Questions/Answers

In Korean Society, menstruation has never been a public issue and people believed that sanitary pads are not daily necessities but a matter of privacy which does not require public support. Recently we found that many low income family girls were suffering from a shortage of sanitary pads and difficulty in approaching a specialized medical system for women. The girls were discouraged about their situation and could not deal with their body changes properly. Furthermore, when they received sanitary support, they did not want their identities to be revealed because of shame. Seoul Metropolitan Government defines "sanitary pads=daily necessities=human right" and makes "the Comprehensive Sexual Health Support Project for teen girls from low income families (CSHSP)." First, the city has pushed forward plans to systemize the sanitary supply system and expand. Second, it established an easy-to-access medical system for girls of low income families. Third, it developed and distributed diverse contents for girls left in blind spots where information is rare. Fourth, it built the project to improve awareness on menstruation and women's sexual health. The CSHSP is innovative in that it is a part of affirmative action toward a gender-equal society through fulfilling not only material demands of girls but also their emotional care, establishing a gender-sensitive social environment. Detailed projects were adjusted to the eye levels of teen girls in an effort to improve its accessibility and efficiency. The CSHSP intends to reform the deep-rooted problem of social prejudice regarding women's sexuality that is embedded in a culture of shame and lookism, and resolve the problems of gender and class inequality in public health. Therefore the project developed the subject of teen girls’ health rights and sanitary pads as a public agenda. This also contributed to creating women-friendly social environments, in multilateral cooperation with civil organizations, corporations, etc.

Establishing a support system for teen girls of low-income families to grow healthy CSHSP establishes a comprehensive and gender-sensitive health support system by figuring out the characteristics of teen girls from low-income families, in order to empower young women, raise their self-esteem and support their healthy growth. In particular, health conditions and status of the youth may continue on in adulthood and this has been linked to gender inequality on health. To prevent this, the project focuses on teenage women's health issues as part of affirmative action. Building a women-friendly social environment Women menstruate every month and undergo much discomfort. However, social prejudice prevents them from visiting gynecology specialists and forces them to endure the pain. In addition, lookism, diet and low physical activity negatively influence women’s health. CSHSP intends to build a women-friendly social environment by improving the problem of social prejudice regarding women's body and sexuality. Strengthening sustainability and accessibility of the CSHSP project through multilateral cooperation Securing a support system through stable financing and institutionalizing to public policy is important. To strengthen efficiency and sustainability, we would like to secure multi-agency cooperative network with corporations and civil organizations.

Offering unprecedented innovative service Sanitary pads were treated as private items and hard to mention in public space. However, the CSHSP defined sanitary pads as daily necessities, institutionalized them as public service items and spread the idea into society. Strengthening accessibility of support services by implementing gender equality values Detailed projects are adjusted to the eye levels of teen girls. First, the CSHSP built a medical infrastructure in local areas, found teenage girls left in blind spots and connected them with related support system. To increase information accessibility, the CSHSP provided pocket books, opened a specialized website and conducted various training sessions. These activities drew participation from a majority of people, high satisfaction and efficiency. Women's participation in policy-making and enforcement As a project 'for the women, by the women, of the women,’ the CSHSP project first reflects what female teens want. In this way, they became not only recipients of but also participants in policy-making. To build the infrastructure for alternative sanitary education, medical support network, and joint corporations in public and private sectors, various forums and symposiums were held with scholars of women’s studies, doctors, civil activists, office workers and government officials.

Enhancing the health rights of teen girls; reducing gender and class inequality The CSHSP institutionalized unprecedented 'free sanitary supply' for low income teen girls. The project built highly accessible medical infrastructure which reflected the girls’ situation. In addition, the project has developed contents to resolve the problem of information blind spots and spread the contents in various ways. Through a program of awareness, the project has reduced inequality in public health caused by poverty and sexism Empowerment through emotional care and increased self-esteem The CSHSP emphasizes emotional care as much as material support. The project change conveyed method from picking up system to delivery system. The project also continues to send the message that ’body changes are natural,’ through greeting cards, sanitary pads and underwear, and events such as body camps and menarche party. With this activity the girls can develop positive images of their body. Turning women's sexual health into a policy agenda Issues of women's menstruation and teenage girls’ body health were almost invisible before, but now the issues have been stabilized as public policy. People believe that society as a whole should solve the issues together. The government spread the idea, cooperating with enterprises and civic organizations.

