Management of menstruation in contexts of humanitarian emergencies can be challenging. A lack of empirical research about effective interventions which improve menstrual hygiene management (MHM) among female populations in humanitarian emergencies and a lack of clarity about which sectors within a humanitarian response should deliver MHM interventions can both be attributable to the lack of clear guidance on design and delivery of culturally appropriate MHM intervention in settings of humanitarian emergencies. The objective of this review was to collate, summarize, and appraise existing peer-reviewed and gray literature that describes the current scenario of MHM in emergency contexts in order to describe the breadth and depth of current policies, guidelines, empirical research, and humanitarian aid activities addressing populations’ menstrual needs. A structured-search strategy was conducted for peer-reviewed and gray literature to identify studies, published reports, guidelines, and policy papers related to menstrual response in emergency humanitarian contexts. Of the 51 articles included in the review, 16 were peer-reviewed papers and 35 were gray literature. Most of the literature agreed that hardware interventions should focus on the supply of adequate material (not only absorbent material but also other supportive material) and adequate sanitation facilities, with access to water and private space for washing, changing, drying, and disposing menstrual materials. Software interventions should focus on education in the usage of materials to manage menstruation hygienically and education about the female body’s biological processes. There was clear agreement that the needs of the target population should be assessed before designing any intervention. Although there is insight about which factors should be included in an effective menstrual hygiene intervention, there is insufficient empirical evidence to establish which interventions are most effective in humanitarian emergencies and which sectors should be responsible for the coordination and implementation of such. Increased monitoring and evaluation studies of interventions should be completed and publicly shared, in order to feed evidence-based guidelines in the humanitarian sector.

PurposeMenstruation is a biological process that approximately half of the world’s population experiences over a significant period of their lifetime. As a displaced female, managing menstruation can be challenging as limited resources and changes in context confront the cultural norms of communities. This study explores the hypothetical acceptability and potential utility of a reusable menstrual underwear product through examining the beliefs, behaviors, and practices toward menstrual hygiene in a Middle Eastern population living in a refugee setting.Participants and methodsA qualitative study employing a questionnaire, semi-structured interviews, and focus group discussions was conducted with 30 refugee women and 5 humanitarian staff in Ritsona, Greece. All 30 refugee women completed a questionnaire, six refugee women and five humanitarian staff participated in individual semi-structured interviews, and four focus group discussions were held containing five to six refugee women per group. Inductive analysis led to the development of key themes.ResultsPrimary data analysis of narratives around the beliefs, behaviors, and practices of menstrual hygiene in this population revealed key themes related to the physical environment, the social environment, cleanliness, comfort, and health, and adaptation and coping. Themes related to the potential use of menstrual underwear included comfort, appearance, and concept, absorbent capacity and selected use, hygiene, and knowledge and implementation.ConclusionMenstrual hygiene beliefs, behaviors, and practices are mostly consistent with existing literature. An acceptance of the concept of reusable menstrual underwear was expressed, although the perceived benefits of this product did not outweigh customary practices. The use of menstrual underwear as a complimentary product to traditional absorbents was expressed as helpful for promoting dignity.