More than a woman’s issue: Meeting menstruators’ practical and strategic menstrual health needs in humanitarian programmes

Poor access to menstrual health is a hindrance to gender equity. Experts now define menstrual health beyond the practical needs of appropriate materials, water, sanitation, and hygiene (WaSH) facilities, education, and healthcare, to address the strategic needs of reducing stigma and taboos and creating a supportive environment. Though a global need, inadequate menstrual health is exacerbated in humanitarian settings. Humanitarian guidance tells us that to address practical menstrual health needs practitioners must consult with those who menstruate, and to address the strategic needs, they must also engage those that do not menstruate. However, there is limited evidence- and context-based guidance on how to do this. To rectify this, I apply realist evaluations to two case studies: a project consulting Syrian menstruators on WaSH facility design in Lebanon, and a programme engaging Rohingya non-menstruators to become advocates of menstrual health in Bangladesh.
Realist evaluation is a theory-driven approach that allows us to understand the contextual factors necessary to establish that trigger the causal mechanisms leading to a programme’s outcomes. To address menstruator’s practical needs, I used this method to find the contextual factors and causal mechanisms that promote participant experience during a WaSH facility design project. These comprised individual (choices influencing and experience during participation), interpersonal (group dynamics and the role of non-menstruators), and organisational (expertise and knowledge, relationship to participants and cultural differences) factors. To address menstruator’s strategic needs, realist evaluation uncovered the contextual factors and causal mechanisms that influence non-menstruator attitudes and behaviours towards menstruation. These incorporated individual (understanding and empathy towards health risks, recognising responsibility, and gaining confidence in the role), interpersonal (family responding well), community (religious framing from the Imam, community mind-set, safe spaces), and organisational (relationship to programme staff and community facilitators) factors.
The results of both evaluations give empirical evidence to humanitarian actors on the contextual factors to set up and the causal mechanisms to seek when implementing such programmes. If humanitarian actors can address menstrual health in a more holistic way that is contextually cognisant, they can address both the practical and strategic needs of menstruators. This is necessary for reducing the gender inequity created by poor menstrual health and our attitudes towards it.