Reusable Pad Training Resource 2 Authors Developed for Irise International by: Dr Emily Wilson-Smith With valuable input from: Dr Victoria Ramsden, Dr Sophie Dickinson, Louise Tyson, Susannah Henderson of Project Mwezi and Family Impact in Zimbabwe. Copyright This work is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License. It may be reproduced by anyone working to promote the menstrual health of women and girls as long as it is clearly referenced. It may not be used for commercial purposes unless written permission has been obtained from Irise International. Irise International would appreciate information on how and where this resource has been used. Please send details to [email protected] Second edition 2013 3 4 Contents Introduction................................................................................................................. 6 Irise Menstrual Hygiene Toolkit .................................................................................. 7 Reusable Pad Training ................................................................................................. 9 Costings ..................................................................................................................... 10 Reusable Pad Training Workshop ............................................................................ 11 Reusable Pad Designs ................................................................................................ 16 Introduction ........................................................................................................... 16 Materials ................................................................................................................ 18 Using the Pads........................................................................................................ 18 Washing and Drying ............................................................................................... 18 How to make Irise ‘Insert’ Pad .................................................................................. 20 Irise ‘Insert’ Pad Pattern ........................................................................................ 23 How to Make Irise ‘All in One’ Pad ........................................................................... 24 Irise ‘All in One’ Pad Pattern .................................................................................. 27 Appendices ................................................................................................................ 28 Appendix 1: Estimates for Costs of Workshops..................................................... 28 Appendix 2: Using, Washing and Drying Reusable Pads Handout ........................ 30 Appendix 3: Costing Tables from East Africa ......................................................... 32 www.irise.org.uk [email protected] 5 Introduction Irise is a charity and research group working to develop a replicable and sustainable solution to Menstrual Hygiene Management in East Africa. We believe that a successful Menstrual Hygiene Project needs to provide an appropriate product, health education and be tailored to the local community. Our Menstrual Hygiene Toolkit is designed to enable other organisations and individuals to replicate our work. We ask organisations and individuals using our resources to make a donation to Irise so we can continue providing our support for free to community groups in East Africa. We also ask you to let us know how and where you used them so that we can measure the impact of our work and network with groups working on this issue. We are constantly developing our resources so feedback is always welcome. 6 Irise Menstrual Hygiene Toolkit This resource is part of a set of resources designed to help organisations develop and evaluate a menstrual hygiene project. The table and timeline below summarise the resources available and how they can be used together. All the resources can be accessed at www.irise.org.uk/online-womens-healthlibrary/resources. Resource Evaluation Toolkit Reusable Pad Training Resource Menstrual Hygiene Project Training Resource Menstrual Health Education Resource Gender Teaching Resource Handouts Questions and Answers about Menstrual Hygiene How to Make an Irise ‘Insert’ Pad How to Make an Irise ‘All in One’ Pad Videos How to Make an Irise ‘Insert’ Pad How to Make an Irise ‘All in One’ Pad Description …contains tools to help assess menstrual hygiene in the community and to evaluate and monitor the impact of training or project delivery. …is a step by step guide on how to make two common reusable pad designs from locally available materials. …contains training sessions to help a group develop a menstrual hygiene project. …contains information and ideas about delivering menstrual health education based around common questions. …is designed to help engage men and boys in menstrual hygiene training and projects. …a leaflet containing common questions and answers about menstrual hygiene. …a pictorial step by step guide to making this pad to be used in conjunction with the Reusable Pad Training Resource. …a pictorial step by step guide to making this pad to be used in conjunction with the Reusable Pad Training Resource. …a step by step guide to making this pad to be used in conjunction with the Reusable Pad Training Resource. …a step by step guide to making this pad to be used in conjunction with the Reusable Pad Training Resource. 