can be beneficial to them. It might be a good idea to have a question and concern box or jar going around and give participants a pen and some papers - so that if they have questions they are afraid to ask in front of everyone they can write them down and put in the box. Before the end of the workshop you should then go through those questions and make sure they are answered. The menstrual cup is a method to manage your periods

It can be re-used for up to 10 years if you take good care of it • Menstrual cups have been used since the 1930s – and many hundreds of thousands of girls and women all over the world already use the cup. • The cup is inserted into the vagina and collects blood, rather than absorbing it, like pads or tampons do. • The cup is emptied every 4 – 12 hours, depending on your flow. Once emptied, you can rinse or wipe (if possible) and insert again. • Most cups are made from medical grade silicone, like the tubes inserted in the body in hospitals - so it will not increase the risk of diseases and allergies when used hygienically. • To ensure good hygiene and prevent any bacteria reaching the cup, the cup is disinfected after each period and stored in a bag until your period starts again. • The cup is cost effective (less expensive than other methods) and environmentally friendly. • When you have gotten used to it – it is very comfortable to wear and you may not even notice it is there.

PUNCH DOWN

C-SHAPE

You can run, jump and play while using a cup. You won´t even feel it!

You can answer question along the way, however note you will answer many questions in the next sessions. This is just a short introduction to the cup – will go more into depth in later sessions.

MENSTRUAL CUP FEATURES

BELL SHAPED RIBS

AIR HOLES

STEM

RIM

• • • • • •

There are many different brands of menstrual cups. Menstrual cups are commonly made of medical grade silicone and have similar features. The rim on the bell-shaped cup allows the cup to sit against vagina walls and collect blood, leakage is prevented because the rim changes its shape to fit the vagina. Airholes allow air in and out of the cup to create a pressure between the cup and the cervix which makes it easy to pop-open when inserted, and to be removed comfortably. Ribs provide grip and ensure that the cup pops-open once it has been inserted. They are thicker than the body to support the structure of the cup. The stem is used to easily grip the cup for insertion and removal, the length of the stem varies across brands, and a few brands do not have a stem.

You might be thinking: It looks too big! How can it possibly fit in? Don’t worry, the cup is soft and bends and folds easily, you can fold it up before putting it in.

2.2

WHERE DOES THE CUP GO? IMPORTANT SESSION 20 MINUTES FLIP CHART 9: WHERE DOES THE CUP GO?

Objective: To explain to your participants how to insert the menstrual cup and where it should be located in the body. Make sure that you yourself have read through this session a number of times and have already tried the cup before you explain how to use it to others.

• • • • •

We will now discuss how to use the menstrual cup! However, first of all, we need to find out: Where does the cup go? Remember that the vulva has three openings. The menstrual cup is inserted into the vagina and should sit under the cervix (show flipchart). If inserted correctly, it should open entirely and create a suction so that it stays in place and does not leak. If the cup is tilted to one side, or has not opened, it can cause leakage and may be uncomfortable. You should not be afraid of the cup disappearing inside your body, it is physically impossible for it to go further than the cervix! If you are going to use a menstrual cup, it’s important that you understand where the cup will sit in your body. Before you start using your cup, we recommend that you spend a few minutes identifying the three openings. You can do this by finding a private place and squatting with a mirror. You can also gently insert your finger inside your vagina to locate your cervix. Just make sure you have clean hands. The cervix is the little bump inside your vagina that feels like a tip of a nose; if you have a low cervix you can feel it after the first knuckle, if it is medium you can feel it after the second knuckle, and if you only feel it when inserting the whole finger (or you cannot feel it at all) you have a high cervix. Sometimes menstrual cups have different shapes and sizes depending on the height of your cervix, so this is also a good way to determine the right size for you. If you have a very low cervix, a menstrual cup might not work for you.

• You should not be afraid to look at and explore your own body – it will help you gain knowledge and confidence!

