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Blood on the leaves: menstruation and the masculinity of humanitarian aid

Your home is in ruins, your possessions scattered, and your livelihood is destroyed. You are on the move now, forced to move away from everything you know. Then you get your period.

Most humanitarian aid is gender-blind. In practice this means that factors of everyday life that impact both women and men are prioritised, and since there are few male-specific humanitarian health and wellbeing issues, this naturally disadvantages women. According to Ugochi Daniels of UNFPA, that’s because aid is a masculine world, filled with male decision makers from aid agencies consulting with residents or refugees in ‘culturally sensitive’ ways, which usually means talking to male heads of household. Though humanitarian situations disproportionately affect women in myriad other ways, it is the lack of feminine hygiene products or specific consideration of feminine health needs that has the widest impact. Menstruation is a biological fact, yet ‘hygiene kits’ rarely contain any menstrual hygiene products. “It doesn’t rank with the same level of importance because it affects women and girls” – Daniels states.

Not all aid agencies operate gender-blind. UNFPA adopt a female-focused approach to aid that differentiates them from other UN aid agencies. They have conducted research specifically on the experiences of women in crises and developed ‘dignity kits’ in response. These kits are among very few truly female-focused humanitarian aid supplies, providing feminine hygiene products, underwear, and other key items that make life much simpler for women in crisis situations. They also provide culturally appropriate items like headscarves and shawls in situations where these are needed.

A counselling session hosted by the International Rescue Committee in Jordan for women fleeing the conflict in Syria. (Photo: Russell Watkins, Wikimedia Commons)

Unfortunately, funding is difficult for UNFPA following the United States’ decision to reinstate the ‘global gag rule’ in January 2017 and remove all UNFPA funding, despite them not engaging in abortion services. Last summer, when two successive hurricanes struck the Caribbean, it fell upon the unpaid intern from Lund University to design the dignity kit, based on nothing but the contents of an old kit and the instruction to cut the costs by around half. Hardly a sophisticated response from the UN’s most female-focused aid organisation. Regrettably, the most expensive parts of the kit are the sanitary towels and the underwear, and to ensure that UNFPA continued to supply these essential items, almost everything else in the kit had to be removed. What women received was a 10-litre bucket with a handful of packs of discount sanitary pads, off-brand knickers and little else. Not much dignity, but a lot more than recipients would have had without them.

What happens to women who don’t receive dignity kits? The answers are not pretty. In disaster situations, women typically use rags, either bundled up and inserted inside themselves, or folded up and used as pads, depending on whether they are wearing underwear. For longer-term displacements and travelling, many women use large leaves, pieces of moss, or pieces of old mattress for the task. These are not items you would put in your mouth, so why should women be forced to put them somewhere more intimate? This is not just an uncomfortable image, it’s a problem with real health and social consequences. Global One found that over half of women in refugee camps will contract urinary tract infections, which often go untreated because of stigma related to feminine health issues. Education is already a problem for long-term displacements, and girls who cannot successfully manage their periods frequently miss school, further inhibiting their educational progress.

A Communal bathroom in a refugee settlement in Tergol, Ethiopia (Photo: Unicef Ethiopia, Flickr)

The problem is twofold. Humanitarian supplies are designed from a male perspective, and men don’t talk about periods. This is not just a developing world problem; both men and women struggle to talk about menstruation in developed countries as well. We sanitise the rhetoric of an unsanitary problem. This is the story of women inserting dirty rags into their vaginas, anything less visceral diminishes the truth. This culture of taboo then leads to the second problem, a private concern in a public place. There is no privacy in a refugee camp or a temporary shelter. Toilets and bathrooms are communal, and public displays of menstruation are unacceptable, so women have to find alternative places to manage their basic biological needs. They then go to dark corners where they are at greater risk of gender-based violence – another inadequately tackled issue rife in humanitarian crises. There are related stories of stolen sanitary towels and assaults specifically on women who are menstruating, because of cultural mystiques that surround periods and beliefs that menstrual blood can cure diseases, created and reinforced by cultures of silence.

The situation is improving. There is a growing spotlight on this issue, most recently highlighted last weekend when Prince Harry and Meghan Markle asked guests to donate to a charity providing sanitary pads in India in lieu of a traditional wedding gift. There is greater understanding among aid organisations that women are disproportionately affected by humanitarian crises, with more attention being paid to women’s access to services including food, labour markets and healthcare. There is also an ongoing paradigm shift in citizen engagement that is changing the perception of women from ‘helpless victims’ into useful partners who can be engaged in the aid process at least as much as men. When it comes to feminine hygiene, increased usage and understanding of alternatives to disposable sanitary pads, like menstrual cups and reusable pads, are providing more affordable and more accessible options. Many major NGOs including Oxfam and ActionAid have begun distributing their own dignity kits, and there is talk of generating an international standard for emergency menstrual hygiene programming. However, women have been menstruating since the dawn of humanity – there is no excuse for ignoring menstrual hygiene in humanitarian aid. As Daniels puts it: “A woman is not going to stop menstruating because there’s a crisis”.

Henry Stout

Henry was an intern at UNFPA over summer 2017, part of the humanitarian relief effort following both Hurricanes Irma and Maria.

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