7 The timeline below illustrates how the resources in Irise’s Menstrual Hygiene Toolkit can support the different stages of project development and delivery. Gender Teaching Resource Irise Resource Evaluation Toolkit Menstrual Health Education Resource Menstrual Hygiene Project Training Resource Evaluation Toolkit Development and Delivery of a Menstrual Hygiene Project Monitoring and Evaluation Reusable Pad Training Resource Menstrual Hygiene Training Stage of Project Development and Delivery Assessment of Menstrual Hygiene Needs Reusable Pad Training Menstrual Health Education Engagement of men and boys Reusable Pad Training Phase 1 Visit local markets and research what materials are available at what price. Buy a selection of the materials available. Work out the cost of making the two pad designs using the costing table provided in this resource. Phase 2 Run a training workshop on how to make, use and wash resuable sanitary pads. Phase 3 Ask the participents to come back in 1-2 months, feedback on the pads and suggest improvements. Phase 4 Meet with the trained participants and the community and collect their feedback on the training and their opinions on how they would like to take it forward. If feedback is positive you can consider developing a project using the ‘Menstrual Hygiene Project Training Resource’ to enable participants to develop their ideas and skills. Costings The following table should be completed prior to the training workshops through research at local shops and markets. Equipment Press studs Buttons Velcro Ribbon Elastic New Fleece Second hand fleece Plastic Plain Cotton Patterned Cotton Towel Thread Equipment costs (£)per unit Amount needed for Irise ‘Insert’ Pad 2 items Cost per ‘Insert Pad’ Amount needed for Irise ‘All in One’ Pad 1 item 4cm 20cm 2cm n/a 23pads/m2 19pads/ m2 25pads/m2 8pads/m2 70pads/ m2 28pads/ m2 23pads/m2 1.5m n/a 1.5m Cost Per ‘All in One’ Pad ‘Insert’ Pad ‘All in One’ Pad Total using…. E.g. buttons, elastic, second hand fleece, plastic, plain cotton, towel, thread Total using… Total using… 10 Reusable Pad Training Workshop Top Tip This session is much more effective in a smaller group where people can interact, ask questions and where individual feedback can be given on the quality of the pads. We would recommend a maximum of 50 women in one session. Outline of what will be covered in the Workshop It is often useful to write the agenda for the day on the blackboard or on a piece of paper stuck to the wall. Start the session by introducing yourself and outlining the plans for the day: “My name is……………………………I am from a group/organisation working to support women and girls. We believe that all women and girls have a right to basic sanitation and education and that through working together we can help to deliver these rights to everyone. Today we are going to be delivering training on how to make reusable sanitary pads. Firstly I will show you the different designs and how to use, wash and dry them. Then I will demonstrate how to make the pads. Finally we will have an interactive session where everyone can have a go at making their own pad.” Icebreaker It is important to create a relaxed and interactive atmosphere. The box below contains some different ideas for icebreakers. Basic Introduction: Ask everyone to share their name, why they have attended the workshop and what they hope to get out of it. This is useful for training sessions with representatives from different organisations and places. Female Role Models: Ask participants to volunteer to share a female role model who has inspired them. This is appropriate for a training session for professionals or a more formal community group. Song: Ask the group if someone would be willing to lead everyone in a song and a dance before the session starts. This is appropriate in many East African women’s groups but not suited to a professional setting. 