Addressing menstrual

hygiene management
(MHM) needs
Guide and Tools for Red Cross and Red Crescent
Societies
Pilot version / July 2019
 Cover image credit: Corinne Ambler/New Zealand Red Cross - Burundi

© International Federation of Red Cross IFRC Menstrual Hygiene Management (MHM) guide and toolkit
and Red Crescent Societies, Geneva, 2019 Second review, July 2019
Copies of all or part of this study may be made for noncommercial use,
providing the source is acknowledged The IFRC would appreciate re-
ceiving details of its use. Requests for commercial reproduction should
be directed to the IFRC at secretariat@ifrc.org.
The opinions and recommendations expressed in this study do not nec- P.O. Box 303
essarily represent the official policy of the IFRC or of individual National CH-1211 Geneva 19
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al Federation or National Societies concerning the legal status of a terri- Telefax: +41 22 733 0395
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IFRC unless otherwise indicated. Cover photo: Juozas Cernius/IFRC. Web site: www.ifrc.org
 Addressing menstrual
hygiene management
(MHM) needs

Guide

The International Federation of Red Cross and Red Our strength lies in our volunteer network, our
Crescent Societies (IFRC) is the world’s largest community-based expertise and our independence
volunteer-based humanitarian network, reaching 150 and neutrality. We work to improve humanitarian
million people each year through our 191 member standards, as partners in development and in response
National Societies. Together, we act before, during and to disasters. We persuade decision-makers to act
after disasters and health emergencies to meet the at all times in the interests of vulnerable people. The
needs and improve the lives of vulnerable people. We result: we enable healthy and safe communities, reduce
do so with impartiality as to nationality, race, gender, vulnerabilities, strengthen resilience and foster a culture
religious beliefs, class and political opinions. of peace around the world.

Guided by Strategy 2020 – our collective plan of action

to tackle the major humanitarian and development
challenges of this decade – we are committed to "saving
lives and changing minds".
International Federation of Red Cross and Red Crescent Societies
Addressing menstrual hygiene management (MHM) needs

List of acronyms
CBHFA Community based health and first-aid
CEA Community engagement and accountability
CVA Cash and voucher assistance
DAPS Dignity, access, participation, safety
DM Disaster management
DREF Disaster relief and emergency fund
EPOA Emergency plan of action
FGD Focus group discussion
HP Hygiene promotion
IEC Information, education and communication
IFRC International Federation of Red Cross and Red Crescent Societies
INGO International non-governmental organisation
KII Key informant interview
KAP Knowledge, attitudes and practices
MHM Menstrual hygiene management
NFI Non-food item
NGO Non-governmental organisation
PPE Personal protection equipment
PGI Protection, gender and inclusion
PSS Psycho-social support
SGBV Sexual and gender-based violence
SRH Sexual and reproductive health
SBCC Social and behaviour change communication
UNICEF United Nations Childrens Emergency Fund
UNFPA United Nations Population Fund
WASH Water, sanitation and hygiene

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International Federation of Red Cross and Red Crescent Societies
Pilot version

Table of contents

Overview: Steps and Tools for MHM action 6

Getting started: This guide 7

1.1 Purpose and target audience 7
1.2 What this guide does and does not include 7
1.3 How to use this guide and tools 8

MHM in humanitarian contexts: The basics 9

2.1 What challenges do women and girls face? 9
2.2 What are the risks of not addressing MHM? 9
2.3 What is MHM? 10
2.4 Who is involved in a humanitarian MHM response? 11
2.5 Making sense of kits and items for menstrual hygiene 12

Volunteers and MHM 19

3.1 Selecting volunteers for MHM activities 19
3.2 Training volunteers in MHM 20

Integrating MHM into humanitarian programming 23

Step 1: Identifying the problem 24
Step 2: Identifying target groups 27
Step 3: Analysing barriers and enablers for behaviour change 28
Step 4: Formulating menstrual hygiene objectives 29
Step 5: Planning 32
Step 6: Implementation 33
Step 7: Monitoring and evaluation 36
Step 8: Review, re-adjust 38

Tools for MHM action 39

Tool 1: Focus group discussion guide – assessment 40
Tool 2: Checklist: minimum standards for inclusive, MHM-friendly latrines 42
Tool 3: Checklist: minimum standards for inclusive, MHM-friendly bathing areas 46
Tool 4: Checklist: minimum standards for inclusive, MHM-friendly solid waste facilities 48
Tool 5: Using cash and voucher assistance for menstrual hygiene 51
Tool 6: Step-by-step tool for deciding priority MHM actions 55
Tool 7: MHM in the emergency plan of action 57
Tool 8: Minimum items to be included in kits for menstrual hygiene 61
Tool 9: Example MHM IEC materials 66
Tool 10: Feedback and mitigation log 68
Tool 11: Focus group discussion guide - post distribution monitoring (PDM) 70
Tool 12: Post-distribution monitoring survey 72
Tool 13: Checklist for menstrual hygiene in humanitarian contexts 74

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International Federation of Red Cross and Red Crescent Societies
Addressing menstrual hygiene management (MHM) needs

Overview: Steps and Tools for MHM action

Assessment
Step 1: Step 2: Step 3:
Identifying the problem Identifying target groups Analysing barriers and
enablers for behaviour change
Tool 1 Focus group discussion guide – assessment

Tool 2 Checklist: Minimum standards for inclusive, MHM-friendly latrines

Tool 3 Checklist: Minimum standards for inclusive, MHM-friendly bathing areas

Tool 4 Checklist: Minimum standards for inclusive, MHM-friendly solid waste facilities

Tool 5 Cash and voucher assistance for menstrual hygiene

Planning
Step 4: Step 5:
Formulating menstrual hygiene objectives Planning
Tool 6 Step-by-step tool for deciding priority MHM actions (based on assessment)

Tool 7 Example MHM outputs, indicators and targets for the Emergency Plan of Action

Tool 8 Minimum items to be included in kits for menstrual hygiene

Implementation
Step 6:
Implementation
Tool 9 Example IEC materials (English, French, Spanish and Arabic) for disposable pads, reusable pads and
tampons - can be adapted and translated to country/context

Monitoring, evaluation & learning

Step 7: Step 8:
Monitoring and evaluation Review, re-adjust
Tool 10 Feedback and mitigation log (can also include rumours, complaints and misinformation)

Tool 11 Focus group discussion guide – post distribution monitoring

Tool 12 Survey for post-distribution monitoring

Tool 13 Checklist for MHM actions in humanitarian operations

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Getting started: This guide

1.1 Purpose and target audience
This guide aims to provide comprehensive guidance and practical tools for designing and implementing
appropriate, comprehensive and effective MHM action in humanitarian contexts, adapted for the Red Cross
Red Crescent context.

Programme and operations managers (male and female) from all areas working to prepare for or respond to
MHM needs of women and girls can use this guide, including:

• Water, sanitation and hygiene promotion (WASH)

• Protection, gender and inclusion (PGI)
• Shelter and NFIs
• Health, including sexual and reproductive health (SRH)
• Psycho-social support (PSS)
• Education

1.2 What this guide does and does not

include
There are a number of existing resources and tools for MHM in both humanitarian contexts and longer-term
development programming. For example, the Global toolkit for integrating Menstrual Hygiene Management
(MHM) into humanitarian response1.

This guide and practical tools aim to complement (rather than duplicate) existing resources. The Red
Cross Red Crescent way of working through community-based volunteers is highlighted.

This guide includes: This guide does not include:

• Considerations for identifying, selecting and • Information on the physiological process of
training community volunteers in MHM menstruation
• Guidance around distribution of dignity and MHM • Information on the different types of menstrual
kits, including minimum content for MHM and how materials available and when they may be
to avoid overlap appropriate or not (e.g. disposable and cloth pads,
• Step-by-step actions for addressing MHM in tampons, menstrual cups, sponges, etc.)
humanitarian contexts
• Practical tools for assessing, planning,
implementing and monitoring MHM (that can be
adapted and translated at country or operation
level).

This guide and tools align with and should be used together with the IFRC Minimum Standards for
Protection, Gender and Inclusion.

1 Sommer, M., Schmitt, M., Clatworthy, D. (2017). A toolkit for integrating Menstrual Hygiene Management
(MHM) into humanitarian response. (First edit). New York: Columbia University, Mailman School of Public
Health and International Rescue Committee.

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Addressing menstrual hygiene management (MHM) needs

1.3 How to use this guide and tools

This guide and tools can be used when preparing for and responding to the menstrual hygiene needs of
women and girls in humanitarian situations.

This guide and tools can also be used for longer-term development programming (for example WASH in
communities or schools, and CBHFA) or preparedness for disasters or crises, to train National Society staff
and volunteers, assess menstrual hygiene practices, preferences, socio-cultural attitudes, taboos and re-
strictions, and trusted sources of information.

This guide is structured into two main parts (see below). The icons link to the
relevant tools. Several examples from the field are included. A summary of key
messages can be found at the end of each section.

See the One-pager Summary for links to further information and additional resources.
EXAMPLE FROM THE
FIELD

Step-by-step key actions to ensure comprehensive,

effective support for menstrual hygiene needs of

Guide women and girls.

Follow the standard project cycle; designed to align
with the steps in IFRCs Hygiene Promotion in
Emergencies Guidelines. SUMMARY OF KEY
MESSAGES

Practical tools for assessing, planning, implementing

and monitoring MHM in operations and programs.
Tools Can be adapted and translated for use at country or
operational level.

TOOL

Menstrual HEALTH or HYGIENE management?

Menstrual health is considered to be "an encompassing term that includes both menstrual hygiene
management (MHM) as well as the broader systematic factors that link menstruation with health,
well-being, gender, education, equity, empowerment and rights"2. In the RCRC context, since many
enabling factors for MHM fall under the responsibility of WASH (e.g. water supply, sanitation fa-
cilities including latrines, bathing areas and solid waste, MHM kits and hygiene items), the term
‘Menstrual Hygiene Management’ (MHM) will be used throughout this guide.

2 UNFPA. Review of Menstrual Health Management in East and Southern Africa.; 2018. https://esaro.
unfpa.org/sites/default/files/pub-pdf/UNFPA Review Menstrual Health Management Final 04 June 2018.
pdf.

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International Federation of Red Cross and Red Crescent Societies
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MHM in humanitarian contexts: The

basics
2.1 What challenges do women and girls face?
In everyday life, women and girls face a number of challenges around managing their menstrual hygiene.
In humanitarian contexts, these challenges – especially related to dignity, access, participation and safety
(DAPS3) – can be exacerbated. Existing coping mechanisms are affected and there is a significant loss of
privacy.

Main challenges faced by women and girls in emergencies are4:

• Lack of sanitary materials, including underwear.

• Inadequate access to private, safe and appropriate latrines, bathing facilities, drying areas and waste
disposal mechanisms.
• Lack of information and knowledge about menstruation (especially adolescent girls) and how to use
sanitary materials (including underwear).
• Significant loss of privacy and dignity (especially in overcrowded, temporary or transit situations).
• Anxiety and embarrassment around leakage of blood, and discomfort associated with menstruation.
• Cultural taboos and restrictions which can impact access to services and daily life.

Remember that some women and girls may need additional assistance or support, such as women
and girls with physical and/or learning disabilities, mobility restrictions or unaccompanied and
separated girls.

Although this guide uses the term 'women and girls', it is important to recognise that transgender
persons may also menstruate. Based on context and situation, take special care to identify and
support transgender persons with MHM in an appropriate, dignified way.

2.2 What are the risks of not addressing

MHM?
There are a number of risks to women and girls if their menstrual hygiene needs are not adequately ad-
dressed in humanitarian contexts:

• Women and girls with no other option may use old, dirty or damp cloth to absorb their menstrual flow,
leading to irritation and/or infections.
• If women and girls need to wait for darkness to visit the latrines or find a private place to change/dispose
of sanitary materials at night, they risk potential sexual and gender-based violence (SGBV).
• Women and girls may have severely restricted movement and be forced to remain at home or in their
shelter while they have their period. They may have difficulties attending distributions, collecting water,

3 DAPS (Dignity, Access, Participation and Safety) is a framework for addressing core minimum standard
commitments to Gender and Diversity in emergency programming. http://www.ifrc.org/Global/Photos/
Secretariat/201505/Gender%20Diversity%20MSCs%20Emergency%20Programming%20HR3.pdf.
4 Sommer, M., Schmitt, M., Clatworthy D. A Toolkit for Integrating Menstrual Hygiene Management (MHM)
into Humanitarian Response. (First Edit). New York; 2017.

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International Federation of Red Cross and Red Crescent Societies
Addressing menstrual hygiene management (MHM) needs

access health services or work. Girls may not attend school during their periods if they lack private, ap-
propriate facilities and sanitary items.
• Anxiety and embarrassment around leakage of blood, and discomfort or pain associated with men-
struation.

2.3 What is MHM? Socio-

cultural
Menstrual hygiene management, or MHM, refers 1. MHM materials & preferences
to a range of actions and interventions that en- items & context
sure women and adolescent girls can privately,
safely and hygienically manage their monthly
menstruation with confidence and dignity.

MHM is not only about distributing pads or

providing education to girls. A comprehensive,
effective MHM response has three main compo- 3. Information
nents (Figure 1)5,6: about 2. Private, safe
menstruation & appropriate
1. MHM materials and supportive items & hygiene WASH facilities
This includes materials such as pads, cloth,
underwear, tampons etc. to absorb the men-
strual flow and items to support use, wash-
ing, drying and disposal.
2. Private, safe and appropriate WASH facili-
ties
This includes facilities and infrastructure for changing used materials, washing and drying cloth, reus-
able pads and underwear, bathing and disposing of sanitary items and wastewater.
3. Information on menstruation and hygiene
This includes basic information on the process of menstruation (especially for adolescent girls), dem-
onstration with any distribution of MHM items (on their use, care, disposal, etc.) and staying healthy
(personal hygiene).

These components are all influenced by various motivators and personal preferences, socio-cultural fac-
tors, and physical barriers.

Continuously engaging and consulting with women, girls, men and boys is critical, to ensure the MHM
response is socially and culturally appropriate and adapts to changing needs and challenges.

Key lesson: Involve men and boys from the start

It is important to communicate with and involve men and boys in MHM programming, so they are
aware of the needs of women and girls, are supportive of activities, to reduce stigma and to help
address harmful cultural taboos or restrictions. Buy-in from men and boys is essential for success
of MHM actions.

5 Sommer M, Schmitt ML, Clatworthy D, Bramucci G, Wheeler E, Ratnayake R. What is the scope for
addressing menstrual hygiene management in complex humanitarian emergencies? A Global review.
Waterlines. 2016;35(3):245-264. doi:10.3362/1756-3488.2016.024.
6 IFRC. Menstrual Hygiene Management (MHM) in Emergencies: Consolidated Report. 2016. https://
watsanmissionassistant.wikispaces.com/file/view/Menstrual Hygiene Management in Emergencies_
Consolidated Report 2016.pdf/.

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2.4 Who is involved in a humanitarian MHM

response?
In many humanitarian agencies, MHM is led by WASH or Protection – but it can also be one sector who has
responsibility at headquarter (or global) level and another who has responsibility at an operational level.

At a global level in IFRC, WASH has overall responsibility for MHM. Many of the core actions to support
MHM fall under the responsibility of WASH (e.g. water supply, sanitation facilities including latrines,
bathing areas and solid waste, MHM kits and hygiene items), however in some operations Protection has
taken a lead. Make sure there is clarity on who has overall responsibility for MHM and for coordinating and
working with others.

One sector cannot address MHM needs alone. Strong coordination and joint planning, implementation and
monitoring are essential – particularly for WASH, PGI, health and shelter – but also including psycho-social
support (PSS), disaster management and relief, and education.

Coordination and collaboration with national ministries, working groups and sector coordination mech-
anisms is important to: avoid duplication of distributed items, prevent distribution of culturally inap-
propriate items, advocate for standardised kit content, and to ensure actions are aligned with national
guidelines, policies and goals as well as humanitarian standards (e.g. Sphere7). Be sure to link with the
Ministry of Health or WASH, WASH cluster, Protection cluster (including GBV sub-cluster) and national
MHM working group (if any).

SUMMARY OF KEY MESSAGES

• Women and girls face a number of challenges around menstruation in emergencies, in-
cluding lack of sanitary materials, significant loss of privacy, anxiety and embarrassment,
cultural taboos and restrictions, and inadequate latrines, bathing facilities, drying areas and
waste disposal mechanisms.
• If menstrual hygiene needs are not adequately addressed, women and girls may face irritation or infec-
tions, the risk of sexual and gender-based violence, restricted movement and inability to attend distri-
butions or access services.
• MHM is a multi-sectoral issue and strong coordination is key for a comprehensive, response that effec-
tively meets changing needs of women and girls.
• The three essential components for an effective MHM response are: access to MHM materials and sup-
portive items; private, safe and appropriate WASH facilities; and information. These are all influenced
by individual preferences, socio-cultural factors including taboos and restrictions, and physical barri-
ers.
• Continuous engagement and consultation with women, girls, men and boys is critical, to ensure that
MHM actions are response and that they address needs and challenges, and are socially and culturally
appropriate.
• It is important to identify women and girls who may be marginalised or need additional support, such
as those with physical disabilities, learning difficulties, transgender people or unaccompanied girls.

7 Sphere 2018: https://www.spherestandards.org/handbook-2018/

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Addressing menstrual hygiene management (MHM) needs

2.5 Making sense of kits and items for

menstrual hygiene
Providing kits and non-food items (NFIs) to people affected crises – either in-kind distributions or through
cash grants/vouchers – continues to be a core Red Cross Red Crescent relief activity.

Figure 1 below provides an overview of hygiene, dignity and menstrual hygiene management kits which are
commonly distributed by National Societies in humanitarian operations. Different kits have different target
groups and different purposes, as well as different timeframes for use (e.g. how long the items last for) and
different distribution mechanisms.

