IFRC’s 8 Steps for Menstrual Hygiene Management (MHM) action is a step-by-step iterative process for assessing, planning, monitoring, reviewing and re-adjusting and evaluating menstrual hygiene action. It provides guidance and practical tools for designing and implementing appropriate, comprehensive and effective MHM action P.7 in humanitarian contexts for the Red Cross Red Crescent and can be adapted for use by other organisations and for different contexts.

The guide follows an eight step systematic approach coherent with the programme cycle and aligned with IFRC’s 8 Steps for Hygiene Promotion in Emergencies F.4 for easy integration and consistency: 

Step 1: Identifying the problem

Step 2: Identifying target groups 

Step 3: Analysing barriers and motivators for behaviour change 

Step 4: Formulating hygiene behaviour objectives 

Step 5: Planning and design 

Step 6: Implementation 

Step 7: Monitoring and evaluation 

Step 8: Review, re-adjust 

The three essential components for an effective MHM response are (1) access to menstrual products and supportive items, (2) private, safe and appropriate WASH facilities and (3) information. The components are all influenced by individual preferences and socio-cultural factors including taboos, restrictions and physical barriers. Continuous engagement and consultation with women, girls, men and boys is critical, to ensure that MHM actions are responsive, address needs and challenges and are socially and culturally appropriate. It is important to identify women and girls who may be marginalised or need additional support, such as those with physical disabilities, learning difficulties, transgender people or unaccompanied girls. 

Tools and Methods used

The 8 Steps for MHM action include a number of practical tools that are available for download from IFRC’s WASH webpage in different formats and languages. They include amongst others: 

• Checklists T.2
• Focus Group Discussion T.14 guides for assessment and post-distribution monitoring
• Minimum items to be included in dignity or MHM kits
• Pocket Chart Voting T.31
• Observation T.28
• Example IEC material T.19
• Example outputs and indicators (T.25) for the emergency plan of action
• Guidance on cash and voucher assistance for MHM P.8
• Three-Pile Sorting T.51

Applicability

The guide and tools are designed for preparing and responding to menstrual hygiene needs in humanitarian situations. They can also be used for longer-term programming, to train staff and volunteers, assess menstrual hygiene practices, preferences, socio-cultural attitudes, taboos and restrictions and trusted sources of information. The main advantage of the 8 Steps is to encourage a systematic, comprehensive approach to MHM which addresses the three essential components of MHM, rather than only focusing on the distribution of MHM items. The guide and tools are easily adapted for different situations and languages and are available in English, French, Spanish and Arabic. Some tools are available in Portuguese, Swahili, Kirundi and Bislama.

Main Requirements / Investments Needed

Comprehensive MHM action requires an investment in both ‘hardware’ (e.g. retrofitting or constructing latrines P.4, solid waste facilities P.5, distribution of MHM items P.6, or access to water P.3 as well as ‘software’ (e.g. engagement with women and girls to understand their needs and preferences, information sessions and social and behaviour change communication to break down cultural restrictions or taboos). The hygiene promotion (HP) team is critical to the implementation of MHM actions throughout the project cycle, often through community-based volunteers. The selection of volunteers should be based on an understanding of the local socio-cultural context and what is appropriate for the specific community. The training and capacity strengthening of male and female volunteers (and staff) for MHM are important. Resources (human, financial) and time must be allocated (as part of preparedness, in an emergency or through longer-term development programming). The supervision and monitoring of community-based volunteers must also be planned and budgeted. Additional resources for HP materials such as IEC T.19 materials, or Pocket Chart Voting T.31, may be needed. 

Evidence of Effectiveness

Several Red Cross Red Crescent National Societies have successfully adapted and used the approach in preparedness activities, acute humanitarian responses and recovery programming. This is evidenced by the growing number of country-specific MHM kits which have been developed and distributed, the development of standard operating procedures for hygiene and MHM kits and adapted versions of KAP Surveys T.24, Checklists T.2 and IEC T.19 materials in different languages. 

Do

• Keep users at the centre and focus on participatory Engagement (chapter [E]) and Assessment (chapter [A]) of MHM practices, needs, preferences and socio-cultural context 

• Think about the ‘life cycle’ of all MHM items distributed - using pads/cloth is only the first step. Washing, drying and disposal of menstrual waste are important and must be considered 

• Involve men and boys in MHM programming 

Don't

• Do not only focus on distributing MHM items. WASH facilities ([P.2], [P.3], [P.4], [P.5], [P.6]), information and social-cultural aspects are just as important 

• Do not address MHM in a silo. MHM is a cross-sectoral issue and coordination with sexual and reproductive health, protection, shelter and relief is critical [P.9]

• Do not rely only on quantitative data and Observations [T.28]. Use participatory methods to stimulate discussion

Practical Example

The Iraqi Red Crescent Society (IRCS) took a user-centred approach to adapt MHM kits and education materials based on the 8 steps and made use of several of the IFRC’s tools. An assessment to understand the socio-cultural aspects of MHM in Iraq and to adapt the WASH infrastructure was done. Based on the participatory consultation and user feedback, IRCS developed MHM kits at a national level and then further localised the MHM kits in Sinjar province, as part of an early recovery programme. Post-distribution monitoring resulted in a number of changes and improvements to the distribution process, MHM kits and overall MHM programming.