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.