Education & Healthcare design in poverty by Lequay paul

Education & Healthcare Design in poverty Engaging homeless women to take ownership on their menstruation care

Lequay Paul Master Industrial Design 2017

List of contents

Abstract

II. Literature Review Chapter 1. Social Innovation Definition and steps Design’ space in poverty, humanitarian design Sustainable intervention Participatory design

6-13 6-9

Chapter 2. Education & Care The need of menstruation education Health prevention : source of empowerment Myths of Care

10-12

Chapter 3. From an Ethics of care to an Ethics of Design Ethics of Care Profit or Common good? Designer as caregiver - A step back from the traditional designer’ role

Research question

III. Methods Experimental taboo fieldwork Ethnographic analysis Self-awareness Engage key actors Promote menstrual cup Co-creation IV. Empirical data Chapter 4. Measuring the taboo Chapter 5. Homeless & menstruation struggle Chapter 6. Confrontation with the menstruation experience Chapter 7. Promotion of the menstrual cup Chapter 8. A social anchor Chapter 9. Educative tool & Workshop feedback

16-19

V. Reflection

30-31

VI. Conclusion

32-33

Bibliography Appendices Partners

34-35 36-41 42

20-29 20-22 23-24 24-26 27 28 29

4-5

Poverty is a struggle lived by billions of men and women throughout the world who lack of solutions to face their basic needs such as education and health. Among those deficiencies remain a taboo for the whole society about menstruation. As such, the conditions of living and the taboo create barriers for poor and in particular homeless women who become more vulnerable, making the management of menstruation an even bigger challenge on a daily basis. In order to break this taboo and ease the menstruation management for those women, the bias of this research is focused on the prevention and education about the hygienic and safe management of menstruation. By breaking the taboo, I aim to raise awareness and empower those women to self-care. In this study, I use theories about social innovation, co-design and how to make a sustainable intervention with those women. Touching at the notion of education in healthcare, I looked at the ways to make prevention that would create a feeling of empowerment and engage my audience. As a filter, I considered that my ethics should be a guide in my approach of design within the social and healthcare field to shift from a traditional vision of designer’ role to the posture of caregiver. The investigation of the taboo was my starting point to draw the notions which must be targeted by my research. Supported by an ethnographic approach and the report provided by the NGO No More Taboo about the menstruation in homelessness conditions, I consolidated the need to talk about menstruation with those women and highlighted the needs. By engaging and confronting both homeless women and their caregivers, the research allowed me to distinguish the psychological and physical needs as well as the importance to rely on key actors to deliver the prevention. With these guidances, I will develop a solution aiming to support volunteers’ work to make prevention along with breaking the taboo for homeless women to empower them and ensure safer management of menstruation.

I. Introduction

Poverty and vulnerability is a daily struggle for 2 billions people worldwide1. The United Nation2 defines a poor person as living under the threshold of 1.25$ per day, adding with multiple deficiencies in health, education and life conditions. However some harmful consequences are less expressed like the feeling of powerlessness, discrimination and the loss of dignity. “For a poor person, everything is terrible illness, humiliation, shame” (Kern A., Ritzen J. ,2005, p9). Collaborating with No More Taboo organisation3 in Bristol, the statistics deal with UK where 13.5 millions people4 live in poor conditions, including 75 000 homeless5 in 2016 which put them under health risks and education deficiencies. Their vulnerability6 (Inability to withstand the effects of a hostile environment) isn’t only due to harsh conditions of living or lack of incomes, but also refers to barriers such as the language, cultural, mental illness or social exclusion. For women (70% of the 1 billion poorest7, 35 000 homeless8 in UK), it is an even bigger issue due to their special intimate needs during menstruation which are more difficult to overcome in poverty when it requires access to sanitary products. Hence, the healthcare issue is a greater threat but if it is tackled, it can break-out the poverty cycle9. The intimate hygiene needs are sources of vulnerability and stigma of poverty when they can’t be alleviated. Thus, the design challenge scale is wide as it touches harsh conditions, social exclusion, society taboo in relation to the natural menstruation. Furthermore, this thesis elaborates a reflexion on the designer work’ targets as design is a humanist discipline10 and aim to work for the whole population, including homeless women. Seeking a social impact by tackling the menstruation hygiene and taboo ; it takes place in the social and humanitarian field. Although, humanitarian projects mainly concern the third world or emergency situations, could this reflexion with homelessness be considered as humanitarian work tackling an emergency situation? Furthermore, to intervene in this context, the designer must orient its effort on solving the wicked problem in a sustainable manner. So, as the prevention is not enough addressed, my bias is to work on education and awareness, keys of a long-lasting solution as it empowers and bridges the gap between impoverished and wealthy women. In this way, we will try to understand the way education can withstand care. Empowerment can be achieved by design as an outcome of care. However, the relation between the healthcare and design hasn’t always been obvious and only recently got closer. Thanks to the evolution of designer’ role, ability to tackle issues from a wider scale with the social innovation field and that both healthcare professions and designers desire to help people. Moreover, Jones P. stated that design has no tradition of care practice11 , thus, design’ methods operated changes