11 Introduction to a Reusable Product Show the group the Irise ‘Insert’ Pad and the Irise ‘All in One’ Pad. Pass some samples around the room. Demonstrate how to attach the pads in the underwear. For the Irise ‘Insert’ Pad demonstrate how to separate the base pad and the insert. Small Group Activity Give the participants some disposable and reusable pads. Ask them to discuss: - What products women in their community use at the moment? - What are the pros and cons of these products? - What are the pros and cons of a reusable product? - What are the pros and cons of a disposable product? Explain/Summarise the following pros and cons of reusable and disposable products Pros Cons Reusable Cheaper Can wash and reuse Can make at home Less absorbent than disposable pads Must have soap and water to use safely 12 Disposable Very absorbent Can use and throw away More expensive Waste disposal issues Not widely available or affordable Outline the differences between the two Irise Pads: Product name Irise ‘Insert’ Pad Description Target population A base pad with Older removable inserts women that can be changed Women and throughout the girls who day. want to make pads at home. Irise ‘All in One’ Pad An all in one pad with no removable absorbent material. The entire pad must be changed regularly. School Girls Individuals who wish to produce pads to sell. Pros Cons The design can be easily adapted for use as incontinence pads or nappies. Removable insert is easy to wash. Easy to make. Similar in design and feel to a disposable pad. Generally cheaper to make. More bulky than the ‘All in One’ Pad Generally more expensive to make. More difficult to wash as absorbent material cannot be removed. More difficult to make. How to Use, Wash and Dry the Pad All women who receive training or plan to use a reusable pad should also receive instructions on how to use them safely. The ‘Using, Washing and Drying Reusable Pads Handout’ (Appendix 2) summarises this information. Outline the key points during the training session: - - The insert of the ‘Insert’ pad or the entire ‘All in One’ pad should be changed at least once every 8 hours. Base Pads can be used for longer but should be changed if they become stained by blood. Pads should be soaked in cold water then washed with soap and water. Pads can be dried in the sun as this helps kill bacteria and dry the pad quickly. Wearing a damp or dirty pad may cause irritation or infection Frequently Asked Questions What if I’m too embarrassed to dry the pads outside? Some people suggest placing the pads in the bottom of a basin so that the pads are hidden from sight but still drying outside. The basin can then be placed on a roof. 13 Others suggest placing the pads on the washing line and covering them with a thin sheet of cotton so they are hidden from sight. Should I use bleach to wash the pads? Some people suggest using bleach to wash reusable pads. However it is important to bear in mind the risks to young children related to keeping bleach at home and the extra expense in households that struggle to afford basic commodities. It is also important to note that if bleach is used to wash the pads and they are not thoroughly rinsed then the bleach may cause irritation to the genital area. We do not feel that bleach is necessary, but if used safely should not be harmful. Should I only wash the pads in boiled water or tap water? Some people ask about the need to use boiled water or tap water to wash the pads. In keeping with the explanation below about the difference between something being clean as opposed to sterile, we feel that it is appropriate to wash the pads using water from the same source that is used to provide water for washing underwear, clothes or menstrual cloths. Boiling water does kill most bacteria and make it very clean but that does not mean other water sources are not sufficiently clean for washing sanitary products. There is no guarantee that tap water will be cleaner than water from other sources. Can I iron the pad? Some women have asked about ironing the pads. This is acceptable but they should be wary of melting the plastic inside the pad. Clean vs Sterile Sterile means an area with no bacteria. From a medical perspective the genitals are not a sterile area and have many ‘healthy’ bacteria that provide a barrier against infection. Washing too regularly or using soaps on the genital area can upset the balance of bacteria and actually cause infection. Disposable pads are not sterile and nor is underwear. There is therefore no need to sterilise pads. They should be washed with soap and should be clean before use. They should also be dry before use. Demonstration of How to Make the Pad Prior to the session you will need to prepare samples of pads at different stages of the manufacturing process. If you have the facilities you can show the Irise videos designed to accompany this resource. You can also distribute the ‘Irise All in One’ Pad and The Irise ‘Insert’ Pad Handouts at this point and use this as an aid to talk 14 through the different stages of making both pads. All resources are available at: www.irise.org.uk/online-womens-health-library/resources/ Make your own Pad Before the session it is useful to prepare packs for the women containing their rations of equipment i.e. pre-cut portions of fleece, cotton and plastic and a needle. This ensures that materials are not wasted and saves time during the session. Scissors and thread can also be included in the packs or they can be shared. While the participants make the pads you should be available to answer questions and help if problems arise. Leave the samples of the different stages laid out on a table so that participants can come and view them while they are making their pads. Conclusion If there is time for everyone to finish making at least one pad, conclude the session by bringing everyone back together and giving feedback on the pads that have been made. You may wish to ask the participants to share one thing that went well and one thing that was challenging about making the pads. If participants have not finished making the pads you can ask them to share one positive thing about the session and one negative thing. It is useful to try and arrange a time to feedback on the finished pads and if you will be seeing the women again in the future you can ask them to bring their pads to this session. The participants may wish to close the session themselves, particularly if they are part of a women’s group or local organisation. You should give them the opportunity to do this. 15 Reusable Pad Designs Introduction There are many different designs of reusable pads available on the internet for individuals to use or produced by businesses for sale. These can be broadly classified into two designs. Design A is a base pad with a removable, absorbent insert that can be changed regularly. Design B has a non-removable absorbent insert, similar to a disposable pad, so that the whole pad has to be changed regularly. Design B Design A Examples of these designs being sold by businesses are included in the table below. Design A: ‘Insert’ Pad Luna pads, Canada Afripads, Uganda UGER pads, (Jatan Sanathan) India Design B: ‘All in One’ Pad Eco femme, India Family Impact, Zimbabwe Angelpadz, UK This resource outlines a simple pattern for both these designs that can be easily adapted to locally available materials and contexts. Market research focus groups in Zimbabwe and Uganda suggest that older women prefer Design A. Women suggested it could also be used for post-partum bleeding and incontinence. This design may be slightly more expensive; however it is very easy to make. It is also easy to wash because the insert can be separated from the base pad. Schoolgirls preferred Design B because it was most similar to a disposable pad. This pad is more difficult to make, may be slightly cheaper but is more difficult to wash because the absorbent material is not removable. We belive that choice is important and empowering so we recommend teaching both designs 16 and allowing women and girls to choose for themselves. Generally the ‘Insert’ pad is more appropriate for programmes where women are expected to receive training and then make the pad at home on their own and the ‘All in One’ Pad, because it is more difficult to make, is more suited to community projects where participants will make pads as a group and receive ongoing training. Product name Irise ‘Insert’ Pad Description Target population A base pad with Older women removable inserts that can Women and be changed girls who want throughout the to make pads day. at home. Irise ‘All in One’ A pad with built Pad in absorbent material. The entire pad must be changed regularly. School Girls Individuals who wish to produce pads to sell. 17 Pros Cons Removable insert is easy to wash. Easy to make. The design can be easily adapted for use as incontinence pads or nappies. More bulky than the ‘All in One’ Pad Generally more expensive to make. Similar in design and feel to a disposable pad. Generally cheaper to make. More difficult to wash as absorbent material cannot be removed. More difficult to make. Materials - - Cotton Plastic (shower curtain, plastic table cloth, umbrella, mackintosh) Absorbent material (fleece, towel: these can be bought second hand or new or used in combination, for example old towel or fleece can be used inside the ‘All in One’ and new fleece on the outside.) Needle and thread or a sewing machine Fastenings: buttons, press studs, ribbon, elastic Dark or patterned materials are better because they hide stains. Dark materials also absorb more sunlight and therefore dry more quickly. Think about the time it will take to attach your fastener of choice. This is the most time consuming stage of making the pads and if the group are going to make them to sell they may wish to spend a bit more on something quicker to attach. The prices of different materials should be carefully researched before the