Flip Chart - 9

2.3

USING MY CUP IMPORTANT SESSION 30 MINUTES FLIP CHART 10: USING MY CUP, BLANK FLIPCHARTS, MARKERS, DEMONSTRATION CUP(S)

Objective: After this session, participants should have a better understanding of how the cup is used, inserted, removed, and they should feel confident to start using those methods themselves. This is an important session – take your time. In this section it is particularly important to include personal stories if possible! Everyone’s experience is different and it is good to share a personal experience or one of a friend so the girls and women can understand how it may feel to use a menstrual cup.

INSERTING THE CUP: So now that we know where to insert the cup, let’s talk about how to insert it. Here are some key steps to follow:

1. Go to a latrine or a private place. 2. Always start by washing your hands with clean water and soap. 3. There are two ways to fold the cup before inserting into the vagina: • A. ‘C-shape’: Press cup flat, then fold the cup in half. • B. ‘Punch down’: Punch down one wall of the cup to fold into its base, hold base as you insert. • C. Before you insert: Relax! take some deep breaths and relax the muscles between your legs. 4. Squat down & gently push the menstrual cup into your vagina – make sure it enters well, so it is able to

open up inside. 5. Once the cup is inserted well, it will wiggle into place and unfold inside. Vacuum will be created when it unfolds, preventing leakage around the sides of the cup. Demonstrate technique by folding the cup, squat down, take some deep breaths and pretend to insert. Demonstrate also by making an “O” with your pointing finger and thumb, and “insert” the folded cup into the “O”, letting it unfold. Ask volunteers to demonstrate with demonstration cups.

C-SHAPE

PUNCH DOWN 43

MENSTRUAL CUP INSERTION TIPS: • Set time aside, so you are not rushed. • Relax, take a few deep breaths. If it doesn’t work the first time, just try again. • When you squat, don’t squat directly over a latrine – so in case you drop your cup, it will not fall into the hole.

• Remember the vaginal opening is the tightest part of the vagina. Once the cup is past there, it will enter

smoothly and there will be more space. • You can wipe warm water or lubricant around the rim of the cup to help insertion. • Pinch the base and/or rotate the cup to help get it into place • If the stem of the cup sticks out and irritates, even after using it a few times, you can always cut the stem. Don’t cut it off completely though, it is there to help you remove the cup. • If it is not working and you cannot insert it after trying those tips – you should maybe try a different size.

REMOVING THE CUP: After 4-12 hours, you will need to empty your cup depending on how heavy your flow is. Here are the steps you need to follow:

1. Wash your hands with water and soap. 2. Go to latrine or private place. 3. Squat down. 4. Insert fingers and gently pull stem downwards. 5. Grab stem and pinch base to release suction (Demonstrate with a cup). 6. Pull gently until you can feel or hear that the suction is released. 7. Stop and get a better hold of it so when you pull it out, it does not spill. 8. Removing the cup might be most comfortable if you keep pinching the base and fold the cup in on itself

as you pull it out (i.e. fold it into one of the shapes you used when inserting the cup). This should not push any blood back inside you. 9. Empty the cup into the latrine or where appropriate. 10. How often to empty your cup: Check every 4 hours when you start using your cup – with time you will start to understand your flow and have a better idea of how often to change it. Do not keep the cup in for more than 12 hours due to risk of leakage.

MENSTRUAL CUP REMOVAL TIPS • Set time aside, so you are not rushed. • Do not worry if you cannot get hold of the cup at first. Use your stomach muscles that you use to stop

and start peeing to push down the cup. • Twirl the cup around slowly while pulling it out. • If your fingers are dry, it will be easier to pull out. If you have toilet paper you can dry your fingers during the process, to get a better grip. • Do not panic, this part often takes some practice, so just keep trying. • If you are concerned and cannot remove the cup then contact your local health provider. However, this is not usually necessary. • Try to insert and remove the cup a few times before your period starts, so you can practice the technique. • The most difficult part of using the cup is inserting and/or removing it the first few times. It will probably be a bit messy the first few times, but it will get much easier with time! Practice makes perfect!