I. Introduction

to tackle healthcare issues. In addition to that, designers have a social responsibility12 to take on such issues concerning the penniless and vulnerable. Nevertheless, this shift implies another approach of risks prevention than health workers due to the difference of expertise and ability to convey ideas, summarise the holistic analysis. Designers can tackle the sources of menstruation-related problems in poverty by increasing the self-awareness. Hence, it puts the designer in a caregiver posture and as a partner who aim to design a solution with his ‘patient’. To do so, designers must question their own relation with creation and challenge their ethics, giving a wider perspective on their posture and role in this social field.

II. Literature review Chapter 1. Social innovation The social innovation has been recently defined by The young foundation (social company) and Ezio Manzini (‘father’ of the reflexion on sustainability and social innovation).

Definition and steps

The first describes social innovation13 as products, services and models that simultaneously meet social needs and create new social relationships, collaborations. In other words, innovations which are both good for society and enhance society’s capacity to act. Generally, they highlight an evolution in terms of methods, topics of reflection, way to collaborate ; but point the misunderstanding and lack of clear definition. Hence, The Young foundation elaborated a structure to carry on a social innovation (figure 1). Firstly, the phase ‘Prompts’ aims to contextualise the problem, to overlook it as an holistic and intertwined causes, triggers and symptoms. Then, in ‘Proposals and Ideas’, the designers should use divers sources of inputs such as the engagement of ex and current users, for instance engaging them to interview other users ; hence change the way to investigate. For example, The new footbridge over the River Aire, was designed by the citizens of Castleford14. It implies a transparency of the process and decentralise the creative power to allow the self-organisation of the participants. Thereafter, ‘Prototypes’ are contextualised by user’ tests when innovation will be assessed, giving the allowance to sustain or even scale up the project. Finally, the ‘Systemic change’ and empowerment of beneficiaries results in new pattern of power and responsibility conveying that all actors of a social innovation should take on a new role within the re-organisation of the creative process. To do so, designers have to take on their social responsibility which require to be empathic and be motivated by a form of altruism15 : meaning, being able to worry about others for their own sake rather than for your own.

(Figure 1 : Social innovation diagram, Young foundation 2010)

Design’ space in poverty, humanitarian design approach

By tackling intimate care in poverty context, this approach re-engage the designer in the essence of design work to care about people’ needs, hence, design to help. Here, the challenge is about the way design can help homeless women during menstruation and overcome intimate problems and discomfort? Moreover, designers have the opportunity to experiment and reinvent a situation which has no anterior design solutions, but it questions if poverty can be a field of new experimental science16 to try out sustainable, ecological solutions, etc… In addition to that, designers are dealing with several parameters, both physically, psychologically and cultural adding with issues such as the scarce of resources, the lack of education due to deficiencies linked to their life conditions.

Sustainable intervention

6 (appendix 1)

(appendix 2)

As mentioned earlier, designers must fulfil some features to make a ‘sustainable intervention’, innovation. To avoid the pitfalls, some conditions need to be fulfilled to carry on the project in a sustainable manner. Firstly, holistic17 is the watchword to analyse a system as everything is connected and each change may influence each parts. It includes to identify the key actors (caregivers, volunteers, family…). It is also crucial to map out and identify the access point of your target (local authorities, creative communities, shelters…) in order to ground your research and spread it. The doctor Joseph Ravenell18 took into account unexpected places to get in contact with his target. As he tried to reach black men to make high blood pressure prevention, he discovered that the barber shop in USA was actually a place where they feel safe and he used it as an access point. He also involved the barbers in making prevention instead of caregivers knowing that those men trust them more than their doctor. This method demonstrated how important it