H Hygiene Kits
M MHM Kits
D Dignity Kits

What is it? NFI NFI Programming tool

Led by WASH WASH PGI

FAMILY PERSONAL PERSONAL

Target (one kit per female of (one kit per female)
user reproductive age)

5 to 7 people per household Disposable Reusable

(or family) Female dignity kit8
Types of MHM Kit A MHM Kit B
kits Standard kits, as well as regional
and country adaptations

To provide basic hygiene items for To provide essential materials and To support dignity of women and
Purpose a household of 5 people, for a items which enable women and girls, including improving safety
period of 1 month. girls to manage their monthly and mobility, and to provide
menstruation hygienically and with information about reproductive
dignity. health and SGBV related issues
and services.

Usually from 1 to 3 months. A lot of Depends on type of kit and Usually a one-off distribution
How long consumables; need regular top-up. sanitary material. Initial linked to programming; not a relief
distribution; then top-up of item. Need to consider top-up of
do they consumable items. consumable items and/or link to
last? other kit distributions to cover
needs.

Figure 1: An overview of hygiene, dignity and menstrual hygiene management kits.

There are some key issues in relation to menstrual hygiene:

• Hygiene kits are generally designed for a family, with a limited number of standard sanitary pads re-
gardless of how many menstruating females there are in the household.
• Standard family hygiene kits that are distributed in the first phase of emergencies can often include
socially and culturally inappropriate items, or items that are not preferred by women and girls in that
context. This can lead to items distributed being unused, discarded or re-sold – and menstrual hygiene
needs going largely unmet. There is a wide diversity of preferences, materials, and practices for manag-
ing menstruation across different cultures and contexts, which need to be considered.
• Important items to enable women and girls to wash, drying and dispose of sanitary materials (e.g. laun-
dry soap and bucket for washing, rope and pegs, additional cloth for privacy while drying, bag or pouch
for privacy and disposal) are generally not included in dignity kits (or hygiene kits).

8 Depending on context can also be developed for other specific groups e.g. males, babies, people with
disabilities, older people, sex workers etc.

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• Dignity kits9 are a programming tool

that aim to serve a broader protection
purpose, and are first and foremost
designed to promote dignity, mobility
and safety of women and girls by pro-
viding age, gender, and culturally ap-
propriate items such as headscarves,
shawls, whistles and torches. Dignity
kit content is decided after consulta-
tion and feedback from women and
girls (or other target groups) on their
specific needs. Dignity kits are always
locally procured and not distributed
in the first or acute phase of an emer-
gency or humanitarian crisis. Because
women and girls continue to menstru-
Credit: Corinne Ambler/New Zealand Red Cross - Burundi
ate from day 1 following an emergency
or crisis – dignity kits do not meet initial MHM needs and should be distributed in addition to hygiene
and MHM kits (with close coordination to avoid duplication; see section below).
• Dignity kits are a one-off distribution, and do not meet the menstrual hygiene needs of women and
girls on a continuous (or ongoing) basis. Disposable sanitary pads and soap are used up quickly – even
cloth or reusable sanitary pads become worn out and not absorbent over time (generally 3 – 12 months
depending on quality of cloth or pads). How long the different kits and items last for and how consum-
able items will be replenished or ‘topped-up’ must be considered and included in any kit distribution
strategy.
• Most hygiene and dignity kits do not include information on the use, care and disposal of menstrual
items (e.g. how to wash, dry and dispose of used sanitary items), or practical information on how to stay
healthy and what the menstrual process is. Women and girls may have incorrect information or cul-
tural beliefs on use and care of menstrual items. It can never be assumed that women and girls know
how to use the type of sanitary pad or items inside each kit (demonstration and information with any
distribution is critical).

Considerations for kit distributions in emergencies10

Key points
• Dignity kits11 are not a standard relief item that can be pre-positioned. Dignity kits are always locally
procured and distributed after the initial, acute response (and are designed following consultation and
feedback of context and culturally specific needs).
• Family hygiene kits, even with sanitary pads included, do not effectively or comprehensively address
MHM needs.
• MHM kits are a relief item that can be pre-positioned and distributed in the initial acute response to
meet immediate MHM needs of women and girls.
• Ideally (see Scenario A), MHM preferences and practices at country level should be assessed as part
of preparedness, and a country-specific MHM kit developed and pre-positioned.
• For countries that do not have country-adapted MHM kits identified (scenario B and C), standard
MHM kits can be pre-positioned and distributed in the first phase. Post-distribution feedback from
women and girls should then be used to adapt MHM kit to the specific context and to revise and
improve the content.

9 In the Red Cross Red Crescent context; other agencies or organisations have different definitions of
hygiene, dignity, female hygiene kits.
10 Developed based on example from UNICEF Guidance: Immediate Response WASH and Dignity Kits and
Family Hygiene and Dignity Kits (2015).
11 A few National Societies may have locally adapted dignity kits which are pre-positioned on a small scale;
this document intends to provide general guidance for the most common scenarios faced by National
Society and movement partners, and therefore this guidance should be contextualised.

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Addressing menstrual hygiene management (MHM) needs

In general, there are 3 different scenarios for kit distributions (see figure 2), based on the pre-disaster level
of pre-positioning as well as the National Society procurement capacity (also in relation to scale and type
of humanitarian needs):

Scenario A: Locally adapted kits pre-positioned at country level; all local procurement.
Scenario B: Standard kits pre-positioned at country or regional level; local procurement following the
initial acute response (including for re-distributions and top-up items).
Scenario C: Standard kits pre-positioned at country or regional level; limited or no local procurement for
the duration of the emergency response (including for re-distributions and top-up items).

H
Standard hygiene
kits (regional or H
Adapted hygiene
kits (for context and M
Standard MHM
kits (regional or M
Adapted MHM
kits (for context D Dignity kits, locally
procured based on
global procurement) culture), locally global procurement) and culture), context, culture and
procured locally procured needs

H MORE

Scenario

POSITIONING & PROCUREMENT CAPACITY

M

A
D

H H

Scenario
M M

B
D

H Scenario

M
C

D
LESS

SUDDEN ONSET INITIAL ACUTE ONGOING RESPONSE:

DISASTER OR RESPONSE 2-3 months after initial response
EMERGENCY OR whenever appropriate

Figure 2: Different scenarios for kit distributions, based on the pre-disaster level of pre-positioning as well as the National Society procurement capacity.

GUIDANCE TO AVOID DUPLICATION BETWEEN KITS

Key points
Distributing pads and underwear alone DOES NOT address MHM needs

• Along with pads and underwear, essential items to support washing, drying and disposal, and informa-
tion on use and care of menstrual items must be distributed.
• MHM and dignity kits are designed for personal use; so that every woman and girl in a household should
receive an individual kit (not one kit per household).

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Dignity kits are NOT a replacement for MHM kits

• Dignity kits usually do not include key items for supporting washing, drying and disposal, or informa-
tion on use and care of menstrual items.
• It takes time to consult, design, procure and distribute dignity kits (often 3 – 6 months); during which
women and girls continue to menstruate and have MHM needs.
• Dignity kits are a one-off distribution; disposal pads, menstrual cloth, laundry soap, body soap (and po-
tential other items like paper bags to support disposal) are all consumables and there needs to be a clear
strategy for replenishment/top-up so that women and girls have continuous access to the basic men-
strual hygiene items they need (always assess potential for using cash and supporting local markets).

GUIDANCE TO AVOID DUPLICATION BETWEEN KITS

IF Hygiene Kits AND MHM Kits will be distributed:
Initial • Remove sanitary items from hygiene kits
acute IF only Hygiene Kits will be distributed:
response • Leave sanitary items in hygiene kits
Dignity kits are not an NFI and are not distributed in first or acute phase of emergencies

Ongoing IF Hygiene Kits AND MHM Kits AND Dignity Kits will be distributed:
• Remove sanitary items from hygiene kits and dignity kits (e.g. only MHM kits have sanitary
response
items) OR
• Remove sanitary items from hygiene kits and ensure sanitary pads in dignity kits are the
same as in MHM kits [note: this option means there will be women/girls receiving more
pads than they need, and women older than reproductive age receiving pads even though
they don’t get their period].
IF Hygiene Kits AND Dignity Kits will be distributed:
• Remove sanitary items from hygiene kits AND
• Ensure dignity kits have ALL minimum MH items (see Tool 8; e.g. pads, underwear, but
also laundry soap, small bucket, carry bag, rope etc.) AND
• Ensure top-up/replenishment of consumable items (e.g. pads, laundry and body soap) in
dignity kits [timeframe based on type of pads and quantity of items]
IF only Hygiene Kits will be distributed:
• Leave sanitary items in hygiene kits, adapt to the context as soon as possible
• Ensure top-up/replenishment of consumable items (e.g. pads, laundry and body soap)
[timeframe based on type of pads and quantity of items]

REMEMBER!

ALL KITS HAVE CONSUMABLE ITEMS WHICH NEED REGULAR TOP-

UP OR REFILL (IN-KIND DISTRIBUTION OR CASH)

MAKE SURE YOU HAVE A CLEAR STRAGETY FOR ANY KIT DISTRIUB-
TION RIGHT FROM THE BEGINNING

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Addressing menstrual hygiene management (MHM) needs

OVERVIEW OF THE PROCESS FOR MHM KITS

Figure 3 shows an overview of the recommended best-practice process for menstrual hygiene kits in emer-
gencies (also useful for dignity kits which include MHM items). The process should be a cycle (e.g. post-dis-
tribution monitoring consultation should inform top-up kits, adaptations to kit content and other activities).
The process should be adapted based on context.

Aim: to determine if
Aim: to understand hygiene and
required items can be
MHM needs and challenges,
procured/sourced locally,
to understand cultural practices
to assess if cash-based
and taboos,
interventions would be
guide the selection of items
feasible & appropriate,
to be distributed and how
procure items
they should be distribut-
ed in a safe way, to 1. Consultation 2. Market survey
know how other and assessment and
actors are support- coordination procurement
ing MHM

3. Distribution
4. Post-distribution (with Aim: Safe distribu-
monitoring demonstration) tion including a
Aim: monitor and demonstration on use,
measure the use, care (washing & drying),
acceptability, impact disposal of MHM items,
and satisfaction. practical and clear hygiene
Continuously gather and personal health
feedback to inform information including SRH
(re)design of activities. and GBV services

Figure 3: An overview of the recommended process for hygiene, dignity and menstrual hygiene related non-food items (NFIs).

Minimum items for menstrual hygiene

Based on field experiences and operational research, IFRC have developed minimum items for menstrual
hygiene to be included in MHM kits and dignity kits which aim to support women with menstrual hygiene.

TOOL 8: MINIMUM ITEMS TO BE INCLUDED IN KITS FOR MENSTRUAL HYGIENE

When designing dignity and MHM kits and selecting menstrual materials, it is important to
consider their whole life cycle. Figure 4 shows the basic life-cycle for reusable and disposable
materials. The whole process from procurement, distribution, use, washing, drying, disposal
and waste management, as well as top-up and replenishment of consumable items must be acknowledged,
planned for and women and girls consulted on each part of the process.

When procuring and planning distribution, it is important to consider the emergency phase, the emergency
type (conflict, natural disaster), climate (dry/rainy), population and setting (camps, urban areas, informal
settlements). In some settings, finding private spaces for washing and drying reusable materials can be a
significant challenge. Where possible, items should be procured locally. See Tool 5 for more information on
assessing use of cash and vouchers for menstrual hygiene items.

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Washing and drying

(incl. wastewater)

Disposal
(solid waste mgmt)

Reusable Regular top-up of

cloth or consumables
pads

Periodic
replenishment of
Procurement Distribution
(in-kind or cash) (in-kind or cash) cloth or pads

Disposal
(solid waste mgmt)
Disposable
pads

Regular top-up of
consumables

Figure 4: Basic life-cycle of reusable and disposal menstrual materials in a humanitarian operation12.

Women and girls need private, appropriate bins or ways to dispose of used pads and cloth, that they feel
comfortable using both day and night. Pads, cloth or other materials thrown into flush latrines will cause
blockages; and can cause issues in pit-latrines that need to be desludged. See Chapter 3, Step 6 (Water and
Sanitation Facilities) for more information.

In protracted crises, people may be displaced, in transit or living in camps or settlements for a long time. In
these situations, consider income-generation activities such as women’s groups sewing or making reusable
pads, or partnership models where women/girls work as sales representatives to sell sanitary materials to
others.

See ‘Additional resource: FAQs on menstrual hygiene and dignity kits’.

12 Adapted from: (Sommer, M., Schmitt, M., Clatworthy 2016).

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EXAMPLE FROM THE FIELD

In a refugee settlement in northern Uganda, an INGO distributed ‘WASH dignity kits’ to
women and girls which contained washable cloth pads and underwear, along with other
dignity items. Most people were using communal latrines and bathing areas (first phase).

No bucket or basin was provided to wash the cloth pads. The cloth pads were washed in a
river nearby, and hung on bushes to dry while the women were bathing or washing. Since this was not
long enough for the cloth to dry – they would reuse the cloth while it was still wet. Women and girls
also reported a fear of men and boys seeing them wash or dry the menstrual cloth out in the open.

The INGO who distributed the kits was not responsible for the water supply. Later on it was found that
the place at the river where women and girls washed their used menstrual cloth was only 50 metres
upstream from the main water intake supplying the camp.

Lesson 1: Analysing and consulting with women and girls on how they will wash and dry reusable
cloth is critical. Regular monitoring and follow up is vital.

Lesson 2: The importance of coordination and communicating with other actors (WASH related, but
also protection, education, health etc.) cannot be underestimated.

SUMMARY OF KEY MESSAGES

• Menstruation is very personal, and there is no ‘one-size fits all’ kit. There is a wide diversity
of materials, practices and cultural norms for managing menstruation across different cultures
and contexts, which need to be considered.
• MHM kits are a relief item that can be pre-positioned (either context-specific adapted kits or standard
kits) and distributed in the initial acute response to meet immediate MHM needs. Ideally, MHM prefer-
ences and practices at country level should be assessed as part of preparedness, and a country-specific
MHM kit developed and pre-positioned. Or, if standard MHM kits are distributed in the first phase, post-
distribution feedback from women and girls should be used to adapt them to the specific context and to
revise content.
• Dignity kits are a broader protection programming tool, not a standard relief item that can be pre-po-
sitioned. Dignity kits are locally procured and are always designed based on consultation and feedback
from women and girls on their age, gender and culturally specific needs.
• Dignity kits are not a replacement for MHM kits. Dignity kits do not meet initial MHM needs (in the acute
response period) or on continuous basis (because they are a one-off distribution).
• Items to enable women and girls to wash, dry and dispose of sanitary materials (e.g. laundry soap and
bucket for washing, rope and pegs, additional cloth for privacy while drying, bag or pouch for privacy
and disposal) must be included in MHM kits and dignity kits that aim to support menstrual hygiene.
• All kits have consumable items and there needs to be a clear strategy for replenishment/top-up so that
women and girls have continuous access to the basic menstrual hygiene items they need (always assess
potential for using cash and supporting local markets).

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Volunteers and MHM

In menstrual hygiene responses or programs, volunteers may be involved with:

• Talking with women and girls about menstruation, their needs, preferences, practices, cultural taboos
and restrictions they face.
• Engaging and communicating with men and boys on menstrual hygiene.
• Assisting with distributions of menstrual hygiene items and materials, including conducting demon-
strations and hygiene promotion.
• Construction, maintenance and monitoring of MHM-friendly WASH facilities (including latrines, bathing
areas, water supply and solid waste management).
• Collecting feedback from women, girls, boys and men on MHM activities, support provided, needs and
challenges they face.

3.1 Selecting volunteers for MHM activities

Selection of volunteers should be based an understanding of the local socio-cultural context and what is
appropriate for the specific community you are working with. In some places, it may be appropriate for fe-
male volunteers to discuss MHM with other women and girls, and for male volunteers to discuss MHM with
men and boys. In other places, it might be different. Ask and listen to community members themselves for
guidance on this – do not rely only on National Society staff who may come from another city, area or back-
ground.
Important considerations when identifying and selecting volunteers for MHM activities:

• Sex of volunteers. It is always important to include both male and female volunteers in MHM activities!
In many communities and cultures, menstrual hygiene is closely linked with fertility and reproduction,
and is seen as a ‘family issue’. Women and men may need to be consulted or triggered separately; with
female volunteers for the women and male volunteers for the men. Depending on the context, after
initial consultation women and men may be able to be mixed and have a discussion together on MHM.
Male volunteers are also likely to be involved with other MHM-related activities such as water supply,
sanitation, distributions, or hygiene promotion activities etc.
• Culture and language of affected communities, especially important in refugee or population move-
ment contexts where people have been displaced. Different volunteers may be needed to engage and
communicate with displaced and host communities.
• Age of volunteers who will be discussing MHM directly with affected communities. Younger adolescent
girls may find it easier to discuss MHM and be more open with adult volunteers, rather than volunteers
who are their peers. Older women and men may find it embarrassing or inappropriate to discuss per-
sonal or intimate matters with younger volunteers.
• Trusted sources of information for personal health issues such as menstrual hygiene. Women and
girls may trust information from coming from their mothers, aunties, teachers or local health workers
– rather than from agencies or government departments. Men may trust information coming from com-
munity or religious leaders, or health workers. It is important to understand where different segments
of community get their information from, and which sources they trust. This is especially critical for
effectively addressing cultural taboos, myths and misinformation around menstruation.
• Existing hygiene promotion volunteers (or PGI, or CBHFA – depending on the situation) should be uti-
lised if possible; especially if MHM activities will be incorporated as one component of broader WASH
activities. Existing volunteers have already been trained in RCRC principles, working with communities,
disease prevention etc. If cash grants or vouchers will be used, existing relief or cash trained volunteers
can be engaged in the process.
• Teachers and parents groups can be engaged for activities in local schools. Local community leaders,
influencers, religious leaders and traditional healers or women’s health providers can also be used to
engage with women, girls, men and boys.

