Menstrual Hygiene Management: What have we learned and how far have we come?

This meeting, hosted by Elrha’s R2HC programme, gathered humanitarian experts and practitioners to review the progress and ongoing challenges of Menstrual Hygiene Management (MHM) in emergency settings and discuss current needs and priorities of the sector particularly in terms of guidance and knowledge exchange to help mainstream good practice. Around 350 people attended the webinar, with all regions of the world represented. This note summarises key insights emerging from presentations and the panel discussion.

Prof. Marni Sommer of Columbia University (Chair) opened the webinar, stating that around 120 million people are displaced globally, with half being women and girls who face challenges in managing menstruation safely and with dignity. Many lack access to private WASH facilities, menstrual supplies, and health information, which affects their rights to education and work, worsening inequalities. Professor Sommer’s previous research, supported by R2HC, focused on how humanitarian practitioners were responding to the menstrual health needs of women and adolescent girls. This informed the development of good practice guidance: the Menstrual Hygiene Management (MHM) toolkit, produced in partnership with International Rescue Committee (IRC).

Despite improved guidance, barriers remain. Humanitarian efforts are still underfunded, with limited capacity to integrate MHM into responses. A significant challenge is that field staff are sometimes uncomfortable addressing menstruation-related needs, and there is still insufficient integration of MHM into Water, Sanitation and Hygiene (WASH), education, health, protection, shelter, and other humanitarian response sectors or clusters.

Prof. Sommer noted that many organisations involved in the webinar were all key in the development of the Toolkit and have been instrumental in advancing good practice in the field.

Lessons from implementing MHM in humanitarian response

Mr. Bansaga Saga shared insights from IRC’s work in Nigeria, where displaced women and girls face significant challenges related to menstrual hygiene management (MHM). Cultural norms and taboos, such as the belief that menstrual materials can be used for evil rituals or that menstruating women should not cook or participate in religious activities, create barriers. These taboos result in the stigmatization, discrimination, and exclusion of women from community life, affecting their health, dignity, and education. The IRC has integrated MHM into education and protection programs, distributing over 25,000 menstrual hygiene kits and educating more than 75,000 women. Feedback shows reduced stigma, enhanced safe and healthy MHM practices, greater comfort discussing menstruation, adaptations to sanitation facilities, and improved school attendance for adolescent girls. However, resource shortages lead to sharing of hygiene kits, highlighting the need for continued support.

Ms. Florence Uwineza discussed Oxfam’s response to the 2023 earthquake in Syria, where the disaster worsened existing menstrual hygiene challenges. Women and girls in temporary shelters lacked materials and private spaces for menstruation management, and stigma surrounding menstruation persisted. Oxfam distributed over 10,000 hygiene kits, improved WASH facilities, and provided MHM education. They also developed a module to educate boys and parents, which has helped dispel misconceptions. Florence emphasized the need for collaboration between WASH, gender, and protection sectors to ensure a comprehensive response, noting that involving boys and men in discussions helped reduce stigma.

Alexandra Machado Soergel of the International Federation of Red Cross and Red Crescent Societies (IFRC) shared progress in their MHM interventions, which began in 2017, inspired by the Columbia University Toolkit and resources, adapting and operationalising these guidelines for their organisational use, including country-specific guidelines. In Bangladesh, IFRC worked on female WASH facilities, community engagement and accountability, and adapted menstrual hygiene kits based on community feedback. Similarly, in response to the2020 hurricanes in Central America, IFRC quickly distributed MHM and incontinence supplies. Alexandra stressed the importance of preparedness and long-term, sustainable interventions tailored to local needs, rather than focusing solely on emergency responses, and the inclusion of motivated and engaged community volunteers.

Raissa Azzalini, Public Health Advisor, Oxfam and Tom Ogello, Environmental Health Technical Advisor, Asia region, International Rescue Committee, joined the dialogue, and the panel discussed key lessons learned from the field and outstanding needs and priorities to improve MHM response.

What works and lessons learned:

• ‘Three pillars’ of MHM: it is important to recognise when designing a response that MHM is not only the distribution of pads, but must consider ‘supplies, facilities, and information (or education) which engages communities.’
• Cross-sector coordination: Speakers emphasised that effective MHM programming requires coordination between WASH, protection, gender, health, education and other key sectors. Cross-sectoral collaboration helps ensure a comprehensive response to the needs of menstruating women and girls. However, because of the lack of ownership, MHM still sometimes ‘falls between the cracks’ during a response.
• Cultural sensitivity: MHM interventions need to be adapted to local contexts, considering cultural beliefs, taboos, and available resources. Community consultation is key to understanding the preferences and needs of the affected populations and can help build understanding and reduce stigma.
• Inclusion of Boys and Men: Engaging boys and men in discussions about menstruation can also promote a more supportive environment for women and girls. Pilot projects have shown that boys and men are often willing to participate when approached in the right way, articulating examples of roles that they can play and appreciated being involved in the conversations.
• Waste Management: This is an ongoing challenge. Examples of how to address this included the use of dedicated chutes for disposal (which are highly appreciated by communities) and in most contexts pit latrines still remain the go to approach though not preferable especially where disposable materials are used. Approaches that reduce waste can also be trialled, such as reusable period underwear that can be washed. However, waste management remains underfunded and technically challenging, requiring further innovation and community consultation. Further research is required to better understand water needs around reusable underwear.

Conclusions

Overall, while significant progress has been made, there is still a long way to go to fully integrate MHM into emergency response, with continued funding and capacity-building required to ensure women and girls can manage menstruation safely and with dignity during crises. Practitioners and programme staff still require guidance and support to mainstream MHM into humanitarian response. The level of engagement in the webinar was significant, both attendance and range of questions, suggesting demand for learning on this topic, with some questions remaining under-researched.

However, the panel also emphasised existing resources available to support humanitarian actors in designing and implementing a comprehensive cross-sectoral MHM response- there is no need to start from scratch. Resources are linked below, and many are available in multiple languages.

Resources mentioned in the webinar

• Menstruation in Emergencies Toolkit and Mini-Guide available in English, Spanish, French and Arabic
• Community Perception Tracker | Oxfam WASH Resources
• Menstrual Disposal, Waste Management &; Laundering in Emergencies: A Compendium
• IFRC Menstrual Hygiene Management – Watsan Mission Assistant
• Trialing Menstrual Hygiene Management Products in High Severity Contexts
• Integrating MHM into Ebola Response

Summary available in several languages:

• (ES) Resumen webinar: Gestión de la higiene menstrual
• (FR) Résumé du webinaire Gestion de l'hygiène menstruelle
• (AR) إدارة النظافة الصحية أثناء الدورة الشهرية