Participatory design

The shift in users, community involvement changes the collaboration. In the 70s, a new design process named ‘Participatory’ or recently ‘Co-design’ occurred to cope with this evolution. This approach aims to design enabling system which are described as “products and services aiming to empower the social actors involved” (Manzini E., 2013, p57-66). With a mutual involvement, the collaboration23 meets both expectations and results in the creation of shared values, exchange of expertise, experience and care. From now on, designers must become facilitator24, tools maker for non-designers to express themselves creatively and ease the co-creation. For Sanders and Stappers, the user’ engagement can be achieved with 4 levels : Doing, Adapting, Making, Creating (figure 3) and rely on the motivations, abilities and purposes. Thanks to their participation and understanding of their ability to create, the participants are empowered and more self-sufficient. More important, they take ownership25 on their solution because they designed their own storytelling.

(Figure 2 : Positive deviance hierarchy plan)

Following the implementation of the innovation, the scalability is questioned due to the complexity of situations, in particular within social and healthcare context where many different actors and resources are involved. Michel Hobbs21, humanitarian adviser explains that we actually face complexes and adaptive systems in the humanitarian approach, he admits that the scaling-up and repetition of a success is never ensured. Hence, systems must be flexible and adaptive in order to be reshaped in other contexts. On the contrary, the designer Emily Pilloton22 is opposed to the ‘instinct to scale everything’ and favours the creation of sustainable and transformative solutions through local stories.

is to use key actors in order to build trust, ease the dialogue between designers, social innovators and the community they are working with. Moreover, Shea A.19 expresses the need for a social innovation to be community-driven and to design in a disruptive way to give the leadership back to the community. As such, it establishes a new creative hierarchy called ‘Positive Deviance Hierarchy’ (figure 2) or ‘bottom-up’ by Ezio Manzini20. It is impulsed by the contribution of users, experts of the situation who should trigger the decision making step. Those ideas must be supported by the middle management group, thereafter, the leader make them happen.

(Figure 3 : From User-Centered Design to Co-Design, Ghandour. & Lequay P., 2016)

Willing to empower homeless women, the education becomes important as it helps to raise awareness. Thus, dealing with an health wicked problem about intimate hygiene and menstruation, the education and prevention are necessary and part of the care process.

The need of menstruation education

From a general scale, the persisting taboo around the menstruation is exacerbated by the lack of dialogue. Therefore, a clear need occurs to discuss and raise awareness about the menstruation management, specifically in poor living conditions to help managing it in a better way even with a lack or resources. To do so, we need to consider healthcare as an holistic26 practice, meaning to care about the psychology and the physiology of your ‘patient’ since they influence each other. Therefore, it is necessary to make prevention about health risks, enhance self-esteem to bring back dignity27. Therefore, the prevention must considers the care system surrounding those women and rely on trusted actors. For instance, in the Bristol Christian Day centre28 for women, local volunteers said that it should be an obvious priority to make prevention and give free sanitary products, so they may carry on this prevention.

Secondly, people must actively participate because 60%33 of what we do is memorised. Freinet C.34 said that active pedagogy, experimentation is fundamental in the ‘experiential learning’ process. So, to encourage autonomous learning, the educative tool should be inspired from the sensorial approach of Montesorri M.35. Empowerment of those women also pass by their ability to talk about menstruation. However, a new storytelling is required to ease the talk as most of them perceive the relation homelessvolunteers as impersonal and are ashamed to ask for sanitary products. It implies to design this scenario with the caregivers and women to define how the dialogue would be easier. For example, the tool L’autre qui avait perdu sa langue36 (figure 4) facilitates the explanation of sexual practices for Chinese prostitutes in France who don’t speak french. To bypass the cultural barrier, she gently suggested the body and sexual practices, hence, avoided to shock. (Figure 4 : L’autre qui avait perdu sa langue, Brugier, J.), 2012

