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A Study on
Seizing Educational Opportunities to
Combat Period Poverty in
Midden-Groningen
Minor More Healthy Years: Current Challenges in Public Health
BWMIN19
Coordinator: Prof. Dr. J. Fleer
22.01.2021
Final Report: Team 2 January 2021
Table of Contents
1. Introduction 5
1.2 Context 6
1.3 Structure and Research Questions 6
1.4 Methodology and Methods 7
2. Discovery Phase 8
2.1 Stakeholder Analysis 9
2.2 Picturing End-Users 10
2.3 Eects of Period Poverty 10
2.3.1 Health Risks 11
2.3.2 Absenteeism 11
2.3.3 Stigmatisation 12
2.4 Causes of Period Poverty’s Endurance 12
2.4.1 Financial Inaccessibility and Intervention 12
2.4.2 Educational Gaps, Lack of Awareness and Intervention 13
2.4.3 Taboos 15
2.5 Discovery Phase Conclusion 16
3. Define Phase 17
3.1 Choosing a Pathway 17
3.1.1 Pathway I 17
3.1.2 Pathway II 18
3.2 Personas and Customer Journeys 18
3.3 Problem Definition and HMW-Question 20
4. Ideate Phase 21
4.1 Solution Visions 22
4.1.1 School Education 22
4.1.2 Social Media for Further Education and Awareness 23
4.2 Solution Package 24
4.2.1 Necessity and Feasibility 25
5. Prototype and Test Phase 27
5.1 Social Media Education Research 27
5.1.1 Design of Prototype 28
5.1.2 Testing 29
5.1.3 Examining Thematic Preferences 29
5.1.4 Improving the Prototype 30
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Final Report: Team 2 January 2021
5.2 School Education 31
5.3 Action Plan 32
5.4 Customer Journey 33
6. Conclusion 33
6.1 Experience and Limitations 35
7. References 36
8. Appendix 38
8.1 List of Stakeholders Contacted 39
8.2 Information on Interviews 41
8.3 Personas and Customer Journeys 42
8.4 Data from School Survey 48
8.5 Data from General Population Survey 50
8.6 Example of Policy Proposal 52
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Final Report: Team 2 January 2021
1. Introduction
At least 500 million individuals out of the quarter of the world population who menstruate lack
access to menstrual products because they cannot aord them (UNICEF, 2018; Boyce, 2020; Tull,
2019, p.3). However, the lack of economic resources to finance menstrual products is not the only
reason for the existence of period poverty. The multifaceted phenomenon combines various
poverty factors, including, but not limited to, access to sanitary facilities and crucially, education
on menstruation (De Bovengrondse, 2019). From a human rights and gender equality
perspective, researching and finding solutions to period poverty is long overdue. However, the
1
amount of scholarly research is still small, and most interest has been devoted to period poverty
in developing countries. Nevertheless, recent media attention to period poverty in the UK has
2
given the Dutch public food for thought: Could period poverty also be a problem in the
Netherlands?
According to Plan International NL (2019), about 9% of 12-25-year-old females in the Netherlands
could sometimes not aord menstrual products. While these figures clearly show a need for
political action, the Dutch government continuously delegates responsibility downwards and
reduces the problem to economic poverty (Bruins, 2020). In order to create political awareness
and solutions for period poverty in the Netherlands, more research seems urgently needed.
Therefore, we investigated period poverty and its many facets in one of the poorest regions in
the Netherlands, Midden-Groningen. We begin this report on our research project with a
description of the context.
According to Human Rights Watch (2017), struggling to aord menstrual products causes situations in
1
which menstruating individuals cannot fully enjoy certain rights, such as those to education (Art. 13 ICESCR,
Art 28-29 CRC, Art. 10 CEDAW), work (Art. 6-7 ICESCR, Art. 11 CEDAW) and health (Art. 11 CESCR, Art. 11
CEDAW). Furthermore, period poverty can be seen as a barrier to gender equality and a violation of the
right to non-discrimination (Art. 5 CEDAW, Art. 5 CCPR). Holding the state accountable for violations of
those rights caused by period poverty and suggesting legal interventions is however beyond the scope of
this report.
Studies by ActionAid (2016, 2017), Plan International UK (2017) and YoungScot (2018) on period poverty
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and menstrual stigma in the UK have attracted a lot of international media attention. Furthermore, the
successful development of the “Period Products (Free Provision) (Scotland)” bill has attracted a lot of
attention in 2020.
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Final Report: Team 2 January 2021
1.1 Context
Midden-Groningen is a municipality with a population of 60.953 people in the province of
Groningen (Figure 1). As suspected in the beginning and later confirmed, the Aletta Jacobs
College (referred to as AJC throughout this report) and the food bank Midden-Groningen stand
out as particularly important locations for our research. Likewise, the alderman (referred to as the
Wethouder throughout this report), Peter Verschuren, needs to be highlighted as an important
local figure for our research. A relevant characteristic of this municipality is that the percentage of
households below the low-income threshold is much higher than the Dutch average (see Graph
1). In its most impoverished areas, like Hoogezand-Zuid, child poverty has been increasing in
recent years, with currently 1 in 5 children growing up in a household with low income. Compared
to a decreasing national average of 1 in 12 aected children, this makes Midden-Groningen often
the centre of political sorrow. The decision to use Midden-Groningen as a research case was
furthermore based on the concerns of a citizen. Due to the above-average levels of poverty and
eyewitness accounts, it is suspected that individuals in the municipality suer from period
poverty. We want to test this assumption with our research and develop solutions to tackle period
poverty in the Gemeente Midden-Groningen based on our results.
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Graph 1: Percentage of households that live
below the low income threshold for a minimum of
4 years,
Source: Gemeente Midden-Groningen, Sociaal
Planbureau Groningen (2018).
Final Report: Team 2 January 2021
1.2 Structure and Research Questions
Reflecting our research process, the content of this report is divided into four sections. First, in
the Discovery Phase, we conducted a problem analysis of period poverty in Midden-Groningen.
We started by examining whether the underlying assumptions could be confirmed and asked:
How are individuals aected by period poverty in Midden-Groningen? After establishing that
there are severe eects that justify the development of solution-oriented interventions, we asked
for underlying causes: Why are individuals in Midden-Groningen in this situation? The resulting
desk and field research were then used to make a reasoned decision on our research direction
and define a problem statement in the Define Phase. From this, our guiding question ‘How might
we increase knowledge about menstruation and raise awareness for period poverty among high
school students?’ emerged. Subsequently, we used the Ideate Phase to elaborate on solution
options and combine them into a solution package. Finally, we tested a prototype and designed
two policy briefs in the Prototype and Test Phase to prepare the implementation of our final
solution. Graph 2 summarises the double diamond design process that underlies this report.
