Managing menstruation is often more difficult in emergencies as people who menstruate may face a significant loss of privacy and dignity (e.g. in overcrowded, temporary or transit situations). They face the challenges of safely managing their menstruation in a new environment (e.g. menstrual products of their choice are not available, water for hygiene is limited, there are only shared bathrooms and toilets). People with disabilities or unaccompanied and separated girls (E.3 and E.5) may face additional challenges and require increased assistance, e.g. those with mobility disabilities may have to change pads in secluded areas, if WASH facilities aren’t accessible and inclusive.

A response to MHH in emergencies needs to address all three components outlined below.  

1. Selection and distribution of appropriate menstrual products and supportive materials: different products exist to manage menstruation. Disposable pads are the most widely commercially available product. They are easy to distribute in an early onset emergency or to people in transit. However, these products require constant redistribution, are more expensive and need to be disposed of after a single use, which often leads to uncontrolled disposal in the environment P.5 or in toilets P.4. Reusable menstrual products such as reusable menstrual pads, menstrual cups or even clean cloth are more environmentally and financially sustainable solutions, though provision for hygienic handling is essential (washing, drying, safe storage). Whichever product is provided, it should meet global quality specifications (see resources). Materials to consider providing include underwear, extra laundry and bathing soap, a container with a lid for storing and soaking of reusable menstrual pads, cloth or dirty clothes and rope and pegs for drying. 

2. Availability and access to safe, private WASH facilities, including bathing areas and disposal: female-friendly sanitation facilities should meet minimum standards and consider menstruation needs (disposal, washing and changing of materials). Gender segregation of toilets is crucially important to ensure all women are safe and feel safe to access facilities. Female segregated and, ideally, private areas for personal hygiene need to be provided that include spaces for washing and drying underwear and reusable menstrual products. If these areas are not available, additional materials for washing and drying at home may need to be provided, such as buckets, extra soap, clothesline and pegs and leak-proof bags. Safe disposal of used products must be provided to prevent blockages of sewage pipes or difficulties in desludging pits or septic tanks clogged with menstrual materials. 

3. Information and awareness on menstruation and MHH: age-specific knowledge about menstruation and how to manage should be provided to girls (before they start their first period (9-12 years), adolescents and other menstruating adults. Particularly if products and materials are unfamiliar, users need information on how to use and dispose of them correctly. Education about menstruation is often a good entry point to wider community issues such as reproductive health and gender roles. Awareness can be raised from the start of the response among men and boys, religious and local leaders to address stigma, menstruation-related restrictions on people who menstruate and provide social support.

MHH requires coordination between sectors P.9 such as WASH, Education, Protection (especially gender-based violence and child protection), Shelter, Health, including sexual and reproductive health and psycho-social support).

Process & Good Practice

• Vary MHH related activities depending on the response phase: 

  • During the preparedness phase MHH mainly involves an assessment of preferences and local practices, the identification and prepositioning of menstrual products and supportive materials, the training of staff and partners and the identification of contextualised IEC material T.19. 
  • During the acute response the focus is the immediate provision of appropriate basic menstrual products and supportive materials P.6, establishing access to water P.3 and sanitation facilities P.4 and ensuring that the designs are appropriate for the safety and comfort of people who menstruate.
  • Longer-term stabilisation and recovery phases (and protracted scenarios) include more in-depth involvement of people who menstruate, potentially leading to refinements regarding the MHH approach and components. 

• Co-ordinate with others to improve the quality and coherence of the response, including the establishment of an MHH task group, the inclusion of MHH indicators in cluster updates and the development of a menstrual hygiene management (MHM) strategy P.9.  

• Work with other sectors to complement general distributions of hygiene items with targeted distributions of dignity kits (including for hard-to-reach populations). Work closely with the Education, Health and Protection sectors to establish female-friendly sanitation facilities in schools and health centres and to coordinate MHH awareness and behaviour change programming P.9. 

• Use the three MHH components (outlined above) to help guide interlinked programming. For example, the type of products distributed determines whether extra water is required, the design of washing places, waste management (mostly for disposable products, P.5), as well as the tailored information based on local beliefs and practices.

• Be aware that due to the private nature, silence and shame around menstruation, certain challenges, practices and needs might not be expressed openly. This might affect the overall success of the intervention and response. Identify challenges to Knowledge, Attitudes and Practices T.24 to menstruation through Observations T.28, Interviews T.23 and Focus Group Discussions T.14. Work with trained female frontline and health workers whenever possible. It may take time to overcome hesitancy to talk openly about menstruation, so ensure safe spaces for learning and sharing. IEC materials T.19 should be as visual and easy to use as possible.

• Understand traditional practices and preferences, e.g. the washing and drying of pads might be more traditional, there may be cultural beliefs about menstrual blood and its disposal. A girl’s coming of age may be associated with her first menstruation and child marriage. Insertable products (tampons, cups) may not be acceptable.

• Distribute and replenish menstrual products at regular intervals, otherwise users are forced to use self-made solutions. Ensure quality products to reduce health and hygiene risks and to guarantee the mobility of people who menstruate. The content of kits (hygiene kits, dignity kits or specific MHM kits) provided by different actors should be aligned. It is recommended that the distribution of menstrual products (in kind or cash) is done by women.  

• Consider market-based programming (MBP) modalities such as cash and voucher assistance P.8 to provide a choice of products and enable humanitarian actors to increase the available product range in the local markets. The Global WASH Cluster’s updated guidance on MBP for WASH includes a dedicated section on menstrual products.

• Seek to identify synergies with general waste management P.5 in case menstrual products can be collected and treated with other waste streams in the camp, especially if there is a facility for medical waste.