Health prevention : source of empowerment

In brief, the prevention aims to promote safe practices and give confidence with the body. Seeking to improve women’ life, it enables them to limit health risks of mismanagement. In this context, the prevention also opens-up the debate about women’ struggle and help those living in harsh conditions. However, some limits occur to conduct it. 47% of the homeless women in UK are diagnosed with mental health conditions and 88% present mental health difficulties29. Moreover, a cultural barrier may be faced “… using one old t-shirt every month to manage her menstruation, as in her home country of Somalia, using cloth was the common practice.“ (No More Taboo, 2017). Hence, the culture or belief shakes up the healthcare education because there is no common good or bad practices between people culturally different. To go beyond, designing with neutrality a flexible system would overcome such issue but not only. The project Es tiempo30 attempted to detect the hidden problems which hampers Latina women to make cervical cancer detection. The main reason wasn’t the fear to do this test but because it required time, including to leave their kids alone, things that they couldn’t allow. Nevertheless, to involve people, hygiene promotion31 must lay on certain rules. Firstly, the message should be based on the advantages perceived to create a positive personal loop. Then it must be adapted with the barriers, resources and the knowledge about safe practices to enable the self-care32. (appendix 3)

Chapter 2. Education & Care

“Giving individuals the necessary knowledge and tools to carry out their own efforts to promote health and care for themselves”(WHO, 2012).

(appendix 4) (appendix 5)

In relation to the ‘teacher’ posture adopted during the prevention workshop, some myths are to be considered while designing the educative tool and the storytelling. Most of the failures which lead to inefficiency of the health promotion come from the myth that “people are empty vessels into which you can simply poor information” (Unicef, 1999). Secondly, the caregiver shouldn’t take for granted that new ideas replace old ideas. Then, the ‘knowing means doing’ pitfall remind us that the promotion must be practical to engage women for assimilating information and change their habits.

Chapter 3. From an Ethics of care to an Ethics of Design Ethics of care

The care practices have evolved towards better consideration of psychological aspects and the relation of care took a central role, developing a certain ethics. Nowadays, ethics committee37 guarantee the patient’ respect by defining morales virtues that caregivers must respect to ensure a decent and human-centred care. Likewise, the patient must be involved in an ‘ethics of learning’ or ‘self-construction’38 to be self-aware and take ownership on seeking help, have hygienic habits… Therefore, both caregiver and designer must be empathic to ease the care relation. Lévinas39 stated that the solicitude is the base of a ‘ethics of care’. It is the ability for a person to be careful with the suffering of someone else in a reciprocal exchange. It symbolises a shared active participation in opposition to the unilateral practice of care. He also said that the confrontation with the vulnerable triggers the feeling of responsibility for other, therefore, design has a responsibility to care of others.

(Figure 5 : Tin Can radio, Papanek, V., 1965)

Profit or common good?

“You have to make up your mind either to make money or to make sense, if you want to be a designer” (Papanek V., 1984). He stated that designers aren’t giving enough time for those issues and asked a bigger participation for mankind in need. For him, it is a consequence of design’ studies which don’t broad enough ecological, social, political issues, therefore, don’t teach to be aware about non traditional topics of the design’ world. Moreover, in this context, a paradox occurs between the social purpose and the outcome of the project which may be commercialised. Hence, a balance between the research of progress and the inevitable profit must be found according to Guellerin C.40. Ethically thinking, should designers commercialised social projects or develop them as open-source solutions adaptable in other needy contexts? It questions again the scaling up of a social innovation that Lloyd Wright F. qualified as the greatest threat to social meaning.41

Designer as caregiver - A step back from the traditional designer’ role

Another ethical issue occurs while designing to help communities : the choice of aesthetics. “Good taste is an invention of designers” (Papanek V., 1984). He criticised openly designer’ posture like master of the aesthetics forcing to adopt their vision of good taste. As such, the Tin-Can radio42 for the third world is deprived of strong aesthetics which allows the future users make it his/her own by customisation. By this, he avoided to bring an aesthetics that could not be understood, hence reducing the possibility of creating a feeling of ownership. Thus, he bypassed the notion of good taste.

Myths of care

My research question is to discover how the educative and preventive solution can empower homeless women to face the menstruation struggle and give them back dignity. From my design perspective, Iâ&#x20AC;&#x2122;d like to recreate the necessary engagement by using the social design theories to promote intimate hygienic cares related to menstruation management in homelessness. Hence, my designerâ&#x20AC;&#x2122; ethics, educative posture will matter to make prevention about healthcare issues. I should be aware of the cultural barrier, educational background and vulnerable situation which frame the boundaries of this social innovation. Last, the engagement of those women will rely on the enabling system designed to help them to take ownership.