1.3 Methodology and Methods
By researching the eects and causes of period poverty in Midden-Groningen, we want to
determine the extent of the problem and the impact of contributing factors. Therefore, we used a
mixed-method approach in our field research, combining quantitative and qualitative methods. In
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Final Report: Team 2 January 2021
additional desk research, we consulted multiple scientific sources, such as peer-reviewed journal
articles. Additionally, we used popular media, such as newspaper articles or social media trends,
to understand current societal attention. In the Discovery Phase, the anonymity of quantitative
surveys allowed us to gather numerous data on health eects, received education, taboos and
awareness of period poverty, for example. Specifically, we distributed surveys to citizens of
Hoogezand and school children from two high schools in the region. To understand general
taboos and behaviours, we also surveyed the region’s general population. Absenteeism data
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provided by the AJC was also examined. However, we acknowledge the limitation of low
response rates and potential bias in our survey responses. To balance this, we also used
qualitative methods that have the advantage of understanding end-users’ experiences and
stakeholders’ views. Such qualitative methods included many email inquiries and
correspondence, telephone and online interviews with stakeholders, and field trips (see
appendix: 1. List of Stakeholders Contacted). Furthermore, we gained crucial insights through five
in-depth interviews with school children in Midden-Groningen. Due to the Covid-19 pandemic,
these interviews were conducted using GoogleMeet. Such qualitative methods were also
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preferred in the subsequent two phases of this research. However, in testing our prototype, we
supplemented user feedback with an analysis of quantitative data on user engagement.
2. Discovery Phase
In the Discovery Phase, we aimed to research the eects and causes of period poverty in
Midden-Groningen. Our strategy was to find common claims in the existing academic literature
(Figure 3) and check whether these could be verified in Midden-Groningen. We deliberately
chose academic over popular literature since we expected the former to be less influenced by
societal taboos. Before conducting desk and field research, we first analysed relevant
stakeholders and imagined our end-users. Throughout our presentation of results, we also refer
to insights gained from educational events that we attended during the ‘Perspectives Weeks’ and
Survey for Hoogezand citizens: 118 surveys distributed (response rate: 2.5%); Survey for high school
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students at Winkler Prins and AJC: unlimited distribution, n=32 (3 students from a third school outside of
Midden-Groningen); General population survey: unlimited distribution, n=152.
The interviews followed the ethical guidelines of the University of Groningen. The interview guide was
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inspired by Hennink, M. Hutter, I., and Bailey, A. (2010). Qualitative Research Methods. SAGE Publications
Ltd. For reasons of privacy, interviewees are anonymised. See appendix 2. Information on Interviews.
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Final Report: Team 2 January 2021
relevant existing interventions. Ultimately, we conclude and reflect on our findings, as well as the
remaining gaps in our knowledge.
2.1 Stakeholder Analysis
An analysis of stakeholders oered the first overview of possible research avenues. The
following organisations or persons are of particular relevance to our project.
If school education contributes to internalisation of taboos at a young age, and girls decide to
skip school because of period poverty, local schools both have an influence and are influenced
by the phenomenon in Midden-Groningen. This makes the AJC, the only high school in the
municipality, a key stakeholder during research and potential future interventions. Demands for
gender equality make period poverty a politicised topic as well. Therefore, local politicians are
important stakeholders, as well. Because we expected a political reluctance in addressing taboo
topics like period poverty, convincing politicians for our cause was considered crucial. At the
same time, we hoped to benefit from political networks and contacts, some of which were
already available through our clients. The local food bank is another stakeholder that is closely
linked to period poverty. Donations of menstrual products reduce individual suering, but the
demands are hardly ever met in a donation-based system. This dilemma lent itself to a closer
examination. Related stakeholders are also product companies and the general public. The
former have the potential to increase product access for individuals suering from period
poverty. The latter are important stakeholders for social awareness.
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Figure 3: Contributing factors and potential effects of period poverty
Final Report: Team 2 January 2021
Other stakeholders can be found on the labour market, since local employers are indirectly
aected by work absenteeism due to period poverty, for example. Furthermore, adverse health
eects resulting from period poverty may increase the burden on stakeholders in the public
health sector, such as health insurance funds, general practitioners and psychologists. We initially
saw an opportunity to investigate such eects of period poverty in contacting Menzis or the GGD.
Because of this wealth of stakeholders, we sought to remain as open as possible to all research
directions. This was also important for understanding the interplay of multiple stakeholders'
motivations for (in)action as we learned in a health psychology workshop. However, our most
important stakeholders are our end-users, whom we will now take a closer look at.
2.2 Picturing End-Users
To carry out a solution-oriented problem analysis, it is necessary to deal with assumptions about
end-users. We expected to narrow down our end-users during the research process but wanted
to remain as open as possible at the beginning. Therefore, ‘Individuals in Midden-Groningen
suering from period poverty’ were broadly established as the group of people to be studied.
Based on research from De Bovengrondse (2019) and our expectations, this category could
include potential target groups like food bank customers, the homeless, refugees, or families
living on a budget of less than 50 / week more generally.
A hypothetical scenario where an end-user is aected by period poverty could be seen in a low-
income household in Hoogezand. While the teenage daughter is too ashamed to ask, the single-
father does not understand his daughters’ needs for menstrual products nor has the financial
means to buy them. Such a scenario also matches concerns of the AJC headmaster about period
poverty among her students. A look at insurance data provided an initial overview of the possible
number of people aected. 828 women currently have the aanvullende zorgverzekering, and in
response to our inquiry, we learned that 288 of 16-45- year-old women in Midden-Groningen
currently have a gemeentepolis from Menzis.
2.3 Eects of Period Poverty
There are several eects associated with period poverty, such as health risks, absenteeism and
stigmatisation. In our field research, we investigated their occurrence in Midden-Groningen. For
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Final Report: Team 2 January 2021
reasons of clarity, we will give a summary here. A full analysis can be found in our discovery
report.
2.3.1 Health Risks
According to some scholars, suering from period poverty leads to adverse health eects such
as a higher risk of Reproductive Tract Infections (RTI) or disruption of vagina floral balance
(Homan et al., 2014; Torondel et al., 2018). After contacting a UMCG gynaecologist and 16
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practitioners and psychologists in the area, we could not confirm these eects in Midden-
Groningen . However, it must be stressed that the possibility of getting infections will remain.
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Some women might be ashamed, unaware of infections, or do not see the importance of
contacting a doctor.
2.3.2 Absenteeism
Claims of a relationship between period poverty and school/work absenteeism are popular but
highly debated. Respondents from the school survey and interviewees confirmed that
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absenteeism is mainly due to menstrual symptoms. Furthermore, we believed to see a pattern in
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girls school absenteeism data. However, more data is needed to support this assumption. Even
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though we could not find any evidence, some students may be aected by period poverty but did
not want to admit having problems or felt uncomfortable filling in the survey.
Due to the limited number of research, this relationship is still debated in the literature. See for example
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Sumpter & Torondel, 2013.
The gynecologist nevertheless mentioned the rare possibility of Pelvic Inflammatory Disease or sepsis
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resulting from infections with group A streptococcus and one psychologist explained that period poverty
can have a negative impact on mental health.
Because some studies do not find a relationship between girls’ school attendance and increased product
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provision (see Oster & Thornton, 2010; Oster et al., 2012), absenteeism could relate to period symptoms
instead (Ichino and Moretti, 2009). However, anecdotal evidence from Scottish schools, for example,
suggests some relationship (Lennon, 2017).
50% of the school survey respondents (N=32) reported to have missed school days because of menstrual
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symptoms. There were no indications of missed school days because of product inaccessibility.
Female absenteeism data, covering a three month period (September - November 2019) received from
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the AJC.