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3.2 Training volunteers in MHM

Menstrual hygiene is a sensitive, largely taboo topic – but there is often a lot of interest from both male and
female volunteers when MHM is introduced and discussed.

Having knowledge and confident male and female volunteers (and staff) is one of the important first steps
in any MHM programme or response. MHM can be a stand-alone training – or it can be incorporated into
hygiene promotion, PGI or health (sexual and reproductive health) trainings.

As a minimum, both male and female volunteers should have13:

• A basic understanding of menstruation: what it is and how long bleeding lasts for, why it happens
(the reproductive cycle), when it begins and ends (menarche and menopause), etc.
• Knowledge of how women and girls manage their monthly menstruation: types of MHM materi-
als and items used locally or in that specific context, including recognising the need to wash, dry,
dispose of items etc.
• An understanding of the common socio-cultural beliefs, taboos and restrictions that women and
girls face around menstruation (in that specific context).
• The confidence and capacity to speak professionally about MHM.

Credit: Swiss Red Cross / Kyrgyzstan

13 Adapted from: D. Sommer, M., Schmitt, M., Clatworthy, A Toolkit for Integrating Menstrual Hygiene
Management (MHM) into Humanitarian Response. (First Edit). (New York, 2017) <https://www.mailman.
columbia.edu/sites/default/files/pdf/mhm-emergencies-toolkit-full.pdf> [accessed 19 December 2017].

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Important points to consider when training volunteers in MHM:

• Depending on the context, male and female volunteers may need to be trained separately (especially at
the beginning when MHM is new and confidence and capacity is being built). In other situations, it will
be okay for male and female volunteers to be trained together. Assess this with National Society staff
before training is planned.
• Do your best to make volunteers feel comfortable. Some women may feel very embarrassed answering
questions, or unsure of their knowledge despite the fact that they experience and deal with their own
period each month. Some men may either be very interested and asking detailed questions or be shy
and happy to listen and learn. Never pressure anyone to answer or do something they don’t feel com-
fortable doing. Do not single anyone out – male or female – to answer questions.
• Bring samples of different types of pads, underwear, soap, buckets, clothes line etc. to the training. Let
the participants get ‘hands-on’ or at the very least demonstrate how pads are inserted into underwear,
how they can absorb blood, how pads are washed etc.
• Terminology can be difficult to translate into local languages. Before training volunteers, make sure
you ask National Society staff, local health centre staff etc. about appropriate language and how best to
explain the process of menstruation, female anatomy etc. Involve local health workers in the training.
• Try and have an open, professional style of communication. Be upfront that MHM is a sensitive topic
which may make some participants feel embarrassed. Reinforce that everyone has a right to learn and
that there are no ‘silly’ questions.
• Use the generic materials developed by IFRC as examples during trainings and for reference [see Tool 9].
IFRC have developed flyers including basic facts of menstruation, how to use and care for pads (disposal
and reusable) and how to stay healthy. These can be adapted for your context or country, for use in your
programmes.

Tip!
Remember that volunteers may also have their own personal beliefs, misconceptions or misunder-
standings about menstruation, menstrual blood or taboos that women and girls face. Ensure that
volunteers are well-trained and that they have clear, practical and correct information. Try and
ensure that volunteers approach discussion about menstrual hygiene with an open perspective and
in a sensitive way.

EXAMPLE FROM THE FIELD

Vanuatu Red Cross Society included MHM in a WASH-for-schools program as part of
the Tropical Cyclone Pam Recovery project in West-Tanna, supported by Australian
RC. Lessons include incorporating peer-teaching, game activities and provision of
private changing rooms at schools for improved MHM. Sessions on MHM for parents
and teachers was identified to be important, to empower teachers and parents with the right tools,
knowledge and confidence to speak with and educate their children about MHM.

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Addressing menstrual hygiene management (MHM) needs

SUMMARY OF KEY MESSAGES

• Selection of volunteers to be involved in MHM programming should be based on an under-
standing of the local socio-cultural context and what is appropriate for the specific commu-
nity you are working with.
• Usually, both male and female volunteers are needed for MHM programming, to fill different roles and
activities (e.g. discussing with women or engaging with men).
• Other important considerations when identifying and selecting volunteers for MHM programming in-
clude age (may not be appropriate for young teenagers to talk about this with older women), culture and
language, as well as which sources of information women and girls trust and have access to.
• Training and building the capacity of male and female volunteers around MHM is an important step to
be able to implement MHM programming, and resources (human, financial) and time must be allocated
for this (as part of preparedness, in an emergency or through long-term development programming).
• Both male and female volunteers (and staff) should have basic knowledge of the menstrual process, how
women and girls manage their menstruation in your area/country (including any socio-cultural beliefs
or restrictions) and the confidence to talk professionally about MHM.

Credit: Netherlands Red Cross / Uganda Red Cross

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Integrating MHM into humanitarian

programming
This part of the guideline follows the steps outlined in IFRCs Hygiene Promotion in Emergencies (HPiE)
Guidelines, so that there is one single, systematic and standard process in humanitarian programming
where time and resources may be limited. These 8 steps for MHM in emergencies also align with the
standard project/programme cycle steps.

MHM questions and activities should be incorporated into existing or planned hygiene promotion (or WASH
and PGI) activities; rather than having two separate process.

Key lessons for MHM programming include:

Involve men and boys from the beginning

It is important to communicate with and involve men and boys in MHM programming, so they are
aware of the needs of women and girls and the challenges they face, are supportive of activities, and
can help to reduce stigma and address harmful cultural taboos or restrictions.

Men are also husbands to wives, fathers to daughters, and brothers of sisters who menstruate. They
may be unaware of the challenges, anxiety and needs around menstruation of the women and girls
in their life – but once they are aware they may support women and girls more and enable them to
manage menstruation effectively.

Software and hardware together for an effective MHM response

Often, hygiene promotion volunteers are the direct link between affected women, girls, men and boys
and the WASH engineers or hardware team. WASH software and hardware teams need to work closely
together – especially for MHM. Figure 5 highlights this.

Use feedback from HP HP volunteers collect

Affected women, girls,
team to improve and feedback on preferences,
adapt facilities ensuring men and boys needs, challenges faced
they are MHM friendly - with WASH facilities or
appropriate and private infrastructure etc.
for women and girls to
manage their monthly
menstruation.

Hardware (WASH engi- Software (hygiene promo-

neers and technical tion volutneers)
specialists)

Teams work closely together, share

information, have regular meetings, joint
planning etc.

Figure 5: Key linkages between software, hardware and the affected population.

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STEP 1: IDENTIFYING THE PROBLEM

This step focuses on understanding the humanitarian context, and understanding the menstrual hygiene
needs and challenges faced by women and girls so that locally appropriate, effective actions to support
their dignity and health can be designed.

Key activities include:

• Review secondary data

• Coordinate with other sectors, teams
and stakeholders
• Consult with and collect information
from affected women and girls
• Consult with and collect informa-
tion from men and boys, local health
workers, traditional carers and com-
munity leaders

Why do an assessment?
Menstruation is a very personal thing.
Women’s and girls’ preferences and strat-
egies for managing menstruation vary
greatly across ages, cultures, religions,
locality (urban versus rural) and context Credit: Corinne Ambler/New Zealand Red Cross - Burundi
(availability of water, population move-
ment, displacement, privacy etc.).

The way that women and girls manage their menstruation, their preferences and situation may be to-
tally different after an emergency – compared to what it was before.

Collecting information on MHM practices, socio-cultural factors, barriers, trusted sources of information
and knowledge is important so that we can:

1. Design specific, appropriate and effective MHM interventions; and,

2. Monitor progress of activities; and
3. Evaluate the impact of the response (baseline and endline).

Which information to collect and from who?

Initially, find and make use of existing data and information that can help inform or guide MHM activities.

Review secondary data such as baseline or monitoring reports from past or present health or WASH pro-
grams, Government reports, national MHM policies or guidelines etc.

Partner with other humanitarian organisations to reduce duplication of assessments and community
visits, which can be overwhelming for communities and can lead to frustration.

Coordinate with relevant ministries (e.g. Health, WASH or Education), humanitarian actors and other agen-
cies through existing or emergency coordination mechanisms (e.g. National epidemic task forces, Health
and/or WASH and/or Protection clusters).

While valuable information can be obtained from National Society staff and volunteers, community leaders
and secondary data – it is critical to consult with and collect information directly from affected women,
girls, men and boys.

National Society staff may be from the affected area or general population – but differences in socio-eco-
nomic status, age, education level and many other factors can mean that they have very different prefer-
ences, knowledge and strategies for managing menstruation than the affected population.

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A market assessment should be included to determine the

availability of menstrual hygiene items in local markets. EXAMPLE
This is important for both cash based interventions or in- FROM THE
kind distributions.
FIELD
What to assess? A study in Bajhang,
Nepal (supported by
Make sure you assess all 3 essential components of MHM;
Australian Red Cross) found a wide
this will ensure you have the right information to design
variety of different materials, beliefs
complete and effective MHM actions.
and cultural practices depending on
As a minimum, collect information on: age and literacy level. Two thirds of
illiterate women did not use any ma-
• Practices – materials and items used both before and terial, while others used old clothes
after the emergency, including if they are purchased (single use) or cloth that they washed
(ask how and where) or made locally and reused. 5% of literate women
• Knowledge – of the basic process of menstruation, per- used disposable sanitary pads pur-
sonal hygiene chased from the market.
• WASH facilities (communal/public and private) – avail-
While the practice of using a men-
ability and appropriateness (including privacy) of water
struation hut (to isolate menstru-
supply, latrines, bathing areas, drying facilities and dis-
ating women/girls from the rest of
posal/solid waste management facilities (how ‘MHM-
the community and family) is de-
friendly’ are facilities?)
clining, young girls are increasingly
• Socio-cultural taboos and restrictions – including local practicing isolation within the house
beliefs, customs, perceptions of menstruation, misin- (in a separate room). Most women
formation, cultural norms and coping mechanisms and girls reported stopping eating
• Trusted and normal sources of information for personal meat and dair y products dur ing
hygiene and health issues like MHM their menstruation.
• Availability of menstrual hygiene items in local mar-
kets, and price

How?
The main assessment methods for collecting information on MHM are:

• Focus group discussions (FGD) with women and girls, boys and men (age and sex-segregated)
• Direct observation of WASH facilities
• Key informant interviews (KII) with community leaders (women and men), local authorities/govern-
ments, staff from other agencies, WASH Cluster, Protection Cluster, Red Cross Red Crescent staff and
volunteers
• Market survey to collect information on availability and price of menstrual items
• Quantitative survey (e.g. KAP or baseline survey)
• Participatory or visual tools (e.g. mapping, 3 pile sorting, voting chart etc.)

Use the following Tools for assessment:

TOOL 1: FOCUS GROUP DISCUSSION GUIDE – ASSESSMENT

TOOL 2: CHECKLIST: MINIMUM STANDARDS FOR INCLUSIVE, MHM-FRIENDLY LATRINES
TOOL 3: CHECKLIST: MINIMUM STANDARDS FOR INCLUSIVE, MHM-FRIENDLY BATHING
AREAS
TOOL 4: CHECKLIST: MINIMUM STANDARDS FOR INCLUSIVE, MHM-FRIENDLY SOLID
WASTE FACILITIES
TOOL 5: CASH AND VOUCHER ASSISTANCE FOR MENSTRUAL HYGIENE

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Is cash and voucher assistance appro-

priate and feasible?

Cash and Voucher Assistance (CVA) re-

fers to any support provided to communi-
ties via cash (restricted or unrestricted),
vouchers or cash-for-work modalities.

Using CVA for hygiene items may give

women and girls more freedom of choice
to select the sanitar y mater ials they
prefer and feel most comfortable using.
Using vouchers instead of distributions
was found to increase beneficiary satisfac-
tion, be more convenient and reduce se-
curity risks associated with distributions,
increase revenue of local vendors, and
save time and money for the implementa-
tion team14.

At the assessment stage, it is important to

determine if CVA is appropriate and fea-
sible. See Tool 5 for more information on
key questions to be answered, examples Credit: Corinne Ambler/New Zealand Red Cross - Burundi
of how CVA can be used for menstrual
hygiene and for an example of a market
survey form.

Using a survey to collect information for MHM

A questionnaire asked to women and girls that collects quantitative data may be possible and appropriate
in some contexts; in others it may not. This depends on the scale, duration and type of emergency, and the
resources available – and whether women and girls are likely to answer personal questions honestly and
openly so that results are meaningful.

Key MHM questions can be included in hygiene promotion surveys (KAP or baseline/endline, or routine
monitoring survey), or surveys done by health or PGI. Consider that male volunteers may not be comfortable
to ask MHM questions as part of hygiene promotion surveys; and women and girls may not be comfortable
answering to a male.

Make sure you complement quantitative data (e.g. how many, numbers) with qualitative information from
focus group discussions, interviews, direct observation of facilities etc. to gain a deeper understanding of
the ‘why’ and ‘how’ and to check correctness of data.

How do you know which women and girls are or reproductive age?
The age that girls begin menstruating (menarche) and the age that women stop menstruating
(menopause) differs from person to person and between countries around the world. During the
assessment, ask local girls and women to get an idea of approximate ages for menarche and meno-
pause. Use this age range for planning and monitoring of activities.

14 UNHCR. Cash Based Interventions for WASH Programmes in Refugee Settings. 2016. http://www.unhcr.
org/59fc35bd7.pdf.

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STEP 2: IDENTIFYING TARGET GROUPS

This step is about identifying women and girls to be targeted and identifying influencers who can support
MHM actions.

Key activities include:

• Identify women and girls to be targeted for support, including vulnerable or marginalised groups
• Identify community leaders and influencers who can be ‘enablers’ for improved menstrual hygiene

Vulnerable or marginalised groups should be identified together with the community and utilising the
knowledge of volunteers. Women and girls with physical disabilities, learning difficulties or challenges,
those who are blind, deaf or living with chronic illness need special attention to make sure their needs are
met and that facilities and information are accessible.

Communities are not homogenous – women and girls who are without family or alone (unaccompanied),
those from ethnic or religious minorities or from social-economic ‘castes’ can be marginalized and ostra-
cized. Work together with PGI to identify these groups and ensure that MHM actions are accessible for these
groups.

It is important to identify influencers who can generate community support for improved menstrual hy-
giene and help to address negative cultural restrictions, taboos or superstitions. These could be community
leaders (male or female), local or government health workers, community providers (including traditional
healers or midwives etc.), religious leaders, National Society staff or volunteers or other community person-
alities.

Should pregnant women and women who are breastfeeding be included

in MHM activities, such as distribution?
Yes! Women who are breastfeeding can begin to menstruate again several months after giving
birth (this can be different for different women). Pregnant women should also be supported with
specialised hygiene items (e.g. delivery kits and post-partum kits with extra absorbent pads for
heavy bleeding), depending on the situation..

Credit: Lebanese Red Cross

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STEP 3: ANALYSING BARRIERS AND ENABLERS FOR BEHAVIOUR CHANGE

This step is about understanding the barriers and enablers (or motivators) for social and individual behav-
iour change for improved menstrual hygiene, including cultural or religious restrictions and taboos.

Key activities include:

• Identify and understand the main perceived and actual barriers for women and girls
• Identify and understand local cultural beliefs, taboos and restrictions

Barriers are things that stop or get in the way of women and girls improving their menstrual hygiene.
Examples include a lack of access to water, lack of private facilities, no soap, or misinformation such as
beliefs that menstruating women will cause a poor harvest in fields, will cause animals to miscarry or are
‘impure’ and cannot touch water or food. Because menstruation involves blood, there can be strong views
and taboos around touching or seeing blood or menstrual materials.

Enablers or motivators are factors that facilitate, persuade or support women and girls to improve their
menstrual hygiene. Examples include access to water and soap for washing pads and underwear, and prac-
tical, clear information about the menstrual cycle and staying healthy, and access to private facilities that
they feel comfortable using day and night.

Some of this information may already have been collected during the assessment as part of step 1. Where
more depth or a more detailed understanding is needed, you can use FGDs, key informant interviews, polls
or surveys to further analyse barriers and motivators.

EXAMPLE FROM THE FIELD

A study in Bangladesh in 201615 of MHM in Rangpur and Gopalganj found that main-
taining secrecy was one of the most influential factors in the MHM decisions of women
and girls. Many reported feeling shy to dry cloth openly and stored pads in unhygienic
places.

Between users and non-users (of sanitary pads) there was not much difference found in monthly
household income. The perceived threat of reproductive health diseases was found to be low. These
factors indicate that the unwillingness to prioritize MHM needs in household budgets is greater than
the inability to pay for sanitary items.

Girls and women were found to base much of their menstrual management decisions on cultural be-
liefs. Common social taboos were based on the belief that menstruation is a curse and menstruating
women are impure. These beliefs add to the mobility restrictions and generate the culture of secrecy
around menstruation.

15 By iDE and BDRCS, supported by Australian Red Cross and IFRC.

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STEP 4: FORMULATING MENSTRUAL HYGIENE OBJECTIVES

This step is about analysing the information collected to identify what you want to achieve. Make sure you
consider:

• What existing coping mechanisms and resources do affected women and girls have?
• What is the responsibility or focus of the RCRC response? Which capacities and level of expertise does
the National Society have?
• What assistance is being provided by others? In particular, what other hygiene or dignity items (or cash-
based support for these items) have been or are planned to be distributed.
• What are the gaps? Think about the three components of a comprehensive MHM response. Ensure that
no one is excluded and that all women and girls of reproductive age have their needs met, including
those with disabilities, health conditions, pregnancy women and those who have recently given birth.
Which WASH facilities and MHM items are needed to support women and girls to manage their men-
struation? What good behaviours do you want women, girls, men and boys to adopt or practice? What
knowledge and information do they need? Which socio-cultural factors needs to be changed and bar-
riers addressed?

REMEMBER!

Effective and comprehensive actions to improve MHM must address all

3 components: access to sanitary items and materials; private, safe and
appropriate facilities for washing, drying, bathing and disposal; and knowl-
edge and information to address cultural taboos, traditional practices or
health issues.

