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Of all the taboos preventing people living full and healthy lives, those connected to menstruation are among the most damaging. Silence and stigma over a natural process carry serious repercussions, including harming girls’ education and endangering health and safety.
The third ever Menstrual Hygiene Day, celebrated tomorrow, is a sign that these issues are gaining wider recognition. It is also encouraging to find menstrual hygiene research beginning to shape the agendas of international relief organisations.
In 2015, the International Rescue Committee (IRC) and Columbia University in New York began a research programme, funded by humanitarian research network Elrha, to analyse menstrual needs during emergencies. So far, the research team have interviewed emergency response teams globally, and interviewed women about their menstrual hygiene needs in two sites: long-term refugees in rural Myanmar and Syrian refugees in urban parts of Lebanon.
This research is meant to feed into a new toolkit of approaches that humanitarian organisations can use to better support women and girls.

“Menstruation is a taboo in pretty much every society and it’s often seen as something negative, something that needs to be hidden.”

Nicole Klaesener-Metzner, IRC

I rang Nicole Klaesener-Metzner, an IRC technical advisor on environmental health, to find out more.
“Menstruation is a taboo in pretty much every society and it’s often seen as something negative, something that needs to be hidden,” she tells me.
Things become more complex when women and girls are forced to flee their homes: cultural taboos prevent women coming forward for support, and aid organisations have been slow to integrate menstrual health into their programmes. No one in the humanitarian cluster system is officially responsible for this.
Stigma is part of the problem, says Klaesener-Metzner. Part of it is also that humanitarian water and sanitation (WASH) engineers are often men, “and so hygiene management is not necessarily the first thing on their mind. Often men just don’t know what’s needed.”
And menstrual hygiene isn’t considered a life-saving priority, even though it affects many people in any emergency.

The result is WASH facilities and camp layouts that neglect women’s needs and even put their lives in danger. In some camps, for example, bins for pad disposal are far from toilets, in full view of the camp. So women opt to change pads after nightfall, a time that puts them at risk of violence.

Klaesener-Metzner says five simple changes in water and sanitation facilities would improve the situation in camps: having cubicles with enough space to change pads and wash; having water inside cubicles, not just outside; installing somewhere discreet to dispose of pads; having a designated area to wash and dry reusable cloth out of the sight; and ensuring access to underwear that pads fit securely into.

I also asked Klaesener-Metzner how the toolkit could be adapted for women from different cultures, and when living together in refugee camps, and on the move. “We’re looking very closely at this,” she says. For example, in the refugee response in Greece, responders have set up kiosks staffed by women to dispense smaller versions of the standard, bulky hygiene kits: “people can choose the specific items that they want”. The next step is to test the toolkit in Tanzania with Congolese and Burundian refugees.
Meanwhile, though, humanitarian organisations must improve at putting basics in place from day one. “What are the universals that you can do? Things as simple as talking to the women and knowing the local preference before you’re purchasing your hygiene kit [will help],” she says. “Make sure you have water available.”

Improving collaboration between different humanitarian sectors — particularly WASH and protection — and making one sector take final responsibility “to make sure it doesn’t fall between the cracks”, is also critical, she says.
Imogen Mathers is producer/assistant editor at SciDev.Net. You can reach her on @ImogenMathers and [email protected]