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Final Report: Team 2 January 2021
2.3.3 Stigmatisation
Individuals aected by period poverty and the process of menstruation are believed to be
stigmatised, partly due to the framing of individuals or products as we learned in a workshop on
moralities. The school survey results suggest that respondents have high leaking fears in public
(MV=7.14) compared to leaking at home (MV=2.4). Furthermore, 75% of the respondents (n=32)
reported feelings of dirtiness/discomfort while menstruating. Finding empirical evidence of period
poverty was challenging since signs are often kept hidden out of shame. However, even the
partial evidence for these eects in Midden-Groningen underlines the necessity to tackle period
poverty in the municipality. Therefore, we now turn to the causes of this phenomenon.
2.4 Causes of Period Poverty’s Endurance
2.4.1 Financial Inaccessibility and Intervention
Due to the widespread definition of period poverty as the lack of financial resources to access
menstrual products, poverty is widely considered its primary cause. Our research confirms this:
With 30-40 women asking for diapers or menstrual products at the food bank per week, many
individuals in Midden-Groningen seem unable to aord menstrual products. Furthermore,
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teachers reported students’ demand for menstrual products but experienced abuse of free
product provision. As the pandemic made it challenging to meet those in need, we ultimately
resorted to survey data. However, since only one respondent knew someone aected, we turned
our research interest to more social causes of period poverty’s endurance. However, one of our
clients developed a product-access intervention: Since the local food bank’s workload even
increased due to the pandemic, Jolanda Oest started her second ‘Bloedserieus’ campaign in
October. Until the end of 2020, she collected menstrual product donations weekly at local stores
and community centres for the food bank. However, despite their success, such individual
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voluntary projects are no substitute for long-term solutions.
At the same time, free supply of menstrual products is rare. We contacted one company (Essity) and four
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supermarkets (Lidl, Aldi, Jumbo, Action) and were mostly turned away. Campaigns like the recent
collaboration of Always, Kinderhulp and food banks (September - November 2020) are rare exceptions.
Other mentionable interventions to tackle problems with product access include the free provision of
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menstrual products in public places and on educational sites (e.g. Scotland, New Zealand), the period-card
scheme (proposal in the UK), or online communities. See our discovery report for more information.
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Final Report: Team 2 January 2021
2.4.2 Educational Gaps, Lack of Awareness and Intervention
The lack of knowledge surrounding menstruation and period poverty is believed to be a crucial
social factor contributing to period poverty’s endurance. Insucient menstrual education has
multiple impacts, not only on gender relations (UNESCO, 2014) but also on family relations, with
menstrual education often being left to mothers (Coast, Lattif & Strong, 2019). If education is
insucient and girls never learn ‘what is normal’, diagnostic delays or handling of period poverty
that is hazardous to health can result (De Bovengrondse, 2019). Both teachers and students
agreed that increased education would normalise conversations on menstruation, which would
increase donations and make asking for products a less uncomfortable experience. This is the
basis for another example of intervention against period poverty: After advocacy from Plan UK to
include biological, physical, emotional and social aspects of menstruation in schools, menstrual
health entered the curriculum in 2020 (BBC, 2019). Although not all demands were met, this
educational intervention shows a political awareness of the need to expand menstrual education,
which may also be achievable in the Netherlands.
After an interview with Jelle Wiering on Dutch sex education, we already expected gaps in Dutch
menstrual education and a meeting with teachers of the AJC confirmed this. Two surveys
provided us with unexpected insights on menstrual education in the Netherlands and among
school children in Midden-Groningen. As Graph 2 shows, while 87.3% of Dutch respondents
(n=71) reported education on menstruation’s biological aspects, this was still the only type of
menstrual education received for 11.3%. Furthermore, compared to German or international
respondents, the Dutch scored worse on menstrual health (12.7%) and TSS (16.9%). Interestingly,
the school children survey in Midden-Groningen showed a dierent picture (Graph 3 on the next
page). Here, only 46.88% (n=32) reported education on menstruation’s biological aspects. An
explanation could be that VMBO-level students do not receive any menstrual school education,
as we learned from teachers. In-depth interviews with school children confirmed trends that the
survey results suggested. All interviewees had only learnt about the biological aspects of
menstruation. Most deal with this lack of school education by educating themselves using social
media, the internet or asking family members. Additionally, all interviewees showed a desire for
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more education, to which we return later.
Corresponding to the literature, all female interviewees sought advice from their mothers.
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Final Report: Team 2 January 2021
The surprise of these educational gaps and our own experiences with some peers’ and
stakeholders’ restrained enthusiasm led us to make a small digression on problem awareness.
Participation in a lecture on health communication further encouraged us to understand dierent
motivations for (in)action in this way. Our assumptions of low awareness of period poverty’s
existence in the Netherlands and its eects were confirmed both by our survey results (Table 1) as
well as our interviews. Interestingly, most interviewees were surprised to hear of period poverty
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Graph 2: Received Education on Menstruation, Data from General Population Survey (n=152).
Graph 3: School Children: Received Education on Menstruation, Data from School Children
Survey (n=32).
Final Report: Team 2 January 2021
in Midden-Groningen, although one female suspected girls at her school suered from period
poverty.
2.4.3 Taboos
Related to education and awareness of period poverty is a unique combination of taboos (NL
Times, 2019). Even in the supposedly progressive Dutch society, open conversations about
menstruation are rare or euphemisms are used (Kissling, 1996). As we noticed in an artistic
workshop, advertisements reflect and promote these taboos. The consequences are a non-
thematisation of period poverty, female insecurities about correct handling of menstruation or
even a negative attitude towards the female cycle (Forbes et al., 2003; Grabinsky, 2019;
Johnston-Robledo et al., 2013).
Likert-scales and experienced levels of cooperation provided us with insights on menstrual
taboos. Our school survey results show that talking about menstruation is still perceived as
uncomfortable (Graph 4). The diculties we experienced in arranging interviews with students
and the low response rates to the surveys additionally indicate discomfort when talking about the
menstruation. However, little interest in interviews might also be influenced by the online setting.
Furthermore, we initially planned to hand out surveys at the food bank, but many customers
indicated that the questions were too personal, resulting in a decision to cancel the distribution.
Jolanda Oest also noticed this discomfort, because some food bank customers were ashamed to
ask for menstrual products. As the following example shows, we also noted an unexpected
gender dierence concerning taboos underlining the necessity for tackling taboos from a
gender-equality perspective. Interestingly, also all female interviewees expected males to laugh
at a woman with a bloodstain. However, when asked to describe a menstruating woman in one
word, all insulting responses were from females.
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Table 1: Awareness of period poverty and its effects, Data from General Population Survey (n=152).
Final Report: Team 2 January 2021
2.5 Discovery Phase Conclusion
Our desk and field research confirms the initial concern that period poverty is a problem in
Midden-Groningen that requires urgent attention and intervention. Regarding our first research
question which asked for eects of period poverty in the municipality, we have looked for
adverse health eects, school/work absenteeism and stigmatisation and found partial evidence
in Midden-Groningen. Due to the current pandemic and taboo surrounding the issue at hand, it
was challenging to contact individuals suering from period poverty directly. The resulting gaps
in knowledge needed to be filled during other research phases. Regarding the second research
question that concerned the causes for period poverty’s endurance, we established poverty to
be the phenomenon’s primary cause but turned to social factors contributing to its persistence.
Knowledge gaps regarding menstruation, lack of awareness of period poverty and culturally
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Graph 4: Levels of discomfort when talking about menstruation, Data from School Children Survey
(n=32).
Figure 4: Statements made by interviewees.