workshop so that women can be presented with a range of materials and costings. In order to find materials that are available locally you may need to be innovative. Remember to ask the group for ideas during the training workshop, our most innovative ideas come from the groups we train. Many East African markets will have second hand fleece jumpers, towels and bed sheets. These are ideal for a training workshop where much of the equipment may be wasted. Using the Pads The pads should be changed reguarly. The removable insert of the ‘Insert’ Pad and the entire ‘All in One’ Pad should be changed every 6-8 hours. The base pad can be changed less frequently but should be changed if it becomes stained. Women may wish to buy or make a small plastic bag to transport their used pads or inserts in. Washing and Drying Both designs should be soaked in cold water for 2-4 hours after use. They should then be cleaned with soap and water and dried in the sun. The soap and sunlight help to kill bacteria. Drying outside in the sun also helps to dry the pads more 18 quickly. The pads may cause irritation or infection if they are worn damp or dirty. There are reports of girls using damp pads or their pads becoming mouldy after being left to dry inside. Many women and girls will feel embarassed about drying their pads outside. It is important to emphasise that reusable pads should be clean and dry when they are worn. You can suggest the following: - The pad designs have been chosen because they are not immediately recognisable as pads. This is particularly true of the ‘Insert’ Pad where the base and and insert can be separated. - The pads can be placed in the bottom of a basin on the top of a roof. The rim of the basin hides the pads from sight but they can still be dried in the sun. - The pads can be placed on the washing line and covered with a thin cotton sheet. - Women and girls can form groups where these issues are discussed so that drying pads outside is more acceptable. Women and girls should be invited to discuss potential issues around washing and drying the pads and to suggest ways they could be addressed. Every woman and girl who make a pad should receive a photocopy of the using, washing and drying instructions in Appendix 2. 19 How to make Irise ‘Insert’ Pad The following steps can be used in conjunction with the Irise training video. There is also a handout which can be used as a teaching aid. All the resources are available on our website: www.irise.org.uk/online-womens-health-library/resources/ 1.Using the pattern provided below, cut three circles out of cotton and one circle out of plastic. Larger size pads can be made by increasing the size of the circle. 2.Place the circles on top of each other in the following order: cotton, plastic, cotton, cotton. Ensure that patterned sides of the cotton are facing each other. Pin in place and sew around the circle leaving a small hole. plastic cotton 4.Turn the pad inside out through the hole you have left and sew around the circle again, sealing the hole and ensuring the plastic is pulled tight. 20 5. Make some straps using ribbon, elastic or scrap material. The straps can be measured out using the diameter of the pad. Measure out a piece of your chosen material the length of the pad and cut in half. If you are using scraps of cotton cut a piece 2-3 fingerbreadths wide, fold in half, sew along one edge and turn inside out for neatness. 7.Fold the pad the way it will sit in the underwear and mark on where the straps need to be attached. It is better if they are near the edge otherwise they will become stained by blood. Mark on where the fasteners will be attached. Using two fasteners is more secure than one alone. 21 8. Attach the straps and fasteners FRONT BACK 9. Cut pieces of absorbent material using the insert patterns. You can alter the length depending on the size of the base pad and personal preference. Oval shaped inserts based on the ‘All In One’ Pad pattern can also be used. You can use towel or fleece or alternating layers of fleece and towel. For light flow use three layers. Add more layers for heavier flow. 22 Irise ‘Insert’ Pad Pattern 20cm 3cm 8cm 20cm 1.5cm 8cm 8cm 18cm 23 How to Make Irise ‘All in One’ Pad The following steps can be used in conjunction with the Irise training video. There is also a handout which can be used as a teaching aid. All the resources are available on our website: www.irise.org.uk/online-womens-health-library/resources/ 1.Cut a cross shape out of cotton and fleece using the pattern provided. Cut one oval shape out of plastic and two oval shapes out of fleece. A larger pad can be made the same way by increasing the dimensions on the pattern. Pads for heavier flow can be made by increasing the number of fleece or towel ovals in the centre of the pad. Fleece Plastic Cotton 24 1. Place the fleece cross on the table. Place the two fleece ovals with one plastic oval on top in the centre of the fleece cross. Pin them in place. 