Use the table in Tool 6 as a step-by-step method for using

assessment data and information collected to make deci-
sions on MHM programming.

TOOL 6: STEP-BY-STEP TOOL FOR DECIDING

PRIORITY MHM ACTIONS

Credit: Daniela Enzler, Malawi Red Cross / Swiss Red Cross

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MHM in the Emergency Plan of Action

Where should different MHM and types of kits go in the emergency Plan of Action (PoA)?

Which section in the

Activity
EPoA?
Distribution of dignity kits (cash, With ANY kit distribution, PGI section
voucher or in-kind) MUST include:
• Demonstration of MHM items
(during or before distribution)
• Use of specific MHM IEC
• Post-distribution monitoring
(with an emphasis on
qualitative methods)
Distribution of MHM kits (cash, WASH section
voucher or in-kind)

Distribution of hygiene kits WASH section

(cash, voucher or in-kind)
Improvements in (or construction of) MHM-friendly WASH facilities for WASH section
MHM

Hygiene promotion and clear, factual information on menstruation WASH section if done by Hygiene
Promotion volunteers; PGI or Health
section if done by other volunteers

Think about joint monitoring: Can PGI volunteers include questions on MHM in their activities? Can hygiene
promotion volunteers include questions on dignity and inclusion in their HP activities or feedback collec-
tion?

See Tool 7 for example outputs, indicators and targets to use when developing your Emergency Plan of
Action.

TOOL 7: EXAMPLE MHM OUTPUTS, INDICATORS AND TARGETS FOR THE EMERGENCY
PLAN OF ACTION

What does Sphere say about MHM16?

Hygiene promotion standard 1.3: Menstrual hygiene management and incontinence. Women and girls of
menstruating age, and males and females with incontinence, have access to hygiene products and WASH
facilities that support their dignity and well-being. Key actions include:

1. Understand the practices, social norms and myths concerning menstrual hygiene management and
incontinence management, and adapt hygiene supplies and facilities.
2. Consult women, girls and people with incontinence on the design, siting and management of facilities
(toilets, bathing, laundry, disposal and water supply).
3. Provide access to appropriate menstrual hygiene management and incontinence materials, soap (for
bathing, laundry and handwashing) and other hygiene items.
• For distributions, provide supplies in discrete locations to ensure dignity and reduce stigma, and
demonstrate proper usage for any unfamiliar items.

16 The Sphere Handbook 2018: https://www.spherestandards.org/handbook-2018/

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International Federation of Red Cross and Red Crescent Societies
Pilot version

Supporting people with incontinence

Incontinence is a complex and largely taboo sub- Examples from the field
ject, which can have a significant impacts on – needs and impacts
quality of life, personal dignity and health17.
An elderly woman in the 2013
Incontinence is when a person cannot hold or con- South Sudanese refugee opera-
trol their urine or faces (or both). It can affect18: tion reported being unable to
• older people; attend a food and NFI distribution due to her
• men, women, and children with physical dis- incontinence. She had no absorbent materials,
abilities and/or learning difficulties; and no access to facilities to wash and dry
clothes. Other people were unwilling or hesi-
• women and adolescent girls who are pregnant,
tant to help her due to the smell and stigma-
or have given birth;
tism.
• women and adolescent girls who have suffered
fistula due from prolonged/obstructed child- During an evaluation of a cyclone response
birth or from sexual assault; operation in the Seychelles in 2013, a man re-
• people with certain illnesses (such as cancer, ported that the most important thing he had
stroke) or who have had an operation (e.g. re- needed in the weeks following the cyclone
moval of the prostate); were adult nappies for his brother, who had a
learning disability and who has incontinence.
• people who have experienced highly stressful
situations, such as conflict or disasters, and
develop night-time bed-wetting.

What are the main challenges and what can we do to support people with
incontinence19?

Challenge or need Suggestions

People with incontinence are • Work together with PSS, PGI and Health teams to first identify older
‘hidden’, and are embarrassed people, persons with disabilities etc. who may have incontinence, as
and shy to talk about it an entry point for programming.
• Build trust by talking about other issues first (e.g. MHM, access to
WASH facilities).
Lack of materials e.g. absorbent • Ask people with incontinence about their preferences and needs.
pads, underwear, cloths, mattress Some menstrual hygiene products can also be used for incontinence
protectors etc. to manage (e.g. reusable and disposable pads).
incontinence • Keep a stock of appropriate supplies in PSS or dignity centres, for on-
demand distribution to people who have incontinence. Different types,
size and absorbency levels may be needed for different types and
severities of incontinence.
Lack of access to sufficient • Make sure people with incontinence (or their carers) are part of
water for washing, and/or private consultations for siting, design and management of WASH facilities,
facilities for laundering, drying and and for selection of NFI items to be distributed.
bathing
People may have restricted • Ensure that people with incontinence are not excluded from
mobility or be unable to leave their distributions or from accessing services.
home due to embarrassment, • Ensure that people with incontinence are linked with specialist health,
negative attitudes towards them disability and/or older person organisations or services.
or an inaccessible environment

17 Chelsea Giles-Hansen, Hygiene Needs of Incontinence Sufferers in Low and Middle Income Countries, 2015 <https://www.ircwash.org/
resources/hygiene-needs-incontinence-sufferers>
18 Benedicte Hafskjold and others, ‘Taking Stock: Incompetent at Incontinence - Why Are We Ignoring the Needs of Incontinence Sufferers?’,
Waterlines, 35.3 (2016), 219–27 <https://doi.org/10.3362/1756-3488.2016.018>
19 Table adapted from ‘Draft tips on incontinence based on cross-sectoral research and field experience of international humanitarian and
development actors (under development 2018)’, shared through informal global incontinence group.

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International Federation of Red Cross and Red Crescent Societies
Addressing menstrual hygiene management (MHM) needs

STEP 5: PLANNING
This step is about working together with other sectors and teams to make a work plan, which aims to ad-
dress the objectives and reach the targets identified in step 4.

Key activities include:

• Choosing methods or approaches and communication channels that are appropriate and trusted by the
target women and girls, men and boys
• Work closely with WASH engineers on planning for ‘hardware’ and facilities, ensuring they understand
the menstrual hygiene challenges and needs of women and girls [see Step 6 for more information]
• Preparing materials, including trialling them with volunteers and a small group of women and girls
• Scheduling the distribution, hygiene and demonstration sessions, and post-distribution monitoring ac-
tivities
• Preparing monitoring and reporting plan for the activities (focus on integrating MHM into existing feed-
back mechanisms and activities etc.)
• Planning feedback mechanisms – including how, from who and the frequency

Collecting feedback alone is not enough; make sure you have a system in place (including identifying who
is responsible) to analyse, track mitigating actions and then communicate this back to communities.

Different options for receiving feedback include: community feedback forms/log sheets that are filled in
by staff or volunteers, surveys, focus group discussions, community committees, phone lines (call and/or
SMS), question desks, complaints or suggestion boxes.

Tool 10 includes an example plan for collecting feedback, and also an example feedback and mitigation
log form, which can be used for collecting feedback and tracking which actions have been taken to address
it.

Credit: Corinne Ambler/New Zealand Red Cross - Burundi

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International Federation of Red Cross and Red Crescent Societies
Pilot version

STEP 6: IMPLEMENTATION
This step is about putting your plans into place and implementing activities. Key activities include:

• Recruiting and training volunteers (see Part 2 of this guide)

• Working with relief/cash teams to conduct distributions and demonstration and hygiene promotion
MUST be done with any distribution
• Carrying out planned activities, with WASH, PGI, shelter and other teams working closely together
• Coordinate with other humanitarian actors and stakeholders

Make sure that the information collected during assessment is used to guide the messages and informa-
tion provided during distribution and information sessions. This can help to address incorrect beliefs,
stigmas and misconceptions around handling pads, washing blood, the menstrual cycle etc.

TOOL 9: EXAMPLE IEC MATERIALS (ENGLISH, FRENCH, SPANISH AND ARABIC) FOR DIS-
POSABLE PADS, REUSABLE PADS AND TAMPONS

Distribution
Consult with women and girls on their preferred method for distribution. If possible and appropriate,
utilise health clinics, schools, women's or mothers groups, PSS centres etc. and ensure a private and safe
environment, where women and girls will not be teased or embarrassed. If using cash based interven-
tions, demonstration and information sessions are still required and can be done at these facilities also.

There should be NO distribution without demonstration on use & care of MHM

items.
In case of cash or voucher, assistance can be conditional and only those who attend the sessions would be
entitled to receive the cash grant or voucher.

Never assume that women or girls already know how to use the items inside the MHM kits. Women and
girls may prefer a certain type of pad but have no experience using it, or they may have incorrect knowl-
edge passed down from mothers, aunts or sisters on menstruation and how to manage it.

Other key recommendations for distributions and hygiene promotion activities are:

• Include a representative from the local health clinic or women’s group (check that they are trusted by
women and girls first) in the demonstration session to support health and hygiene promotion. They
can answer questions on preventing and treating vaginal infections, managing menstrual pain and
they ca n help to address cultural taboos, misinformation, myths, or risky practices.
• Many discussions with women on MHM will inevitably bring up questions around pregnancy, sexually
transmitted infections, intimate hygiene, and possibly sexual or domestic violence or genital mutila-
tion. Make sure that everyone who is involved in distribution or consulting with women and girls are
briefed on protection issues and have up-to-date information on support services (health, PSS, policy,
legal) that are available, including where they can safely refer a survivor of SGBV in case of a disclo-
sure.
• Do not distribute MHM kits in branded buckets, as this can lead to unwanted association between the
bucket and menstruation (e.g. people may know when a woman has her period and this can cause
embarrassment).

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International Federation of Red Cross and Red Crescent Societies
Addressing menstrual hygiene management (MHM) needs

WASH facilities and services

Input and preferences of women and girls should feed into the design and improvement of WASH facilities.
WASH engineers need to understand the menstrual hygiene challenges and needs of women and girls, and
should work closely with HP volunteers.

Main considerations around WASH facilities for MHM include:

• Water needs increase during menstruation for increase bathing, laundering of pads and/or underwear
and/or soiled clothing, handwashing after changing used menstrual materials etc.
• Privacy and safety of facilities are critical, including the ability to lock doors, separate facilities for
males and female, well-lit. Women and girls need to feel comfortable using latrines, bathing facilities
etc. in the night and day. Accessible facilities for people with disabilities should also be separated by sex.
• Wastewater from washing used menstrual materials can have a red ‘bloody’ tinge to it. Drainage and
water supply should be adequate to ensure this does not become a source of embarrassment, teasing or
prevents women and girls from using bathing facilities.
• Disposable pads or used cloth thrown into flush latrines can cause blockages. It is important to provide
private, easily accessible waste bins or mechanism for disposing of pads and menstrual waste. Include
simple information (in local language and using pictures) inside each latrine to explain key messages on
disposal. In some situations, use of incinerators for final disposal of menstrual waste may be appropri-
ate.
• Disposable pads or used cloth thrown into pit latrines can make desludging difficult and can clog (or
block) desludging equipment. Whether this is an issue will depend on depth of the latrine pit, need for
desludging, space availability, type of equipment available etc.
• Regular cleaning, and ongoing maintenance and operation of WASH facilities (including communal
latrines, bathing areas, collection/transport of rubbish from bins or pits, operation of incinerators, etc.).
Make sure it is clear who is responsible, and that there is a system is in place. Explore the possibility of
using cash-for-work.
• Ensure that anyone handling or who may come into contact with menstrual waste (with blood) wears
appropriate personal protection equipment (PPE).

Figure 6 on the next page shows an example of a MHM-friendly latrine, with key design features and con-
siderations.

Use Tools 2 – 4 as checklists for assessing how MHM-friendly facilities are and whether they meet the
minimum standards.

Credit: Daniela Enzler, Malawi Red Cross / Swiss Red Cross

34
International Federation of Red Cross and Red Crescent Societies
Pilot version

I A

C
G

E F

A - Adequate numbers of toilets F - Walls, door and roof

seperated (with clear signage) from male facilities. are made of non-transparent materials with no
gaps or spaces.

B - Easily accessible water

(ideally inside the cubicle) for girls and women to
G - A shelf (or hook)
for hygienically storing belongings during usage.
wash themselves and menstrual materials.

H - Some units should be accessible

C - Safe and private toilets to people with disabilities.
with inside door latch.

I - Night time light source

D - Waste bin (with lid) both inside and outside of the toilets.
to dispose of used menstrual materials.

E - Clear signs
instructing girls and women how to dispose of
menstrual waste.

Figure 5: Example of a MHM-friendly, accessible toilet with minimum standards for MHM19

19 Sommer, M., Schmitt, M., Clatworthy.

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International Federation of Red Cross and Red Crescent Societies
Addressing menstrual hygiene management (MHM) needs

STEP 7: MONITORING AND EVALUATION

The progress and performance of MHM actions, and feedback from women, girls, men and boys should be
continuously collected and used to adapt activities and messages as the needs and situation changes.

Key activities include:

• Conduct post-distribution monitoring for any MHM or dignity kits

• Monitor the use, appropriateness and maintenance of WASH facilities
• Continuously collect, analyse and use feedback from women, girls, men and boys
• Continuously monitor the situation for changes
• Coordinate with other humanitarian actors and stakeholders

Use Tool 13 to check or reflect on the progress and level of MHM actions.

TOOL 13: CHECKLIST FOR MHM ACTIONS IN EMERGENCIES

Monitoring of MHM activities can be integrated into existing hygiene promotion (HP) feed-
back mechanisms. For example, if HP volunteers conduct a FGD with affected women every two weeks,
some key questions on MHM can be included. If HP volunteers are conducting house to house visits to pro-
mote handwashing, they can collect informal feedback or observe WASH facilities.

Tool 10 provides an example log which can be used to collect feedback (both informal and formal) – in-
cluding which actions have been taken to address them (mitigation) and the outcome. This table can also be
used for rumours and complaints.

TOOL 10: EXAMPLE FEEDBACK AND MITIGATION LOG (can also include rumours, com-
plaints and misinformation)

Was there a distribution of MHM or dignity kits?

It is important to follow up with women and girls on the use, acceptability and satisfaction with any items
distributed (or if cash/vouchers are used, on the service and providers), and to identify any unforeseen is-
sues or challenges.

Post-distribution monitoring for MHM should focus on qualitative methods (e.g. FGDs and KIIs) in addi-
tion to quantitative surveys. Detailed understanding (e.g. the ‘how’ and ‘why’ questions) on use of men-
strual items, experiences and challenges, cultural taboos or restrictions etc. cannot be collected through
surveys. Qualitative methods are the only way to collect meaningful and in-depth information on use,
satisfaction, preferences and challenges which can be used to adapt and improve programming.

Post-distribution monitoring for menstrual items should be done between 1 and 2 months after distribu-
tion. Any earlier than 1 month, and there is a risk that many women and girls have not got their period yet
and so have not actually used the pads, items etc. After two months it can become difficult for women and
girls to remember what happened during distribution, what they received etc.

TOOL 11: FOCUS GROUP DISCUSSION GUIDE – POST DISTRIBUTION MONITORING

TOOL 12: EXAMPLE POST-DISTRIBUTION MONITORING SURVEY

36
International Federation of Red Cross and Red Crescent Societies
Pilot version

Credit: Corinne Ambler/New Zealand Red Cross - Burundi

Monitoring of WASH facilities

This should be done together with the WASH hardware team. Key questions to ask include:

• Are latrines private and well-lit? Do women and girls feel comfortable to use them in the day and night?
• Is there enough water for increased bathing and washing pads during menstruation?
• Adequate supply or access to soap and handwashing facilities?
• Are waste disposal bins regularly emptied? Are latrine pits becoming full and need desludging? Is the
system for cleaning and maintenance working, and if not how can it be improved?
• Were women, girls, persons with disabilities and vulnerable/minority groups (e.g. transgender persons)
consulted about their preferences for designing the latrines, their location, and how they would be
cleaned and maintained? Is this information used to guide programming or activities? Why or why not?

Protracted crises or evolving population movements

In these circumstances it is important to regularly assess and update the demographics of girls and women
who are of reproductive age. This is to make sure that adolescent girls who begin getting their period during
the crisis or who newly arrive to a refugee camp (for example) are included in programming and provided
support.

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International Federation of Red Cross and Red Crescent Societies
Addressing menstrual hygiene management (MHM) needs

STEP 8: REVIEW, RE-ADJUST

This step is about making sure that MHM actions are responsive and that programming adapts to meet
changing needs and challenges.

Key activities for MHM actions include:

• Revise, adapt or add activities based on feedback from women and girls and any changes in the situation
• Document and use lessons learnt
• Coordinate and share recommendations with national working groups, agencies etc.

Learn from the experience of implementing MHM actions. Document lessons and share them both inter-
nally and externally. Make sure to link with national or regional coordination structures, working groups,
government ministries etc. to share lessons and recommendations.

Use these lessons and recommendations to better prepare for the next emergency or disaster. Work to-
wards improved preparedness by linking with recovery and long-term resilience programming (particularly
WASH and CBHFA) and strengthen national level coordination.

Credit: Netherlands Red Cross / Uganda Red Cross

38
Addressing menstrual
hygiene management
(MHM) needs

Tools
1 Menstrual hygiene management (MHM) in emergencies

FOCUS GROUP DISCUSSION GUIDE –

TOOL 1
ASSESSMENT

Overview
This tool provides example questions for a Focus Group Discussion (FGD) with women and adolescent girls to unders-
tand menstrual hygiene management practices, preferences, social-cultural beliefs and restrictions and health.
The questions include the key things you should assess around MHM in a humanitarian context. The questions should
be adapted so they are appropriate and context specific. Introduction/background, consent, ice-breaker and probing
questions should be added.
Important details:
FGDs should be age-disaggregated, for example 12 to 18 years, 19 to 35 years, and 36 to 55 years.
The number of FGDs to be held depends on the scale, geographical spread, time available and context. It is recom-
mended to have at least 2 FGDs with each age group; if operation or programme is larger then more may be
needed.
See Section 3 of the Guide for more information on selecting volunteers for MHM activities.