Final Report: Team 2 January 2021
produced taboos were highlighted and identified as unexpected but highly relevant findings. We
shared these results with our clients who had already suspected diculties in empirically
studying and quantifying the problem. Nevertheless, they welcomed the many perspectives we
included in our problem analysis and encouraged us to decide which path to follow for the next
research phases.
3. Define Phase
3.1 Choosing a Pathway
In the Define Phase, we reflected on our insights from the Discovery Phase and decided on our
project’s future direction. Based on a reasoned decision, we then narrowed down our end-users
in a process of re-adjusting our initial expectations through dialogue with end-users and clients.
The resulting personas and customer journeys facilitated a problem definition and the
formulation of a ‘How-Might-We-Question’.
During our desk research, we identified inaccessibility of products, lack of knowledge, and
culturally produced taboos as contributing factors to period poverty. From this, two pathways
follow, each suggesting dierent courses of action. Wanting to pool our resources eectively, we
made a reasoned decision on which pathway to follow.
3.1.1 Pathway I
A prevalent definition of period poverty defines it as the lack of financial resources to access
menstrual products. This implies that interventions need to focus on facilitating product access.
Although problems to finance menstrual products could be the leading component of period
poverty in Midden-Groningen, our field research could only find partial evidence. However, our
tentative findings regarding product accessibility, such as concerns of food bank volunteers, can
inspire further research. Especially citizens’ discomfort regarding the topic impeded gathering
more empirical evidence. On the one hand, future long-term research in low-income areas like
Hoogezand-Zuid may enable researchers to establish necessary trust levels to research such
taboo topics. On the other hand, such experience suggests that period poverty should not be
reduced to product inaccessibility at the expense of socio-cultural factors. This corresponds with
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Final Report: Team 2 January 2021
some scholars’ criticism of interventions that only focus on product access and thus oversimplify
a “complex socio-cultural” problem (Bobel, 2019, p.9). Having reflected on the limits of our
research and seeking to avoid simplification, we ultimately decided against this pathway.
3.1.2 Pathway II
An alternative definition of period poverty accounting for socio-cultural factors seems more
appropriate for us. This also corresponds to the unexpected evidence on the lack of menstrual
knowledge in our field research. Accordingly, period poverty can also take the form of knowledge
poverty. This can firstly refer to a lack of knowledge on menstruation. Our survey among school
children confirms knowledge gaps in multiple aspects of menstruation. Unfulfilled learning needs
can be found in biological aspects, menstrual health, practicalities, and socio-cultural aspects of
menstruation. The extent of menstrual knowledge obtained at a young age determines how
individuals handle period poverty. Learning about health risks may prevent individuals suering
from period poverty from resorting to alternative products. Secondly, knowledge poverty can
refer to a lack of awareness of period poverty. Our survey on the general public confirmed this. If
society and especially policymakers do not know about period poverty, let alone its existence in
the Netherlands, they will not contribute to a solution.
Given our empirical findings regarding insucient menstrual education and lack of awareness of
period poverty, we feel motivated to tackle these factors. Furthermore, following the educational
and awareness pathway may even lay the foundation for product access interventions. Having
chosen this pathway, it is now time to zoom-in further and imagine potential end-users by
creating personas and customer journeys.
3.2 Personas and Customer Journeys
In the Discovery Phase, we defined our end-users as individuals in Midden-Groningen aected
by period poverty. However, due to our decisions, we need to concretise this definition. Our
educational approach makes school children, whether aected by period poverty or not, our
primary end-users. However, the chosen pathway is also about long-term social awareness of
period poverty. Therefore, the public at large can be considered a secondary end-user. The
following personas and customer journeys are the product of a continuous readjustment process
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Final Report: Team 2 January 2021
based on communication with our clients and our observations from in-depth interviews with
school children.
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Emma is an ambitious VMBO student at AJC and has a passion for dancing. Most of the time, she
practices at home, as her family cannot aord ballet class. Besides dancing, she enjoys spending
time with friends.
This morning Emma got her period again. She is stressed out because she knows that her low-
income family is always short on period products. Because the thought of leaking at school
terrifies her, she decides not to go to school and meet her friends today. Instead, she stays in
bed, feeling insecure and anxious.
Sara is a VWO student at the AJC in Hoogezand. Being an optimistic and diligent person, she
dreams of becoming a teacher. She lives together with her financially stable parents.
Last week, Sara learned about reproduction and the menstrual cycle in biology class. Although
she did not learn anything about the use of menstrual products, related health issues, or the
socio-cultural aspect of menstruation, she feels suciently educated. Tampons and pads seem to
be the most common menstrual products for her. However, being a busy student, she
infrequently changes her menstrual products, causing her occasional discomfort (she is unaware
See appendix for a full version of personas and customer journeys.
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Final Report: Team 2 January 2021
that she suers from minor infections). Sara also has a friend who skips school when she is on
her period or keeps on “forgetting” products without telling her the reason. Sara is confused by
her friend's behaviour, as keeping products in the school bag is “common sense” to her.
Milan Dijkstra is a 24-year-old Dutch student. He went to school in Midden-Groningen but
currently studies law at the RUG. Being a member of a student organisation, he has a strong
social network, and he seeks to give the impression of a down-to-earth, emancipated young man.
In line with this, he occasionally engages in welfare work with his friends and documents such
activities on social media.
For 10 minutes, Milan has been absorbed in his phone. He has just read a trending Instagram
post about period poverty, something he had never heard of. He is shocked by the information
that this is a problem in his home-town, Midden-Groningen. Although the topic makes him a little
bit uncomfortable at first, this quickly turns into a sense of guilt: Why does he know so little about
this problem? When he reads that he can donate menstrual products to the local food bank, he is
relieved. Not only does he feel better about himself now, but telling his friends about his actions
also boosts his confidence.
3.3 Problem Definition and HMW-Question
Having narrowed down our research and empathised with end-users using personas and
customer journeys, we are now able to state the following problem definition:
There is a lack of menstrual knowledge and awareness of period poverty in the Netherlands.
Education tends to be limited to the biological aspects of menstruation, thereby neglecting socio-
cultural elements. Instead of discussing menstruation within the syllabus, it is only discussed by
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Final Report: Team 2 January 2021
some teachers after a related ‘accident’ occurs. This exemplifies that the students only receive
education when the situation demands it and not in a consistent and controlled manner.
If individuals lack knowledge about period poverty and menstruation, this negatively impacts
their health in multiple ways. Not knowing of existing diseases, health complications, and
practical aspects of menstruation (e.g. product types and treatment of period symptoms) may
increase the vulnerability to infections or menstruation-related diseases, like in the case of our
persona Sara. Furthermore, if education is reduced to biological aspects of menstruation only, the
topic is abstracted from daily experiences, aggravating open conversations. Individuals suering
from period poverty, such as Emma, might consequently refrain from seeking help and the short-
term stress caused by this experience may develop chronic anxiety.
As Milan’s customer journey shows, this problem is not limited to the school environment, since it
has long-term societal implications. What is learnt and not learnt in school, especially at high
school, will be reflected at the societal level. The lack of knowledge about period poverty and
menstruation results in a lack of social empathy: As our field research confirmed, there is
currently little stimulus to think of possible eects of period poverty in daily life and thus no
motivation to seek a collective solution as a society. Accordingly, a sustainable solution to period
poverty needs to start with enhancing knowledge about menstruation and awareness of period
poverty, ideally already at high school. Specifying this aim even further, we let the following
question guide us through the next research phases:
4. Ideate Phase
The goal of the Ideate Phase was to decide on a final and impactful, yet feasible solution to this
HMW-question. In order to do so, we first developed two solution visions. Then, we summarised
our ideas in a solution package to concretise these visions together with input from clients and
related stakeholders.