2. Sew the oval shapes to the cross using backstitch. 3. Turn the piece over so the oval is facing down on the table top and the fleece cross is facing upwards. Place the cotton cross with the pattern face down on top of the fleece cross. 25 4. Sew around the cross attaching the cotton to the fleece using backstitch. Leave a small gap. 5. Turn inside out and seal the hole. Sew around the insert again so it is held securely in place. 6. Attach the fasteners. 26 Irise ‘All in One’ Pad Pattern 18cm 8cm 5cm 18cm 20cm 5cm 7.5cm When cutting out the fleece the following arrangement maximises the number of pads that can be made per metre. 27 Appendices Appendix 1: Estimates for Costs of Workshops Below are some estimates for the cost of a training workshop in Uganda. We use generous estimates of the amount of equipment needed to make the pads for training. This budget can be adapted (e.g: 25 women making 3 of each pad, 50 women making 1 of each pad) to suit the individual organisation’s budget and programme. 50 women making 3 of each pad Total: £195 Costs for 150 Irise ‘Insert’ Pads Item Cost/pad (£) Quantity per pad (max) Pads/m Total quantity(m2)+10% contingency Total Cost (£) Cotton 0.47/m2 0.06 0.6x0.6 8 21 9.87 Plastic 1.01/m2 Fleece 5/m2 Velcro 0.3/m 0.04 0.2x0.2 25 7 7.07 0.22 0.24x0.18 23 7 35 0.01 0.04 25 6 1.8 53.74 Costs for 150 Irise ‘All in One’ Pad Item Cost/pad (£) Quantity per pad (max/m) Pads/unit Total quantity(m2)+10% contingency Total Cost (£) Cotton 0.47/m2 0.02 0.18x0.2 28 6m 2.82 Plastic 1.01/m2 0.01 0.08x0.18 70 2.5m 2.53 Fleece 5/m2 Velcro 0.3/m Total 0.26 0.01 0.02 19 9m 45 50 4m 1.2 51.55 Additional Costs Item Cost/unit Quantity Total (£) Printing 0.05/double sided sheet 330 16.5 Scissors 2.5 25 62.5 Needles 0.03 50 1.5 Trainer 12.5 2 25 Trainer transport 10 2 20 Food - 1 32.5 Total (£) 158 Total equipment cost ‘Insert Pad’(£) 53.74 Total equipment cost ‘All in One’ Pad(£) 51.55 Additional Costs(£) 158 Total (£) +10% 290 29 Appendix 2: Using, Washing and Drying Reusable Pads Handout The following page is a copy of the using, washing and drying reusable pads handout. It has been included here for ease of photocopying. A copy should be given to anyone who will be using a pad. 30 Using, Washing and Drying Reusable Pads Using… The pad insert or the entire ‘all in one’ pad should be changed at least once every 8 hours. Base Pads can be used for longer but should be changed if they become stained by blood. …Washing… Pads should be soaked in cold water then washed with soap and water ©SODIS/Eawag …Drying. Pads should be dried outside in the sun. ©SODIS/Eawag Wearing a damp or dirty pad may cause irritation or infection 31 Appendix 3: Costing Tables from East & Southern Africa Please send us your costings table so we can keep our information up to date and accurate. Bulawayo, Zimbabwe Equipment Equipment costs (£) Press studs 0.3/item New Fleece 2.75/m2 Plastic 2/m2 Patterned Cotton 2/m2 Total using press studs and fleece (£) Irise ‘Insert’ Pad 0.6 0.12 0.08 0.25 1.05 Irise ‘All in One’ Pad 0.3 0.14 0.03 0.07 0.54 Kisumu, Kenya Equipment Equipment costs Irise ‘Insert’ Pad (£) Press studs 0.04/item 0.08 Buttons 0.01/item 0.02 Velcro 0.57/m 0.02 2 Nappy Fabric/Towel 6.44/m 0.28 Fleece Not known Plastic 0.36/m2 0.01 2 Plain cotton 0.55/m 0.07 2 Patterned Cotton 0.60/m 0.08 Thread 0.15/200m 0.01 Total using press studs and patterned 0.46 cotton (£) Total using velcro and plain cotton (£) 0.39 Other Items Scissors 0.21-0.50/item 32 Irise ‘All in One’ Pad 0.04 0.01 0.01 0.34 0.01 0.02 0.02 0.01 0.42 0.39 Kampala, Uganda Equipment Irise ‘Insert’ Pad Press studs Equipment costs (£) 0.04/item 0.08 Irise ‘All in One’ Pad 0.04 Buttons 0.01/item 0.02 0.01 Velcro 0.3/m 0.01 0.01 Elastic Ribbon New Fleece 0.38/m 0.25/m 5/m2 0.08 0.05 0.22 n/a n/a 0.26 Second hand fleece 1/m2 0.04 0.05 Plastic 1.01/m2 0.04 0.01 Plain Cotton 0.47/m2 0.06 0.02 Patterned Cotton 0.74/m2 0.10 0.03 Towel Thread 8.75/m2 0.5/200m 0.38 0.01 Totals Total using new fleece, patterned cotton, 0.45 and press studs (£) Total using second hand fleece, plain 0.16 cotton and velcro (£) Other Items Needles Sewing machine Scissors n/a 0.01 33 0.35 0.10 0.03/item 50-125 2.5 Kasese, Uganda Equipment Velcro Second Hand Fleece New Fleece Plastic Plain Cotton Patterned Cotton Elastic Thread Total using old fleece, plain cotton and velcro (£) Needle Pins Equipment costs (£) 0.75/m 1/m2 Not available 1.01/m2 0.63/m2 1.5/m2 0.02/m 0.63/200m Irise ‘Insert’ Pad 0.03 0.04 Irise ‘All in One’ Pad 0.02 0.05 0.4 0.08 0.19 0.004 0.01 0.57 0.01 0.02 0.05 n/a 0.01 0.11 Other items 0.03/item 0.38/1500 34 35 Educate. Empower. Evaluate.
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