HEALTH | ADVOCACY & POLICY | VIOLENCE AGAINST WOMEN | ENVIRONMENT
Menstruation in Humanitarian Crises
WORDS BY ELSPETH BRIMACOMBE | ELSPETH@THEIWI.ORG | 24 MAY 2024
1. An overview
Menstruation is natural and inevitable within human populations, and therefore menstrual hygiene management (MHM) should be a guaranteed component of humanitarian response. Its omission is symptomatic of both the continued stigma around menstruation and a lack of attention to gendered needs within the humanitarian sector.
Access to menstrual hygiene is paramount for female physical and mental health. MHM is defined by WHO and UNICEF as:
"[w]omen and adolescent girls [using] clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of used menstrual management materials.” (UNICEF & WHO, 2012).
Here, we can identify four important aspects of MHM: (1) the physical period products - including disposable pads, reusable pads, and menstrual cups, (2) access to privacy, (3) access to clean water and hygiene products, and (4) adequate disposal facilities. We know the basics of MHM, but 'too often in humanitarian crises, these needs go unmet' (Doctors Without Borders, 2021). From this definition alone, the difficulty in providing MHM within humanitarian crises is understandable. This understanding, however, does not make its absence acceptable.
2. Access to period products
According to the World Bank, over 500 million women, girls and people who menstruate do not have access to menstrual supplies (UNFPA, 2023). The total and concentration of those without access to MHM greatly increases in humanitarian crises. Whilst there are key organisations coordinating MHM in emergency response, including UNICEF, ActionAid and UNFPA, there is still a significant gap between what is provided and what is needed.
This lack of period products is underscored by an inadequacy of funding dedicated to MHM, and the protection of gender-related needs more broadly (including maternal healthcare, and GBV programming and response). In 2021, around 3.4% of all humanitarian funding was dedicated to gender-specific response (Development Initiatives, 2021). The uncertainty surrounding this data collation is itself emblematic of the limited attention towards gendered needs in humanitarian crises. Nevertheless, insufficient funding is a clear indication as to why MHM is consistently under-supplied in humanitarian response.
3. Cross-cutting issue
As identified in the definition provided by UNICEF and WHO, there are other key practical considerations for MHM beyond the provision of menstrual products, including access to clean water, and access to soap and personal hygiene. WaterAid has reported that around 1.8 billion humans menstruate and 1 in 5 have no access to toilet facilities; an issue 'exacerbated during times of upheaval' (WaterAid, 2022). A lack of clean water and poor hygiene during menstruation can lead to illness and infection. This not only furthers the vulnerability of the individual but also increases the strain on medical supplies, which are often already stretched (UNFPA, 2018).
Access to clean water and hygiene facilities must also be considered akin to access to privacy, another component of MHM as addressed in the 2012 definition. As such, MHM must also be viewed in relation to infrastructure, such as refugee settlement planning. It is widely acknowledged that female vulnerability in humanitarian settings is heightened by a lack of sex-separated toilet facilities (Amnesty, 2016) (IRC, 2017). Menstruating women need to access facilities more regularly and therefore their exposure to this identified vulnerability increases. In knowledge of this, UNICEF distributes whistles and torches with period products to alert others to violence (UNICEF). Whilst an immediate and feasibly large-scale response, this response allows the risk to actualise and places the responsibility with those who are most vulnerable. It is therefore vital that MHM is incorporated into broader structural planning to help mitigate such vulnerability, and bring MHM from an issue of response to one of prevention and preparedness.
4. Beyond the physical
MHM is also fundamental in maintaining human dignity; an absence of MHM can lead to embarrassment, vulnerability and exclusion (UNFPA, 2022). This broader connection is repeatedly drawn by the UNFPA, emphasising their core mission to uphold 'women's and girls' dignity and protect their sexual and reproductive health and rights in any crisis' (UNFPA, 2023). This is emblematised in their delivery of 'dignity kits' in emergency response (UNFPA, 2023).
The persisting stigma, and often discrimination, towards menstruation exacerbates the physical vulnerabilities that women experience. This often leads to emotions of shame and isolation, and even more physical and violent ostracization. Deconstructing these social norms is essential in empowering women and instigating community-led responses, both within and beyond humanitarian settings. Effective MHM must therefore also consider community engagement in order to build sustainable MHM programming (USCRI, 2024).
5. Shift in approach
It has been reported that women in Gaza have no access to period products, and are forced to use tent scraps (ActionAid, 2024). These reports echo the experiences of women and girls in Sudan (ACAPS, 2024), Haiti (Plan International, 2023), Morocco (Aljazeera, 2023), and Syria (Oxfam, 2020). A fateful timeline of an entirely expected, yet insufficiently addressed, need.
The continued stigma towards menstruation - both communal and structural - further hinders the development of MHM preparation and response. The UNFPA's 2023 report on 'Menstrual Health and the Climate Crisis' emphasises the importance of investments from 'forward-thinking governments' into menstrual health and 'community-led solutions' to ensure adequate response (UNFPA, 2023). What is clear is that MHM requires cross-cutting considerations from all aspects of humanitarian response, including distribution, community engagement and infrastructure planning. Ultimately, those who menstruate and know the needs of menstruation must be involved in humanitarian decisions and coordination, to help centralise MHM programming and bring MHM from response to anticipatory action.