Practice Note: Menstrual Health Management in Humanitarian Settings

Abstract

Tellier et al. take stock of menstrual health management in humanitarian settings, seeking to shed light on the goals, key components, and coordination efforts to address menstruation needs under duress. The authors are volunteers or staff with WoMena, an NGO that works to improve menstrual health and management in Uganda. Based on this experience and focusing on Uganda and Nepal, this practice note probes how the issue is approached in different contexts and at different stages—comparing urgent response after a sudden onset disaster (for example, earthquakes) to protracted crises (for example, long-term refugee settings). The authors discuss how interventions can be made sustainable beyond the short-term ‘kit culture’ response; they highlight experiences with more developmental approaches involving policy support, community participation, capacity building, and the use of products that are economically and environmentally sustainable.

The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research

“…However, these individuals (and others who may communicate about menstruation) themselves have important knowledge gaps and misconceptions, and often pass on these knowledge gaps and misconceptions inadvertently [ 17 ]. Thirdly, most health education programmes in school and community settings do not adequately address menstruation, or do not address it at all [ 18 ]. When menstruation is addressed, the information provided typically focuses on the biology of menstruation and lacks information on its association with sexual and reproductive health (SRH), as well as practical guidance for managing menstruation, including pain, and opportunities for care and support if needed [ 19 , 20 ].…”

“…Firstly, there is greater attention to menstruation in the context of health, development and human rights, and in the media. This has led to stronger calls for investment and corresponding action [ 18 ]. Secondly, there is greater political appetite to tackle this issue in some countries and greater investment in this area from some funders and investors.…”

Biological, material and socio-cultural constraints to effective menstrual hygiene management among secondary school students in Tanzania

“…Menarche without prior information is commonly associated with negative emotional reactions, including shock, fear, and lack of confidence to seek help [4]. Other risks of insufficient information may include unintended pregnancy and subsequent marriage [6] and urogenital infection [33].…”

“…Menstrual hygiene management is an important determinant for girls' educational outcomes in low and middle-income countries. The qualitative research points to a multitude of constraints [1][2][3][4][5][6][7][8][9][10][11] affecting a wide range of outcomes [12][13][14][15]. However, the quantitative literature, especially that focusing on impact evaluations, has lagged behind both in terms of the breadth of interventions and the various impacts such interventions can have [13,[16][17][18][19][20][21][22].…”

“…Several reviews covering over a hundred individual studies share a common prevalent finding; across the LMIC, girls self-report higher rates of absence while menstruating compared to when not menstruating (e.g. reviewed in Southern and East Africa [6]). However, in addition to absenteeism, research from Sub-Saharan Africa [14,27,28] has found that girls self-report worsened school performance, decreased mobility, and difficulty concentrating during their period.…”