Supplying sanitary pads The CSHSP sent sanitary pads to recipients of public aid. The project also furnished sanitary pads in 800 teen girl’s facilities Building a medical support system The CSHSP built specialized health centers for teen girls, which offered medical treatments of gynecologists, dentists and family medicine doctors (33,909 cases in 4 years and 4 months, a monthly average of 652 cases). MOU was signed between girls’ schools and hospitals to make it easier for young women to visit gynecology clinics. 250 pharmacies were assigned as special pharmacies for girls’ care. The pharmacies supported 2,298 cases. Enforcing accessibility of health information The CSHSP distributed health information pocket books (80,000 books) and opened a website (http://www.girls1004.info), which 40,495 people visited over three months. The project held many diverse activities, such as making sanitary cotton pads, drama education, talk concerts with celebrities, etc. (119,279 cases). Expanding women-friendly culture by raising public awareness The CSHSP opened a collaborators’ workshop, seminar and forum with teachers, doctors, pharmacists and government officials. There were contests searching for good contents sponsored by corporations, sanitary cotton pad-making with executives and staff, sanitary pad donation events with celebrities, and LCD advertisements in 950 teenagers’ favorite shops nationwide.

Expanding nationwide from Seoul After executing this project, the central government reviewed the CSHSP and decided to institutionalize and distribute sanitary pads to teen girls from low income families nationwide Obtaining social value in general Each detail and method in the project was designed to pursue the value of gender equality. For example, we expanded the program for making sanitary cotton pads to local communities and diverse companies. The scene where male executives and staff members were making sanitary pads came as a fresh surprise to the traditionally patriarchal Korean society, since this makes cultural discourse on sanitary pads and breaks the gender role associated with sewing Influence on welfare delivery system for social minorities The meticulous support system of the project, taking into consideration the situations of targets receiving help, emphasized 'emotional caring' for social minorities which the previous welfare system had not taken into count. This has brought change to the welfare delivery system: the Ministry of Gender Equality and Family, which controls the public distribution of sanitary pads, now reflects the suggestion of Seoul Metropolitan Government and chose the voucher system as the delivery method

Institutionalization and expansion of sanitary pad supply The problem of sanitary pad supply was not a public issue, but the CSHSP brought it to public agenda and spread the issue all over society. People start to put sanitary pads in the disaster preparing emergency kits. They also furnished sanitary pads in various teenage facilities and pharmacies. Comprehensive support in material need and emotional care The CSHSP is innovative because this comprehensively supports material needs, emotional care, with building of women-friendly environment. The project details and delivery system were carefully designed with gender sensitivities. Furthermore, the project has focused on reducing gender/class inequality by raising public awareness for women's sexuality, social prejudice on menstruation, shame, and lookism which embedded in our society. Recipient-centered multi Collaboration: Maximize service approach and efficiency. ‘Medical accessibility’ is an important issue because low income family teen girls avoid visiting medical centers and have little information. The project built multilateral cooperation network with companies and clinics, as well as providing gender-sensitivity education to related people for securing gender equality value and service quality. The efficiency of these activities could be maximized because they were based on the needs assessment, participation and evaluation of teen girls.

An innovative sexual health support project Seoul City was the first one to establish a comprehensive sexual health support system for girls in Korea. Since the Seoul Municipal Health Center for teenage girls (SMHC) was established in 2013, SMHC carefully considered the specific situations of low income family teen girls, from construction of space to programs. Because this is the first and the only center exclusively built for teenage girls from low income families in Korea, other local governments and foreign country officials visited the facility for benchmarking. "Supporting the girls in secret" comes from delicate consideration for girl's emotion. People and media show a cheerful response by saying, “support like Seoul City does." Selected as a case of unique policy by other agencies This project has been evaluated as original and successful models, and was presented as outstanding cases in National Assembly meetings (Jun. 8, 2016 and Jul. 7, 2016) and by Daejeon City Council (Sep. 20, 2016). Also, this won the National Sustainable Development Committee’s Presidential Award (Oct. 2016). The case was presented as examples of best policy in a casebook compiled by the Ministry of Gender Equality and Family (Dec. 31, 2017) and were distributed nationwide.

Financial Resources The Seoul Metropolitan Government compiles a budget for sanitary pad, Seoul Municipal Health Center for Teen girls(SMHCT) and special pharmacies for girls’ care, and other related projects. In cooperation with donor organizations and companies, the CSHSP has worked in multilateral ways by supplying sanitary pads, underwear, medical equipment, HPV vaccinations and etc. Human Resources First, the CSHSP reflected the voices of teenaged girls from the beginning. Seoul Metropolitan Government held forums and conferences with experts and scholars, sought alternative ideas and reflected them to the project. The city trained not only the youth-related agents such as youth facilities staffs and school health nurses, but also medical experts such as gynecologists, pharmacists with women's studies and Youth studies, and through this training, the service quality also improved. Material Resources Seoul Municipal Health Center for Teen girls acts as the base institution for supporting sexual health for teen girls. The CSHSP signed an MOU between local schools and specialized clinics, and assigned 250 pharmacies as special pharmacies for girls’ care. In order to find teen girls left behind in blind spots and support them, the CSHSP built networks among schools, social workers, youth centers, clinics, pharmacies, and so on.

