Why is staining a problem? There are not enough toilets in schools — only 1 per 100 students in Indonesia — so girls may not be able to change their pads as needed. Or there may not be a place to dispose of soiled pads in schools.
The comic book tells boys that menstruation is perfectly normal. It's experienced every month by millions of girls and women, including their moms. And it's important to be courteous and supportive to friends.
But this is not a boys-only comic.
The UNICEF survey also found that 1 in 6 girls skipped school while they were on their period. One reason was the lack of toilets. But sometimes they stayed home to avoid the taunts of boys. And some said they didn't come to class because of a long-standing local belief that it's not a good idea to wash your hair when you're having your period. They felt embarrassed to come to school with dirty hair.
So the comic book is a two-in-one product. Hold it one way and it's a 10-page guide for boys. Turn it upside down and it's a guide for girls, talking about everything from what menstruation is to how to put on a pad. And that yes, you can wash your hair when you're on your period. And no, eating meat does not increase the flow of blood.
The initial 3,500 copies of the comic book were funded by UNICEF. The Indonesian health and education ministries will publish another 35,000 this year and begin distributing them this spring.
It wasn't a bunch of adults who came up with the content. "We didn't want to do just want we thought was a good idea," says Reza Hendrawan, UNICEF's hygiene manager for the project in Indonesia. The team used a "participatory design process," says Aidan Cronin, UNICEF's chief of water, sanitation and hygiene for Indonesia. Team members met with about 100 boys and girls age 10 to 14 as well as teachers and parents in six provinces.
The idea for creating a comic came from the kids.
UNICEF began testing the comic last June, sharing it with about 4,000 boys and girls. The agency then hired Myriad Research, a research firm based in Jakarta, to talk to kids in two communities before and after the comic was published. They gathered survey responses from 245 girls and 129 boys.
"The overall feedback was great," says Cronin. "The students said challenging the myths gave them an opening to discuss menstruation with their parents and teachers." Among the other findings from the survey:
- Knowledge that menstruation is a normal process jumped from 81 percent to 97 percent in girls and from 61 percent to 89 percent in boys.
- The percentage of girls feeling that menstruation should be kept secret fell from 38 percent to 20 percent.
- The percentage of boys who felt it was wrong to bully menstruating girls increased from 61 percent to 95 percent.
"What does seem to be good about the comic is that it keeps the messaging simple and emphasizes that menstruation is a normal experience," says Marni Sommer, an associate professor of sociomedical sciences at the Mailman School of Public Health at Columbia University. Sommer runs a conference with UNICEF each year on menstrual hygiene management in schools. She herself has created illustrated books on menstruation used in several countries in the developing world but was not involved in the development of the Indonesian comic.
She likes the fact that the Indonesian comic book was produced with an eye to local traditions and taboos: "You need to know the local culture as well as beliefs, perceptions and norms in that community," she says, "so you can gently challenge them."
It's not only comic books that are doing the job. A new animated video on menstruation aimed at Indonesians — and also produced by UNICEF — is having an impact. It hasn't yet been widely shown to students, but when members of the Indonesian Council of Islamic Scholars viewed it, they decided it was time to partner with UNICEF on a book on menstrual issues that'll be shared at women's prayer groups.
Fran Kritz is a health policy reporter based in Washington, D.C. Her work has appeared on the Goats and Soda blog as well as in the Washington Post and Kaiser Health News. Find her on Twitter @FranKritz
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