Initially, we collected multiple ideas before deciding on the ideal solution and evaluated these
according to the criteria of practical feasibility, cost-eectiveness and end-user needs. For
How might we increase knowledge about menstruation and raise awareness for period
poverty among high school students?
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Final Report: Team 2 January 2021
example, we considered incorporating menstruation and period poverty topics into the existing
school curriculum. However, each school’s freedom concerning teaching format and content may
increase taboos and therefore, end-users’ needs cannot be met. To prevent this, another idea
was to use existing external providers of menstrual education. Schools could invite these
providers to give quality-assured lessons on menstruation. Since the AJC and the government of
Midden-Groningen stated that they would not appreciate external parties interfering in local
aairs, we also ruled out this option due to the lack of practicability. Lastly, to make the
educational content accessible for a larger audience, we saw great potential in using
informational websites. This solution was also rejected after a cost-benefit analysis. The costly
creation and maintenance of a website do not pay o with the expected eects.
4.1 Solution Visions
In multiple brainstorming sessions, we asked ourselves how we might ideally close existing
knowledge gaps and create more awareness of period poverty. Finally, we decided on the
following two visions:
4.1.1 School Education
Ideally, all Dutch school children should receive an all-encompassing menstrual education.
School is an attractive setting for this since lessons can be tailored to fill the identified gaps in
knowledge and directly address school children’s educational needs. Furthermore, next to
menstrual knowledge, students can also be taught empathy and donating behaviour. Our
research has indicated that there is a need for action here as well. Lastly, lessons may also be
research objects themselves and thus continuously improved: Learning outcomes can be
measured and learning content evaluated and adapted where necessary.
To make such a vision reality, some basic requirements must be met. After learning that there are
no school lessons on menstruation oered in the Netherlands, we realised that such new lessons
would need to be added to the curriculum. As our clients point out, this is only possible if such
lessons have been scientifically tested beforehand, meet quality standards and exhibit
demonstrable learning success. Furthermore, this solution would also need to be standardised
nationally or be available to schools free of charge or at low cost as an external oer. Lastly,
teachers must have received the necessary training to prevent backlash eects, such as
unintentionally increasing taboos.
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Final Report: Team 2 January 2021
However, this vision alone is no satisfactory answer to the HMW-question. Such educational
solutions will only address our primary end-users, school children, thereby only improving
menstrual knowledge in society in the long-run. Furthermore, depending on the quantity of these
lessons, the risk remains that children who feel uncomfortable or ashamed decide not to attend
them.
4.1.2 Social Media for Further Education and Awareness
Another vision focuses on virtual education. For example, social media is a popular virtual context
for knowledge creation, with 84% of Dutch teenagers regularly engaging in social networking
(Statista, 2019; Dron and Anderson, 2014). Our Interviews with teenagers confirmed our
assumption that using social media for educational purposes is perceived as more modern and
innovative than traditional school lessons. Quizzes and challenges can be added to platforms,
stimulating users to learn more and test their knowledge. Being easily accessible for anyone,
educational content will also reach beyond the classroom: In this way, knowledge gaps of today’s
society, not just tomorrow’s, could be closed. The anonymity of this virtual context may also invite
more open conversation on experiences with period poverty. Ultimately, also this vision is
dynamic: User behaviour can become a research object, and social media content is adaptable to
identified users’ needs. A hypothetical implementation of such a vision would also be easier than
a curriculum change. Once the content has been created, and a provider has been found, only a
large number of followers have to be generated to ensure proper working of social media
algorithms. This can be facilitated by promoting such platforms in various ways.
However, this vision also has its limitations. After all, social media use is voluntary. Individuals who
do not actively seek or want to find educational content on menstruation and period poverty on
social media will only be addressed by chance. This is particularly regrettable since many are still
not convinced of the necessity to tackle period poverty. Furthermore, nobody can be expected to
take advantage of every virtual learning opportunity. Therefore, the learning eect for members
of society who no longer receive school education may be less than hoped. Since menstruation
is largely considered a sensitive topic, some individuals may also prefer a personal conversation,
especially about menstrual taboos and period poverty.
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Final Report: Team 2 January 2021
4.2 Solution Package
While both of these visions undoubtedly have potential, neither constitutes an impactful answer
to our HMW-question as an individual solution. Therefore, we decided together with our clients
and mentors to make a solution package.
Our goal is to develop an original solution that addresses the educational needs of both our
primary end-users, school children in Midden-Groningen, and of our secondary end-users,
members of society. Both types of end-users have knowledge gaps regarding menstruation that
need to be filled and a lack of awareness of period poverty. Only combining physical and virtual
education can achieve this goal.
School education should lay a knowledge foundation for life. If school children receive an all-
encompassing menstrual education as we envisioned, then females will understand how to deal
with their menstruation safely and healthily, which may decrease female school absenteeism or
the risk of self-inflicted adverse health eects. Furthermore, a taboo-free safe space may be
created to share experiences and discuss problems. As teachers point out, such a safe space is
needed to encourage children to voice their needs. At the same time, students sensitised for
period poverty may develop a desire for long-term eradication of the phenomenon and
increasingly see themselves as part of its solution. Social media are both a supporting factor and
a solution component in its own right.
In general, it makes sense for practical reasons to integrate social media into the classroom. On
the one hand, this would promote more interactivity: Our peers mentioned ideas of contests and
challenges, for example, that could be initiated and guided by social media. On the other hand,
available tools such as quizzes can regularly measure students’ learning outcomes and enable
adaptation of educational content to individual learning needs. This is especially important since
dierent school levels may require dierent learning approaches.
Besides, teachers agree that educational content on social media is also a possibility for further
voluntary education. Students who want to continue learning may use educational social media
to get and exchange information. In this way, our second vision balances out the shortcomings of
the first. The anonymity of virtual learning allows students to have a shame-free learning
experience. Furthermore, educational social media content is also freely available for our
secondary end-users, members of society. Although use is voluntary, goals like broader societal
awareness of period poverty will be achieved. Importantly, the unrestricted availability of social
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Final Report: Team 2 January 2021
media education must be highlighted. Menstruation or period poverty is experienced mostly
outside of school. At times, information needs to be available on-demand and enable “here and
now learning” (Martin and Ertzberger, 2013, p. 77) to make decisions in a real-life context (Lave,
1988).
As already indicated in our problem statement, menstrual education, let alone an all-
encompassing one, is not yet part of Dutch school curricula. Midden-Groningen could lead the
way and become the first municipality to educate its youth and citizens in such an original and
innovative way. A look at end-users needs, habits, and teachers’ feedback will provide further
insights into this solution’s necessity and feasibility.
4.2.1 Necessity and Feasibility
First, we see a great demand for more comprehensive menstrual education. According to the
Menstruatie Voorlichtingsinstituut, 80% of 15.000 Dutch girls between 12-19 would like to have
more information about menstruation (De Bovengrondse, 2019) and all interview participants
showed a desire for more comprehensive menstrual school education. A student at AJC also
stressed that she would have liked to receive basic information on menstruation at school before
educating herself online. Teachers especially highlighted the need for more menstrual education
to remove taboos and also confirmed the feasibility of including menstrual education in schools,
provided they have been tested.
