What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? A global review

Abstract

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...

Pilot testing and evaluation of a toolkit for menstrual hygiene management in emergencies in three refugee camps in Northwest Tanzania

“…The study also generated valuable insight on the importance of non-WASH actors to identify and initiate new opportunities and roles to support MHM. As MHM responses are often led by the WASH sector in a given emergency, other sectors are often not clear on the scope of their supporting (or leading) role to ensure a comprehensive MHM response (Schmitt et al 2017;Sommer et al 2016). The pilot provided an important example of the health sector determining their role in addition to effectively engaging with WASH actors to address facilityfocused improvements in areas of overlapping operations.…”

“…Data sources were primarily qualitative, but quantitative data were collected in terms of estimating numbers and proportions of women and girls affected and the outcomes of environmental inspections of MHM infrastructure. The methods used in the formative assessment are described in two published articles (Schitt et al 2017, Sommer et al 2016.…”

“…From 2015 to 2016, formative research was conducted to identify knowledge gaps around MHM in emergencies. This included a desk review of gray and scientific literature, key informant interviews with humanitarian staff from headquarters and regional offices of humanitarian organizations, and qualitative assessments with adolescent girls and women and response staff in two emergency contexts (internally displaced persons (IDP) camps in Rakhine State, Myanmar, and Syrian refugees living in host communities/informal settlements in Lebanon) (Schitt et al 2017, Sommer et al 2016.…”

“…A global review conducted in 2012 highlighted numerous issues around existing organizational responses for MHM in humanitarian emergencies, including an overall lack of evidence, practical guidance, monitoring measures, and coordination across sectors and organizations (Sommer 2012;Sommer et al 2016). The majority of guidance available was often concentrated in the water, sanitation and hygiene (WASH) sector and did not incorporate the range of multi-sector actors needed for a cohesive and effective response (Sommer 2012).…”

Making the Case for a Female-Friendly Toilet

“…In addition, actual consultation with girls and women regarding their sanitation needs is relatively rare [1,20,21]. This is particularly the case in humanitarian contexts where emergency responders' baseline knowledge about the cultural sanitation practices and needs of displaced females may be low [5,22,23]. Consultation with girls and women is often further hindered by strong taboos linked to menstruation and general discomfort discussing female sanitation.…”