BackgroundThere is a significant gap in empirical evidence on the menstrual hygiene management (MHM) challenges faced by adolescent girls and women in emergency contexts, and on appropriate humanitarian response approaches to meet their needs in diverse emergency contexts. To begin filling the gap in the evidence, we conducted a study in two diverse contexts (Myanmar and Lebanon), exploring the MHM barriers facing girls and women, and the various relevant sectoral responses being conducted (e.g. water, sanitation and hygiene (WASH), Protection, Health, Education and Camp Management).MethodsTwo qualitative assessments were conducted: one in camps for internally displaced populations in Myanmar, and one with refugees living in informal settlements and host communities in Lebanon. Key informant interviews were conducted with emergency response staff in both sites, and focus group discussion and participatory mapping activities conducted with adolescent girls and women.ResultsKey findings included that there was insufficient access to safe and private facilities for MHM coupled with displacement induced shifts in menstrual practices by girls and women. Among staff, there was a narrow interpretation of what an MHM response includes, with a focus on supplies; significant interest in understanding what an improved MHM response would include and acknowledgement of limited existing MHM guidance across various sectors; and insufficient consultation with beneficiaries, related to discomfort asking about menstruation, and limited coordination between sectors.ConclusionsThere is a significant need for improved guidance across all relevant sectors for improving MHM response in emergency context, along with increased evidence on effective approaches for integrating MHM into existing responses.

Massive population displaceMent has becoMe a reality across much of the world, with an estimated 60 million people currently displaced by war, conflict, or disaster (unhcR, 2015). With nearly half of the displaced comprising girls and women (unhcR, 2015), there has been a growing impetus within the humanitarian response community to better address the gender-specific needs of displaced populations. this includes increasing efforts by many international relief organizations to mainstream gender priorities through targeted policy, programming, and research (Gasseer et al., 2004;Kovacs and tatham, 2009;Mazurana et al., 2011). a critical gender issue that has yet to be adequately prioritized is that of meeting the menstrual hygiene management (MhM) needs of adolescent girls and women. Girls and women across low-income contexts face numerous challenges managing their menstruation safely, hygienically, and with dignity including physical access to latrines during menstruation, dedicated places of disposal for materials, and being able to manage menses without shame and repercussions (house et al., 2012;Mahon and Fernandes, 2010;sebastian et al., 2013). in emergencies, they face additional challenges. Girls and women who flee their homes may not be able to carry adequate supplies of materials (cloths, pads, underwear) to manage monthly bleeding. they may prioritize children, the elderly, and other family members' needs over their own body-related needs. they may be on the move, or living in crowded, unsafe environments that lack access to private and safe water and toilet facilities (especially at night) for changing menstrual materials and washing themselves (parker et al., 2014;sommer, 2012; iFRc, 2013;hayden, 2012). they may lack mechanisms for privately disposing of used materials, or for discreetly washing and drying reusable menstrual materials. all of these factors increase women and girls' exposure to risk of sexual violence and exploitation in humanitarian settings (sommer et al., 2014;Gosling et al., 2011;davoren, 2012).the range of challenges girls and women face may differ if an emergency is acute or protracted, urban or rural, or if they find themselves on the move, living in camps, host communities, or informal settlements. Girls and women from different cultures will also have unique menstrual beliefs that influence how they manage menstruation, including strongly held taboos around disposal of menstrual waste (e.g. burying versus burning, or disposing of waste in a secret manner) (hayden, 2012;sommer, 2012;sommer et al., 2013;Kjellén et al., 2011) and methods for washing and drying used menstrual materials (de lange et al., 2014; nawaz et al., 2006). they may, for example, prefer to manage menstruation in private bathing spaces instead of toilets. the varying socioeconomic backgrounds of the changing displaced global population may influence preferences for menstrual material distributions. as with other interventions in emergencies, the type of emergency (e.g. natural disasters, acute conflict) will d...

