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Menstrual health and hygiene management in humanitarian settings

  • Page updated onMarch 22, 2026
Menstrual health and hygiene management in humanitarian settings
Text and photo: Bruno Abarca

Menstruation has been for decades a topic largely invisible in humanitarian action. Yet today it is estimated that more than one third of people who menstruate lack access to sanitary pads or other necessary materials, to sufficient information, to privacy and means to manage their hygiene with dignity, or to health services to address their discomfort and pain.

Today, the humanitarian response already includes many of these aspects among its priorities, though much remains to be done for their full inclusion in global health policies and reproductive rights frameworks.

Needs and rights of menstruating people in humanitarian crises

Millions of people menstruate every day and, for many of them in low-resource settings, this represents a critical problem. This is due to economic barriers, limited access to adequate materials, insufficient privacy and social stigma, which at times restricts attendance at school or work. However, the scale of this public health problem has barely begun to be addressed until the 2020s, when the first global monitoring frameworks and reports revealed deeply alarming data.

Millions of women and girls lack sufficient information about menstruation

Knowledge about menstruation before menarche (the first period) is one of the main indicators of the global menstrual health and hygiene problem. In 2020, however, only two countries had national data on this: Egypt and Bangladesh. In Bangladesh, barely 32% of girls had heard about menstruation before their first period. In Egypt, this figure was 66%, but dropped to 56% among the poorest girls and women, and to 45% among those with some form of disability.

Other studies have revealed that the information girls receive tends to be insufficient, delayed and, in many cases, inaccurate and laden with taboos. As a result, when family and community support networks break down in humanitarian emergency settings, the first period can be experienced as a terrifying event or even a traumatic curse. The scarce information available, moreover, barely reaches men and boys, generating distrust and discomfort and perpetuating stigma. This male discomfort around menstruation can even reduce the availability of materials and safe spaces for menstrual hygiene, when those who control access to these resources do not understand their importance.

Menstrual poverty: lack of access to materials and privacy for adequate menstrual hygiene management

Regarding access to materials, recent studies analysed the situation in humanitarian crises (natural disasters, epidemics, conflicts and displacement) in the Middle East, India and Africa. Results showed a 34% lack of access to sanitary pads and a 46% lack of access to adequate means of disposal once used. When products are unavailable or unaffordable, people use unhygienic or inappropriate materials at risk of infection, or resort to transactional sex to purchase the materials they need. Also common are problems of insufficient access to water, hand soap, detergent, buckets for washing, or even bags for discreet disposal.

Even when materials are available, their use sometimes requires an environment and privacy that do not exist. In Niger or Tunisia, for example, population surveys have revealed that 48% and 44% of girls and women do not have private spaces at home where they can wash and change. In humanitarian emergencies, moreover, bathrooms often lack internal locks, lighting or discreet systems for disposing of used materials without others seeing them. This means that in refugee camps in countries such as South Sudan, Malawi and Cameroon, fewer than half of women (44%, 43% and 20%, respectively) are satisfied with the materials and services available to them.

From menstrual hygiene management to menstrual health as a human right

Attention to menstruation in international cooperation initially focused on menstrual hygiene management: the ability to use clean materials to absorb or collect menstrual blood that can be changed in privacy as often as necessary, to wash the body with water and soap as needed, and to dispose of used materials appropriately. This WASH-centred approach, which emerged around 2005, quickly gained popularity in international cooperation research, policy and practice, particularly to help adolescent girls attend school continuously in low- and middle-income countries.

Over time, however, this approach evolved towards more inclusive and comprehensive frameworks, beyond hygiene materials and infrastructure. In 2021, the Global Menstrual Collective advanced towards the concept of menstrual health, broadening attention to other neglected issues related to menstruation, such as the importance of access to information, the need for care for associated discomforts and disorders, and addressing stigma, discrimination and abuse.

Using the term menstrual health also invites discussion today of the right to menstrual health with dignity and autonomy across the life course, from before menarche to after menopause. It also helps to integrate these needs under the umbrella of sexual and reproductive health and reproductive rights, an area where they have traditionally been marginalised. Finally, it represents a further step towards menstrual justice, to combat the oppression experienced by all people who menstruate, including transgender boys and men and non-binary people.

How to integrate menstrual health into humanitarian responses

From the 2000s onwards, and in line with the conceptual evolution already described, menstrual health and hygiene were gradually incorporated into important standards, such as UNHCR's operational indicators in 2006, the Minimum Initial Service Package (MISP) for sexual and reproductive health in crisis situations in 2010, the Sphere Handbook in 2011, and the piloting of dignity kits in 2012, with basic hygiene products for women and girls.

In 2017, an important milestone was reached when Columbia University, the IRC and ELRHA's R2HC programme published a guide for integrating menstrual hygiene management into all phases of humanitarian emergency response. It set out the importance of well-coordinated multisectoral and mainstreamed approaches to address needs in materials and supplies, facilities and support services, and information and education.  