Research question

In this part, I introduce the methods that Iga Slowik (project partner) and I will use through the research to create a prevention tool focus on the menstrual cup and menstruation management in homelessness conditions.

Experimental taboo fieldwork

A taboo about menstruation persists and the scale, the topics, the scope of the knowledge need to be clarified. Firstly, we will spread a survey, according to the answers, we will precise which information women may miss by designing a poster to fill in, pinched on the public toiletsâ&#x20AC;&#x2122; walls. It will connect us with women from different backgrounds and help to understand the general feeling, validating the need of discussion with homeless organisations.

Ethnographic analysis

Then, we will focus on homelessness conditions and how those women live this struggle on a daily basis. Firstly, the interviews will clarify their state of mind regarding this struggle from a physical and psychological aspect which will be essential to understand to what extend it may affect the menstruation management. Adding with photo interviews because it helps to relate easily to the story we narrate. In addition to that, we will investigate with a photo-reportage the street environment where those women have to deal with menstruation, for instance, public toilets.

Self-awareness

During the interviews, we want to raise the self-awareness by talking about their stories and problems. Consequently, we will confront them to menstruationrelated situations with photos. Those conversation starters43 would help to know their knowledge about hygienic and safe menstruation management. Secondly, we plan to map (figure 6) the eco-system (physical, social) around those women (places, interactions, objects, people whom they need to talk in case of problemsâ&#x20AC;Ś). Then, by giving some disposable cameras44, we hope that some women will share their unique story as it bypass some barriers of talking. Thus, it may highlight unexpected needs.

III. Methods

(Figure 6 : Roadmap icones, 2017)

Engage key actors

Afterwards, we will talk with health, social experts (figure 7), volunteers working in shelters to identify who can deliver more easily the prevention to those women. Therefore, we need to discover if trust is established and how it can be helpful to provide the intimate care promotion. Also, they could give us another perspective on the psychological aspect of homeless women. It will as well, confront them to the lack of concern on this major problem and challenge the way we imagine the promotion may be done.

Promote menstrual cup

To support the workshop of No More Taboo on alternatives sanitary products promotion to homeless and low-income women, we will create an educative workshop. We will demonstrate the menstrual cup use and advantages to avoid misuses and convince of the beneficial aspects. To bypass the barriers, we will record a video of usage in public toilets to show how keeping an hygienic menstrual care with this product. Also, we will display testimonies of current menstrual cup users to create a closeness with wealthy women sharing the same period, subsequently, enabling homeless women to trust what the volunteer explain them.

(Figure 7 : Meeting between social counselor Nancy P. and ex-homeless, Sandudvalg, 2017)

women and the shelter’ staff if they have to ask for sanitary products or advises regarding health issues which could be too private. “Some participants felt uncomfortable discussing their bodily needs with those employed to watch over them and regulate their behaviour.”(No More Taboo, 2017) In addition to that, the report highlighted a cultural sensitivity concerning mainly immigrated women due to some mainstream hygienic practices or beliefs which forbid some practices such as insertion. Therefore, there is a necessity to take into account such differences and bring alternative solutions in a soft way.

Throughout the research, I will attached my focus on the way homeless women can be engaged in their own education about menstruation management to raise their awareness.

Chapter 4. Measuring the taboo (Figure 8A : Poster intimate menstruation care knowledge, 2017)