Depending on how much time and resources you have, these questions can be integrated as part of other activities (for
example, asked as part of a FGD on hygiene promotion, PGI or health) – or a separate FGD just for MHM can be held.

Example FGD questions

A Menstrual hygiene information
Where do you get information about women’s health and menstruation?
Who do you feel most comfortable to talk with about your menstrual hygiene?
At what age do women in this community normally start to get their period [menarche] and finish getting
their period [menopause]?
[For adolescent girls] Did anyone tell you about what it means to get your monthly period, or how to manage
it?

B Menstrual hygiene practices and WASH facilities

Before this emergency/event, what did you normally use to manage your period? Where did you get it from
(e.g. purchased from shop, made at home etc.). What was the cost?
What do you use now to manage your monthly period? [After this emergency/event]
Where do you change your cloth / materials / pads? How often do you change the cloth or pad?
If disposable pads: Where do you dispose of or throw used pads? Why? Probe on challenges, beliefs, if they do
it at night etc.
If cloth or washable pads: Where and how do you wash the cloth? Why? Probe on challenges, including with
bloody wastewater etc.
If cloth or washable pads: Where and how do you dry the cloth? Why? Probe on challenges, including with
privacy, taboos etc.
If cloth or washable pads: Once it is worn out, where do you dispose of or throw the old cloth? Why? Probe on
challenges, beliefs, if they do it at night etc.
What changes or improvements would you make to WASH facilities here, so that you can better manage your
menstruation?

International Federation
of Red Cross and Red Crescent Societies
www.ifrc.org Saving lives, changing minds.
1 Menstrual hygiene management (MHM) in emergencies

FOCUS GROUP DISCUSSION GUIDE – ASSESSMENT (cont.)

TOOL 1
C Health, socio-cultural aspects
During your last monthly period, did you experience any pain (before or during), itching or irritation? Any
discharge or smell? How did you deal with this?
During your last monthly period, did you feel embarrassed or anxious at all? Why? What could help you to
feel less embarrassed or anxious?
What are the beliefs or customs with menstruation in your culture/community? How do they affect you?
Is there anything that you are restricted from or can’t do during your period?
What do men (and boys) know and think about menstruation here?
What information about your body would you like to know?

D MHM Items – pass around sample items when you ask the questions
[Pads: Disposable or Reusable]: Have you ever used these items before? Do you like them? Why or why not?
Which type of pad would you prefer now? Why? (Discuss aspects of sustainability / reuse (how long the types
of pads last), washing, drying, privacy issues, access to water etc.)
Discuss preferences for:
[Disposable pads]: With or without wings? Level of absorbency?
[Cloth or reusable pads]: Colour? Type of material? How many needed per day (or per menstrual period)?
Fasted in underwear or using elastic band around waist?
[Underwear]: Colour? Size? Style?
[Soap]: Smell/fragrance or unscented? Preferred brand or colour? Bar or powder laundry soap?
[Rope, pegs or drying rack]: How would you prefer to dry your pads and underwear? Why?
Are there any other items or things you are missing to help you manage your menstruation?
[IEC material]: Do you understand the pictures/*language on this paper? (*If already translated to local
language). Can you explain what they mean?

E Distribution of items
Have you received any dignity or hygiene items recently (or since the emergency/crises)? Which ones? Were
they useful? Why or why not?
[If yes]: Did you feel safe or embarrassed during the distribution? Why or why not?
How do you think menstrual hygiene items should be distributed? How would you prefer the distribution to
happen?
Are some women and girls unable to go to distributions? Why? What restricts them?
[If planning to use cash assistance]: Do you think vouchers for menstrual hygiene items is a good idea here?
Why or why not? Do you feel comfortable purchasing personal items from the local market/ shopkeepers?
How far would you have to travel to the market? Is there anything that could prevent you from using the
voucher for menstrual hygiene (e.g. pads)?

F Closing
What are the main challenges you face in managing your monthly period now? If there are many, get women
and girls to vote (by show of hands) or rank them in order of importance.
Is there anything else you would like to share about MHM or your experiences?
Do you have any questions?

Thank participants and explain next steps. Make sure they know how they can access support (e.g. about sexual and
reproductive health or about sexual and gender based violence)

International Federation
of Red Cross and Red Crescent Societies
www.ifrc.org Saving lives, changing minds.
1 Menstrual hygiene management (MHM) in emergencies

CHECKLIST: MINIMUM STANDARDS

TOOL 2
FOR INCLUSIVE, MHM-FRIENDLY
LATRINES
Overview
This tool includes two checklists:

A Household latrines
B Communal latrines, including public (e.g. markets) and institutional (e.g. schools) latrines

Use these checklists to assess whether household and communal latrines meet minimum requirements for being
inclusive and MHM-friendly – including being accessible for persons with disabilities.
Inclusive means that latrines are designed to ensure the dignity, access, participation and safety of all persons in the
community using the facilities. Accessible means that people with disabilities, older people and pregnant women have
access to the physical and built environment, information and communications, and to related facilities and services.
MHM-friendly means that the latrine meets the minimum requirements that ensure women and girls can privately,
safely and hygienically manage their monthly menstruation.
These checklists can also be used as a monitoring tool to track progress towards latrines becoming inclusive and
accessible, and measuring improvements during an operation or program.
There are two parts to each checklist – 1) direct observation; and 2) discussion and direct feedback from women and
girls, persons with disabilities and whoever is responsible for emptying, collecting or transferring menstrual waste1.

Checklist: latrines – household2

For direct observation:

Minimum standard to check Yes/no Action or change needed to meet standard

1 Latrine is less than 50 metres from household.

2 Latrine has sufficiently high walls (and/or screens) with no gaps,

holes or windows that allow others to see in.
3 Latrine has a door with an internal lock/latch.
4 There is a functional hand-washing facility located near latrine.
5 Hand-washing facility has water available.
6 Soap is available or located in an accessible place near handwas-
hing facility.
7 There is a hook and/or shelf inside the latrine (to place personal
sanitary items off the floor)

8 Latrines have a light source available during the night. (also

consider torches if applicable)

9 There is an appropriate facility or method for disposing of menst-

rual waste (e.g. bin inside latrine, or shared rubbish bin or pit close
to the latrine). [This question needs to adapted based on direct
consultation and the context]

1) Note that only key discussion points are included here; more in-depth monitoring of WASH programming should be done
(see the full MHM guide [Step 7], Tool 1, Tool 11 and Tool 13 for more guidance).
International Federation 2) Adapted from Global toolkit for integrating Menstrual Hygiene
Management (MHM) into humanitarian response
of Red Cross and Red Crescent Societies
www.ifrc.org Saving lives, changing minds.
1 Menstrual hygiene management (MHM) in emergencies

CHECKLIST: MINIMUM STANDARDS FOR INCLUSIVE,

TOOL 2
MHM-FRIENDLY LATRINES (cont.)
Action or change needed to meet
Minimum standard to check Yes/no standard

If household includes a person with a disability:

10 Latrine is:
at ground level or has a 90cm wide ramp of <1:10 slope,
has 90cm wide doors that open outwards,
has a bar to pull the door shut from inside,
has space for a wheelchair to turn inside,
has seating/commode for the toilet and
handrails on both sides of the toilet seat.
11 Hand-washing facility is accessible to persons with mobility
limitations.
Additional non-essential improvements:
12 There is a mirror (in a low position) inside the latrine (for women
and girls check clothing for blood stains)
13 Access to water (e.g. hand-washing facility) and soap inside the
latrine. [ideal case]

For discussions with women and girls:

Minimum standard to check Yes/no Action or change needed to meet standard

14 Do you feel comfortable and safe to use the latrine in the day and
at night? Is there enough privacy? Why or why not?

15 Is there always water available near the toilet to wash hands and
menstrual materials? Where is water sourced? Who is responsible
for filling the water container?
16 Can you access, reach and use the water for washing your hands
and menstrual materials?
17 Do you feel comfortable changing, washing/drying and disposing
of menstrual materials? Why or why not?
18 Who is responsible for cleaning the latrine? Do you have any
challenges keeping the latrine clean (and emptying menstrual
waste bin if relevant)? How could it be improved?

International Federation
of Red Cross and Red Crescent Societies
www.ifrc.org Saving lives, changing minds.
1 Menstrual hygiene management (MHM) in emergencies

CHECKLIST: MINIMUM STANDARDS FOR INCLUSIVE,

TOOL 2
MHM-FRIENDLY LATRINES (cont.)

Checklist: latrines – communal, public or institutional

(e.g. schools or clinics)3
For direct observation:

Minimum standard to check Yes/no Action or change needed to meet standard

1 Male and female latrines are physically separated and have clear
signs (for female/male).
2 Latrine has sufficiently high walls (and/or screens) with no gaps,
holes or windows that allow others to see in.
3 Latrines have doors with a handle and an internal lock/latch.

4 There is a functional hand-washing facility located near the latrine.

5 Hand-washing facility has water available.

6 Soap is available or located in an accessible place near handwas-

hing facility.

7 Hand-washing facility is accessible to persons with physical Target = at least 10% of all communal
disabilities. hand-washing facilities

8 There is a hook and/or shelf inside the latrine, at a height accessible

for girls and persons using a wheelchair (to place personal sanitary
items off the floor)

9 Latrine has a light source available during the night. (If latrines are
open then)

10 Waste bins (or other appropriate mechanism for disposal) for

menstrual waste are located inside the [female] latrine.

11 Latrine meets minimum requirements for accessibility (for women Target = at least 10% of all communal
and girls with disabilities, pregnant and older women): latrines; or, if there is only one commu-
at ground level or has a 90cm wide ramp of <1:10 slope, nal, public or institutional latrine then
has 90cm wide doors that open outwards, it should be accessible (e.g. meet all
has a bar to pull the door shut from inside, minimum requirements outlined).
has space for a wheelchair to turn inside,
has seating/commode for the toilet, has
handrails on both sides of the toilet seat, and
is clearly signposted to be accessible.

12 Latrine is clean with no menstrual waste, faeces or other material

on the floor.

13 There is a poster or sign inside the latrine with instructions on how

to dispose of menstrual waste.
If yes: The poster/sign is in easy-to-understand language and
includes pictures/pictograms.
14 Products and items for cleaning the latrine are located close by (or
inside) [if applicable, adapt based on context].

3) Adapted from Global toolkit for integrating Menstrual Hygiene Management (MHM) into humanitarian response.

International Federation
of Red Cross and Red Crescent Societies
www.ifrc.org Saving lives, changing minds.
1 Menstrual hygiene management (MHM) in emergencies

CHECKLIST: MINIMUM STANDARDS FOR INCLUSIVE,

TOOL 2
MHM-FRIENDLY LATRINES (cont.)
Action or change needed to meet
Minimum standard to check Yes/no standard

Additional non-essential improvements:

15 There is a mirror (in a low position) inside the latrine (for women
and girls check clothing for blood stains)
16 Access to water (e.g. hand-washing facility) inside the latrine
cubicle/stall. [ideal case]

For discussions with women and girls, persons with disabilities:

Minimum standard to check Yes/no Action or change needed to meet standard

1 Are people following the gender segregation instructions for

latrines? (E.g. are males only using male latrines)

2 Do you feel that the latrines are located in an appropriate and

accessible place? Why or why not?

3 Do you feel comfortable and safe using the latrines in the day and
at night (if relevant)? Is there enough privacy? Why or why not?
4 Is there always water available near the latrine to wash hands and
menstrual materials? Where is water sourced? Who is responsible
for filling the water container?
5 Do you feel comfortable changing, washing/drying and disposing
of your menstrual materials? Why or why not? How could it be
improved?
6 Who is responsible for cleaning the latrine? Are there any challen-
ges keeping the latrine clean? How can it be improved?
7 Who is responsible for emptying the menstrual waste bins (if
relevant)? Is the system working? Why or why not? How can it be
improved?

For discussions with whoever is responsible for emptying or collecting or transfering menstrual waste:

Minimum standard to check Yes/no Action or change needed to meet standard

1 Do you ever find used menstrual products or waste in or around

the latrine cubicles? Why do you think this is?

2 Do you wear gloves and boots when handling menstrual waste?

Why or why not?

3 Is there any informal or formal waste sorting done? Who does

this? Where?
4 Do you face any taboos, restrictions or teasing from your work
(including handling menstrual waste)? What are they? Do you
have any suggestions to mitigate them?

5 Did you receive a training about your work and how to be safe?
What information did you think was missing or would you have
liked?

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1 Menstrual hygiene management (MHM) in emergencies

CHECKLIST: MINIMUM STANDARDS

TOOL 3
FOR INCLUSIVE, MHM-FRIENDLY
BATHING AREAS
Overview
Use this checklist to assess whether communal bathing areas meet minimum requirements for being inclusive and
MHM-friendly – including being accessible for persons with disabilities. Bathing areas may also be used for laundering
and drying menstrual materials, depending on the context.
Inclusive means that bathing areas are designed to ensure the dignity, access, participation and safety of all persons in
the community using the facilities. Accessible means that people with disabilities, older people and pregnant women
have access to the physical and built environment, information and communications, and to related facilities and
services.
MHM-friendly means that the bathing area meets the minimum requirements that ensure women and girls can
privately, safely and hygienically manage their monthly menstruation.
These checklists can also be used as a monitoring tool to track progress towards bathing areas becoming inclusive and
accessible, and measuring improvements during an operation or program.
There are two parts to each checklist – 1) direct observation; and 2) discussion and direct feedback from women and
girls, and persons with disabilities 1.

Checklist: bathing areas2 (communal)

For direct observation:

Minimum standard to check Yes/no Action or change needed to meet standard

1 Male and female bathing areas are physically separated and have
clear signs (for female/male).
2 Bathing area has sufficiently high walls (and/or screens) with no
gaps, holes or windows that allow others to see in.
3 Bathing area has a door with a handle and an internal lock/latch.

4 There is a hook and/or shelf inside the bathing area, at a height

accessible for girls and persons using a wheelchair.
5 Water is available close to or at the bathing area.

6 There are drying racks or hangers (or similar) for drying menstrual
materials (e.g. cloth or reusable pads). [If bathing area is also used or
drying; delete or adapt based on context].
7 Wastewater from the bathing area drains into gravel (or similar)
and drain outlets are covered (to ensure privacy for wastewater
which may be pink or red tinged from washing menstrual materials).

8 There are no muddy areas or standing water inside the bathing

area.

9 Bathing area has a light source available during the night [if
relevant].

1) Note that only key discussion points are included here; more in-depth monitoring of WASH programming should be done
(see the full MHM guide [Step 7], Tool 1, Tool 11 and Tool 13 for more guidance).
2) Adapted from Global toolkit for integrating Menstrual Hygiene
Management (MHM) into humanitarian response.
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1 Menstrual hygiene management (MHM) in emergencies

CHECKLIST: MINIMUM STANDARDS FOR INCLUSIVE,

TOOL 3
MHM- FRIENDLY BATHING AREAS (cont.)
Action or change needed to meet
Minimum standard to check Yes/no standard

10 Waste bins (or other appropriate mechanism for disposal) for

menstrual waste are located inside the bathing area.
11 Bathing area (cubicle) meets minimum requirements for accessibi- Target = at least 10% of all
lity (for women and girls with disabilities, pregnant and older communal bathing areas; or,
women): if there is only one communal
at ground level or has a 90cm wide ramp of <1:10 slope, bathing facility then it should
has 90cm wide doors that open outwards, be accessible (e.g. meet all
has a bar to pull the door shut from inside, minimum requirements
has a seat, outlined).
has handrails for support and
is clearly signposted to be accessible.
12 Water source for bathing is accessible to persons with mobility Target = at least 10% of all
limitations. facilities
13 Bathing area is clean with no menstrual waste, faeces or other
material on the floor.
14 Products and items for cleaning the bathing area are located close
by (or inside) [if applicable, adapt based on context].
Additional non-essential improvements:
15 There is a poster or sign inside the latrine with instructions on
how to dispose of menstrual waste.
If yes: The poster/sign is in easy-to-understand language and
includes pictures/pictograms.
16 There is a mirror (in a low position) inside the bathing area (for
women and girls check clothing for blood stains)
17 Direct access to water inside each bathing cubicle/stall.

For discussions with women and girls, persons with disabilities:

Minimum standard to check Yes/no Action or change needed to meet standard

1 Are people following the gender segregation instructions for

bathing areas? (E.g. are males only using male bathing area)

2 Do you feel that the bathing areas are located in an appropriate

and accessible place? Why or why not?

3 Do you feel comfortable and safe using the bathing area in the day
and at night (if relevant)? Is there enough privacy? Why or why not?

4 Is there always water available near or at the facility to bathe and to

wash menstrual materials? Where is water sourced?
5 Where do you wash and dry your menstrual materials (if using
reusable pads or cloth) and underwear? Why?
6 Do you feel comfortable changing, washing/drying and disposing of
your menstrual materials? Why or why not? How could it be improved?

7 Who is responsible for cleaning and maintaining the bathing area?

Are there any challenges keeping it clean? How can it be improved?

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1 Menstrual hygiene management (MHM) in emergencies

CHECKLIST: MINIMUM STANDARDS FOR

TOOL 4
INCLUSIVE, MHM-FRIENDLY SOLID
WASTE FACILITIES
Overview
The solid waste chain for menstrual hygiene includes waste collection (often in containers or bins), emptying and
transfer, and final disposal (through burying, burning or incineration, or composting).
Checklists for three different types of facilities are included below, focussing on aspects of waste collection where the
main concerns are privacy and convenience for women and girls, and persons with disabilities to dispose of menstrual
waste:

i Waste collection containers (in communal facilities, not individual households)

ii Communal waste pits
iii Incinerators
Use these checklists to assess whether solid waste facilities meet minimum requirements for being inclusive and
MHM-friendly – including being accessible for persons with disabilities.
Inclusive means that waste facilities are designed to ensure the dignity, access, participation and safety of all persons
in the community using the facilities. Accessible means that people with disabilities, older people and pregnant
women have access to the physical and built environment, information and communications, and to related facilities
and services.
MHM-friendly means that the solid waste facilities meet the minimum requirements that ensure women and girls can
privately, safely and hygienically manage their monthly menstruation.
These checklists can also be used as a monitoring tool to track progress towards solid waste facilities becoming
inclusive and accessible, and measuring improvements during an operation or program.
There are two parts to each checklist – 1) direct observation; and 2) discussion and direct feedback from women and
girls, persons with disabilities and whoever is responsible for emptying, collecting or transferring menstrual waste1.