USING MY CUP I NS E R T C U P

ROT

INSERTING

E NS U R E C U P EN S

C FOLD UP

ION YOURSE T I L OS

SH HANDS A W

I ON YOURSE LF

CUP

WHILE P I NC

TY CUP EMP

REMOVING

REM

IT OS

R W I P E THE O E C NS

Flip Chart - 10 If you have a few demonstration cups – ask your participants to demonstrate to each other how to fold the cup, insert it, and remove it.

2.4

HYMENS AND VIRGINITY IMPORTANT SESSION 30 MINUTES FLIP CHART 11: UNDERSTANDING THE HYMEN.

Objective: Virginity is highly valued in some communities, and often people confuse virginity and hymens. Therefore, some people may have concerns about the menstrual cup ‘breaking’ virginity. This is a tricky session, but if you get it right you will help to dispel some of the misconceptions that have been around hymens and virginity for years. Some of your participants may be wondering: I am a virgin; don’t I have a hymen covering my vagina? So how can I get a menstrual cup inside? And if I break my hymen won’t that mean I’m not a virgin anymore?. This is a really important area for us to look at.

UNDERSTANDING THE HYMEN

CLITORIS URETHRA VAGINAL OPENING HYMEN

OUTER LABIA INNER LABIA

Anus Anus

DIFFERENT TYPES OF HYMENS

Flip Chart - 11

1. Explain that being a virgin and having a hymen is not the same thing. You can start by asking the

participants, what does being a virgin mean to you? Most likely they will define a virgin as someone who has not had sexual intercourse. In very simple terms, this already answers the question of menstrual cups ‘breaking’ the virginity. However, it is also important for the participants to understand how the hymen works. 2. Most people think the hymen completely covers the entrance to the vagina, which is then broken when a girl has sex, thereby losing her hymen and her virginity. In communities that value virginity, blood on the sheets on the wedding night is often seen as proof of the woman’s virtue, and the lack of blood can be interpreted as a sign of infidelity and get girls and women into trouble. This is problematic because the hymen is more complicated than that, and because not all virgins bleed. 3. Every girl or woman’s hymen looks different, just like ear lobes, noses, etc. It differs in size, colour and shape. It is not a solid membrane but a mucous membrane which surrounds the vaginal opening. 4. A normal hymen does not completely cover the vaginal opening, otherwise the period blood would have nowhere to pass. In extremely rare cases where the hymen fully covers the vaginal opening, it stops girls and women from menstruating, in which case they need to seek medical attention. 5. A common belief is that it tears or breaks during sex or even through normal daily activities such as play and exercise. However, the hymen is elastic and does not tear or break, however can stretch if something is inserted into the vagina. 6. Pain during first sexual intercourse may not be due to tearing of the hymen but because girls/ women may be nervous, this makes them tighten their pelvic floor muscles and narrow the opening of the vagina. Inserting something into the vagina for the first time can stretch the hymen which can lead to bleeding or spotting, but this does not always happen. 7. Importantly, not even a trained doctor can see or feel if a woman has had sex! Virginity tests therefore have no value. The only way to know if a woman is a virgin or not, is to ask her and believe her answer. 8. In conclusion: The menstrual cup does not break a girl’s virginity. It may however stretch the tissue, just like other activities.

If things have been going well your participants have learned a lot of new things today – it might be hard to concentrate in the final hour. Ask one of your participants to lead the group into an energizer before wrapping up the workshop!

2.5

KEEPING MY CUP CLEAN IMPORTANT SESSION 30 MINUTES FLIP CHART 12: KEEPING MY CUP CLEAN, BLANK FLIP CHARTS, MARKERS, DEMONSTRATION CUP(S). ANYTHING THAT HELPS WITH DEMONSTRATION SUCH AS POT/SAUCE PAN, STOVE, FOOD TIN, STERILISING TABLETS, COTTON BAG/BOX, GLASS/PLASTIC JAR WITH A LID

Objective: To make sure your participants understand and know how to follow the hygienic guidelines for the cup. This session is very important as not following the guidelines can cause infections!