First of all, the menstruation taboo touches the intimacy of women and must be approached in a delicate way. To reach a divers panel, we spread out a survey among 50 women from 20 to 35 years old and very different backgrounds, countries. We understood the lack of talk in public institutions and even that elementary information such as the anatomy of women’ sex is little known. “I only discovered last year what was a clitoris, and I am 25 years old”. Subsequently, a real necessity to be informed occurs as most of the women interrogated said that they had only basic discussions at school. Secondly, it highlighted that a singular percentage use non hygienic solutions when they have to clean themselves without running water. “I use a wet tissues and fragrance spray”. Therefore, regarding the lack of knowledge or wrong habits of those women, we assumed that a greater need of raising awareness occurs for homeless women. Afterwards, we pinched posters (figure 8A,B) in schools, train station, public toilets in Kolding. We asked women in a gentle and anonymous way to share their knowledge about menstruation and the attention given to health risks. To sum up, most of them didn’t recognise symptoms of illnesses. But as, homeless women have only limited access to health workers and gynaecologists, it makes sense to understand yourself the signs of your body. Last, a surprisingly number are using the menstrual cup, alike the tampons users’. Somehow, It confirmed that this alternative product is going mainstream, thus, the project could reach a wider number of women and make a significant impact. Meanwhile, our collaborator No More Taboo shared with us a report of 14 homeless women interviews and field analysis. It occurred that the taboo and other barriers remain a real challenge for them to manage their menstruation, for instance, to access sanitary product. Moreover, those women are also concerned by the lack of talk, highlighting the need to raise awareness about menstruation and intimate hygiene. Christina from Sandudvalg45 in Aarhus said “I’ve been homeless since I am 12 and I have never talked about menstruation like this before”. On the other hand, Michelle, Bristol’ homeless woman expressed the shame and embarrassment of talking to someone else about it, or asking for products, hence, retaining her in an unhygienic cycle. Seemingly, there is a distance between

IV. Empirical data

Chapter 5. Ethnographic research Homeless & menstruation struggle Aware of the taboo which hamper to face with dignity their period, we’ve been investigating what are the context-based problems. With Sandudvalg and No More taboo, we did interviews with ex-homeless women and men, volunteers, social counsellor and users of the centres, shelters. First and foremost, to overview the emotional, physical constraints or organisational, we analysed the No More Taboo report. We discovered that the scarce of money lead to use solutions such as cloth, rags, plastic bags to keep their menstrual state concealed. It turns the menstruation into an unhygienic, unhealthy and discomfortable experience in addition to their life in harsh conditions. “In that time, I make sure I’m always near a toilet… Being on your period is the worst time for a woman to be homeless. It gives you that extra blow. I would just love to be somewhere warm.” (No more taboo, 2017).

(Figure 8B : Poster intimate menstruation care knowledge, 2017)

In parallel, we interviewed Fontaine J., nurse in a drug addicts centre for homeless in France. She mentioned the mental disorder as a disruptive trouble affecting their body’ perception, often minimising the seriousness of their symptoms. Somehow, this lose of connection is also due to the fact that they wash themselves more rarely, therefore, don’t see their body. Nevertheless, a certain level of consciousness remains because some of the women felt uncomfortable to show their body to someone else when she had to provide cares. “Oh sorry, I didn’t shave my legs, I apologise”. Therefore, in order to reduce this distance, Fontaine J. found out a preventive strategy to talk easily about the drug injection. Displaying the demonstration tools in the centre, she triggered interest of users.

Therefore, keeping a decent intimate hygiene depends if you can afford the products. Moreover, as the blood could leak out and stain their pants while being in the street, they also face stigmatisation. Christina (ex-homeless and drug addict) told us that she was scared to seat down on a bench when she has her period due to the DIY solutions she used to control the blood flow. Other difficulties were pointed out by Sian Webb from Bristol women’s voice46 such as the violence, stigmatisation, drug or alcohol addiction, mental illness, prostitution can affect the confidence, body’ and world perception etc… It is generally combined circumstances that lead to homelessness. Thereafter, Pelle N., social counsellor for Sandudvalg made us consider the categories of homelessness because it frames several approaches of the workshop due to different barriers. Sandudvalg welcomes ‘Rough sleepers’, ‘Couch surfers’ but also ‘Functional homeless’ who already have a flat but fear and can’t manage their life in society. Thus, the official contacts could create a certain fear, subsequently, creating a barrier and discrediting our message.

(appendix 6)

no feedback. To conclude, we believe that to fully empower those women, the educational part is as much important as an on-the-go solution. Therefore, this analysis lead us to promote the menstrual cup given by No More Taboo as it could enhance the comfort, reduce the health issues, extend the time of use which allow oversight and above all, decrease drastically the expenses. Thus, we will withstand the promotion with an educative tool.

