Each month, 1.8 billion people around the world menstruate (UNICEF). Of that number, the World Bank estimates that 500 million will struggle to access menstrual products or suitable facilities to manage their periods.
Accessing products and services is just one of a complex set of challenges that contribute to period poverty. Around the world, cultural taboos and societal stigmas continue to impact the health, dignity and wellbeing of girls, women, and other people who menstruate.
In a humanitarian crisis, these factors are intensified, with a lack of privacy, basic materials and safe sanitation facilities only adding to the sense of shame, fear and isolation. For those with physical or intellectual disabilities, the difficulties multiply further, and their voices are often left out of conversations on menstrual health needs in emergencies.
We want to help tackle the barriers to safe menstrual hygiene management (MHM) for all people regardless of ability, culture, geography or context. In 2015, our Research for Health in Humanitarian Crises (R2HC) programme supported the development of the Menstrual hygiene management (MHM) in emergencies toolkit, a landmark publication which provides practical direction and tools for planning, implementing and monitoring MHM programming in humanitarian contexts. It’s now among the most recognised pieces of guidance in the sector.
We’ve also funded a number of MHM innovations through our Humanitarian Innovation Fund (HIF), and as part of Menstrual Hygiene Day 2024 – with its theme of ‘Together for a #PeriodFriendlyWorld’ – we spoke with two grantees, Chloe AJ Morrison, a consultant with World Vision Vanuatu for the Veivanua Project, and Emily Au-Young, co-founder of Reemi period underwear.
Read their Q&As below to hear about the positive shifts around acceptability, accessibility and inclusion they’re already seeing through their work, as well as the ground still left to cover.
VEIVANUA PROJECT
“Raising the visibility of who is still being left behind in emergency response is important… We need to always be asking, who are we not reaching? And how can we?”
Chloe AJ Morrison, Consultant, World Vision Vanuatu
The Veivanua Project is an intervention to help young women with intellectual disabilities and their carers understand and manage menstruation through more holistic, customised support. They are given a ‘period pack’ containing menstrual materials, a menstrual calendar, a doll (‘Veivanua’) and a visual story about Veivanua menstruating for the first time.
The team at World Vision Vanuatu worked closely with young people with intellectual disabilities and their carers to understand and address their specific needs. The approach was first piloted in Nepal, before adapting their tools for Vanuatu to support households impacted by Tropical Cyclone Harold and the Ambae volcano evacuation.
Since you began implementation of the Veivanua campaign in humanitarian contexts, what changes or shifts have you seen in terms of cultural or community attitudes towards menstruation, and how does your project support this aspect of implementation?
Chloe: Due to the scope of our project, we worked at a household or family level rather than a community level and saw shifts in both behaviour and attitudes, including from male caregivers. In Vanuatu, as with much of the world, caring responsibilities are largely carried out by women. Similarly entrenched cultural taboos and misconceptions around menstruation mean that men are rarely involved in supporting menstrual health activities. Throughout our project, however, we met men (often fathers or brothers) who wanted to be engaged in the project and training and learn more about menstruation and how they can better support their family member with a disability with menstruation as demonstrated by the quote below:
“I am a male, you know, and when they were running this training, they were discussing women’s sickness [menstruation], and so I learnt things that I had never learnt, that I never knew, you know. And it has helped me. If sometimes her mother is not there, I can…”
– Lono, male caregiver
Where do you feel work still needs to be done to break down barriers – cultural or otherwise – to safe menstrual hygiene management for people with intellectual disabilities? How can innovation play a role in finding solutions to the remaining challenges?
Chloe: Throughout our project, we heard and saw many instances where the intersection of disability and menstruation led to isolation, stigma, and discrimination for the young person with intellectual disability and their caregiver. They were rarely included in community activities, including in evacuation measures, and conversely, families often kept the young person at home when menstruating. One of the innovations that we piloted in our project was the use of Reemi period underwear, as fear of leakage or concerns the young person may show their menstrual material was often listed as a reason why they were kept at home while menstruating. Secondly, raising the visibility of who is still being left behind in emergency response is important. It’s easy to think that if we make toilets and latrines accessible for wheelchair users, we are addressing menstrual health for people with disabilities. We need to always be asking, who are we not reaching? And how can we?