CLEANING & RE-INSERTING THE CUP (DURING YOUR PERIOD): • Once you have removed the cup from the vagina, you can clean it before reinserting. • To clean it, either: • Rinse the cup with clean water (without soap) • Wipe the cup clean with toilet tissue/paper • After you have emptied and cleaned just re-insert the cup as before. • If there is no water or toilet paper available, it is ok to empty, fold and re-insert directly.

You can always be prepared and carry a bottle of water and soap with you in case you need to wash your hands or empty and rinse your cup somewhere.

DISINFECTING THE CUP (BETWEEN YOUR PERIODS): • You should disinfect your cup before first use and

between each period, if it falls on the ground, or if someone else has touched it.

• There are four different ways to disinfect your cup. 1. Boil in a pot: Boil the cup for five minutes in a

pot/sauce pan. If possible, get a pot that will only be used for this purpose. If no pot/sauce pan is available, boil the cup in a clean food tin – not a tin that has been used for paint or other chemicals. 2. Boiled water: Place the cup in a container and pour boiling water on the cup (fresh boiling water 3-4 times). If you are not comfortable to boil the cup in common area, you can use this method. 3. Sterilising tablets: If available, sterilising tablets can be used. Place the cup in a container (e.g. bowl) with clean water and add ¼ of a sterilising tablet. Leave for 10-15 min.

Demonstrate the different methods if possible, and show participants what they can use (a pot/ saucepan, food tin, container, sterilising tablets)

When boiling the cup, remember to cover the cup with water and don’t boil for more than 10 minutes – otherwise the water might boil away and your cup will burn!

• To avoid smell the small holes can be cleaned by: • Pouring water in the cup and pressing down on the rim with flat

hand and squirting out water through the holes. • By gently cleaning the holes using a needle or a toothbrush. • It is important to have clean hands when handling the cup after disinfecting it. The cup will change colour over time – will become brown. This is completely normal and does not mean that the cup is too old to be used anymore. To remove the stains, you can wipe off the cup with alcohol once a year (Should not use drinking alcohol such as beer). The cup should be boiled again after rubbing it with alcohol, to make sure all traces of alcohol are removed before the cup is reinserted. Rubbing the cup with lemon or lemon juice and putting it in the sun for a bit is another method which has worked for many women

STORING THE CUP

Between your periods, you will need to dry and store the cup until your next cycle. 2. Keeping the cup dried (after cleaning) in clean conditions prevents germs. 3. Most cups come in a cotton bag or a box. It is best to store your cup there because it is ventilated. 4. However, if you stay in an area where there are rats or insects, it is better to store the cup in an airtight container such as: Glass jar, plastic jar or tin can with lid. Important: Make sure the cup is dry before putting it into the container, so that it does not get mouldy.

Learning by doing is always the most effective! Ask your participants to demonstrate how to clean, disinfect and store the cup using the tools that you have.

THE THREE CUP COMMANDMENTS The 3 cup commandments are one of the most important take home message from this workshop. Those are: 1. Always wash your hands before inserting or removing the cup 2. Always disinfect the cup between your periods and before the first use 3. The cup is yours and yours only â&#x20AC;&#x201C; If you or the other person has an infection you might infect each other â&#x20AC;&#x201C; Do not share the cup with anyone!

2.6

WHO IS THE CUP FOR? 20 MINUTES BLANK FLIPCHART, MARKER

Objective: We love the menstrual cup, however we also believe that girls and women have the right to make informed decisions regarding their bodies. After getting all the necessary information about the cup, participants can now reflect on what they have learned, the advantages and disadvantages of the cup, and decide if it is suitable for them or not. Ask your participants the following questions: • Now that you have learned about the menstrual cup and how it works, what do you think about it? • Who do you think benefits from using the cup and is there anyone who would not benefit from it? • Ask participants to give examples and write them on a flip chart. • Reflect on the answers and correct misunderstandings if any. • See some examples below.