Yes

Expansion of project and increase in beneficiaries nationwide Seoul Metropolitan Government has strongly recommended the project to expand on a nationwide scale to the Central Government and the National Assembly. This became a national project and each local government is expanding target recipients to other vulnerable groups. This has influenced on safety policy, in which sanitary pads were enclosed in disaster relief supplies. In addition, other local governments continued requesting to learn about medical support network such as the SMHCT or the special pharmacies for girls' care. Spreading alternatives to sanitary pads and the culture of donation After the execution of projects, the culture of sanitary pad donation spread not only to other local areas or companies but also to celebrities and individuals. The city also sent lecturers to spread the cotton sanitary pad culture. People from a wide range of ages and jobs participated, from teenagers to senior citizens in their sixties, housewives, college students, office workers, foreigners, company executives and employees. A Malaysian participant in an event for making cotton pads said, "Many children from poor families in our country also face the same problems. I would bring my friends here to learn about this."

Social Aspects For a project to be sustainable, not only is institutionalization essential but also the social consent on the project. Seoul Metropolitan Government has made the issue of teenage sexual health a public one through cooperating with other governmental agencies, civic organizations and companies. Various dimensional approaches such as regular research on actual status of targets, open forums, diverse campaigns, and training for teachers and officials are necessary to raise awareness and interest regarding problems of women‘s sexuality and health. Financial Aspect To continue the project, securing of budget is essential. Currently, the budget is secured and compiled by the Central Government and local government. Seoul Metropolitan Government has also prepared the budgets to support SMHCT and special pharmacies for girls’ care, and related budgets have been increasing continuously in a stable manner. Furthermore, donations as well as cooperation from companies, hospitals and individuals need to be maintained and developed. For this end, a transparent system is essential regarding mutual trust, interaction and contributions. The project has been promoted based on a transparent system. Environmental Aspects To continue the policy, the budget needs to be secured institutionally. Therefore, we revised , and are in the process of enacting the . In addition, securing sustainability through infrastructure is important. CSHSP utilizes outreach community centers, schools, youth communities, pharmacies and medical clinics. This is the network which connects teenage girls in low income families to related experts. In particular, the CSHSP provided training to related people and helped them to be specialized and resourceful one who would be able to continue helping teen girls.

Women's health issue is a continuing task The issue of women's sexual health including menstruation is a continuing generational task. Women's sexual health is threatened by stress, diet, lookism, physical inactivity in rapidly changing society. Women's diseases such as period pain and irregular menstruation have increased due to harmful chemicals. In such environment, continuing concerns, research and support for improving awareness are necessary for the protection of women's sexual health. Securing systematic sustainability for the project Seoul City manages a task force called Women’s Policy Officers, which develops and carries out women’s policy. Through Seoul Foundation of Women and Family, an affiliate of the Seoul Metropolitan Government, CSHSP is receiving many research and policy proposals regarding women's issues. The city has posited the women's health issue as a social issue through interaction with other government entities, companies and civic organizations. The Central Government and Seoul City have also acknowledged the issue of women's health as an important policy and compiled mid- to long-term budgets. Seoul City established the Metropolitan Youth Health Center and compiled mid- to long-term budgets, and after a certain period of time, the project will be evaluated. In this way, CSHSP develops women's sexual health project. Cooperating closely with Seoul Pharmaceutical Association, the project has been upgrading the functions of special pharmacies for girls’ care every year, by running an advisory entity, Gender Equality Committee, with women and experts from civic organizations. They are monitoring the detailed projects closely for sustainability so that the policy would not be cut off from support.

Yes

Policy Evaluation of Seoul Metropolitan Government in 2016 and 2017 Every year, Seoul metropolitan selects several important policies and places them on vote online and offline for citizens’ evaluation. The CSHSP was selected as the best policy for two consecutive years in 2016 and 2017. Evaluation of SMHCT In 2016, evaluation has been carried out for recontract and delegation to private sector of SMHCT, and in 2014 a satisfaction survey was performed by 102 teen girls who had visited SMHCT. In 2017, university professors of social welfare major and consulting companies were commissioned for a qualitative analysis based on comprehensive interviews of night-time hospital users. Evaluation of sexual health education (Arumda'womb' class) Every year, survey assessment has been carried out for the Arumda‘womb‘ class. The numbers of people who have participated in the surveys are as follows: 2012 (3,478 people) 2013 (2,043 people), 2014 (1,835 people), 2015 (2,039 people), 2016 (3,417 people), and 2017 (688 people). External Agency Evaluation In 2016, Seoul Metropolitan Government applied the project to the Sustainable Development Award Contest held by the 18th National Sustainable Development Committee.

