Understanding the menstrual hygiene management challenges facing displaced girls and women: findings from qualitative assessments in Myanmar and Lebanon

Abstract

BackgroundThere is a significant gap in empirical evidence on the menstrual hygiene management (MHM) challenges faced by adolescent girls and women in emergency contexts, and on appropriate humanitarian response approaches to meet their needs in diverse emergency contexts. To begin filling the gap in the evidence, we conducted a study in two diverse contexts (Myanmar and Lebanon), exploring the MHM barriers facing girls and women, and the various relevant sectoral responses being conducted (e.g. water, sanitation and hygiene (WASH), Protection, Health, Education and Camp Management).MethodsTwo qualitative assessments were conducted: one in camps for internally displaced populations in Myanmar, and one with refugees living in informal settlements and host communities in Lebanon. Key informant interviews were conducted with emergency response staff in both sites, and focus group discussion and participatory mapping activities conducted with adolescent girls and women.ResultsKey findings included that there was insufficient access to safe and private facilities for MHM coupled with displacement induced shifts in menstrual practices by girls and women. Among staff, there was a narrow interpretation of what an MHM response includes, with a focus on supplies; significant interest in understanding what an improved MHM response would include and acknowledgement of limited existing MHM guidance across various sectors; and insufficient consultation with beneficiaries, related to discomfort asking about menstruation, and limited coordination between sectors.ConclusionsThere is a significant need for improved guidance across all relevant sectors for improving MHM response in emergency context, along with increased evidence on effective approaches for integrating MHM into existing responses.

Health-related needs and barriers for forcibly displaced women: a systematic review

“…Women frequently report that sexuality cannot be explicitly addressed, neither with family members nor with healthcare professionals [19]. Taboos around sexuality include themes ranging from menstruation to intercourse to contraception to sex work [23][24][25]. Female genital mutilation is also common and might represent a clinical challenge for inexperienced physicians.…”

“…Misconceptions about menstruation, its function and management, safe intercourse and contraception are frequently reported. For example, girls confound menarche with injury or bleeding, young women are not informed about the relationship between intercourse and pregnancy [23,25] and might not know that condoms cannot be used more than once [24]. Lack of knowledge limits female agency making women vulnerable for disease, but also abuse and violence ().…”

Improving the impact of menstrual health innovations in low- and middle-income countries: a theory of change and measurement framework

“…[6][7][8] Compounding this challenge is the inadequacy of safe, clean, and easily accessible water and sanitation facilities with disposal options for adolescent girls and women to manage their menstruation while at school, at work, 9,10 in transit 11 and in displacement contexts. [12][13][14] Many girls and women report having insufficient supplies for managing their blood flow, and having to use tissues, toilet paper, rags or underwear alone. Lack of appropriate supplies makes walking long distances, sitting in the classroom, visiting the market or waiting in long distribution lines in displacement camps difficult to manage.…”

“…Lack of appropriate supplies makes walking long distances, sitting in the classroom, visiting the market or waiting in long distribution lines in displacement camps difficult to manage. 7,11,12,15 Across many LMIC, girls and women are already disadvantaged, facing numerous hurdles related to gender equity in education and employment, 16,17 and gendered norms within families and communities that may diminish their opportunities, such as early marriage 18,19 or pregnancy-related school dropout. [20][21][22] Widespread gender discrimination contributes to the barriers faced by adolescent girls and women in managing menstruation with dignity and comfort, and negatively impacts health and wellbeing, hinders ability to succeed, 10,23,24 and potentially contributes to sexual and reproductive health harms.…”

“…Although minimal large-scale data exists on the types of products adolescent girls and women are using in different country contexts (and across varying demographics and geographies within countries), qualitative data from numerous LMIC indicate a wider use of cloth than disposable sanitary pads, despite many girls and women indicating preferences for disposable pads. 12,[44][45][46][47] In some impoverished settings, adolescent girls have reported that they lack access to underwear, hindering their ability to manage monthly menstrual flow given that there is nothing on which to attach a cloth or pad. 48,49 More recent surveys conducted by PMA2020 in India, Uganda, Kenya and Nigeria indicate only a small proportion of women have everything they need to manage their menstruation.…”