In emergencies, women and girls are often at particular risk. Response agencies have recorded this pattern during disasters such as the 2015 Nepal earthquake, the COVID-19 pandemic, the Ukraine war, the 2022 floods in Pakistan, and now the Turkey-Syria earthquake. According to the UN Refugee agency, UNHCR’s latest data released in mid-2022, 103 million people are forcibly displaced worldwide, following a trajectory of constant growth over the past decades. Almost half of them are women and girls; and while these numbers are overwhelmingly high, it is unclear those of reproductive age and consequently dealing with their menstruation.

Menstrual needs during emergencies have been mainly addressed using the Menstrual Hygiene and Management (MHM) model, developed in 2005. Researchers highlighted its flaws and gaps in implementation, including a primary focus on products and infrastructure provision, and the inability to handle the underpinning gender structural inequalities. Menstrual inequalities are indeed generated by psychological, socio-political, and environmental factors, and, in emergencies, barriers to menstrual health can be exacerbated by the complexity and length of the emergency context in which women and girls live. If not addressed and considered in implementation, women and girls risk not being able to fulfil their needs.

The 2017 Oxfam Review reported successful cash programmes that contributed to restoring menstrual dignity. However, as emerged in the interviews with Syrian women residing in Informal Tented Settlements in Beeka, sociocultural and environmental barriers were left out in the planning process. Women reported usually going for the cheapest option (such as nappies) when buying products, sacrificing quality over quantity. Furthermore, avoiding buying menstrual products if a male is at the shop counter due to stigmatisation.

In the effort to overcome the gaps of MHM, the Menstrual Health and Hygiene (MHH, or Menstrual Health) model was developed in 2019. It highlights four interrelated areas of intervention – primary needs, health and well-being, human rights, and sociocultural and structural factors – and takes a holistic and intersectional approach to the individual. In 2021 Menstrual Health was evaluated as a relevant enabler for the overall achievement of the 2030 Sustainable Development Goals. And recently, during the 50th session of the Human Rights Council Panel in June 2022, the World Health Organization (WHO) called for action on menstrual health in emergencies.

Committed advocacy efforts have increased attention on the topic to include menstrual health within humanitarian responses. This also in light of the 2016 “Leaving No One Behind” report and United Nation’s Office for the Coordination of Humanitarian Affairs (UNOCHA)’s publication of the 2021-2025 “Policy Instruction on Gender Equality” plan, calling for the sector’s active involvement in achieving gender equality. This includes addressing underlying and structural inequalities, and long-term needs through a gender-transformative approach in all phases of programming and intervention in humanitarian crises.

Menstrual Health therefore provides the supporting framework to respond to UNOCHA’s call and address the flaws highlighted by researchers in implementation. However, four hidden structural challenges could affect the success and limit its complete application in such complex contexts.

1. Defining population’s needs in humanitarian action.

The humanitarian paradigm, as reported by UNOCHA, dictates that interventions are designed to meet the population’s basic needs, with the ultimate aim of saving lives. The emphasis on the unmet needs of the body and dignified life leads to the identification of a technical and material solution, such as ensuring access to menstrual products and infrastructures. While crucial, it leads to a Band-Aid approach, providing merely a technical and material solution. If immediate intervention and provision of essential materials are crucial in rapid emergency onset, this approach is limited in protracted crisis contexts.

2. Defining gender equality

Following the needs discourse, gender equality risks to be defined as equal access to resources, benefits, and services, ensuring that females’ and males’ needs are equally considered. However, it is limited, incomplete and fails to understand the underpinning factors that generate and maintain a state of inequality. Gender equality indeed refers to equal rights, responsibilities and opportunities for women, men, girls and boys, addressing the structural and root causes that perpetuate inequality.

3. Humanitarian engagement with multicultural contexts

While UNOCHA has called for active effort, as stated by the researcher Megan Daigle of the Overseas Development Institute, two specific humanitarian principles might restrain the engagement with gendered norms, roles and power relations. The first is impartiality, stating that intervention must be carried out only based on fundamental, urgent and lifesaving needs. Along with limited and restrained funding and capacity, it might limit aspirations, energy and resources towards the goal. The second is the principle of neutrality, preventing humanitarian actors from engaging with “sensitive topics” – such as gender norms. Falling beyond the mandate, changing norms might risk imposing a Western perspective.

4. Gender composition of the sector.

The humanitarian and Water, Sanitation and Hygiene (WASH) sectors are male-dominated environments, which might lead to a gender-blind perspective in assessment and planning. An example is the 2021 “Gaps in WASH in Humanitarian Response” report, which highlights the priority of the sectors as assessed by the population affected by the emergency, WASH practitioners, NGOs, and UN workers. The gender composition across the groups varied from more than half of women in the affected population, to less than half women for the other two groups, highlighting the lack of females in key decision-making positions. Furthermore, the affected population reported menstruation within the first ten gaps priorities to be addressed by the sector, while neither the other two groups mentioned it within the top ones.

The way forward

“Achieving menstrual health is fundamental to the equality, rights, and dignity of all individuals who menstruate” and recognising the experience of women, adolescent girls, and people that menstruate living in emergencies is essential. Not addressing menstrual needs raises issues of human rights and human dignity during times of uncertainty, stress, and instability.

While working on removing the physical, psychological, and sociocultural barriers encountered in emergency, a deeper reflection of the humanitarian internal structure is also necessary to improve strategic responses to humanitarian crises:

• The concept of needs must be revisited, especially for protracted crises, as they drive the intervention strategy i.e. people should not be reduced to their material and physical needs, and the environment must be considered.
• A universal definition and understanding of gender must be established – in support of UNOCHA’s call to a transformative-gender approach, clear guidelines, tools and frameworks should be developed to capture beneficiaries’ needs in differing contexts, and within different cultural practices.

• Women’s leadership within the sector, the use of a people-centred system and a bottom-up approach must be promoted, which will build self-efficacy, and co-develop innovative and gender- responsive solutions that place human rights in the centre of responses, and apply an intersectional lens to address SRH needs.

Periods don’t pause in emergencies. Given the number of humanitarian crises that we are currently facing, action needs to be taken now.

All authors are members of the Pandemic Periods collective. For more info on Pandemic Periods, see https://pandemicperiods.com/.