Second, in line with our findings from the Discovery Phase, our school survey showed that the
internet is more often mentioned as a source of knowledge on menstrual product use, menstrual
health, or TSS than teachers (Table 2). A similar phenomenon can be seen with the awareness of
period poverty (Table 3). While these statistics show apparent deficiencies in school education
that need to be addressed, they also display the opportunity that social media presents for our
goals. Our clients also believed that social media is a great way to reach a large audience, but
that such virtual education should not be limited to one platform. Usage of multiple social media
platforms must be considered to reach users with dierent preferences. In addition, magazines or
short articles can inform individuals who do not use social media at all. However, this could be a
possible idea for the long term, once social media has reached a certain amount of people and
sparks interest in the other media platforms.
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Final Report: Team 2 January 2021
Having discussed two ideal visions from our brainstorming process and combined them into an
original solution package that reflects our end-users’ needs, we are now able to formulate an
answer to our HMW-question:
In the next phase, we determine what we can contribute to this solutions’ implementation.
A combination of school and social media education may fill the existing gaps in menstrual
knowledge and raise awareness of period poverty among high school students.
26
Sources to Gain Awareness of Period Poverty
Friends
Family
Social Media
News
Internet
Documentaries
19.3%
12.3!%
22.8%
15.8%
15.8%
15.8%
Table 3: Sources to gain awareness of period poverty. Data from General Population Survey (n=152).
Sources to Gain Knowledge About Menstruation-Related Topics
Books
Family
Teacher
Internet
Friends
Biological
process of
menstruation
13.3%
40!%
87!%
26.7 %
-
Menstrual
product and their
use
-
73.9 %
8.7%
52.2 %
17.4 %
Menstrual health
-
50!%
12.5%
75!%
-
TSS
-
50!%
10!%
60!%
20!%
Table 2: Sources to gain knowledge about menstruation-related topics. Data from School Children Survey (n=32).
Final Report: Team 2 January 2021
5. Prototype and Test Phase
The Prototype and Test Phase’s goal was to determine how our solution package of combined
school and social media education may be implemented. We first address the idea of social
media education, since this plays a role both within school lessons and independent from them.
A prototype of a social media page was designed, and user engagement with this prototype
analysed. This way of testing oered us preliminary insights into user preferences on thematic
categories, which helped us improve this prototype. Next, we looked at what is required to
implement school lessons on menstruation and period poverty and explain our political actions
and ambitions. Lastly, we exemplify how an end-user will benefit from the implementation of our
solution package using a service scenario.
5.1 Social Media Education Research
“Testing is just another form of research (...) (It) ensures that the design becomes more and more
focused toward getting it right” (Baer, 2008, p.78)
Because we wanted to gain first insights into how young people react to information on the
thematic areas that we have found knowledge gaps in, we designed a prototype of an
educational social media page on Instagram. Over a month we published 1-2 posts daily from
14 15
dierent thematic categories, which we based on our end users’ identified learning needs: Period
health, period products and their use, and information on period poverty. We also followed our
peers’ recommendation to add challenges to test whether end-users would favour interactive
learning methods. We started our testing process, assuming that users engaging with our
prototype would have similar knowledge gaps and learning needs that we identified in the
Discovery Phase. Furthermore, due to the popularity of Instagram, we expected to reach a large
audience and that users will feel comfortable with the simple design and ease of use in a virtual
context they are already familiar with. Particularly, we assumed that users would react positively
to posts on period health since we identified the greatest knowledge gaps here.
Our Instagram page prototype can be accessed via this link: https://www.instagram.com/period.jungle/.
14
Time period for testing: 31.11.2020 - 31.12.2020.
15
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Final Report: Team 2 January 2021
5.1.1 Design of Prototype
Since this was considered appealing to our target audience, all educational posts had a comic-
style design and the informational texts were provided in English and Dutch. To increase the
outreach of this social media page and upon client recommendation, we also used available
tools, such as hashtags or links to popular profiles. Most content was obtained from reputable
internet sources. To test knowledge and build in interactivity, we ultimately included quizzes and
16
examined how users’ react to virtual knowledge assessments.
5.1.2 Testing
We tested our prototype to determine the value of Instagram as a social media opportunity for
menstrual education and period poverty. Furthermore, testing served the purpose of continuously
improving our prototype to make it employable both within school lessons as well as
Examples of such sources are the NICHD, Mayo Clinic, or Planned Parenthood.
16
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Final Report: Team 2 January 2021
independently. Improvements were made based on collected data on user behaviour and
preferences over four weeks and individual feedback.
17
5.1.3 Examining Thematic Preferences
According to our data analysis, content on period poverty was liked the most, including and
excluding content that was promoted externally, while content on period health was liked the
least (Graph 5).
However, the dierence in the average number of likes could also be explained by the fact that
period poverty-related content was viewed more often or that a comparably larger number of
such posts were shared early on. This insight suggests that Instagram may be better suited for
raising awareness than for in-depth education. However, this result strengthens our argument as
it shows that school education is highly needed and that social media has nevertheless potential
to create awareness beyond the classroom. At the local level, this can be particularly beneficial:
We monitored the daily amount of followers, the development of likes per post (Days 1-4, Day 7), the total
17
number of times a post has been seen and individual posts’ comments (Day 1, 3). 3 and 7 days after a post
had been published we also noted the number of times period.jungle was visited, the number of unique
accounts that have seen the post, the number of accounts that started following period.jungle and the
percentage of accounts reached that were not following period.jungle. A full list of data can be requested.
29
Graph 5: Average amount of likes per theme, Data collected by research team over four weeks.
Final Report: Team 2 January 2021
Interestingly, an informative post on Jolanda Oest’s Bloedserieus campaign had the most
views.
18
5.1.4 Improving the Prototype
In addition to data analysis, we considered feedback from followers for the prototype’s
improvement. Most of the individuals who provided feedback were aged 20 and either from the
Netherlands or living in Groningen.
The professional, similarly designed posts, and the regularity of posting were highlighted as
assets of our prototype. Moreover, statements about surprised reactions to our period poverty-
related content confirmed the awareness-raising potential of social media. Through constructive
feedback, we found opportunities for improvement that we could include into the testing phase.
For example, we have complied with the request to provide more information on the answers for
quiz questions from the first testing week onwards. We also followed the suggestion to create
several pictures with information per post and were thus able to present educational content
more attractively. A significant change was the introduction of a ‘Linktree’ which made it easier
19
for users to reach dierent sources.
A follower inspired us to add an anonymous feedback quiz. This gave us an impression of user
preferences in addition to our data analysis. The results confirm our previous findings: For
example, 71% of respondents preferred content on period poverty over challenges (29%), and all
wished to have more quizzes. Additionally, 82% of respondents said that they learned something
from our Instagram page over one month. Such feedback shows us that social media can also
fulfill an educational function.
The supportiveness of our clients about using Instagram as an education tool remained. They
attempted to get in contact with Dutch influencers to increase outreach, but this was
unsuccessful. Instead, we decided to reach out to similar pages, acquaintances and the university
newsletters to promote our page, which was more successful.
5.1.5 Maintenance of Social Media Education
Due to limited space, we had to limit our analysis of Instagram data in this report. Please contact us for
18
further information or data.
Linktree is a tool used to link multiple sites through a single link.
