Periods in poverty: finding innovative solutions

Can an innovative approach find culturally appropriate solutions to menstrual hygiene for displaced women? Medical Coordinator Chiara Domenichini introduces a new MSF project aiming to find out.

“I have been working for MSF since 2013, first as a nurse and later as a medical coordinator, mostly in places that don’t have a lot of resources or infrastructure. One thing all female MSF staff know is that managing your own menstrual hygiene is not always easy. 

"In many of the contexts where we work products for menstruation can be scarce or completely absent, and lack of toilets and water, poor hygiene conditions and few spaces for privacy complicate things further. Pads have often taken up a lot of my luggage space. Recently, however, I’ve found something that works better for me: period underwear. It is washable, durable underwear, capable of absorbing the menstrual flow without need for other products. 

"While on assignment in South Kivu province, in the Democratic Republic of Congo (DRC), I shared my experience using period underwear with a female colleague. From that conversation, we started wondering: could this work in a rural setting for women who have been displaced, who face many more challenges than we do?

The context: South Kivu

"People in DRC have lived through decades of conflict. When violence erupts, people have few options but to flee, leaving behind their homes and livelihoods, and often find themselves living in temporary camps with little access to basics like clean water, toilets and medical care. There are over five million people who have been internally displaced like this in DRC. Around 400,000 of these people live in South Kivu, of whom over 50 per cent are women.

"Although there has been some work addressing menstrual hygiene in humanitarian responses, there is a very limited body of evidence on adequate menstrual products in the context of displacement. Menstrual hygiene is part of reproductive health, and is a fundamental right and basic need that must be considered. The lack of adequate menstrual products and safe spaces to manage menstrual hygiene can cause women great discomfort and anxiety, which can lead to stigma, shame and fear. 

"So how do displaced women in DRC deal with menstruation? And could period underwear be usefully introduced in the hygiene kits MSF provides them? All innovation begins with a question and an idea. To test ours, we successfully applied to the Sapling Nursery, an MSF fund that helps teams pilot new approaches that could change how we work for the better.

The first step

"A team of Congolese staff in Bukavu city, South Kivu, provide technical and administrative support to MSF projects in the region. We approached the female members of the team with a request: would they participate in the project, and be the first to assess the period underwear? They received the idea with enthusiasm, and this is how our first pilot began. 

"Every context that MSF works in is different. Although people living through humanitarian crises might have similar needs which can be met with comparable solutions, it’s vital to understand the culture you’re working within in order to develop appropriate solutions. 

"That’s why we spent a morning session with our Bukavu colleagues, discussing menstruation beliefs and taboos, where we get information about it, our first menstruation experiences and the most common challenges. We learned that one of the key aspects of menstruation for women in DRC is privacy: women don’t want anyone, even other women, to know that they are menstruating. 

"We distributed the period underwear to our colleagues, and three months later we got back together to discuss their experiences with the product. The feedback was positive overall. The underwear was comfortable and clean, easy to wear and wash and, most importantly, it tackled the important issue of privacy.

"The next step will be to take this idea to a rural area in South Kivu and run a second pilot with a larger number of participants. If the feedback is positive, a third phase will look at introducing the underwear in MSF’s hygiene kits for displaced women in the province.

Communities at the centre

"It’s essential that our pilot has an inclusive process with Congolese women, with their opinions and experiences at the centre, so that together we can understand whether the menstrual underwear would improve women’s quality of life. To achieve this, we are working with the MSF Japan Innovation Unit to design community feedback sessions aimed at understanding beliefs, taboos and challenges of menstruation. We’re also linking with health promotion and community engagement experts and reproductive health specialists to structure how the community feedback will be obtained and evaluated. 

"Menstruation is both a sensitive topic and an issue of empowerment, and as such it must be addressed sensitively, by women and for women, so that they are supported to make the decisions that are right for them.”

Improving knowledge and choice

Elisha Swift is a midwife and women’s health advisor with the MSF Australia Medical Unit. She is currently looking at opportunities for our projects to support menstrual hygiene solutions for women.

“Globally, many women face stigma, harassment and social exclusion when they are menstruating. Young women and girls miss out on school and employment opportunities due to these factors, and often because they don’t have the resources or opportunity to manage menstruation for themselves. 

"Overall, many women and girls aren’t equipped to make informed, personal choices about their bodies, or about sexual and reproductive healthcare. Current work by myself and other MSF staff aims to improve management of menstruation through simplifying hygiene and focusing on dignity for women. Particularly for women who are on the move after being displaced, or living in precarious settings like refugee camps, having a sanitary option that works for them will improve their safety and their ability to manage other challenges.

"Projects where MSF works with adolescent women offer good opportunities for providing safe menstrual hygiene options like period underwear. Whether we’re looking at Australia or overseas, it’s during adolescence that young women make decisions about their health for the first time. The options available at this age, and the choices women make, play a large role in moulding their health behaviour later in life.

"There are many social, cultural and practical factors we need to take into account when looking at menstrual hygiene solutions in the communities we work in. Will women have access to water, soap or buckets to wash reusable products like underwear? How can they wash these discreetly, when privacy is important? Working with women and girls, community leaders and schools through workshops, events and focus groups will help ensure the solutions work and that communities take ownership of them.

"If we can provide knowledge and choices for women, and help demystify periods, we can contribute to ending the stigma and discrimination associated with them.”