Evaluation of the CSHSP in 2016 and 2017 by citizens In 2017, the CSHSP was evaluated as the third best policy, voted by 6,611 Seoul citizens. In 2016, the CSHSP was marked fifth in rank among 45 representative policies of Seoul Metropolitan Government, and 132,590 citizens participated in the vote. Evaluation of SMHCT Women and youth-related experts conducted a screening for recontract, and the result showed the center to be qualified (85 out of 100 points). Satisfaction level survey was carried out, targeting teen girls users. It received a score of 4.7 out of 5 points. University professor and consulting company evaluated and conducted that the center is the best institution for vulnerable teen girls. Evaluation of sexual health education (Arumda'womb' class) For each item, five full points may be given: adequacy of educational content (4.49), adequacy of utilized resources (4.37), level of satisfaction of educational content (4.26), level of help provided for improvement of sexual health (4.28), and lecturer's expertise (4.49). The total average was shown to be 4.35%. External Agency evaluation In 2016 the CSHSP won the National Sustainable Development Committee Presidential Award, held by the 18th National Sustainable Development Committee.

Evaluation by citizens in 2016 and 2017 Citizens voted for the best policies which meet to citizen’s needs Evaluation of SMHCT - Eligibility evaluation index for delegation to private sector for Seoul Municipal Health Center for Teen girls(SMHCT) · Quantitative assessment areas: Result of project (10), retainment status of experts (10), financial support capacity (10) · Qualitative assessment areas: Capability of managing body (15), project plan and probability of enforcement (15), management capacity (10), financial situation of the institution (10), adequacy of managing manpower (10), plan for interconnection with local society (10) · The level of satisfaction of center user was carried out by five point scale or qualitative evaluation; doctors’ treatment methods and attitude during night treatment. Evaluation of sexual health education (Arumda'womb' class) Satisfaction survey on 'Arumda'womb' class indicates 5 points as full marks for each index. The index scales consist of appropriateness of curriculum, resources, content satisfaction, degree of help provided for improvement of sexual health, and lecturers’ expertise. External Agency evaluation - National Sustainable Development Committee contest evaluation index: Sustainability (15), empowerment of partnership capabilities (15), local society issue and analysis (10), implementation evaluation (10), evaluation and achievement (10), and evaluation of on-site visits (40).

Participation of Low income family teen girl and experts First, research on actual status of low income families teen girls was conducted and women’s studies experts, youth experts and health experts made policy for teen girls. Doctors, nurses, pharmacists and social workers received gender-sensitivity education, took responsibility for medical treatments and carried out counseling for them. Cooperation with administrative agency and civic organizations CSHSP promoted the program, cooperated with the Ministry of Education, the Ministry of Health and Welfare and municipal officials. Women’s civic NGO offered feedback for policy and conducted outreach education to local schools or community children’s center. Enforcement of campaign and project promotion, in cooperation with companies Professional donation organization found cooperative companies which would supply sanitary pads and corporations contributed to the project by offering goods and funds as well as participating in joint campaigns. For example, at the contents contest held in association with CJ Olive Young, which is one of the youth's favorite shops and has 950 members nationwide, we campaigned and promoted the project on the LCD screen behind POS. Seoul Metropolitan Government conducted a promotional campaign with 1.86 million CJ Olive Young Kakaotalk friend members and 50,000 CJ facebook followers. Communication with citizens The Seoul Metropolitan Government used various windows for civil petitions. Using prize-winning contents such as video clips, webtoons and posters, we asked citizens including teen girls, parents and teachers to provide their opinions. About 40,495 people visited, posted encouraging replies and gave policy suggestions.

Gender Sensitive Perspectives and innovative Spirit The issue of sanitary pads and women's sexual health was invisible and difficult to talk about in public in Korean society. In the early stage of the project, there was still argument about whether sanitary pads belong to items of public supply or not. However, we dared to bring the issue of women's sexuality and menstruation in the public eye, with gender-sensitive perspectives and an innovative spirit. Recipient-centered detailed policy CSHSP can succeed because it was a recipient-centered policy from the beginning. We analyzed the traits of recipients; avoiding gynecology, lack of information and fear of medical centers in general. Based on the finding above, the city raised accessibility to medical centers and health information, built policy and added effectiveness of policy by providing services. Beyond material support to specific targets Because women's menstruation and sexuality have been attached to social prejudice and values, material supply is not enough to protect teen girls' rights. Instead of proceeding with the project alone, the Seoul Metropolitan Government has worked with civic organizations and corporations to develop diverse activities. It is important to change the biased perception of women's sexuality and build a women-friendly social environment.