Imagine trying to deal with a period while cramped into a one-room tent with 10 other people, some family and some not. When you fled your home, quickly grabbing whatever belongings you could, carrying lots of sanitary pads was an impossibility. So now you’re trying to make do, managing the blood flow each month with a piece of cloth or whatever tissues you can find.
When you wake in the middle of the night, stressed at the thought that you need to urgently change your pad to ward off a leak onto the bed, you stare into the pitch-black night toward a distant block of toilets, a daunting 500 feet away. Your only option is these communal toilets, which although technically designated for women, are often frequented by men; you really hope there is no one there to harass you tonight. The door locks may or may not be working, and there is no lighting inside the stall. And access to water to wash up after changing? Dream on.
Can you imagine a place more difficult to have your period than a refugee camp?
Over the past five years I have worked with Columbia University and the International Rescue Committee researching the harsh realities around menstruation facing displaced people around the world. Through conversations with displaced people, we learned about the unique challenges they face in refugee camps, informal settlements, and while fleeing by foot to safety, oftentimes for days on end. These complex settings, coupled with deeply rooted cultural stigmas about menstruation, create barriers for them as they try to manage their periods, ranging from no privacy to inadequate toilets, lack of water, insufficient supplies of menstrual pads, and risk of sexual assault when needing to change at night.
It is increasingly common for humanitarian organizations to distribute menstrual products to displaced people, although the scale and frequency of distributions varies per emergency. Rapidly growing entrepreneurial efforts, with a particular focus on reusables, are improving product choice. But products are just one part of the solution, and much more needs to be done.
Innovation must shift beyond products. Consider the toilet: In a typical emergency, toilets are identical regardless of gender, yet our bodies’ demands are not. Something as simple as a hook for hanging a bag with pads, a dustbin for waste, or a lock on the door guaranteeing safety are essential. No matter how many innovative pads, panties, or menstrual cups are passed out, people need an enabling space to change. Or think about the disposal of used menstrual pads and cloths — one of the least sexy topics for a media story — and the focus of our current research. The lack of disposal options in toilets has costly implications, including clogging pipes, creating unhygienic piles of dirty materials, and even rendering toilets unusable.
Addressing these needs should be an integral part of humanitarian work, not just a shiny new program derived from larger global menstrual equity movements. People who have periods cannot wait in line for distributions, fetch water and food for their families, or attend school if they can’t manage their monthly blood flow.
The average duration of humanitarian emergencies continues to climb, with current estimates at more than nine years. The protracted nature of these crises is of critical concern when planning support for menstruating people. There are environmental implications to the provision of disposable and reusable products — both eventually need to be disposed of. And there are challenges with creating dependency on aid for products. Shifts in global aid support can mean an abrupt end to supplies, meaning we need to find more sustainable solutions, including partnering with local markets, entrepreneurs, and people who have periods themselves.
A period is only one of the many challenges in a displaced person’s day. But being able to manage it, on one’s own terms, is a universal need. With the right support, we can help alleviate this one issue, allowing these people to focus on the many other hurdles they face. Menstrual hygiene agency is a matter of personal dignity, something that every person deserves.
Maggie Schmitt is a project director in the Department of Sociomedical Sciences at Columbia University Mailman School of Public Health. Her work focuses on improving the integration of menstrual hygiene management into global humanitarian response.