By Lorena Fuentes and Tara Cookson. May 28, 2018.
When news outlets cover the refugee crisis, there is an understandable tendency to fixate on the most extreme end of that crisis—the most visible violence. We are relayed horrific accounts of rape, arson, and mass killing in the case of the Rohinghya, and we are shown photos that attempt to capture the sheer scale of human displacement as families flee from their homes in Syria.
This Menstrual Hygiene Day is an opportunity to talk about a less visible experience of violent conflict, and one that impacts over half of all refugees: the challenge of managing a period in a situation where women’s bodies have not been considered.
Half the world’s population has to manage a period, and this biological reality makes no exceptions for the forcibly displaced. Nevertheless, menstruation management frequently gets relegated to the sidelines of other humanitarian needs deemed more ‘immediate.’ But this tendency overlooks how much the physical safety and well-being of women and girls living in refugee camps is held hostage by a lack of adequate menstrual hygiene management (MHM) supplies – pads, tampons, and cups – and suitable infrastructure like gender-specific restrooms, clean water, and sanitation systems that can handle all types of household waste.
To be sure, the risks and indignities associated with “period poverty” are experienced by women and girls in many low-income contexts, not just refugee camps. But the lack of privacy, adequate sanitation, and freedom of movement in refugee and resettlement camps make these risks and indignities that much greater.
Despite these facts, there is a critical shortfall in global funding for MHM supplies and women-friendly infrastructure for this population. This may in part be because of the general hushing and blushing that accompanies references to menstruation – and which is not unique to refugee contexts. The enduring“period taboo” is nearly universal in its reach across cultures, religions, and societies. But for the millions of refugee women and girls worldwide, the problem is not just that menstruation is taboo, it’s that the necessary products and services are also often unavailable. We talk less about menstruation, we do less research on menstruation, and we act less on menstruation. And this stigma-driven embarrassment has consequences.
The gender data gap
According to the United Nations High Commissioner for Refugees (UNHCR), there are approximately 22.5 million refugees globally. To break down this staggering figure further, we also know that at least half of the world’s refugees are women and girls. These statistics are hugely important for understanding the scope of the refugee crisis. But they are limited by the sterility of numbers, which do not, in and of themselves, give a clear picture of the particular risks and indignities faced by women and girl refugees as they try to navigate their day to day lives.
There is a significant data gap in our understanding of the specific kinds of MHM challenges faced by women and girl refugees.
The available research does indicate that women and girls have uneven and inconsistent access to menstrual hygiene and other unmentionable supplies in refugee camps globally. It also shows that lack of access to MHM products creates a perfect storm of risks for women and girls’ physical and emotional health, safety, and mobility. Recent reports from Greece cite serious associated health risks. In the absence of adequate MHM products, women and girls are forced to use whatever they find lying around. In some cases this means tree leaves or dirty rags. When combined with the lack of access to clean and warm water, the health risks are compounded.
But the problems stem from more than a simple lack of MHM products. When these products are made available through humanitarian distribution, they are not always contextually or culturally appropriate, which can exacerbate pre-existing problems. For example, recent data from the responses to crises in Lebanon and Myanmar underscores how important it is that MHM responses be tailored to women’s preferences while at the same time being adapted to the realities of local conditions. Sustainable (reusable) MHM supplies make sense in a lot of contexts, but in emergency contexts in Lebanon and Myanmar, women and girls prefer disposable MHM products – because the camp infrastructure is not appropriate to meet their needs. For instance, there aren’t enough women-only only bathrooms, soap and warm water to wash reusable products. Taboos around disposing of used MHM products in garbage bins means that they get flushed down toilets. This creates problems for already poorly maintained sanitary systems, which men in turn refuse to fix because of the ‘bloody’ source of the clogging.
In other cases, women and girls’ mobility—and safety—is compromised by the lack of access to MHM products and the absence of appropriate spaces for them to use or clean those products. Some reports indicate that women and girls choose to remain in their tents when they have their periods because of fears associated with walking to or using shared latrines. In other words, they restrict their mobility in order to remain safe from gender-based violence.
Similarly, it is not periods, as such, that cause refugee girls to skip or leave school: this phenomenon is driven by the lack of MHM supplies and adequate facilities in these spaces, alongside the fear and embarrassment girls feel when they menstruate. Let’s not mistake a symptom with a cause: whether in refugee or other emergency or low-income settings around the world, girls are inhibited from education because of contextual factors and gender norms that shame women and girls over a process over which they have no control.
Given that this basic biological function does not turn off when it is inconvenient to access a private restroom, a pad, or clean water, what could the humanitarian sector do to support women and girls?
What we should and shouldn’t do
In a perfect world, women and girls (and men and boys) would not live in refugee camps. Until we exist in that patriarchy– and violence-free planet, we must design spaces of refuge that work for women.
Human centered design (HCD) is an important field of practice in global health and development. Some organizations are using this approach to build health systems that better serve rural communities, and others are using it to design radically democratic governance processes.
What we need in the case of refugee camps is women-centered design.
What would such a process look like?
It would definitely involve consulting women. For instance, asking women and girls about restroom availability and whether they would prefer pads or tampons, reusable or disposable MHM products might seem like an obvious way to ensure gender and cultural sensitivity. We know, for example, thatmeaningfully including women and young women in the design of responses to MHM in humanitarian crises is one of the most surefire ways to improve health and safety conditions. But this participatory approach to Needs Assessments is relatively uncommon across emergency, humanitarian and refugee contexts.
To be sure, there are a number of organizations that involve women and girls in MHM and WASH (water, sanitation and hygiene) projects, in a variety of different ways. Some of these include education projects, building on a history of hygiene education in development.
