Meeting menstrual health and hygiene needs during emergencies – more than just sanitary pad distribution
As the COVID-19 caseload started to increase exponentially, India entered into another lockdown between April – May 2021. Accentuating this, the western and eastern coasts of India were hit by cyclones and flooding, resulting in the temporary displacement of many communities, including thousands of girls and women. While crises affect whole communities, they reinforce existing and deeply embedded gender inequalities. Women and girls in low resource settings face challenges in managing menstruation in general, as a consequence of deep-seated socio-cultural norms related to menstruation, limited information and poor support services, constrained access to products, and unreliable access to safe sanitation facilities. These challenges are exacerbated during emergencies, often due to the loss of privacy, safety, and access to essential services, usual coping strategies, and support structures, including access to menstrual management materials, relevant information. For instance, the COVID-19 related lockdown in March-May 2020 illustrated how access to menstrual hygiene was limited in face of significant mobility restrictions, financial constraints, and disrupted supply chains. In addition to the COVID-19 lockdown in 2020, the burden of double disaster when cyclones and monsoons hit various states of India, further accentuated the lack of access to menstrual hygiene products laying bare the intimate nexus between gender and its vulnerability to disasters.
Given the trying situation girls and women find themselves in during emergencies, menstruators need basic supplies such as pads/cloth to manage periods safely and with dignity. As a way to ease access to menstrual hygiene products, the first line of the response of various international and national organizations involves the distribution of menstrual hygiene products. Drawing upon interventions of organizations across India, this blog examines strategies to ease access to quality menstrual hygiene products to ensure a concerted and streamlined menstrual hygiene disaster response.
1. Alternatives for sanitary pads and introduction of informed product choice
In the majority of emergencies, the most common relief support is the distribution of menstrual materials, notably sanitary pads. However, there is no one menstrual hygiene material that is suitable for or acceptable to all, and preferences differ. A product choice approach needs to be the way forward. Informed product choice enables menstruators to choose from a safe and hygienic product from a basket of products according to their needs, comfort, ability to pay and the context one is living and experiencing menstruation. While emergency efforts may not be able to provide a basket of menstrual materials to choose from, the selection of menstrual materials to be distributed must be informed by the predominant preferences in the affected community, what can made available locally and what can be feasibly introduced and used hygienically. Other than sanitary pads, options available for menstruators among reusable hygiene products are reusable cloth pads and menstrual cups. Although introducing menstrual cups may not be appropriate for use during emergency relief efforts as cup requires practice and support over 3-4 menstrual cycles, reusable sanitary pads can be a more sustainable option both long term and environmentally. During floods, cyclones and even the COVID-19 pandemic, several organizations provided disposable sanitary pads as a part of hygiene or dignity kits, and some have provided plain cotton cloth for women to fold and use. If communities are affected for a long duration (e.g., long-term curfews in Kashmir, COVID-19 lockdown), or displaced and relocated in shelters or relief camps for extended periods of time, reusable readymade fabric pads can be considered if support facilities are available for appropriate maintenance and hygienic use.
Further, distribution of a regular supply of sanitary pads to all those in need would be challenging for the entire duration. Thus, a more sustainable option can be to providing guidance and instructions on making homemade cloth pads, using materials available at home. The Government of Madhya Pradesh, with technical support from WaterAid India, shared digital posters and videos on how to make reusable cloth pads based on the Uger (Jatan Sansthan) model. Thus, making girls and women from a user to a “manufacturer” who can meet their own needs!
2. Procurement of menstrual hygiene materials for relief:
Procurement for emergencies needs to be quick, seamless and there are many ways that this can happen. Firstly, procurement of both reusable and disposable menstrual hygiene materials should be guided by needs assessment carried out in the disaster-affected community, or based on existing evidence from these geographies. Secondly, organizations involved in providing disaster relief can have an emergency procurement committee in place for quick purchase keeping in mind the quality and standards for given products. When disaster is anticipated, tentative tenders for sanitary pads notifying vendors about potential need can be posted on public platforms (e.g., DevNet, newspapers) as a part of emergency preparedness. In areas where the disasters are recurrent, organizations may opt for a fixed-term vendor for sanitary pads for a period of 2-3 years. Local vendors must have the necessary supplies in sufficient quantity and quality, and be able to provide supplies quickly to the affected areas. Hence, the procurement committee can ask the field team to identify local vendors for essential supplies who meet certain criteria for quality and quantity and seek the necessary quotations. SHGs can be considered a local vendor for sanitary pads, providing they are able to provide the quantity and quality of sanitary pads required for the affected population, and within the necessary timelines. Several States implement MHM schemes, and districts are often proactive in running campaigns and ensuring the distribution of sanitary pads. During emergencies, State and District level MHM initiatives can be leveraged to provide menstrual materials to affected communities and can facilitate the use of existing IEC materials to create awareness on hygiene.
3. Integration of menstrual hygiene response with larger disaster response
Menstrual hygiene management must be seen beyond emergency relief efforts. To ensure that girls and women manage their menses safely and with dignity, concerted action on menstrual health and hygiene is needed across the phases of emergency response that includes pre-disaster prevention, mitigation, preparedness, on-disaster response post-disaster response relief, reconstruction, and recovery. To start with, strengthening and scaling routine interventions on adolescent health and nutrition, sexual and reproductive health, adolescent and women’s empowerment, girls’ education, water, sanitation and hygiene, rural and urban development, will better prepare and enable communities and frontline responders to meet MHHM needs during the crisis in an appropriate manner. Secondly, in geographies or communities that face recurrent or predictable disasters like floods or cyclones, to ease access to menstrual hygiene products can be procured and stored in relief shelters, or healthcare facilities or pad banks and ATMs can be established. It can also be distributed to families in advance as a part of emergency preparedness efforts. Continued support to access affordable menstrual hygiene materials during the recovery and rebuild phase is important. When the community is transitioning into the “Early Recovery Programme”, organizations can focus on implementing a market-based WASH response. During this phase, the distribution of commodity vouchers for buying sanitary pads and other hygiene items like washing and bathing soaps from local small-scale vendors/shopkeepers can be implemented. This approach will not only make menstrual hygiene materials available to girls and women but also boosts the local economy by using existing market actors’ capabilities.
Enhancing menstrual health and hygiene requires a multi-faceted approach, even during emergencies. Along with providing menstrual hygiene materials, the provision of supportive items like underwear, washing and bathing soap, and non-transparent bags is essential to facilitate the use of the products. Further, information and education communication (IEC) materials on proper and hygienic use of materials and their disposal in local language illustrative language is imperative. Provision of the items is done in the form of dignity and hygiene kits. While distributing hygiene kits it is essential to provide a kit to each menstruator to prevent sharing of materials and underwear. This will ensure that each person has adequate materials to manage menstruation safely and that prevent them from the risk of contracting an infection. Where possible, demonstration of the use of menstrual hygiene materials may be undertaken as girls and women may also receive, as a part of relief efforts, products that they are unfamiliar with or lack inadequate information to support hygienic use.
When emergency strikes communities, they must-have essentials to help them cope – food, shelter, security. For girls and women, their personal need remains unexpressed but must be addressed as they deal with loss and destruction. Menstrual health and hygiene is not a luxury – its an essential for overall health and wellbeing for all those who menstruate.