Building a Cross-Sectoral Toolkit and Research Foundation for the Integration of Menstrual Hygiene Management into Emergency Response

Grant awarded: £497,568

Lead organisation: International Rescue Committee

Partnering organisations: Columbia University, Mailman School of Public Health

Project length: July 2015- January 2018 (COMPLETE)

Study locations: Formative assessments in Myanmar and Lebanon, pilot in North West Tanzania.

Principal Investigator: Dr Marni Sommer

  • A woman who has been living in a camp on the outskirts of Goma for two months is ecstatic when she receives her dignity kit today.


The project sought to better understand the ways in which humanitarian emergency organisations respond to adolescent girls’ and women’s menstrual hygiene management needs in humanitarian emergency contexts, through key informant interviews and qualitative assessments with women, girls and staff in two different emergency contexts (in Myanmar and Lebanon). It aimed to develop a toolkit for use in emergencies that could help address menstrual hygiene needs, followed by an evaluation of the pilot toolkit in a refugee camp setting in Tanzania. The study wanted to assess the extent to which the toolkit was implemented, the factors that supported and prevented its uptake, its influence on the provision of MHM programming, and how the toolkit guidance was modified during implementation.

Progress and outcomes achieved:

The research and tool-kit developed was undertaken as planned. A broad range of focus group discussions and key informant interviews, including with women and girls in Myanmar and Lebanon, helped to inform the development of a comprehensive Menstrual Hygiene Management (MHM) tool-kit. This was piloted in Tanzania using a process and endline evaluation to establish its effectiveness and use in an emergency setting. There was strong engagement of NGOs and UN agencies in the development of the final version of the tool-kit, which has been published in open access format and widely disseminated within the sector.

Key findings:

  • There was broad consensus on the value of the toolkit and the training activities for improving basic MHM understanding for an MHM response. The toolkit trainings were also important for convincing other sectoral actors, outside of the WASH sector, that they had a role to play in supporting MHM.
  • Specific gaps in the tool-kit content were identified, for example the need for more guidance on vulnerable populations and links with the shelter sector. The indicators also needed to be simplified.
  • There are three essential components for an MHM response – to ensure girls and women have access to: a) materials and supplies; b) information (including menstrual hygiene promotion and health education), and c) MHM supportive facilities (toilets and washing spaces).
  • Consultation with girls and women remains the single most effective tool for ensuring that each of these three components are effectively and appropriately addressed.
  • Undertaking direct qualitative consultations with women and girls about their experiences with menstruation was very successful and should be more routinely conducted in emergency contexts.

 Key outputs:

  • Menstrual Hygiene Management in Emergencies tool-kit, mini-guide and infographics (available in English, French and Arabic)
  • Tool-kit launch events in Bangladesh, Kenya, UK and USA
  • Webinars conducted with UNICEF and UNHCR global teams and WASH staff
  • Three peer-reviewed articles
  • Findings presented at Emergency Environmental Health Forum, Water and Health Conference (UNC), amongst others.

Next steps:

Further advocacy for the uptake of the toolkit is planned.  The tool-kit is anticipated to be listed as a key reference in the revised Sphere Humanitarian Guidelines which will be published in autumn 2018. The tool-kit will require revisions as further evidence is generated about effective MHM strategies in emergency contexts.

Elrha is a registered charity in England and Wales (1177110).

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