Why a monthly period is especially hard for millions of women and girls around the world
Millions of girls and women are displaced and on the move right now globally – and the Trump administration's proposed drastic cuts to humanitarian aid will have a major impact on these girls' and women's health.
An especially important but often overlooked issue is one of the most basic parts of life for women – menstruation. This routine part of female life is a pronounced burden for women in low-income countries and those who are displaced. It disrupts many girls' abilities to participate actively in school, potentially consigning them to second-class status for the rest of their lives. A lack of easy access to adequate toilets in schools or elsewhere can also place them at higher risk for sexual violence as they seek out safe places to manage their menstruation and other sanitation needs.
As someone who is studying ways to help girls and women manage their periods with dignity, I see Menstrual Hygiene Day on May 28 as a critical opportunity to talk about and bring attention to this too often taboo topic.
Lack of privacy and access to facilities
Over the past year, the International Rescue Committee has partnered with Columbia University's Mailman School of Public Health, with support from Research for Health in Humanitarian Crises, to improve standards in menstrual hygiene management programming in emergencies across the world.
Its aim is to raise the bar and provide guidelines for a comprehensive response – one that considers more than just sanitary pads.
To do so, the project needed to ask adolescent girls and women what they actually need and want, and effectively integrate a variety of perspectives and experiences.
What we found was that the main difficulties women and girls faced went beyond a need for materials and included a lack of privacy and facilities to manage their menstruation. Living in tents without doors, with only curtains, they had no choice but to use the shared toilets, which were cramped, unclean, poorly lit and had no running water.
This ranged from girls and women living in informal settlements in urban settings in the Middle East and Europe, to those in camps for refugees and internally displaced populations in Asia and Africa.
Secrecy and taboos also complicate
For women and girls displaced by conflict or natural disaster, managing their monthly periods can be challenging. Few female hygiene products are available, private sanitation facilities are hard to find and clean water is not always guaranteed. Often, even just talking about periods can be challenging, given the secrecy and taboos that surround menstruation in many societies.
Without the ability to properly manage their periods, women and girls are increasingly vulnerable in their day-to-day lives. It makes them more susceptible to gender-based and sexual violence as they seek appropriate materials and private places to wash, dry and dispose of used materials. For example, many may need to seek out private spaces in forests or under cover or darkness to try to manage their washing and drying privately, but being alone puts them at risk of attack.
Other girls and women may encounter harassment when they go to pick up monthly distributions of pads. They risk embarrassment and ridicule from a menstrual leak, which can hinder their ability to engage socially, attend school or carry out daily activities. This can prove more challenging with limited laundry soap, water and few changes of clothes.
"If you take too long at the toilet someone will come in while you are changing and no one is supposed to see you during menstruation," one girl shared.
"You must dry your underwear and pads in secret. People may steal it for witchcraft. This can cause you infertility," said another.
We also found that disposal of waste materials was a common concern. There were no or few waste bins in the toilets in displacement camps, so women and girls needed to find their own ways of disposing of used pads. They were not willing to throw them away in the provided waste facilities in fear that people would see their pads and get hold of them. Strong cultural beliefs contributed to existing fears that if someone were to see their used menstrual material, they might be cursed.
In Myanmar, for example, women resorted to burying them in the ground at some distance from their homes, in the hours of darkness. Others tried to dispose of pads directly into toilets, leading to frequent blockages.
Information lacking, and sometimes badly sourced
Access to information was also scarce. Girls learned about menstruation from mothers, sisters or friends. As is often the case, this advice wove together folklore with more practical information.
For instance, we found that Syrian refugee girls in Lebanon believed that they were prohibited from washing themselves, cutting their hair or participating in physical activities while they were menstruating.
We found that women and adolescent girls strongly desired increased education around menstruation. Mothers especially wanted information on how best to discuss it with their daughters.
Instead, girls often learn about their periods from male teachers.
"When the teacher is telling them about menstruation, he is male, and there are boys there. The boys start to laugh and shout at them and afterward continue to tease us," explained a Congolese girl in Nyarugusu Camp.
The humanitarian community has become better at distributing materials to women and girls, and in incorporating menstrual hygiene management into their responses.
Working for solutions
Making sure women and girls have access to suitable materials (and underwear!) and know how to use them is important; but there's more to solving this problem.
Toilets and washrooms need to be private, safe and clean. Waste disposal systems need to address all waste flows generated in the camps effectively and discreetly. Schools need to be able to cater to girls when they have their period. Better information is necessary to break societal taboos around menstruation. We've heard all of this from women and girls themselves.
The next step of our menstruation investigation project aims to finalize a comprehensive package of tools and guidelines to help agencies rapidly identify key needs; provide needed materials, facilities and support; and monitor the effectiveness of the program so that gaps can be identified and filled.
This is possible only if the humanitarian aid community works across sectors, including education, protection, health, water and sanitation, to provide the best possible programs in emergencies.
And it is possible only if aid workers talk with women and girls, listen to their concerns and provide appropriate programming, not just providing programs by the book.