When we looked at global research and evidence about the menstrual health experience of people with disabilities in emergencies, one of the glaring gaps was the lack of interventions designed to support people with disabilities, but also that people with disabilities were rarely included in designing interventions or in research. We aimed to show that this was possible. We also used participatory research techniques such as observation and PhotoVoice to ensure that the perspectives and views of young people with intellectual disabilities were captured in our research and can be used to inform future programming.
Are there any other ideas or reflections you would like to share?
Chloe: Partnering with disability actors, and including people with disabilities as part of the research team and facilitation team, was key to the success of our project. It was through early discussions with one of our team members with a disability that she raised that menstrual materials like reusable pads can be hard for her to use as she has low muscle strength in her hands and struggles with press studs. We then explored this further with the families we were working with and found people with vision impairments, including caregivers, also found using these difficult.
REEMI PERIOD UNDERWEAR
“A solution may address the need but may not address the stigma around the entire process of menstrual hygiene products.”
Emily Au-Young, co-founder of Reemi
Reemi is a social enterprise that aims to provide sustainable and culturally appropriate menstrual products, together with education, for people in most need. They developed the world’s first self-sterilising period underwear, along with several zero-waste MHM solutions, and successfully piloted these products to 6,000 garment workers in Bangladesh.
They’re currently distributing Reemi products in Mali, Central African Repubic and Somalia with Oxfam. They are also distributing products in Gaza. Evidence from these studies will contribute to better MHM solutions for people affected by crisis in high severity and rapid response settings.
Q: What changes or shifts have you seen in terms of cultural or community attitudes towards menstruation? How does your project support this aspect of implementation?
Emily: Our first piece of research with the University of Munich sought to address stigma surrounding menstruation, to understand if addressing stigma could increase the adoption of a new MHM product (our Reemi period underwear). We saw that a simple intervention of women coming together to share their experiences for a one-hour facilitated discussion, was enough to shift stigma and increase valuation and adoption of Reemi period underwear. We also discovered that male shopkeepers were a key obstacle for women obtaining hygienic period products.
We’ve just completed a pilot in Bangladesh* that included the education of men and resulted in very high adoption rates (86-97%) of all of Reemi’s period products. Men shared with us that they ‘now know they should look after their wives during menstruation.’
We also observed statistically significant improvements in menstrual health knowledge and reduction in social stigma, through listening to audio jingles and skits about MHM. At the beginning of the pilot, 94% of women and 95% of men believed menstrual blood was toxic, and this was reduced to 50% and 49%, respectively.
Q: Where do you feel work still needs to be done to break down barriers – cultural or otherwise – to safe menstrual hygiene management for women in these contexts? How can innovation play a role in finding solutions to the remaining challenges?
Emily: There is still a significant lack of post-distribution data for menstrual hygiene products. For a highly stigmatised issue and product, we would love to see the approach become more demand-driven, rather than needs-driven. A solution may address the need but may not address the stigma around the entire process of menstrual hygiene products. For example, menstrual cups may be the perfect solution from a needs-perspective but the cultural stigma surrounding its use would prohibit high adoption rates in certain contexts.
Innovation that focuses on human centred design and demand-driven approaches will find better solutions that actually sees a shift in cultural stigma by the users. Our research has shown that when a product has a high user satisfaction score, those users are willing to talk about it with others that they may not have been comfortable talking to beforehand.
Q: Are there any other ideas or reflections you would like to share?
Emily: Although the issue of MHM has been highlighted in media and research in recent years, we still have a long way to go to being able to offer dignity for women in humanitarian contexts with the provision of sufficient menstrual products. We encourage any agencies or partners that would like to trial Reemi products to reach out.
*Reemi’s most recent Bangladesh pilot was funded by the brand, AS Colour.