Displaced adolescent girls and women face many challenges managing their monthly menstrual flow with dignity and comfort in various challenging settings around the world, such as refugee camps, informal settlements, and while in transit across geographies as they flee disaster or conflict. Menstrual hygiene management requires easy access to safe, private water and sanitation facilities, along with appropriate menstrual materials and supplies, discreet disposal and waste management, and basic information on menstrual hygiene for displacement contexts. Yet, a significant gap exists in terms of available guidance on effective, coordinated multi-sectoral approaches for a complete menstrual hygiene management response. This paper describes one effort to address this gap, the development and pilot testing of the Menstrual Hygiene Management in Emergencies Toolkit in three camps hosting Burundian and Congolese refugees in Northwest Tanzania. Multiple methods were used to evaluate the implementation of the toolkit, which included a process and endline evaluation. Key findings included the identification of content gaps in the draft toolkit, the mapping out of a training and capacity building approaches needed for integrating menstrual hygiene management into ongoing programming, the relevancy and appropriateness of the guidance prescribed, and the potential for novel approaches to be identified by both water, sanitation and hygiene (WASH) and non-WASH sector actors subsequent to sufficient training. Important lessons from this exercise may be useful for the introduction of MHM programming into future global humanitarian response efforts.

Inadequate access to a private, comfortable, and well-located toilet remains a critical challenge for many girls and women around the world. This issue is especially acute for girls and women living in densely populated urban slums, displacement camps, and informal settlements, often resulting in anxiety, embarrassment, discomfort, and gender-based violence. The unique sanitation needs of girls and women are rarely accounted for during the design and construction of toilet facilities, including needs related to their physiology, reproductive health processes, prevalent social norms, and their heightened vulnerability to violence. It is critical that a new norm be developed regarding the design of female-friendly toilets which better enables girls and women to feel confident, safe, and dignified while managing their daily sanitation needs. This includes adopting specific design measures which account for their menstrual hygiene, personal safety, and dignity-related needs. Ultimately, an enhanced dialogue must take place among designers, policy makers, water, sanitation, and hygiene (WASH) practitioners, and other relevant actors, in addition to the target female users themselves, about how to adapt toilets in a range of development and emergency contexts and operations to better address these critical needs of girls and women.

Background There is growing attention to addressing the menstrual hygiene management (MHM) needs of the over 21 million displaced adolescent girls and women globally. Current approaches to MHM-related humanitarian programming often prioritize the provision of menstrual materials and information. However, a critical component of an MHM response includes the construction and maintenance of water, sanitation and hygiene (WASH) facilities, including more female-friendly toilets. This enables spaces for menstruating girls and women to change, dispose, wash and dry menstrual materials; all of which are integral tasks required for MHM. A global assessment identified a number of innovations focused on designing and implementing menstruation-supportive WASH facilities in the Rohingya refugee camps located in Cox’s Bazar (CXB), Bangladesh. These pilot efforts strove to include the use of more participatory methodologies in the process of developing the new MHM-supportive WASH approaches. This study aimed to capture new approaches and practical insights on innovating menstrual disposal, waste management and laundering in emergency contexts through the conduct of a qualitative assessment in CXB. Methods The qualitative assessment was conducted in the Rohingya refugee camps in CXB in September of 2019 to capture new approaches and practical insights on innovating for menstrual disposal, waste management and laundering. This included Key Informant Interviews with 19 humanitarian response staff from the WASH and Protection sectors of a range of non-governmental organizations and UN agencies; Focus Group Discussions with 47 Rohingya adolescent girls and women; and direct observations of 8 WASH facilities (toilets, bathing, and laundering spaces). Results Key findings included: one, the identification of new female-driven consultation methods aimed at improving female beneficiary involvement and buy-in during the design and construction phases; two, the design of new multi-purpose WASH facilities to increase female beneficiary usage; three, new menstrual waste disposal innovations being piloted in communal and institutional settings, with female users indicating at least initial acceptability; and four, novel strategies for engaging male beneficiaries in the design of female WASH facilities, including promoting dialogue to generate buy-in regarding the importance of these facilities and debate about their placement. Conclusions Although the identified innovative participatory methodologies and design approaches are promising, the long term viability of the facilities, including plans to expand them, may be dependent on the continued engagement of girls and women, and the availability of resources.