A TOOLKIT FOR INTEGRATING MENSTRUAL HYGIENE MANAGEMENT (MHM) INTO HUMANITARIAN RESPONSE THE FULL GUIDE ACRONYMS ACKNOWLEDGEMENTS CCCM Camp Coordination Camp IRC International Rescue Committee Management KAP Knowledge Attitude This research project is funded by Elrha’s CFS Child Friendly Spaces And Practices Research for Health in Humanitarian Crises (R2HC) 4 Cs Coordination, Consultation, KII Key Informant Interviews Programme, which aims to improve health outcomes Culture, Communication by strengthening the evidence base for public health M&E Monitoring And Evaluation CTP Cash Transfer Programming interventions in humanitarian crises. The R2HC MHM Menstrual Hygiene Management Disabled Persons Organizations programme is funded equally by the Wellcome Trust DPO NFI Non-Food Item FGD Focus Group Discussion and the UK Government. Visit www.elrha.org/r2hc NRC Norwegian Refugee Council FGM Female Genital Mutilation for more information about Elrha’s work to improve PDM Post Distribution Monitoring humanitarian outcomes through research, innovation, HWF Hand washing facility SRH Sexual And Reproductive Health and partnership. IDP Internally Displaced Person UNFPA United Nations Population Fund IEC Information Education UNHCR United Nations Refugee Agency Communication UNICEF United Nations Children’s Fund IFRC International Federation Of The Red Cross WASH Water Sanitation And Hygiene INEE Inter-Agency Network for WHO World Health Organization Education in Emergencies WRA Women Of Reproductive Age © 2017, Columbia University and International Rescue Committee. All rights reserved. This material is under copyright but may be reproduced by any method for educational purposes by anyone working to improve the lives of displaced girls and women in emergency and development contexts, as long as the source is clearly referenced. It should not be reproduced for sale or commercial purposes. First edition, 2017 CONTENTS 1 2 3 4 5 6 7 INTRODUCTION TRAINING CONDUCTING PROVIDING MHM MHM AND MHM AND MHM AND WATER STAFF A NEEDS MATERIALS AND TRANSIT SHELTER AND SANITATION ON MHM ASSESSMENT SUPPLIES FACILITIES Page 7 Page 15 Page 17 Page 21 Page 31 Page 35 Page 39 8 9 10 11 12 13 14 MHM, DISPOSAL MHM AND HYGIENE MHM AND MHM AND MHM AND MHM AND MONITORING AND WASTE PROMOTION & VULNERABLE EDUCATION HEALTH PROTECTION AND MANAGEMENT HEALTH EDUCATION POPULATIONS EVALUATION ACTIVITIES Page 49 Page 57 Page 63 Page 67 Page 73 Page 77 Page 83 BACK TO PREFACE CONTENTS 1 Introduction The Menstrual Hygiene Management (MHM) in Resource Format: The MHM in emergencies Emergencies toolkit aims to provide streamlined toolkit is comprised of 2 main sections, serving The resource has been collaboratively produced 2 Training staff on MHM guidance to support organizations and agencies different functions: by David Clatworthy (International Rescue seeking to rapidly integrate MHM into existing Committee), Margaret Schmitt (Columbia 3 Conducting a needs programming across sectors and phases. This toolkit University, Mailman School of Public Health) assessment MHM IN EMERGENCIES TOOLKIT: was informed by an extensive desk review, qualitative and Dr. Marni Sommer (Columbia University, THE FULL GUIDE. This document serves assessments with a range of humanitarian actors 4 Providing MHM as a more extensive guidance resource. The Mailman School of Public Health) with inputs Materials and Supplies and organizations, and direct discussions with girls chapter structure follows the same structure from displaced adolescent girls and women and and women living in emergency contexts and directly as the sections in the mini-guide, providing humanitarian practitioners and organizations affected by this issue. 5 MHM and Transit deeper discussion on each topic, including key (see acknowledgements).* Toolkit audience: The toolkit was designed to assessment questions, case studies from around 6 MHM and Shelter Please contact Dr. Marni Sommer with any support a range of humanitarian actors involved the world, design considerations, resources for in the planning and delivery of emergency responses. gathering monitoring and feedback, and links to concerns or insights you would like to share 7 MHM and Water and The guidance is therefore aimed to support additional resources. with the MHM in emergencies toolkit team at: Sanitation Facilities 1) program staff directly delivering services; [email protected] 2) program supervisors and country-level staff 8 MHM, Disposal and • MHM IN EMERGENCIES: THE MINI GUIDE. responsible for designing, coordinating and Preferred citation: Sommer, M., Schmitt, M., Waste Management This complementary document provides a monitoring field activities, and 3) technical staff, Clatworthy, D. (2017). A toolkit for integrating brief summary of the key actions necessary for focused on providing technical support and Menstrual Hygiene Management (MHM) 9 MHM and Hygiene addressing MHM during emergencies. It serves Promotion & Health developing standards. into humanitarian response. (First edit). Education Activities as a quick read to gain a basic understanding New York: Columbia University, Mailman but it is advised to review the complete guide School of Public Health and International 10 MHM and Vulnerable when designing programs or developing Populations Rescue Committee. response activities. 