But women from Syria, Afghanistan, and every other country on the planet have been menstruating for thousands of years.
Hygiene education has been critiqued in many feminist circles, not least because of its roots in deeply racialized assumptions about the ‘backwardness’ of ‘third world women’. There is no doubt that MHM infrastructure and resources are woefully inadequate in refugee contexts across the globe, but we might need to reconsider what is truly needed to transform MHM and WASH approaches so that they work for women and girls, even in precarious settings like refugee camps. Yes, women and girl refugees benefit from projects that provide information about the choices of MHM products, and, which make those products accessible. But we would do well to ‘flip’ the equation on ‘who is educating who’ here: the humanitarian sector should invest in consultative processes that center refugee women and girls’ needs and perspectives around MHM and, in turn, use these insights to design WASH projects that prioritize the creation of safe, functional spaces and the provision of appropriate products.
This is a good time to remember that women rarely sit in the rooms where decisions are taken to wage or sustain war. Sidelining them from the decision-making processes about what their lives look like in war’s aftermath is neglecting women’s agency, knowledge and wellbeing twice.
Now, let’s get into the specifics. Drawing from what we call the ‘feminist library’, we might be able to find some concrete features of women-centered responses to matters of menstruation in contexts of conflict and crisis.
Let’s start with sanitation systems.
First of all, where are the toilets and clean water located in relation to women’s tents? Are they private? Do women and girls report that it is safe to travel there? These are basic questions about accessibility and suitability. Feminist geographers have all kinds of cool training in participatory mapping that can help planners and engineers design women-friendly refugee spaces.
That brings us to the toilets. When women are forcibly displaced into camps where the sanitation system does not support a basic biological function of half the human population, clogging toilets are simply not women’s fault. Women’s menstruation is not the reason there are potential public health concerns like those in the research from Myanmar, Lebanon, and Greece. The actual reason (after war) is that the WASH systems are not always adequately designed for masses of people.
This considered, the response of the humanitarian sector should not be to locate the “solution” to public health concerns in changing the behavior of embarrassed women trying to dispose of used health products. The response should be to design – innovate, shall we say? – adequate WASH systems. If Elon Musk is about to fly a plane to the moon, we can surely design a toilet that can handle a tampon.
Now let’s move to the sourcing and distribution of MHM supplies – pads, tampons, and cups.
Research suggests that access to MHM products and other intimate items like bras significantly reduces women and girl’s susceptibility to violence. Days for Girls is an example of an organization that supports women with the supplies to make and distribute culturally appropriate, reusable pads, often out of local fabrics that can be discreetly washed and hung to dry. The Unmentionables insists on local distributors for MHM products and other intimate items in order to support surrounding economies. In the past, they’ve also used gender-specific tents to allow product distribution in a way that prioritizes women’s privacy and dignity – and have since opened a Resource Center in Greece for refugees.
And finally, let’s talk attitudes and beliefs.
While menstruation is a biological function, the stigma and embarrassment surrounding it are not. These are socially created, and can be changed. One way to do so is through campaigns that bring menstruation out into the open as the entirely average thing that it is (one of the reasons Menstrual Hygiene Day is so important). Another is to rethink programming that claims to ‘educate’ women about their menstruation – of course, giving women and girls information about available MHM products so that they can make their own choices is important. But if we are going to frame MHM in the language of ‘education’, let’s not get it twisted: period stigma, like any harmful gender norm, requires bringing boys and men into the conversation. Menstruation is part of the process by which they were brought into the world, and so they too can bear some of the responsibility for making it a manageable – and dare we say respected – bodily function.
It might seem as though there are many more ‘urgent’ priorities in refugee settings than the provision of culturally and contextually appropriate menstrual hygiene products and sanitation systems. But the world agreed to the United Nations Agenda for Sustainable Development, and this fits squarely within it.
No one should have to live in a refugee camp. The real root of the MHM problem in refugee contexts is patriarchy and militarization. And since women and girls are displaced for political and economic manoeuvres that they largely did not lead, we should probably skip blaming them for toilets that don’t work, or ‘educating’ them on how to adapt their biology to a terrible situation they did not ask to be in.
The period taboo does a lot of harm to women and girls around the globe, but the humanitarian sector has an important opportunity to disrupt— rather than mirror— the flawed beliefs and assumptions that drive how we deal (or fail to deal) with matters of menstruation. There are concrete things we can and should be doing to support the forcibly displaced.
It starts by asking the right questions and centering the perspectives of the right people.
A feminist approach would prompt us to consider things like: Where are services for refugees and displaced populations located? Are there gender-specific restrooms? Is there easy, consistent access to MHM products that suit women and girls’ needs and preferences in this particular context? Asking these questions provides an entry point for crafting humanitarian responses to emergencies that include consideration of sexual harassment, gender-based violence, and women’s privacy.
Secondly, we should build sanitation systems that suit all human needs – inclusive of women, men, children, and people living with disabilities – instead of asking traumatized women and girls to change their behaviour. As with the provision of MHM products, we should center women’s needs and perspectives in the design of WASH in emergency contexts.
Finally, we should demand that our governments find diplomatic, peaceful solutions to conflict. Menstruation isn’t going to become a thing of the past, but wars could. This requires elevating approaches to conflict that are more likely to secure peaceful resolutions. We’ve talked here about substantively involving women in the design of WASH systems in refugee camps – what we referred to as women-centered design. Women human rights defenders also need to be wielding power in the national and international institutions currently dominated by men. In fact, we know peace processes work better when local women’s movements influence the outcomes, and there is evidence to support the idea that displacement responses would work better too if women and girls were involved. So, in the mark of Menstrual Hygiene Day, let’s be aspirational about what can and should change.
Periods aren’t offensive, wars are.