Checklist: solid waste facilities2 (communal/shared; not household)

For direct observation:

Minimum standard to check Yes/no Action or change needed to meet standard

For waste collection containers (bins):

1 Waste collection container has a lid.

2 Waste collection containers are in a discrete location (preferably

inside each latrine).

3 The container is clearly identified to be for menstrual waste (and

not for other types of waste) using pictures and easy-to-unders-
tand local language.
4 Waste collection containers are washable and easy to clean.
5 Waste collection container is easy to carry (if it has to be transfer-
red to a disposal site).

1) Note that only key discussion points are included here; more in-depth monitoring of WASH programming should be done
(see the full MHM guide [Step 7], Tool 1, Tool 11 and Tool 13 for more guidance).
2) Adapted from Toolkit 3, Menstrual Hygiene Matters and based on IFRC experiences.

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1 Menstrual hygiene management (MHM) in emergencies

CHECKLIST: MINIMUM STANDARDS FOR INCLUSIVE,

TOOL 4
MHM-FRIENDLY SOLID WASTE FACILITIES (cont.)
Action or change needed to meet
Minimum standard to check Yes/no standard

6 No menstrual waste or other rubbish is visible on the floor around

the waste collection container.
7 There is a poster or sign near (or on) the waste collection contai-
ner with instructions on how to dispose of menstrual waste, using
pictures and easy-to-understand local language.
For communal waste pits (or similar):
1 Waste pit is not located near male communal latrines.
2 Waste pit is not located near areas where men and boys frequent-
ly meet or gather.

3 Waste pit is fenced.

4 Waste pit is sufficiently deep (so that no one can reach the waste).

5 Waste pit can be easily accessed by and is barrier-free for persons Target = at least 10% of all
with mobility limitations: facilities
Has a 90cm wide ramp with <1:10 slope
the path is a solid surface and
has handrails (if needed) etc.
For incinerators – to be modified depending on the context/situa-
tion:
(Note: these questions may need discussion with person responsible
for maintenance, rather than only observation)

1 Incinerator is attached to the latrine block, or is located within 10

metres.

2 Menstrual waste cannot easily be seen after it has been

thrown/inserted into incinerator.

3 The incinerator has barrier-free access for persons with mobility Target = at least 10% of all facilities. If
limitations: only one incinerator (e.g. in a school),
Has a 90cm wide ramp with <1:10 slope then it should be accessible (e.g. meet
the path is a solid surface and all minimum requirements outlined).
has handrails (if needed) etc.

4 Incinerator is easy to operate and uses a minimum amount of fuel.

5 Incinerator can reach a sufficient temperature to burn menstrual

materials adequately.

6 There is system in place for regular burning / operation of the

incinerator.

7 There is system in place for regular maintenance of the incinera-

tor.
8 The ash from incineration is buried or disposed of in another
appropriate way.

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1 Menstrual hygiene management (MHM) in emergencies

CHECKLIST: MINIMUM STANDARDS FOR INCLUSIVE,

TOOL 4
MHM-FRIENDLY SOLID WASTE FACILITIES (cont.)
For discussions with women and girls, persons with disabilities:
Action or change needed to
Minimum standard to check Yes/no meet standard

1 Do you feel comfortable using the waste collection container or

disposal mechanism for your menstrual materials? Why or why
not?
2 Do you feel the waste collection containers, waste pits (or incine-
rator) are located in an appropriate and private place? Why or why
not?
3 Do women and girls, men and boys with disabilities feel the waste
collection containers, waste pits (or incinerator) are located in an
appropriate and accessible place? Why or why not?

4 Do you ever feel embarrassed, shy or get teased when disposing

of your menstrual waste? Where and why?

5 Who is responsible for emptying the menstrual waste bins? How

often do they do it? Where do they put (or transfer) the waste
after it has been collected? Is the system working – why or why
not, and how can it be improved? [delete if not relevant]

6 Who is responsible for burning the waste pit contents? How often
do they do it? Is the system working – why or why not, and how
can it be improved? [delete if not relevant]

7 Who is responsible for burning the incinerator? How often do they

do it? Is the system working – why or why not, and how can it be
improved? [delete if not relevant]

From discussions with whoever is responsible for emptying or collecting or transfering menstrual waste:

Minimum standard to check Yes/no Action or change needed to meet standard

1 Do you ever find used menstrual products or waste in or around

the latrine cubicles? Why do you think this is?

2 Do you wear gloves and boots when handling menstrual waste?

Why or why not?

3 Is there any informal or formal waste sorting done? Who does

this? Where?

4 Do you face any taboos, restrictions or teasing from your work

(including handling menstrual waste)? What are they? Do you
have any suggestions to mitigate them?
5 Did you receive a training about your work and how to be safe?
What information did you think was missing or would you have
liked?

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1 Menstrual hygiene management (MHM) in emergencies

USING CASH AND VOUCHER

TOOL 5
ASSISTANCE FOR MENSTRUAL HYGIENE

Overview
Using Cash and Voucher Assistance (CVA) for hygiene items may give women and girls more freedom of choice to
select the sanitary materials they prefer, are used to and feel most comfortable using. Using vouchers instead of
distributions was also found to increase beneficiary satisfaction, be more convenient and reduce security risks associa-
ted with distributions, increase revenue of local vendors, and save time and money for the implementation team1.
The decision on which response option is most appropriate (in-kind, cash or voucher) and feasible for menstrual
hygiene depends on a number of factors, including beneficiary preferences, operational markets, access to markets,
availability of appropriate menstrual hygiene products, safety and security of staff, volunteers and beneficiaries,
household dynamics, and programme objectives. In addition, National Society capacity and financial transfer mecha-
nisms (e.g. mobile phone payments, paper vouchers, bank card etc.) also play an important role in decision making.
This tool provides:
i Key assessment questions and considerations for using CVA for menstrual hygiene,

ii Examples of how cash or voucher assistance could be used for menstrual hygiene,

iii An example Minimum Expenditure Basket (MEB) table which is used to define and calculate the value of the
grant/voucher, and
iv An example form for collecting information from local markets on the type of menstrual hygiene items are
available, their cost and other important details (e.g. absorbency of sanitary pads, style – wings or no wings,
sizes and styles of underwear etc.).
Contact the country or regional CVA Focal Point for support and advice right from the beginning. Further information
can be found in the IFRC Guidelines for Cash Transfer Programming, IFRC Market Analysis Guidance and the Red Cross
Red Crescent Cash in Emergencies Toolkit.

Key assessment questions and considerations

Some key questions which need to be answered to help make decisions are:

Can the identified needs be met through specific commodities and/or services or can be through cash/vouchers?
Is CVA in accordance with local government policies?
Are markets accessible after the emergency?
Are needed items available in sufficient quantity and at acceptable prices in the local markets?
Does the NS has the internal capacity (programmatic, financial, logistic) to implement cash interventions or has
implemented cash or voucher projects in past?
Does the IFRC has HR capacities with CVA expertise available in the country?
Is assistance through cash or vouchers a preferred option for the beneficiaries?

Remember that although women and girls are the end-users of menstrual hygiene products; they may not be the
‘decision makers’ about how household income is spent or what is purchased. Although CVA can target individual
women and girls (rather than household level), it is important to understand the local dynamics of decision making and
household spending.
In some contexts, women and girls may also not feel comfortable to purchase menstrual hygiene items such as sanitary
pads from male vendors, or from vendors where they can be seen obviously purchasing sanitary items. It is important
to consider and understand these aspects when assessing which response options (cash/voucher or in-kind) are
appropriate for the context.

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1 Menstrual hygiene management (MHM) in emergencies

USING CVA FOR MENSTRUAL HYGIENE (cont.)

TOOL 5
The preferences of women and girls for different types of sanitary items can be different after an emergency
compared to before.
Where women and girls have been displaced or moved due to an emergency or crises, remember that the items
available may be different compared to what they used to use ‘back home’ before the emergency. They may not
be familiar with or have experience using the type of pads and other materials available.
If using cash/vouchers as response modality, it is vital to make sure that women and girls are still given a demonst-
ration and training on how to use, wash, dry, dispose etc. their menstrual materials, as well as practical and factual
information (including IEC material) on personal hygiene, staying healthy and the menstrual process.

Examples of using CVA for menstrual hygiene

Some examples of how CVA can be used for menstrual hygiene include:

Cash grants or vouchers to women and girls for purchase of menstrual hygiene items (pads, underwear, and soap –
ensuring not to forget core supportive items such as bucket, rope, pegs, pouch or bag for privacy). Grants or
vouchers could be restricted (e.g. they must purchase certain types of materials from certain vendors) or unrest-
ricted (e.g. they decide what to purchase depending on their priority needs).
Cash grants or vouchers to households for water, or construction or improvements of latrines or bathing areas.
Grants or vouchers could be conditional (e.g. provided once the household has reached a milestone such as
having private walls or a barrier around the toilet, or construction of a handwashing facility). They can be targeted
to vulnerable groups (e.g. targeting unaccompanied minors, female-headed households or those women and
girls with physical or learning disabilities).
Cash-for-work mechanisms for maintenance and operation of communal/facility latrines, bathing areas or for
collection, transportation and management of solid waste (Note: must think about personal protection equipment
for people handling menstrual waste).

Minimum expenditure basket (MEB) for menstrual hygiene

The Minimum Expenditure Basket (MEB) is a tool which is used to define and calculate the value of a grant (or voucher).
For menstrual hygiene, the MEB calculated is for one women or adolescent girl (NOT for a household or family).
There are a number of core items that women and girls must have in order to be able to manage their menstruation.
These minimum items are outlined in Tool 8; and the MEB for menstrual hygiene must be aligned and include:
Initial, core items (full kit): needed every 12 months
Replenishment of consumable items (top-up kit): needed every 3 months
Any additional items that are needed, as well as specific details on menstrual products (e.g. style of pads, colour of cloth
and underwear, type and fragrance of soap etc.) need to be discussed directly with women and girls in focus group
discussions. Remember to also consult with women and girls on “how to” (and not only limited to “what”).

An example MEB for disposable sanitary pads is shown below. Note that there is:

Initial (ONE-OFF) transfer, then2

Replenishment or top-up (RECURRENT) transfer every 3 months2

2) Or whatever timeframe the kit has been designed for (depends on type e.g. disposable, reusable).

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 1 Menstrual hygiene management (MHM) in emergencies

USING CVA FOR MENSTRUAL HYGIENE (cont.)

TOOL 5
Initial (one-off) NFI expenditures for MHM
Expenditure per
Quantity per Unit price woman or girl
Products woman or girl (local currency) (local currency) Comments

Disposable sanitary pads (pack, minimum

8 pads per pack) 6 0.0
Bathing soap (100 grams minimum) 6 0.0 Items aligned with IFRC minimum
items for MHM kits, and additional
Underwear (cotton) 3 0.0 items agreed with women and
girls. (E.g. Pads, underwear and
Small carry pouch or bag 1 0.0 bathing soap alone are not
Plastic bucket with lid (6 to 10 litres enough - women and girls must be
capacity) or wash basin 1 0.0 supported with buckets, rope,
pegs, laundry soap, bag or pouch
Additional item 1 0.0 for privacy as well as additional
Additional item 2 0.0 optional items depending on the
context such as torch, skirt or
Additional item 3 0.0 cloth, extra bags for disposal and
Total NFI (for MHM) expenditure per so on).
woman or adolescent girl 0.0

Recurrent (top up of consumables) NFI expenditures for MHM

Expenditure per
Quantity per Unit price woman or girl
Products woman or girl (local currency) (local currency) Comments

Disposable sanitary pads (pack, minimum Items aligned with IFRC minimum
8 pads per pack) 6 0.0 items for MHM kits, and additional
items agreed with women and girls.
Bathing soap (100 grams minimum) 6 0.0 (E.g. Pads, underwear and bathing
soap alone are not enough - women
Additional item 1 0.0 and girls must be supported with
buckets, rope, pegs, laundry soap,
Additional item 2 0.0 bag or pouch for privacy as well as
Additional item 3 0.0 additional optional items depen-
ding on the context such as torch,
Total NFI (for MHM) expenditure per
woman or adolescent girl 0.0 skirt or cloth, extra bags for disposal
and so on).

Example from the field – external

In 2014 the Norwegian Refugee Council (NRC) distributed family hygiene kits to refugee and internally displaced persons
(IDP) as part of the Syria crisis. Post-distribution monitoring showed that sanitary pads, towels and safety pins had low
rates of usage.
Main challenges were that standard family kits did not account for family size, beneficiary preferences or hygiene needs.
Kit distribution also undercut local markets and had a complex supply chain.
A market survey was conducted and it was recommended that humanitarian actors consider using a market-based
approach with vouchers for hygiene items. See ‘Market survey for essential hygiene items, Kurdistan, Iraq, July 2014’ by
NRC and UNICEF.

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1 Menstrual hygiene management (MHM) in emergencies

USING CVA FOR MENSTRUAL HYGIENE (cont.)

TOOL 5
Example form for collecting information on MHM items
Adapt and use this example form to collection information on availability and prices of menstrual hygiene items
in local markets. Use this information to complete the MEB.

A Location
City / Town
Name of market/ shopping area
B Availability and price of MHM related items
Is it Price: top 3
available? brands
Item Yes or √ (local currency) Other information

1 Pack of disposable sanitary pads (regular Write name How many pads in a pack?
absorbency) of brand Sticky on the bottom?
Write price
Underwear – cotton, elastic waistband, ‘bikini’ Colours and sizes available?
2
style (e.g. without legs) so that pads with wings
can be used
Washable (reusable) sanitary pads
3 How many grams (size)?
*Purposefully sewn cloth pads or absorbent, soft
cotton cloth pieces.
Plastic bucket with lid, approx. 7 Litre capacity, Bar or powder? How many grams?
4 not see through
5 Personal bathing soap, bar

6 Laundry soap (for washing pads and clothes)

7 Rope (for clothes-line), plastic coated or similar Length in metres?

8 Plastic pegs (for fastening pads and underwear Number of pegs in pack?
onto drying line)

9 Small drying rack for pads and underwear

(round, with clip at top for hanging)

10 Small plastic bags, 1 - 2 L capacity, with handles,

non- black colour

11 Pouch for storing or transporting pads, small

size, not see-through
Add other items as applicable; for example:

12 Tampons (pack of) Regular or super absorbency?App-

licator or not? How many in a pack?

13 Locally appropriate cloth e.g. kanga, sulu etc.

14 Torch

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 1 Menstrual hygiene management (MHM) in emergencies

STEP-BY-STEP TOOL FOR DECIDING PRIORITY MHM ACTIONS

TOOL 6
Overview
This is a step-by-step tool that can be used to help you analyse and prioritise the MHM needs and actions required1. Based on the assessment information and data collected,
fill in the table below beginning at number 1 and continue across to number 5. Several examples are provided.

Tool for deciding MHM actions

1 2 3 4 5
Problem identified during Priority – rank Goal – if the problem was solved, what Actions required to achieve the goal RCRC area of responsibility in this
assessment the severity of would the outcome be? response/context?
the problem Yes or No
1 = high
2 = medium (see actions on next page)
3 = low

Example: Women and girls Women and girls feel comfortable and safe Latrines are gender segregated. Y – because the National Society has
do not use camp latrines to always use camp latrines when menst- Latrines are well lit. responsibility for WASH in that context
when menstruating. 1 ruating. Waste disposal bins are available inside latrines.
Latrines can be locked from inside. Coordinate with PGI team
Men and boys are not hanging around latrines.
Example: Women and girls Women and girls have access to private, Construction of bathing areas that are lockable, private Y – for water related actions
have no private places for appropriate washing and drying facilities. and have sufficient access to water and drainage. N – for others: another agency is
washing or drying pads (they 1 Construction of drying areas OR distribution of responsible for bathing areas. Coordi-
wash in river & dry them on rope/pegs/small drying racks to women and girls. nate with shelter sector and NFI team.
the bushes).
Example: Women and girls Women and girls have access to approp- Distribution of reusable cloth pads to women and girls, Y – PGI team is distributing dignity kits.
do not have any sanitary riate sanitary pads (based on their along with underwear, bucket, laundry soap, and rope Ensure dignity kits include ALL
materials to absorb menstru- 1 preferences, and context) to absorb their and pegs to support drying. minimum items for MHM
al flow (because they are menstrual flow. Or: cash grant or voucher for menstrual hygiene items PGI to coordinate with WASH (access to
displaced). Conduct post-distribution monitoring to check use, water, private and safe latrines, bathing
satisfaction and challenges with use of pads etc. areas, waste management facilities)

1) Adapted from: Save the Children, Menstrual Hygiene Management Operational Guidelines, 2015 <http://www.savethechildren.org/atf/cf/%7B9-
International Federation def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/MENSTRUAL_HYGIENE_MANAGEMENT_OPERATIONAL_GUIDELINES.PDF>.
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 1 Menstrual hygiene management (MHM) in emergencies

STEP-BY-STEP TOOL FOR DECIDING PRIORITY MHM ACTIONS (cont.)