Chapter 6. Confrontation with the menstruation experience To confront homeless women, we created tools for our interviews with 3 women from Sandudvalg. First of all, we designed a set of conversation starter cards (figure 9) displaying pictures of the situations that could face those women in their daily management of intimate hygiene and menstruation by analysing the campaign #TheHomelessPeriod47. Then, we reviewed the situations, for instance, showing a women using a sock as a tampon and we let them comment it. The idea was to say whether or not they faced this experience and express if they are aware that the situation is unhygienic and risky health-wise. It highlighted a certain consciousness of basic hygienic practices such as the need to clean your hand after manipulation of the spoiled sanitary product. However, we assumed that this glimpse of awareness might not be fully representative of the homeless women as we interviewed ex-homeless. One of them, Pia (figure 10), immediately mentioned that she and most of those women forget a lot of things, including their own goods. Finally, it consolidated the necessity to design a prevention tool forgetfulnessproof, aiming to empower and learn by experiencing the needy practices. At the following, we used a road map (figure 11) to get an overall vision of the menstruation experience in the street. We asked them to describe in which system they are taken in charge, including the social centre, shelter, the social and health workers. It occurred a lack of free sanitary products, separated facilities which allow privacy. Then, we steered the conversation towards the barriers to maintain a decent hygiene in public toilets and carry the sanitary items in their bag. The main challenge pointed out about public toilets is the lack of private place with running water as most of them are equipped with common sinks outside the cubicles. Moreover, the lack of warm water tap limits the possibility to clean yourself properly and with comfort already affected by the feeling of dirtiness. It occurred a need of an on-the-go solution to use safely the menstrual cup in public toilets. Thereafter, we gave some disposable cameras with diaries to get more private information, or tricks used by those women but it was a failure as we had

(appendix 7) (appendix 8)

(Figure 9 : Conversation starter cards, 2017)

In addition to that, using cards representing the injection process, she asked to replace them in the right order. She also sneaked non-related injection steps in order to see if the users would be mislead, therefore, donâ&#x20AC;&#x2122;t know the correct process. So then, we understood that the strategy of confronting would be an efficient and empathic way to start up an internal reflexion and raise awareness.

Chapter 7. Promotion of the menstrual cup

(Figure 10 : Interviews Sandudvalg, 2017)

Nevertheless, the cup utterly change the usage, implying to neatly explain advantages, consequences and hygienic practices. First, we want those women to assess whether it is worthy to shift of solution. Therefore, the explanation must focus on the faced situations in the future and be experiential to help remembering the usage. We also found out that most of those women arenâ&#x20AC;&#x2122;t aware of the alternatives solutions (menstrual cup, pantiesâ&#x20AC;Ś). Then, we thought that using testimonials of menstrual cup users would inform in a more empathic way. We believed that for example, revealing the first fears would help homeless women to bypass the fear of the unknown. Moreover, thanks to Helle, drug addict, ex-prostitute ; we found out that the fear to insert a cup could be bypass as for a part of homeless women prostitute themselves to buy drugs, therefore, are very confident with their body. Last but not least, to strengthen our message, we recorded a video (figure 12) showing the usage scenario of the menstrual cup (insert, clean, dry) in public toilets, highlighting the mistakes to avoid in order to keep the usage hygienic.

(Figure 12 : Video of toilet usage, Aarhus, 2017)

(Figure 11 : Roadmap answers, Sandudvalg, 2017)

Chapter 8. A social anchor

Chapter 9. Educative tool & Workshop

Like the Young Foundation or Ideo suggest it, local actors must be involved to design the solution but also to deliver the promotion using the relation they have created with the women. Woz, leader of the homeless centre in Bristol said that as an ex-homeless, the trust is more or less established thanks to the common experience shared with him, hence, it eases the dialogue. Considering that volunteers or social workers (figure 13) may deliver the workshop and promoting the cup, we understood that some instructions (figure 14), guidelines, topics to broad must be designed to go along the educative tool. Therefore, ensuring the full understanding and the scope of what those women should be aware of.

As a result, we designed an educative tool (figure 15) along with a workshop about the menstrual cup which will be delivered by No More Taboo. The goal is primarily to explain how to use the menstrual cup (fold, insert, cleanâ&#x20AC;Ś), dispel the myths of the cup and promote the advantages of it compared to the tampon (health and leak wise). This tool allows women to experience how to insert the cup, aiming to train and enable them to perceive if the usage is too complicated or not. In addition to that, a support was designed to let each woman explaining the information she has in front of her, creating an exchange between them. It includes also the future situations they may face using the menstrual cup in public toilets in particular. Also, to alleviate their fears, we are designing with the platform Clean your cup48, a map listing the toilets where to clean safely the cup in Bristol.

