Study reveals challenges of menstrual hygiene management in emergencies

May 9, 2018 — Researchers at Columbia University's Mailman School of Public Health with colleagues at the International Rescue Committee and 27 humanitarian organizations and agencies developed a toolkit to address the menstruation-related needs of girls and women fleeing disaster or conflict. A pilot-test of the toolkit gathered feedback from ?humanitarian experts as well as displaced girls and women in refugee camps in Tanzania. The findings showed that there remains a lack of effective, coordinated approaches for assisting vulnerable groups to manage their menstruation with dignity in challenging settings around the world, and that the menstrual management needs of girls and women in transit, such as those walking days to find shelter and arriving at borders, are particularly overlooked. The findings are published in the Journal of Humanitarian Action.

Menstrual hygiene management (MHM) requires easy access to safe, private water and sanitation facilities, along with appropriate materials and supplies, discreet disposal management and basic information on menstrual hygiene for displacement contexts. Yet a significant gap exists in terms of the information available and practical guidance for those responding to emergencies around the world.

"We designed the toolkit to help address the gap in practical guidance for integrating menstrual hygiene management within humanitarian ?response efforts," said Marni Sommer, DrPH, MSN, associate professor of Sociomedical Sciences at the Mailman School. "While challenges remain, we learned important lessons from the pilot for improving the resource guide itself–its format and visuals, along with the need to provide more robust training materials to build staff confidence, among both males and females, on talking about menstruation and knowing how best to address MHM within a response."

The pilot revealed the need to expand the toolkit content to include girls and women with disabilities and their caretakers, as well as the currently overlooked needs of girls and women in transit who arrive at borders with no supplies or privacy for managing menstruation.

Using multiple methods to evaluate the Menstrual Hygiene Management in Emergencies Toolkit, the research team analyzed responses from women and girls aged 14 to 49 in three camps hosting Burundian and Congolese refugees in northwest Tanzania, along with feedback from the humanitarian response staff implementing the toolkit, between October 2016 and March 2017.

The feedback provided lessons on how caretakers of girls with special needs struggled to assist them with managing menstruation, particularly when girls had only male caretakers, and how response staff themselves needed training to feel more confident about consulting girls and women on what is frequently perceived as a very taboo topic.

Earlier studies by Sommer and colleagues included a 2017 paper on the menstrual hygiene management related experiences of girls, women and humanitarian staff in two on-going emergencies–Lebanon and Myanmar. A second paper published in 2016 was a global review of existing evidence and practical learning from the humanitarian sector.

"This pilot highlighted the need to expand the content for specific vulnerable groups," noted Sommer. "We learned many important lessons from this exercise that allowed us to finetune the resource, including ?the scope of ?content which will be useful for better integrating menstrual hygiene management programming into future global humanitarian response efforts."

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Co-authors are Margaret L. Schmitt and Samanatha Khandakji, Mailman School of Public Health; and Tom Ogello, Penninah Mathenge, Magdalena Mark, David Clatworthy, and Ruwan Ratnayake, International Rescue Committee.

The study was supported by the Research for Health in Humanitarian Crises Programme (grant 12964). The authors declare no competing interests.

Columbia University's Mailman School of Public Health

Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu.

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