19
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Final Report: Team 2 January 2021
The improved prototype is now ready to be used for educational purposes. Since our final
solution is a combination of school and social media education, we focus here on the use of this
prototype for our primary end-users, school children. Therefore, we will look at the
implementation of the prototype in school education in the next step. However, it should be said
that an NGO is needed to manage the platform and regularly share content in the long-run. NGOs
tend to have the means to professionally test user behaviour and interests, which is needed to
improve the content and the way information is communicated to society.
5.2 School Education
All-encompassing menstrual school education would use social media resources, such as our
prototype, to test students’ learning outcomes and encourage their use for further voluntary
learning. However, our clients have reminded us that we are not qualified to prototype and test
such lessons as undergraduate students. Nevertheless, testing prior to implementation is
needed. Therefore, our mentors and clients support the idea of making two political proposals to
set processes in motion that we are not allowed to carry out ourselves.
Our first proposal is addressed to the AJC. Using our research findings, we will convince the
headmaster to establish a multidisciplinary team to test a menstruation lesson pilot. In a second
proposal, we ask the Wethouder of Midden-Groningen to support this pilot financially and
establish cooperation with stakeholders, like the GGD. These proposals were initially prototyped
and subsequently tested and improved through feedback. Thanks to a committed politician’s
eort, we could discuss our ideas with teachers from the AJC and the Wethouder. Thereby, we
were able to increase the chances of our proposals’ success. The Wethouder assured us that the
municipality could oer funding opportunities and assist with establishing contacts. The AJC
teachers confirmed that such a pilot could be tested and evaluated at their school. They also
welcomed the funding possibilities through the municipality and political leverage.
5.3 Action Plan
The implementation process is just beginning with these proposals. While our goal within this
minor is to convince the aforementioned stakeholders and set the testing process of a
menstruation lesson in motion, we would like to see our proposal fully implemented in the long-
run. For the best results, a team of experts and motivated people is required. Although the AJC
teachers would prefer a school-internal pilot, support from health professionals (e.g. GGD), or
researchers from the Aletta Jacobs School of Public Health may be useful for learning content
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Final Report: Team 2 January 2021
and methodology. The Wethouder and possibly the City Council may help finance the pilot if the
political will is there.
Following the approval of our clients, the motivation of all stakeholders is necessary for success.
Headmasters must be convinced of such a pilot's necessity, and teachers must be motivated to
make a change. Although it is not mandatory, action from the municipality to fund the pilot is
beneficial. Related to these factors of success are potential challenges. We already experienced
that period poverty is often cast aside as unimportant due to social stigma. We hope to convince
stakeholders such as headmasters, who may meet our ideas with resistance, of the urgency for
action by presenting our research. Despite the Wethouders’ assurances, argumentation skills
regarding financing are likely to be required. Nevertheless, we are confident that the following
steps can be implemented:
First, Jolanda Oest will present our policy recommendations to the college of Burgemeester and
Wethouders and upon client confirmation, two policy briefs will be sent to the AJC and the
Wethouder, respectively. Ideally, the headmaster of the AJC would be convinced by our findings
and create an expert group to prepare and conduct the pilot. The municipality of Midden-
Groningen would oer funding opportunities and establish contact with the GGD to provide
optimal framework conditions. The results should be analysed and evaluated so that a reasoned
decision on the future implementation on menstruation lessons can be made. Potentially, a
successful pilot could also grab the attention of national policymakers.
5.4 Customer Journey
To round o, we would like to return to the personal level. If our idea were to be realised, how
would Emma van der Waal, our first persona, benefit?
Emma would have received a basis of menstrual education in school. For example, she would
have been taught that a tampon should not be worn longer than eight hours to reduce the risk of
getting TSS. She was also shown how to use social media for further education. One morning,
she notices that she has no period products left and wonders whether she could use toilet paper
instead. But she remembers a warning on social media about this and ultimately decides against
it. Instead, being more comfortable talking about periods, she will ask her friends for products
and eventually talk about her problems with a close teacher.
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Final Report: Team 2 January 2021
The thought of such added value of our solution makes us confident that we have initiated an
important process that will hopefully be followed up with motivation.
6. Conclusion
We want to summarise this report with a chronological overview of our research process before
finally reflecting on our experience and the limitations of this project.
The starting point of this project was a comprehensive problem analysis of period poverty in
Midden-Groningen. Two questions accompanied our research in this Discovery Phase: We
wanted to know how individuals were aected by period poverty in Midden-Groningen and why
individuals were in this situation. Through the stakeholder analysis, a description of the research
context and an initial imagination of our end-users, we familiarised ourselves with the problem
and prepared our research.
Our subsequent analysis compared existent claims in scholarly literature with our findings from
qualitative and quantitative field research in Midden-Groningen. Potentially due to our limited
time and lack of data at hand, little evidence could be found on adverse health eects of period
poverty and increased absenteeism of aected individuals. We found some evidence on the
financial inaccessibility of products and evidence on taboos regarding menstruation and period
poverty within society. Importantly, we came across unexpected findings related to knowledge
and awareness. Our surveys and insights from in-depth interviews yielded strong evidence of
gaps in menstrual knowledge and a lack of awareness of period poverty among school children
in the area and the general population.
Because of these research findings, we decided to choose the ‘educational path’ over the
‘product access path’ in the Define Phase. This decision allowed us to concretise our end-users.
From this point onwards, school children in Midden-Groningen constituted our primary end-users
and members of society our secondary end-users. Empathising with both types of end-users
through personas and customer journeys, we were then able to formulate a problem definition.
Gaps in menstrual knowledge and lack of awareness of period poverty contribute to individuals
potentially exposing themselves to health risks through harmful behaviours due to period poverty
(e.g. the use of toilet paper as an alternative menstrual product). Secondly, this results in a lack of
open conversation, making it dicult for people aected to express their needs. Thirdly, the lack
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Final Report: Team 2 January 2021
of awareness leads to a lack of social empathy and motivation in Dutch society for solution-
oriented action.
In the search for solutions to close gaps in menstrual knowledge and raise awareness about
period poverty during the Ideate Phase, we elaborated on two visions, the combination of which
proved to be promising. On the one hand, comprehensive school education on menstruation, by
filling all knowledge gaps our research identifies, ensures a necessary basis of menstrual
knowledge. On the other hand, virtual education opportunities, like social media, can be used in
the classroom or outside of it, thereby enabling on-demand “here & now” learning in a real-life
context.
Within the Prototype and Test Phase, we used our research and understanding of the problem to
develop a prototype educational Instagram page. While we continuously sought to improve this
prototype during a four-week testing phase, we also gained insights into how young people react
to information on the thematic areas that we identified knowledge gaps in. These findings
confirmed our conviction that the combination of school education and virtual education would
be impactful. Afterwards, we communicated with teachers from the AJC, a high school student,
the wethouder and our clients on how to implement the school education part of the solution
package. The result is a package of two policy briefs, one recommending the AJC to prepare,
test and evaluate a pilot and another one advising the municipality of Midden-Groningen to
support this pilot financially and to establish useful contacts.