TOOL 6
1 2 3 4 5
Problem identified during Priority – rank Goal – if the problem was solved, what Actions required to achieve the goal RCRC area of responsibility in
assessment the severity of would the outcome be? this response/context?
the problem Yes or No
1 = high
2 = medium (see actions below)
3 = low

Actions from column 5:

if Yes
Consider adding the action or activity into the emergency PoA
Also think about RCRC capacity and expertise, and requests or decisions from government/clusters
Coordinate with other agencies and sectors
if No
Advocate with partners and other stakeholders for the problem to be addressed
Continue to monitor the situation for changes
Coordinate with other agencies and sectors

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1 Menstrual hygiene management (MHM) in emergencies

MHM IN THE EMERGENCY PLAN OF ACTION

TOOL 7
Overview
This tool provides example outputs, indicators and targets for menstrual hygiene management related actions that may be included in the IFRC Emergency Plan of Action
(EPoA)1. Actions for all three essential components of MHM are included, as well as for RCRC hygiene promotion actions.
See ‘Integrating MHM into humanitarian programming’, Step 4 in the Guide for more information on which section of the EPoA different types of kits and activities should be
under.

Example outputs and indicators for RCRC MHM actions

An example specific outcome for MHM is: ‘Women and adolescent girls in [specify country and/or location] can privately, safely and hygienically manage their monthly
menstruation from [specify time period].’
WRA = Women and girls of reproductive age (assess what ages are normal in local area)

MHM Component 1 - Access to MHM materials and supportive items

Output Indicators Target

Women and adolescent girls have WRA that receive MHM materials / MHM or dignity kits #, 100%
access to and use appropriate MHM
materials
WRA reporting that MHM materials or kits received are appropriate and sufficient in quantity [for the 100%
timeframe planned and provided for]
WRA reporting being satisfaction with MHM materials or kits distributed 100%
Schools who serve girls older than 10 years that provide contingency MHM supplies 100%
WRA reporting that they felt safe and not embarrassed at distribution of MHM or dignity items 100%

1) Component 1 – 3 adapted from: Sommer, M., Schmitt, M., Clatworthy; Save the Children.

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1 Menstrual hygiene management (MHM) in emergencies

MHM IN THE EMERGENCY PLAN OF ACTION (cont.)

TOOL 7
MHM Component 2 - Private, safe and appropriate WASH facilities

Output Indicators Target

Target population have daily access Target population who have at least 15 liters / person / day of water available 100%
to safe water supply in sufficient
quantity
Households who have at least 2 20 liter water storage containers 100%
Target population have access to Latrines, bathing areas and solid waste facilities that are designed after consultation with affected 100%
appropriate sanitation facilities women, girls, boys and men (including those with disabilities)
(including latrines, bathing and
drying areas, solid waste manage-
Latrines, bathing areas and solid waste facilities that meet the minimum requirements for being 100%
’MHM-friendly’
ment)
Households who live within 50 meters of a latrine/toilet facility 100%
Communal latrines that are gender-segregated. 100% (at least 50% female-only latrines)

WRA who report feeling safe to use communal latrine facilities during the day and night. 100%
WRA who report hygienically washing and drying reusable menstrual cloth 100%
WRA who report properly disposing of absorbent materials (sanitary napkins or menstrual cloth) 100%
Handwashing facilities constructed #
Functional handwashing facilities that have water and soap 100%
Latrines, bathing areas and solid waste facilities that are regularly cleaned and maintained 100%
Communal/institutional/school sanitation facilities that have handwashing facilities with water and 100%
soap
Communal/institutional/school sanitation facilities that have private waste disposal bins (or incinera- 100%
tion facilities) for menstrual waste
Communal/institutional/school sanitation waste disposal bins/facilities that are emptied or collected 100%
daily / weekly [modify as appropriate]
Latrine is accessible for persons with physical disabilities: latrine is at ground level or has a 90cm wide 10% of all communal latrines
ramp of <1:10 slope, has 90cm wide doors that open outwards, a bar to pull the door shut from
inside, space for a wheelchair to turn inside, and seating for the toilet and handrails on both sides of
the toilet seat.

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1 Menstrual hygiene management (MHM) in emergencies

MHM IN THE EMERGENCY PLAN OF ACTION (cont.)

TOOL 7
MHM Component 3 Information and knowledge on menstruation and hygiene

Output Indicators Target

Women, girls, boys and men have WRA who received training on use, care, disposal and personal hygiene at time of distribution of 100%
practical, clear information on MHM or dignity items
menstruation and personal hygiene WRA who report restrictions during menstruation % (reduction)
WRA who have received training on how to use MHM items (PDM) 100%
Women, girls, men and boys who know that menstruation is a natural, normal process 100%
Women, girls, men and boys that have a basic knowledge of the process of menstruation (e.g. can 100%
answer 2 – 4 questions on MHM correctly)
Local male and female health workers who have a basic knowledge of the process of menstruation 100%
WRA that know how to hygienically manage monthly menstruation 100%
WRA that know how to hygienically dispose of menstrual materials 100%
General

Output Indicators Target

Continuous assessment of situation Feedback mechanism in place including responsible person for collecting, analysing, tracking and # and type, functioning
and engagement with affected communicating mitigation
population is carried out Feedback (including complaints and rumours) that are successfully mitigated 100%
[MHM] actions are well coordinated Relevant coordination / cluster meetings attended #
between sectors and agencies MHM included in joint assessment or monitoring activities #

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1 Menstrual hygiene management (MHM) in emergencies

MHM IN THE EMERGENCY PLAN OF ACTION (cont.)

TOOL 7
Generic Hygiene Promotion

Output Indicators Target

Hygiene promotion activities are Number of volunteers/staff trained #

conducted according to RCRC Hygiene promotion (HP) plan developed Plan available
standards and guidelines.
Households visited by volunteers (door-to-door visits) # or %
People who attended group sessions held by volunteers #
Radio spots/SMS messages/TV spots broadcast #
People reporting satisfaction with RCRC response # or 100%
MHM is included within National Society WASH or HP policy or guidelines Yes

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1 Menstrual hygiene management (MHM) in emergencies

MINIMUM ITEMS TO BE INCLUDED IN KITS FOR MENSTRUAL

TOOL 8
HYGIENE
Overview
There are a number of essential items that are critical to enable women and girls to manage their menstruation. The minimum items outlined below are aligned with current
global best practice guidelines, and are based on operational research and field experiences of both IFRC and other humanitarian agencies.
Pads and underwear alone are not enough – items like bucket, laundry soap, rope and pegs to enable washing, drying and disposal are critical. This tool provides
minimum items that should be included in any MHM kit or any dignity kit which supports menstrual hygiene.
Minimum items are included for kits with:
A Disposable pads Re-distribution of core, full kit 12
Initial distribution: months after initial
B Reusable pads or cloth Core, full kit - if needed/appropriate
C Tampons (for areas/countries where they are already used).

Part D shows additional top-up items that can be included depending on context,
needs and approach taken to avoid overlap (coordinated between PGI and WASH). Top-up of consumables
Each kit has been designed for personal use (e.g. for one woman or adolescent girl of (in-kind or cash):
Top-up, replenishment kit
reproductive age) for a certain number of months; after which the consumable items
will run-out (e.g. disposable pads, bathing soap, laundry soap etc.). Think about what
strategy you will use for distribution and top-up or replenishment of consumable items – either in kind or using cash programming. Depending on the timeframe, the core, full kit
may need to be distributed again (timeframe of non-consumable items estimated to be 12 months).
Consultation with women and girls should guide the selection of any hygiene, dignity or menstrual hygiene related items to be distributed. This includes aspects like size and colour of
underwear, type of laundry soap (e.g. bar or powder, scented or unscented) and type of disposal pad (with or without ‘wings’, absorbency etc.). Consult with women and girls on ‘how’
distributions (in-kind or vouchers) should be done, ensuring safety, access and provision of information.
Additional supplementary items can be added into each kit, depending on what is appropriate for the local context and socio-cultural situation, and based on preferences and needs.
For example, a cloth skirt/sari/kanga/sulu could be added to support dignity of women during bathing, or to hide blood stains on clothing etc. A torch could be included to increase
safety (be sure to coordinate with PGI).
Remember that there can be large differences in preferences and materials used between urban versus rural areas; in water-scarce or arid regions washing cloth or reusable pads may
be challenging due to lack of water; and in transit situations where women and girls are frequently on the move reusable cloth pads may not be practical or appropriate.
If using cash assistance, key considerations include market functionality, availability of preferred items in the market, women/girls access to markets/shops, household dynamics, etc.
The prices of these items should be included into the MEB (minimum expenditure basket), updated through price monitoring and should be reflected in transfer value calculation.

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1 Menstrual hygiene management (MHM) in emergencies

MINIMUM ITEMS TO BE INCLUDED IN KITS FOR MENSTRUAL HYGIENE (cont.)

TOOL 8
MHM kit A - disposable pads
Core, full kit: timeframe of consumables = 3 months. Re-distribute full kit every 12 months.
Top-up, replenishment kit: every 3 months

Full, core kit - redistribute every 12 months Top-up, replenishment kit (consumables)
Every 3 months (in-kind or cash)
Description Qty Comments
Description Qty
DISPOSABLE SANITARY PADS (pack of), 6 Two packets (minimum 8 pads) per month x 3 months = 6 packets. If
straight or winged, medium to heavy pads are the type fastened by an elastic band around the waist; DISPOSABLE SANITARY PADS (pack of),
flow, minimum 8 pads per pack. minimum 2 x elastic waist bands must be included in kit. minimum 8 pads per pack. 6
BATHING SOAP, 100 grams minimum. 6 2 bathing soaps per month x 3 months = 6 bars of soap. BATHING SOAP, 100 grams minimum. 6
UNDERWEAR, cotton, not white or 3 Choose most appropriate size and color dependant on context, Possibly: PAPER BAGS, 1 – 2 litres,
1
light colour. and/or set-up exchange/selection during distribution. non-transparent (brown), pack of 20.
SMALL CARRY POUCH, ½ to 1 litre 1 Non-branded and non-transparent. Maybe included in pad pack from
capacity, for storing or carrying pads. manufacturer. Recommended additional items – depending on
context:
INSTRUCTIONS FOR USE AND CARE, 1 Pictorial, with simple text in local language. [Examples that can be
including personal hygiene, washing, adapted are available in English, French, Spanish and Arabic]. PAPER BAGS; For supporting disposal of sanitary
drying, disposal. materials, depending on context. Paper or
compostable material preferred over plastic to
PLASTIC BUCKET, with lid, 6 to 10 1 For soaking and washing stained underwear or clothes. Also can be
reduce environmental impact.
litres capacity, non-transparent, used for private storage of menstrual materials.
non-branded.
CARRYING BAG, with handles for easy 1 Non-transparent. Preferably textile not plastic.
transport, minimum 5 litres capacity.

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1 Menstrual hygiene management (MHM) in emergencies

MINIMUM ITEMS TO BE INCLUDED IN KITS FOR MENSTRUAL HYGIENE (cont.)

TOOL 8
MHM kit B – reusable / washable pads
Core, full kit: timeframe of consumables = 3 months. Re-distribute full kit every 12 months.
Top-up, replenishment kit: every 3 months

Full, core kit - redistribute every 12 months Top-up, replenishment kit (consumables)
Every 3 months (in-kind or cash)
Description Qty Comments
Description Qty
WASHABLE / REUSABLE SANITARY PADS OR Specifically manufactured cloth pads (preferred) or pieces of cloth, which
CLOTH, see specifications on material quality,
6 fasten in underwear (or are held in place with an elastic band around BATHING SOAP, 100 grams
absorption, drying etc. waist). Quantity will depend on the material: quality, absorption, minimum.
6
drying rate etc. Note that 6 is minimum for high-quality, specifically
LAUNDRY SOAP, bar: 200 grams
manufacture pads – for cotton cloth a suggested minimum is 8
minimum, or powder: 0.5
3
pieces. If pads are the type fastened by an elastic band around the waist;
minimum 2 x elastic waist bands must be included in kit. litres/200 grams minimum.
BATHING SOAP, 100 grams minimum. 6 2 bathing soaps per month x 3 months = 6 bars of soap. Possibly: CLOTH or PADS– 6
depending on quality and
LAUNDRY SOAP, bar: 200 grams minimum, or 3 Bar soap = 3 bars of minimum 200 grams each. Powder soap = 1.5 litres
quantity included in kit.
powder: 0.5 Litres/200 grams minimum. volume or 600 grams minimum (bag or other container).

ROPE, at least 4 metres in length. 1 To support drying.

Recommended additional items
PEGS, pack of 8 (minimum). 1 To support drying. – depending on context:
UNDERWEAR, cotton, not white or light colour. 3 Choose most appropriate size dependant on context, and/or set-up
CLOTH, as is locally appropriate (e.g.
exchange or selection methods during distribution.
kitenge/khanga/sarong/sulu); for
SMALL CARRY POUCH, ½ to 1 litre capacity, for 1 Non-branded and non-transparent. Maybe included in pad pack from supporting private drying of menst-
storing or carrying pads. manufacturer. rual materials and for dignity in case
INSTRUCTIONS FOR USE AND CARE, including 1 Pictorial, with simple text in local language. [Examples that can be of blood leakage.
personal hygiene, washing, drying and disposal. adapted are available in English, French, Spanish and Arabic].
PLASTIC BUCKET, with lid, 6 to 10 litres capacity, 1 For soaking and washing stained underwear or clothes. Also can be used
non-transparent, non-branded. for private storage of menstrual materials.
CARRYING BAG, with handles for easy transport, 1 Non-transparent. Preferably textile not plastic.
minimum 5 litres capacity.

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1 Menstrual hygiene management (MHM) in emergencies

MINIMUM ITEMS TO BE INCLUDED IN KITS FOR MENSTRUAL HYGIENE (cont.)

TOOL 8
MHM kit C – tampons (for areas/countries where they are used already)
Core, full kit: timeframe of consumables = 2 months.
Top-up, replenishment kit: every 2 months

Note: It is intended that this kit would only be distributed in areas where women and girls have previous experience using tampons and prefer this method; NOT to women or girls
who have used sanitary pads or cloth their whole lives.

Full, core kit - redistribute every 12 months Top-up, replenishment kit (consumables)
Every 2 months (in-kind or cash)
Description Qty Comments
Description Qty
TAMPONS, regular flow, box with minimum 10 2 Minimum 3 tampons per day x 7 days bleeding = Approximately 21
tampons. tampons per month x 2 months = 42 tampons approx. [Assuming boxes TAMPONS, regular flow,
of 10 tampons this will be 40 tampons]. Always use the lowest absor- minimum box of 12.
2
TAMPONS, light flow, box with minimum 10 2 bency for the flow.
tampons. TAMPONS, light flow, minimum 2
box of 12.
BATHING SOAP, 100 grams minimum. 6 2 bathing soaps per month x 3 months = 6 bars of soap.
SMALL CARRY POUCH, ½ to 1 litre capacity, for 1 Non-branded and non-transparent. Maybe included in pad pack from BATHING SOAP, 100 grams 6
storing or carrying tampons. manufacturer. minimum.
UNDERWEAR, cotton, not white or light colour. 2 Choose most appropriate size dependant on context, and/or set-up
exchange or selection methods during distribution. Recommended additional items
– depending on context:
INSTRUCTIONS FOR USE AND CARE, including 1 Pictorial, with simple text in local language. [Example that can be
personal hygiene, washing, drying and disposal. adapted are available in English, French, Spanish and Arabic].
PAPER BAGS; For supporting disposal
CARRYING BAG, with handles for easy transport, 1 Non-transparent. Preferably textile not plastic. of sanitary materials, depending on
minimum 5 litres capacity. context. Paper or compostable
material preferred over plastic to
reduce environmental impact.

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1 Menstrual hygiene management (MHM) in emergencies

MINIMUM ITEMS TO BE INCLUDED IN KITS FOR MENSTRUAL HYGIENE (cont.)

TOOL 8
Add on items (optional)

Description Qty Comments

PAPER BAGS, 1 – 2 litres, non-transparent 1 For supporting disposal of sanitary materials, depending on context. Paper or compostable material preferred
(brown), pack of 20 over plastic to reduce environmental impact.
CLOTH, kitenge/khanga/sarong/sulu 1 As is locally appropriate. Can use for covering pads and underwear that are drying (for privacy). Can also be used
to wrap around body in case of blood leakage.
LAMP, TORCH, solar, solar panel integrated 1
CARRY BAG, cloth or plastic, non-transparent, 1 For carrying extra menstrual supplies when female is away from household. Non-branded.
minimum 5 litres capacity
WASH BASIN, for washing, round, plastic, 20 1
litres
WASTE BIN with lid, minimum 8 litres 1
SCISSORS, office, 15 - 18cm 1

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1 Menstrual hygiene management (MHM) in emergencies

EXAMPLE MHM IEC MATERIALS

TOOL 9
Overview
Example IEC materials that can be adapted and translated to country/context have been developed in English,
French, Spanish and Arabic for:
disposable pads
reusable pads (or cloth)
tampons

The materials include general, pragmatic information on the menstrual cycle and personal hygiene as well as
instructions for use, care (washing and drying), and disposal of menstrual materials.

Disposable pads

Being a woman What is inside your body? Use and disposal How to keep healthy
Tips for your monthly period The female reproductive system
of your pads during your monthly periods
Disposable pads
Ovary: where a woman’s eggs are stored 1
Egg: one leaves the ovary each month. If an
egg comes together with sperm from a man
Peel off the paper from the back
it may grow into a baby Make sure you change
7
of the pad (and the wings).
Midday
About your period Uterus: where a baby Morning Evening your pad regularly.

grows Do not throw

Your period is used pads into
when blood flows from your vagina. Always use clean and dry pads.
the latrine.
This normally happens every month (around every 28 days). Using dirty or damp (wet) pads can
cause itching or an infection in your
vagina.
The bleeding normally lasts for between
2 to 7 days. Getting your period is

2
Put the pad in your underwear Wash your hands with soap and water after
normal and healthy.
with the sticky side down. changing your pad. Keep yourself clean during
periods by washing regularly.