A multisectoral and coordinated approach is needed to protect menstrual health and rights

First, to avoid humanitarian responses to menstrual health and hygiene needs being reduced to isolated actions, consensus and coordination mechanisms between agencies must exist. This calls for coordination led by the WASH sector, in collaboration with the Protection sector, and with constant communication. It also highlights the importance of directly consulting women and girls to design programmes and to understand existing social norms, cultural sensitivities and local taboos.

This integrated approach requires collaboration across the WASH, protection, education, health, camp coordination and camp management, and shelter and non-food item distribution sectors. For example, while the Protection sector can mitigate risks of sexual and gender-based violence when accessing services, other sectors can ensure adequate facilities in schools, privacy in accommodation, or care for menstruation-related discomforts in health services.

Access to menstrual products: beyond distributing pads in standardised kits

When discussing menstrual materials, it is necessary to consider two product categories: absorbent materials and other support supplies for the hygienic use of absorbents.

Absorbent materials may include disposable pads, reusable cloth pads, menstrual cups or tampons. Choosing among these requires careful needs assessment and context analysis, as well as prior consultation with the people who will use these products. This makes it possible to understand which product is preferable based on water access, availability of waste management systems, ease of air-drying washed reusable materials quickly, or cultural acceptability.

Beyond this, it is also necessary to consider other additional products, such as soap, buckets, underwear, clothespins and a washing line, bags, torches and information leaflets, for example.

Depending on the context and the availability of these products in the local market, cash transfers and vouchers can sometimes be used. This can offer greater freedom of choice and support the local economy.

Menstruating people need friendly services and environments, as well as facilities for discreet waste management

Having menstrual materials is not enough if the environment in which people need to use them does not guarantee a minimum of privacy and protection. For this, it may be essential that infrastructure and facilities are sex-segregated, include locks, have adequate lighting, and are accessible in residential areas, schools and health centres.

It is also important that mechanisms exist for discreet waste management, particularly when disposable materials are used, to prevent them from being visible to the community, causing blockages in latrines or contaminating the environment. When reusable materials are used, private washing and drying spaces are essential.

Beyond hygiene, menstrual health needs must also be addressed. Menstruation is often accompanied by symptoms such as acute abdominal cramping, fatigue or headaches. Health facilities in emergency settings must therefore have trained and sensitised staff, as well as adequate medical supplies to respond to requests for pain relief and to promote self-care. Staff providing contraceptive services must also understand and help manage the effects these can have on the menstrual cycle.

Menstrual information and education for boys, girls, men and women

Menstrual education must be grounded in participatory methodologies that ensure messages and informational materials are culturally acceptable and comprehensible. Furthermore, this education should not only be directed at girls and women, but also at boys and men, and at humanitarian staff in general. This can be decisive in reducing stigma and mockery, but also in ensuring that families allocate the necessary resources for menstrual health and hygiene.

It is important to understand that both girls and transgender boys need information prior to their first period, and that this information must reach them through culturally appropriate channels. This includes education about the changes that occur during puberty, the normality of menstruation, menstrual hygiene management, the importance of pain management, adequate nutrition to mitigate the risk of iron-deficiency anaemia, and how to identify medical warning signs.

🧠 Let's pause and reflect

What indicators would allow for comprehensive monitoring of menstrual health in humanitarian settings, including its physical, mental and social dimensions, and how could the impact of multisectoral interventions on it be measured?

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Menstruation in global health policy and reproductive rights

Despite progress in integrating menstrual health and hygiene into humanitarian responses, it remains a neglected topic in important agendas, such as the Sustainable Development Goals. This, however, appears to be beginning to change from 2021 onwards, albeit in a fragmented and insufficient manner.

In general, menstruation is mentioned sparingly in the policies and documents of international organisations such as UNESCO or the World Bank. Others, such as UNICEF or the WHO, do not include menstruation among their priority topics, but do refer to it in some key documents. These references, however, have traditionally been limited to a WASH and education approach focused on menstrual hygiene management in adolescent girls and their dignity at school, without being framed as a health priority until 2022 or 2023. What is particularly striking is that UN Women and UNFPA barely reference menstruation in their sexual and reproductive health and rights frameworks.

In 2026, menstruation continues to be sidelined in global health policy and reproductive rights, with significant gaps remaining. Areas such as menstrual health during perimenopause and menopause, care for conditions such as endometriosis, inclusivity of transgender men and non-binary people who menstruate, and the environmental impact of plastics in disposable pads remain overlooked. Closing these gaps still requires political will, investment in research, a better understanding of these problems and needs, and more inclusive normative frameworks.

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How to cite this page

Abarca, B. (March 22, 2026). Menstrual health and hygiene management in humanitarian settings. Salud Everywhere. https://saludeverywhere.com/en/health-in-humanitarian-crises/menstrual-health-and-hygiene-management-in-humanitarian-settings/

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