Using human-centered design to co-design dedicated menstrual health spaces with menstruators in Bidi Bidi refugee settlement, Uganda: Learnings for further adaptation and scale in humanitarian settings

Abstract

Background: Menstruators in low- and middle-income countries struggle to manage their menstruation safely, hygienically, and with dignity. This is exacerbated in humanitarian settings with limited access to products and safe, private spaces for changing, washing, and disposing of menstrual products. To address these challenges, Youth Development Labs (YLabs) used a human-centered design approach to co-design the Cocoon Mini, a safe, physical structure for managing menstruation in the Bidi Bidi Refugee Settlement in Uganda. Methods:The study comprised five phases, including secondary research, design research, rough prototyping, live prototyping, and a pilot study. A total of 340 people participated in interviews, focus groups, and co-design sessions. Solution prototypes were created, evaluated, and iterated upon in each successive project phase. The final intervention design, the Cocoon Mini, was evaluated qualitatively for feasibility and acceptability during a three-month pilot using semi-structured interviews with menstruators utilizing Mini structures, other community members, and Mini supervisors. Results:Our results show widespread desirability and acceptability of the Cocoon Mini among menstruators and other community members. Overall, 95% of menstruators stated the space had made menstrual health management easier, primarily by providing designated disposal bins, solar lights, and additional water sources. The Mini provided an increased sense of physical and psychological safety in knowing where to manage menstruation. Furthermore, the Mini demonstrated that an intervention could be run and maintained sustainably at the household level in humanitarian contexts, without continued external stakeholder intervention. Each Mini structure cost approximately $360 USD to build and maintain and served 15-20 menstruators, leading to a cost per person of $18-$24. Additionally, each incinerator attached to the Mini structure used to dispose of soiled menstrual products cost $2110 USD. Conclusions:Menstruators lack access to safe, private spaces for menstrual health and product disposal in humanitarian settings. The Cocoon Mini provides a solution for the safe and effective management of menstruation. Customizing and scaling up dedicated MH spaces like the Cocoon Mini should be considered a high-priority intervention in humanitarian settings.