(Figure 15 : Educative tool, 2017)

(Figure 13 : Nancy Pelle, social counselor, Sandudvalg, 2017) (appendix 9)

(Figure 14 : Instructions educative tool, 2017) (appendix 10)

Firstly, the involvement of women pass by the workshop and the exchange it creates between homeless and volunteers about the menstrual cup, experiences, fears. Moreover, the manipulation of the tool trains and enables to get a better idea if they should shift of solution. Then, because the volunteer only introduce the tool and cup, the session is shaped more like a discussion than a lesson and it bypasses barriers that the impersonal relation may create. Also, the instructions seemed necessary to inform inexperienced volunteers about the tool and menstrual cup. Secondly, the participatory approach didnâ&#x20AC;&#x2122;t fully work cause of the irregular contact with those women. Therefore, we optimised this time with the roadmap or the diaries which engaged them in another level. During the interviews, being empathic was necessary cause those women want to be listened, thus, it led to broad divers topics about their life, helping to understand their general situation.

(Figure 16 : Ideo toolkit, camera, 2015)

Regarding the approach, as a man, my researcher posture was immediately in jeopardy. Some women felt I was too intrusive with their intimacy or that I shouldn't ask about. It was crucial to rely on my partner who could more easily talk about the embarrassment, womenâ&#x20AC;&#x2122; issues but also, helping me to project myself in their situation. Method wise, giving the disposable cameras (figure 16) without clear instructions to take pictures interesting for us, it affected the expected result because we didn't enough guide them. Generally, we tried to respect a certain ethics because our methods allowed to participate anonymously, also adapted to the ability or willing to share private information respect the privacy. Furthermore, our Instagram (figure 17) profile permitted to discuss publicly about homeless issues and thanks to other organisations we challenged the workshop design. Regarding the tool, we plan to make it open-source. Scaling up this project could be beneficial as it would support othersâ&#x20AC;&#x2122; work and make a big social impact but also change the way menstruation issues are explained. We didn't design a strong aesthetics to avoid misleading the user and explain the cup usage without shocking, thus, it bypasses the possible cultural difference by a subtle explanation. Stepping back, it had been the first time I openly talked about menstruation, breaking the embarrassment. Moreover, working with homeles, drug addicted, ex prostitute, I got really confronted to the stereotypes about their identity, life.

V. Reflection

(Figure 17 : Instagram, Clean your cup stickers and educative tool, 2017)

To conclude this thesis, regarding the engagement of homeless women in their own education and awareness about menstruation management, this research triggered a lot of positive responses and interest as much from those women as their caregivers. Open a discussion about menstruation with those suffering women acted sometimes as a liberator of speech thanks to the feeling that people start to care about some of their fundamental issues. Moreover, it created a connection between the participants of this research as it broke down some of the barriers and the embarrassment to speak, ask for yourself about sanitary products for instance. On the other hand, bringing a new solution like the menstrual cup, appealed a lot of those women as it may change for good their menstruation management, giving them back dignity during this period. As an opening to this reflexion, we plan to make the educative tool and workshop items open-source. We would like to allow organisations to download the model of the tool and print it on their side. It could also be used by organisations working with schools in order to do prevention earlier with young girls.

VI. Conclusion

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Bibliography

Projects

The new footbridge over the River Aire, Castleford

Es tiempo, USA

Joseph Ravenell, Denny Moeâ&#x20AC;&#x2122;s barbershop

Appendices

Educative method, Montessori M.

Research 6

#TheHomelessPeriod

Lâ&#x20AC;&#x2122;autre qui avait perdu sa langue, Brugier J.

Photo-reportage Bristolâ&#x20AC;&#x2122; toilets

Appendices

Christina, Pia and Johanne interviews, Sandudvalg

Menstrual cup usage scenario - Desktop research

Educative tool and instructions

I would like to thank our contacts from Sandudvalg in Aarhus, No More Taboo in Bristol, Ruby cup and Clean your cup for they help throughout this project.