6.1 Experience and Limitations
Overall, this project has been a challenging yet ultimately rewarding experience for the entire
team. While we were sometimes frustrated by some stakeholders’ lack of understanding, social
empathy, and willingness to make a change, we were also pleasantly surprised by others’
motivation and ambition. Although many of our peers saw period poverty as a problem of product
inaccessibility, we observed an increasing understanding of the phenomenon’s educational
dimension over time. We also see this as a success and confirmation of our achievements. In
general, the growing number of people who recognise and want to fight the problem of period
poverty in Midden-Groningen and the Netherlands gives us confidence that progress will be
made despite the ocial end of our involvement. Furthermore, several stakeholders predicted a
high probability for the implementation of our policy proposals. A great confirmation of our eorts
is also the invitation from the municipality of Midden-Groningen policy advisor, Alice Tamminga, to
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Final Report: Team 2 January 2021
present our policy brief and research publicly. We hope that we can meet the expectations of our
clients with these prospects.
Ultimately, however, we have to point to the limitations of our research. Expectedly, the Covid-19
pandemic influenced our field research opportunities. Due to the topic's sensitive nature, we
would have preferred face-to-face meetings and interviews, but for public health reasons, we had
to settle for virtual means in most cases. The current situation also often delayed or prevented
communication with stakeholders (see the large number of email inquiries compared to email
correspondence in the list of stakeholders contacted in the appendix). In addition, the taboo
concerning the topic made it dicult to approach people, for example, for interviews. When using
our research results, these circumstances should be taken into account. They also had a
significant influence on our project development. If we had been able to establish contact with
food bank customers, we might have opted for the ‘product access path’ and sought solutions to
facilitate access to free menstrual products in Midden-Groningen. In the end, however, we
believe to have found a promising alternative in the form of the ‘educational path’. In retrospect,
this had at least as much intervention potential, and we are very satisfied with the results of our
research project. Nevertheless, we hope that we could also provide an incentive for further
research on period poverty in the Netherlands since this will be required to put an end to the
problem once and for all.
7. References
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Bruins, B. J. (2020). Reactie op verzoek commissie over het onderzoek over menstruatie-
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Bruins, B. J. (2020). Reactie op verzoek commissie over het onderzoek over menstruatie-
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Grabinsky, J. (2019). The SDGs, Surveys, and the Need for Additional Evidence on Menstrual
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Homan, V., Adelman, S., & Sebastian, A. (2014). Learning by Doing Something Else: Experience
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Article
Full-text available
Objectives This study presents a scoping review of evidence relating to knowledge and experiences of puberty and menstruation among females aged 10–14 years in low- and middle-income countries. Methods Forty-four items from 12 countries were identified from a systematic scoping review and screening of 8083 items. Included studies were quality assessed. Results A majority (40/44) of studies used school-based samples, and fifteen studies reported on interventions. Girls had inadequate knowledge about menstruation; menarche as a trigger for girls learning about menstruation was common. Adolescents struggled with menstrual hygiene. Negative emotions were associated with menarche and menstrual management. A minority of studies dealt explicitly with puberty. Most girls obtained information about menstruation and/or puberty from their mothers, although mothers were not necessarily girls’ preferred source for learning about these topics. Conclusions Young adolescent girls are under-prepared for puberty and menstruation. Predominantly school-based studies mean we know little about young out-of-school adolescents. The evidence base lags behind the rise in interest from practitioners as well as the development (and evaluation) of puberty and/or menstruation interventions.
Article
Full-text available
Background: The extent to which reproductive tract infections (RTIs) are associated with poor menstrual hygiene management (MHM) practices has not been extensively studied. We aimed to determine whether poor menstrual hygiene practices were associated with three common infections of the lower reproductive tract; Bacterial vaginosis (BV), Candida, and Trichomonas vaginalis (TV). Methods: Non-pregnant women of reproductive age (18-45 years) and attending one of two hospitals in Odisha, India, between April 2015 and February 2016 were recruited for the study. A standardized questionnaire was used to collect information on: MHM practices, clinical symptoms for the three infections, and socio-economic and demographic information. Specimens from posterior vaginal fornix were collected using swabs for diagnosis of BV, Candida and TV infection. Results: A total of 558 women were recruited for the study of whom 62.4% were diagnosed with at least one of the three tested infections and 52% presented with one or more RTI symptoms. BV was the most prevalent infection (41%), followed by Candida infection (34%) and TV infection (5.6%). After adjustment for potentially confounding factors, women diagnosed with Candida infection were more likely to use reusable absorbent material (aPRR = 1.54, 95%CI 1.2-2.0) and practice lower frequency of personal washing (aPRR = 1.34, 95%CI 1.07-1.7). Women with BV were more likely to practice personal washing less frequently (aPRR = 1.25, 95%CI 1.0-1.5), change absorbent material outside a toilet facility (aPRR = 1.21, 95%CI 1.0-1.48) whilst a higher frequency of absorbent material changing was protective (aPRR = 0.56, 95%CI 0.4-0.75). No studied factors were found to be associated with TV infection. In addition, among women reusing absorbent material, Candida but not BV or TV - infection was more frequent who dried their pads inside their houses and who stored the cloth hidden in the toilet compartment. Conclusion: The results of our study add to growing number of studies which demonstrate a strong and consistent association between poor menstrual hygiene practices and higher prevalence of lower RTIs.
Book
The Managed Body productively complicates ‘menstrual hygiene management’ (MHM)--a growing social movement to support menstruating girls in the Global South. Bobel offers an invested critique of the complicated discourses of MHM including its conceptual and practical links with the Water, Sanitation and Hygiene (WASH) development sector, human rights and ‘the girling of development.’ Drawing on analysis of in-depth interviews, participant observations and the digital materials of NGOs and social businesses, Bobel shows how MHM frames problems and solutions to capture attention and direct resources to this highly-tabooed topic. She asserts that MHM organizations often inadvertently rely upon weak evidence and spectacularized representations to make the claim of a ‘hygienic crisis’ that authorizes rescue. And, she argues, the largely product-based solutions that follow fail to challenge the social construction of the menstrual body as dirty and in need of concealment. While cast as fundamental to preserving girls’ dignity, MHM prioritizes ‘technological fixes’ that teach girls to discipline their developing bodies vis a vis consumer culture, a move that actually accommodates more than it resists the core problem of menstrual stigma.
Article
Perceptions of menstruating women were studied in a sample of 244, predominantly European American, college freshmen. Both women and men rated the menstruating woman, as compared with the average woman, as higher on the Neuroticism factor from Lippa's (1991) measure of the Big Five personality factors. Men also rated her as lower on the Openness, Agreeableness, and Conscientiousness factors, and women rated her lower on the Extraversion factor. Women rated her as perceiving herself as less masculine and more feminine. Both women and men rated her as less “energized” and “sexy,” but more “irritable,”“sad,” and “angry.” In addition, men rated her as less “clean and fresh,”“nurturing,” and “reasonable,” and more “spacey” and “annoying.” Significant relationships were found between negative impressions of the menstruating woman and the Hostile Sexism Scale (Glick & Fiske, 1996). Although most ratings by men and women were negative, women perceived the menstruating woman as more “maternal,”“strong,” and “trustworthy.”
Sex education: Menstrual health to be taught in school by 2020
BBC (2019). Sex education: Menstrual health to be taught in school by 2020. BBC. https://www.bbc.com/news/newsbeat-47350835.
How Social Media Helps Reduce Menstrual Stigma
  • S Boyce
Boyce, S. (2020, December 8). How Social Media Helps Reduce Menstrual Stigma. Accessed December 12. https://borgenproject.org/tag/period-poverty/.
Reactie op verzoek commissie over het onderzoek over menstruatie
  • B J Bruins
Bruins, B. J. (2020). Reactie op verzoek commissie over het onderzoek over menstruatie-