11 MHM and Education 12 MHM and Health PUBLISHED BY: 13 MHM and Protection 14 Monitoring and Evaluation 4 BACK TO CONTENTS 1 Introduction CO-PUBLISHED BY: 2 Training staff on MHM 3 Conducting a needs assessment 4 Providing MHM Materials and Supplies 5 MHM and Transit 6 MHM and Shelter 7 MHM and Water and Sanitation Facilities 8 MHM, Disposal and Waste Management 9 MHM and Hygiene Promotion & Health Education Activities 10 MHM and Vulnerable Populations 11 MHM and Education 12 MHM and Health 13 MHM and Protection 14 Monitoring and Evaluation 5 JUST THE FACTS: UNDERSTANDING MENSTRUATION WHY IT MATTERS? WHAT IS MENARCHE? THE BASICS • Girls who get blood on their clothes are • Menarche is the onset of menstruation. MENSTRUATION IS NORMAL! often teased by teachers, boys or other girls. Girls generally get their first period between ages 11–15, although some can be IT IS THE MONTHLY • Social norms may lead women and girls younger or older. SHEDDING OF BLOOD AND to feel that menstruation is dirty, UTERINE TISSUE AND AN • The first period is generally a surprise! shameful or unhealthy. IMPORTANT PART OF THE Sometimes girls are scared or worried they are sick. They may not know who to REPRODUCTIVE CYCLE. • Without access to good menstrual materials ask for advice. TYPICALLY, IT LASTS... and private toilets or washrooms for changing, girls and women may not want • Information about menstruation is 2-7DAYS to go far from home. Teachers may miss frequently passed on from mothers, friends, school, health workers may miss work, and sisters or aunts, and is often a mixture of girls and women may not attend school, go cultural beliefs, superstition and practical THE AMOUNT OF BLOOD to the market or wait in line for supplies. information that is sometimes helpful and IS USUALLY BETWEEN sometimes not. Menstruation is very personal. • In many cultures mothers may feel Women and girls often do not want uncomfortable to talk to their daughters others to know they are menstruating – about periods because it is linked AND even other women and girls. 1 6 to sexuality. TABLESPOONS EACH . MONTH AND CAN BE MESSY. WHAT DO THEY NEED? ABDOMINAL CRAMPS, • A range of materials can be used to • Menstrual periods are irregular and can • Even when using good menstrual NAUSEA, DIARRHEA catch the blood, including a sanitary pad catch girls and women by surprise. This materials, women and girls may be AND HEADACHES (disposable or reusable), a tampon, causes anxiety about finding a bathroom worried about blood stains on their and materials quickly! clothes. ARE COMMON or a piece of cloth in their underwear. BEFORE AND • Menstruation can be messy! Women • Women and girls need access DURING A PERIOD. and girls need a private space with to a private, clean space (toilet or water and soap to clean themselves washroom) to change materials and soiled materials. throughout the day and night and to hygienically dispose of menstrual waste. 1 INTRODUCTION BACK TO CONTENTS 1 Introduction Managing menstruation in resource-poor MHM CHALLENGES FACING GIRLS AND WOMEN IN EMERGENCIES settings is often challenging, especially when 2 Training staff on MHM away from home all day. Such challenges are increased by societal taboos, secrecy and 3 Conducting a needs embarrassment around menstruation. Lack of sanitary assessment During emergencies, girls and women face materials, 4 Providing MHM even greater barriers managing menstruation including Materials and Supplies given the loss of privacy and safety often underwear associated with living in emergency contexts 5 MHM and Transit and the transitory nature of displacement. Lack of private Cultural taboos female friendly 6 MHM and Shelter Menstrual Hygiene Management (MHM) and restrictions toilets and programming in emergencies involves adjustments related to MHM 7 MHM and Water and and improvements to a range of sectoral interventions bathing spaces Sanitation Facilities including Water Sanitation and Hygiene (WASH), Protection, Reproductive Health, Education, 8 MHM, Disposal and Waste Management Non Food Items (NFIs) and Shelter. While some components are specific to menstruation (such as 9 MHM and Hygiene the provision of sanitary pads), most components Promotion & Health Education