WHO IS THE CUP FOR? Anyone who menstruates

WHO IS THE CUP NOT FOR? Anyone who does not menstruate

Any girl or woman who would like to Girls and women who have had birth complications (should save money on menstrual products wait until they have recovered and a consult with a doctor before using it) Any girl or woman who does not want to Anyone who cannot follow simple hygiene guidelines be restricted by her periods Any girl or woman who wants a discrete Anyone who has a sexually transmitted infection – should get menstrual management it treated first

ROLE PLAY: Role plays are a fun way to get your participants more comfortable talking about

menstruation and the menstrual cup. You can either divide everyone into groups of two or ask a few volunteers to do a role play in front of the others. One can take the role of explaining what the menstrual cup is and one can take the role of someone who does not know and who has many questions. Here are some ideas of roles (you can choose the ones most relevant for your participants):

1. Daughter talking to mother 2. Daughter talking to father 3. Wife talking to husband 4. Woman talking to a community leader 5. Woman talking to a religious leader 6. Teacher talking to a student 7. Health worker talking to community member

If you have been passing around the Questions & Concerns box, this is a good time to go through the questions and make sure all of them are answered!

2.7

RECAP ON ‘ONE WORD ABOUT MENSTRUATION’ 30 MINUTES FLIPCHART FROM FIRST SESSION, BLANK FLIP CHARTS, MARKERS.

Objective: To get your participants thinking about if and how the workshop has changed their views on menstruation to the better, and what they can do to influence other people’s views. At the end of the workshop, bring out the first flip chart where you wrote down everyone’s words or feelings on menstruation. Go through the list again and ask participants if they still feel the same about their periods and menstruation or whether they have new feelings. If they have new feelings write them on a new flip chart. This is a good opportunity for your participants to share any final remarks about the workshop.

Thank you for participating. We hope that you now feel confident to start using your menstrual cup!

You are now all Champions of Menstruation! Please help us spread the knowledge you have gained!

ENERGIZERS’ 5-10 MINUTES NONE NEEDED Objective:nergizers can be done every 45 minutes or when there is a need to shake people up, get them moving and laughing.

BODY SPELLING Ask participants to come up with a few words to spell by moving their bodies in the shape of the letters, while the others follow.

SIMON SAYS • Ask participants to stand up. As the leader, you are now Simon and you give commands

such as “Simon says jump, Simon says touch your ear”, doing the activity yourself while your participants should do the same. If the command does not begin with Simon says - they should not do what you ask them. • Example: “Simon says jump! Sit down!”, here everyone should have jumped, but not sit down as it did not begin with “Simon says”. • When someone obeys a command that did not start with “Simon says” they are out. The last one standing wins.

STORY TELLING CHAIN • The game is about making up a story together. You start the story by saying a sentence or two, for an example: “Once upon a time, there was a girl called Mary.” • The next person continues the story with one or two sentences. • The chain continues until everyone has told their bit of the story.

WoMena is an NGO focusing on bridging the gap between reproductive health innovations and implementation of these innovations. WoMena promotes the use of evidence-based, effective reproductive health technologies and solutions such as menstrual cups through research, advocacy, awareness raising and project implementation. Address: WoMena Uganda Plot 2150 Kaduyu Close – Ntinda Kigowa zone P.O Box 40198 Kampala Uganda Email: info@womena.dk

Ruby Life Ltd is an award winning social business that produces and distributes the Ruby Cup menstrual cup, a healthy, eco-friendly and cost saving alternative to tampons and pads. Ruby Life runs a “Buy One Give One” programme: for every Ruby Cup purchased, another one is donated to a girl in Africa or Asia, in collaboration with locally based organisations. Address: Ruby Life CREC Carrer Blesa 27 08004 Barcelona Spain Email: contact@rubycup.com Ilustrated and Designed by Estela de Diego. www.esteladediego.com