The need for expanding the scope for addressing the menstrual hygiene needs of girls and women during emergencies

“Menstruation does not know you are displaced or that you are traveling. It will just come; so it came while we were on the road [and] for others it came right when we arrived.” – Congolese woman, Nyaragusu Refugee Camp

When driven from their homes by disaster or conflict, girls and women are frequently forced to travel long distances, carrying very little with them.  They often prioritize the needs of their families and children over their own wellbeing.  Many will lack supplies to manage their menstruation, or private, safe toilets along the way. Upon finding refuge in temporary camps or settlements, they often live in extremely crowded environments, with very little privacy. There may be strong societal taboos around menstruation, which forces them to hide their menstruation or risk embarrassment, ridicule or violence. This may make it harder for girls and women to move away from their homes for the daily survival tasks of collecting food and water, engaging with social support networks, and caring for their families.

Addressing girls’ and women’s menstrual hygiene management (MHM) needs in emergencies is critical.  Although MHM is receiving growing attention from humanitarian actors, current response efforts are often inadequate, not being provided in a timely or holistic manner. Most humanitarian response is delivered and funded through ‘sectors’ such as water and sanitation or health, however a complete MHM response falls across sectors, posing challenges for a coordinated response. For example, pads and underwear may be in the ‘Core Relief Items’ sector, while toilets fits into the WASH (Water sanitation, hygiene) sector; living spaces are overseen by the Shelter sector, while schools and health facilities are overseen by Education and Health actors.

Current MHM responses frequently neglect to recognize the full scope of MHM beyond the provision of sanitary pads; including considerations for safe and private spaces for changing materials, disposal options, waste management, and support in the washing and drying of reusable materials. Key questions are often overlooked at the beginning – such as menstrual management practices – which may lead to clogged toilets (with pads) or experiences of violence accessing facilities at nighttime.

Recognizing the existing gap in adequately tackling MHM during emergencies, Columbia University and the International Rescue Committee (IRC) embarked on a learning initiative in July 2015 aimed at improving the evidence and guidance needed for the integration of MHM into emergency response activities. This included developing a cross-sectoral guidance document – the MHM in Emergencies Toolkit – which aims to provide practical support to emergency responders globally.

This effort included interviews with a range of global emergency experts (water and sanitation, protection and other key sectors); country level assessments with displaced girls, women and staff in two emergency contexts (displacement camps in Myanmar and informal settlements in Lebanon); and a global desk review of existing documentation (e.g. reports, checklists).

The global assessment revealed barriers to implementing an MHM response, including cultural taboos held by staff and beneficiaries, insufficient evidence on best practices, and poor cross-sectoral coordination. Most respondents indicated that a lack of clear guidelines and practical resources hindered their abilities to deliver and monitor MHM activities, such as improved disposal, toilet and washing facilities, education and addressing cultural taboos.

Ensuring the safety, dignity and well-being of girls and women can have an impact beyond them as individuals. As one practitioner explained, “women take on so many roles in society or households; if they don’t have the menstrual materials or information they need, this can limit how they can manage their lives and their households.” It remains critical for the humanitarian community to champion this concern, recognizing the broader value that addressing MHM can have on girls, women and their families.

Authors: 

Margaret Schmitt, Project Researcher, Columbia University, Mailman School of Public Health

David Clatworthy, Environmental Health Technical Advisor, International Rescue Committee