6
Put the used pad into a
rubbish pit or bin. If you
need to, use the bucket or
pouch to store used pads. Never share pads with someone else. Sharing
things that might have blood on them can spread
Girls normally get their first period infection.
between 10 and 15 years of age. In the If your pad has wings, fold
beginning it might not come every month. them under to help keep
This is normal. Uterus wall: a layer the pad in place. Talk to someone you trust about your period
When you need to
Around 45 or 50 years of age, women on the edge of the and how to stay healthy. Do not be scared or
3
change the pad, take it
will normally stop getting their period. uterus builds up each embarrassed - getting your period is normal and
out and fold it up in the
month. If you are not healthy!
wrapper or put it inside
pregnant this becomes The pad is ready to use.
another bag.
If your period does not come one your period blood
month, this might mean that you are Many women and girls have pain in their
pregnant. Visit your local health clinic stomach or back before or during their period.
or community health worker. Vagina: opening (or hole) where
To help the pain, you can stretch, or put a
blood from your period and
bottle filled with warm water or a warm
babies leave the uterus

5 4 cloth on your lower back or stomach.

Talk to someone you trust about the
ways women in your community
manage the pain.

Reusable pads

Being a woman What is inside your body? Use and care How to keep healthy
Tips for your monthly period The female reproductive system
of your reusable pad during your monthly periods
Ovary: where a woman’s eggs are stored
Reusable pads Egg: one leaves the ovary each month. If an
egg comes together with sperm from a man
it may grow into a baby
1 Make sure you change
Midday
About your period Uterus: where a baby Morning Evening your pad or cloth
Use the regularly.
grows Before using the pads for the first time, wash

8
Your period is washed,
them with soap and water and dry in the sun.
when blood flows from your vagina. dry pads Always use clean and dry pads.
This will make them soak up more blood.
This normally happens every month (around every 28 days). again. Using dirty or damp (wet) cloth or
pads can cause itching or an infection in
your vagina.
The bleeding normally lasts for between
2 to 7 days. Getting your period is 2
normal and healthy. Wrap the wings of the pad around the Wash your hands with soap and water after
Dry the underwear and button underneath. Make changing your pad or cloth. Keep yourself clean
pads in during periods by washing regularly.
7
sure the soft side is up.
the sun.

Never share pads or cloth with someone else.

Sharing things that might have blood on them can
Girls normally get their first period
The pad is ready to use. Change spread infection.
between 10 and 15 years of age. In the
beginning it might not come every month. your pad at least 3 times a day.
Use clean water
This is normal.
Around 45 or 50 years of age, women
Uterus wall: a layer
on the edge of the
and soap to
wash your pads.
3 Talk to someone you trust about your period
and how to stay healthy. Do not be scared or
will normally stop getting their period. uterus builds up each Rinse with clean embarrassed - getting your period is normal and
Soak the dirty pad
month. If you are not water. healthy!
in cold water for 15 Use the pouch
pregnant this becomes
minutes. This makes to store the dirty
If your period does not come one your period blood

6
it easier to wash the pad if you cannot
month, this might mean that you are blood out. wash it straight Many women and girls have pain in their
pregnant. Visit your local health clinic away. stomach or back before or during their period.
or community health worker. Vagina: opening (or hole) where To help the pain, you can stretch, or put a
blood from your period and
4
bottle filled with warm water or a warm
babies leave the uterus cloth on your lower back or stomach.
Talk to someone you trust about the
ways women in your community
5 manage the pain.

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1 Menstrual hygiene management (MHM) in emergencies

EXAMPLE MHM IEC MATERIALS

TOOL 9
Tampons

Being a woman What is inside your body? Use and disposal How to keep healthy
Tips for your monthly period The female reproductive system
of your tampons during your monthly periods
Tampons
Ovary: where a woman’s eggs are stored 1
Egg: one leaves the ovary each month. If an
egg comes together with sperm from a man
it may grow into a baby Change your tampon
Midday
About your period Uterus: where a baby
Wash your hands with soap Morning Evening at least 3 times a day. Do
not use a tampon for longer
(before and after changing a

2
grows than 8 hours.
Your period is tampon).
when blood flows from your vagina.
This normally happens every month (around every 28 days).
8 Put the used tampon into
the rubbish bin, pit or Always use a clean and dry tampon.
Using dirty tampons or wearing the
incinerator. Do not throw
pads into the latrine. same tampon for more than 8 hours
increases the chance of getting a serious
The bleeding normally lasts for between Unwrap the tampon. If the illness called Toxic Shock Syndrome.
2 to 7 days. Getting your period is wrapper is broken, use
Change your
normal and healthy. another one. Wash your hands with soap and water before
tampon at least 3
and after changing your tampon. Keep yourself
times a day.
7 Sit or squat in a
clean during periods by washing regularly.

Pull down on the

comfortable position.
3 Never share tampons, pads or cloth with someone
Girls normally get their first period
between 10 and 15 years of age. In the
6 string to take the
tampon out.
else. Sharing things that might have blood on them
can spread infection.
beginning it might not come every month. Use one finger to gently
This is normal. Uterus wall: a layer push the tampon (or
applicator) into your Talk to someone you trust about your period
Around 45 or 50 years of age, women on the edge of the
and how to stay healthy. Do not be scared or
will normally stop getting their period. uterus builds up each Make sure the string vagina, towards your
embarrassed - getting your period is normal and
month. If you are not is always outside lower back. If you are
Put the end of the healthy!
pregnant this becomes the vagina. If you can using an applicator; push
your period blood the inside tube all the tampon at the opening
If your period does not come one feel the tampon, you
way in. of your vagina. The
month, this might mean that you are have not pushed it far Many women and girls have pain in their
string should be
pregnant. Visit your local health clinic enough inside your stomach or back before or during their
Vagina: opening (or hole) where away from your body.
or community health worker. vagina. period. To help the pain, you can stretch,
blood from your period and
or put a bottle filled with warm water or
babies leave the uterus a warm cloth on your lower back or

5 4 stomach. Talk to someone you trust

about the ways women in your
community manage the pain.

Link:
https://ifrcwatsanmissionassistant.wordpress.com/menstrual-hygiene-management/

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1 Menstrual hygiene management (MHM) in emergencies

FEEDBACK AND MITIGATION LOG

TOOL 10
Overview
This tool provides an example log which can be used to collect feedback (both informal and formal), and to document which actions have been taken to address them
(mitigation) and the outcome. This table can also be used for rumours, complaints and misinformation.
Before activities start, it is important to plan how you will collect feedback – including mechanics or activities, who to collect it from, and how often (frequency). Use the
table below as example to help you plan.

Activity or mechanism Target group / who with? Frequency

e.g. focus group discussions Adolescent girls and women of reproductive age e.g. every month
e.g. rapid survey using mobile Randomly selected group from target population e.g. weekly or monthly rapid survey
phones [see links to additional
resources below]
e.g. radio show with call-in Affected population e.g. ongoing for entire response

e.g. interviews with key informants e.g. community leaders, local health officers, traditional healers, e.g. every two weeks
women’s leaders

e.g. complaints desk Women and girls who receive MHM items e.g. during each distribution

e.g. feedback box or post-cards Affected population e.g. ongoing

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1 Menstrual hygiene management (MHM) in emergencies

FEEDBACK AND MITIGATION LOG (cont.)

TOOL 10
Example feedback and mitigation log
(Adapted from CDAC Network)
Remember! Collecting feedback alone is not enough; make sure you have a system in place to analyse, track mitigating actions and then communicate this back to communi-
ties.

Feedback and mitigation log – can also include rumours, misinformation and complaints

Date Location Details Channel Risk rating Verification status Mitigation status Outcome

When was the Where was Details of the How was the Low Verify if it is: Details of who, what, when, where and Has the
feedback/rumour/ it heard? feedback/rumour/ feedback/rumour/ Medium how you mitigated or addressed the feedback/rumour/
complaint heard? complaint. What complaint heard? True or Untrue feedback/rumour/ complaint, including complaint stopped?
High
was it? engaging with the community

Additional resources
IFRC Community Engagement and Accountability (CEA) Guide <https://media.ifrc.org/ifrc/wp-content/uploads/sites/5/2017/12/IFRC-CEA-GUIDE-0612-LR.pdf> and Toolkit <https://me-
dia.ifrc.org/ifrc/document/community-engagement-and-accountability-toolkit/>
Information on tools for data collection and analysis; part of IFRC Guide: How to Establish and Manage a Systematic Feedback Mechanism with Communities <https://media.ifrc.or-
g/ifrc/wp-content/uploads/sites/5/2018/06/IFRC_feedback-mechanism-with-communities_ok_web.pdf>

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1 Menstrual hygiene management (MHM) in emergencies

FOCUS GROUP DISCUSSION GUIDE -

TOOL 11
POST DISTRIBUTION MONITORING (PDM)

Overview
This tool provides example questions for a Focus Group Discussion (FGD) with women and adolescent girls for
post-distribution monitoring (PDM). The aim is to get a detailed understanding on the use of menstrual items (e.g. the
‘how’ and ‘why’ questions), satisfaction, experiences and challenges, cultural taboos and restrictions etc. Qualitative
methods are the only way to collect meaningful and in-depth information on use, satisfaction, preferences and challen-
ges which can be used to adapt and improve programming.
The questions include the key things you should ask during post-distribution monitoring of MHM (or dignity kits). The
questions should be adapted so they are appropriate and context specific. Introduction/background, consent, ice-brea-
ker and probing questions should be added.
Important details:
FGDs should be age-disaggregated, for example 12 to 18 years, 19 to 35 years, and 36 to 55 years.
The number of FGDs to be held depends on the scale, geographical spread, time available and context. It is recom-
mended to have at least 2 FGDs with each age group; if operation or programme is larger then more may be
needed.
See Section 3 of the Guide for more information on selecting volunteers for MHM activities.

Depending on how much time and resources you have, these questions can be integrated as part of other activities (for
example, asked as part of a FGD on hygiene promotion, PGI or health) – or a separate FGD just for MHM can be held.

Example FGD questions

A Items / kits received and their use (Introduction)
Which items / kit have you received? Do you know who gave you these items?
Have you used any of the items? Which ones? Why or why not?

B Distribution
Can you explain how the distribution of the kits was done?
Did you feel safe or embarrassed during the distribution? Why or why not? What could help you to feel safer
or less embarrassed?
Were all women and girls that you know able to go to the distribution? If some were unable to, what restric-
ted them? What could support or help them to attend next time?
Were you given a demonstration on how to use and care for your pads? Was any information missing?
Were you given information on who you could contact for more information on sexual and reproductive
health? Was any information missing?

C Menstrual hygiene practices and WASH facilities

What did you use to manage your last monthly period? (E.g. find out if they have actually used the cloth/pads
that were distributed)

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FOCUS GROUP DISCUSSION GUIDE - POST DISTRIBUTION

TOOL 11
MONITORING (PDM) (cont.)
*Questions below assume that some or all actually used the pads/cloth that were distributed*

Did you like to use the pad/cloth? Was it comfortable and absorbent? Did you have enough cloth/pads
to use during your period?
Did you have any difficulties using the pad/cloth? How or why?
Where do you change your cloth / materials / pads? How often do you change the cloth/pad?
If disposable pads: Where do you dispose of or throw used pads? Why? Probe on challenges, beliefs, if they do
it at night etc.
If cloth or washable pads: Where and how do you wash the cloth? Why? Probe on challenges, including with
bloody wastewater etc.
If cloth or washable pads: Where and how do you dry the cloth? Why? Probe on challenges, including with
privacy, taboos etc.
If cloth or washable pads: Once it is worn out, where do you dispose of or throw the old cloth? Why? Probe on
challenges, beliefs, if they do it at night etc.

D Preferences and improvements

Would you prefer another type of pad / cloth now? If so, why? Ask about colour, absorbency, type of pad or
cloth etc. – would they like any changes? (You can also discuss aspects of sustainability / reuse (how long the
types of pads last), washing, drying, privacy issues, access to water etc.)
For underwear and soap: discuss the colour, size, smell, brand etc. – any changes?
Are you missing any items or things that would help you manage your menstrual period?
What changes or improvements would you make to WASH facilities here, so that you can better manage your
menstruation? [latrines, bathing areas, waste management facilities]
Have you recently purchased any pads or other items to use during your period? What did you buy? Where
from and how much did it cost? What are the main sources of income now?

E Health, socio-cultural aspects

During your last monthly period, did you experience any pain (before or during), itching or irritation? Any
discharge or smell? How did you deal with this?
During your last monthly period, did you feel embarrassed or anxious at all? Why? What could help you to
feel less embarrassed or anxious?
What are the beliefs and customs with menstruation in your culture/community? How do they affect you? Is
there anything that you are restricted from or can’t do during your period?

F Closing
What are the main challenges you face in managing your monthly period now? If there are many, get women
and girls to vote (by show of hands) or rank them in order of importance.
Is there anything else you would like to share about MHM or your experiences?
Do you have any questions?

Thank participants and explain next steps. Make sure they know how they can access support (e.g. about sexual and
reproductive health or about sexual and gender based violence)

International Federation
of Red Cross and Red Crescent Societies
www.ifrc.org Saving lives, changing minds.
1 Menstrual hygiene management (MHM) in emergencies

POST-DISTRIBUTION MONITORING

TOOL 12
SURVEY

Overview
It is important to follow up with women and girls on the use, acceptability and satisfaction with any items distributed
(or if cash/vouchers are used, on the service and providers). This information should be used to revise and improve kits
and items distributed and to adapt programming, to better meet needs and preferences and to address any unfore-
seen issues or challenges. Some key points around PDM for menstrual hygiene are:
Although post-distribution monitoring for MHM should focus on qualitative methods (e.g. FGDs and KIIs), quantita-
tive surveys are useful for collecting useful data and information which is representative of a wider geographical
area, for reporting against targets and for measuring change.
Post-distribution monitoring for menstrual items should be done between 1 and 2 months after distribu-
tion. Any earlier than 1 month, and there is a risk that many women and girls have not got their period yet and so
have not actually used the pads, items etc. After two months it can become difficult for women and girls to remem-
ber what happened during distribution, what they received etc.

This tool provides an example post-distribution monitoring questionnaire (for MHM kits or menstrual hygiene items)
which can be adapted as appropriate.
Note that mainly ‘closed’ questions are included in this example; open-ended questions about ‘how’, ‘why’ or
‘preferences’ etc. can be asked and discussed in focus groups and key informant interviews to get more meaningful and
detailed information.

Example post-distribution monitoring questionnaire

Optional:
Add questions on knowledge (to measure any change from baseline, if relevant)
Add questions on health e.g. irritation, infections (to measure any change from baseline, if relevant)
Add questions on socio-cultural aspects e.g. restrictions or taboos (to measure any change from baseline, if relevant)
Add more questions on dignity or inclusion e.g. feeling of privacy, safety

Question Coding Notes

1 Location (e.g. sector of camp) or other details 1-… As applicable

2-…
2 What is your age? Number As applicable
1 - Disposable
3 Which type of kit (or items) did you receive? 2 - Reusable pads Change to be relevant for the
3 - Cloth situation
4 - Tampons
1 – Yes
4 Did you feel safe at the distribution (when you were
given the items)? 2– Somewhat / a little
3 – No
4 - Didn’t attend
distribution
1 – Yes
5 Did you feel embarrassed during the distribution?
2 – Somewhat / a little
3 – No

International Federation
of Red Cross and Red Crescent Societies
www.ifrc.org Saving lives, changing minds.
1 Menstrual hygiene management (MHM) in emergencies

POST-DISTRIBUTION MONITORING SURVEY (cont.)

TOOL 12
Question Coding Notes

6 Were you given a demonstration on how to use 1 – Yes

and care for your pads? 2 – No
3 – I don’t remember
4 – I don’t know / didn’t
attend distribution
Were you given information on who you could 1 – Yes And/or gender-based violence –
7 2 – No
contact for more information on sexual and depending on situation
3 – I don’t remember
reproductive health?
4 – I don’t know / didn’t
attend distribution

8 Did you use the pads for your last monthly period? 1 – Yes, continue Women or girl must have used
2 – No, skip to end pads or kit items to provide useful
feedback
1 – Yes
9 Did you find the pads acceptable?
2 – Somewhat
3 – No
1 – Yes, I had enough pads
10 Were there enough pads for you to use during
your period? 2 – No, I ran out of pads/
needed more
Did you have any difficulties using the disposable / 1 – No
11 2 – Sometimes
reusable pads? If yes, why?
3 – Yes – why?
1- Shower or bathing area Reusable pads / cloth only
12 Where did you wash the reusable pads / cloth?
2 – Latrines
3 – In my house or shelter
4 – At the river or lake
5 – Other. Specify
1- Shower or bathing area Reusable pads / cloth only
13 Where did you dry the reusable pads / cloth?
2 – Latrines
3 – In my house or shelter
4 – At the river or lake
5 – Other. Specify
1 - Latrines or toilet Disposable pads only
14 Where did you dispose of (throw away) the
2 – Rubbish pit
disposable pads (or reusable pads or cloth, once it
3 – Bury in ground
was worn out)?
4 – Incinerator
5 – Other. Specify
15 Are you missing any items or things to help you 1 – No
manage your menstrual period? 2 – Yes. What?
1 – No
16 Did you have any irritation or itching during your
2 – Yes
last menstrual period?
3 – A bit
4 – Don’t want to say
17 Did you feel embarrassed or anxious during your 1 – No
last menstrual period? 2 – Yes
3 – A bit
4 – Don’t want to say
18 Will you continue to use the washable pads for 1 – Yes Reusable pads / cloth only
your monthly periods? 2 – No, why not?
3 - Maybe
19 Overall, how satisfied are you with the MHM (or 1 – Very satisfied
2 – Somewhat satisfied
dignity) kit that Red Cross/Crescent gave you?
3 – Okay /neutral
4 – Not satisfied. Why not?
20 Any other comments or questions? Open text

International Federation
of Red Cross and Red Crescent Societies
www.ifrc.org Saving lives, changing minds.
1 Menstrual hygiene management (MHM) in emergencies

CHECKLIST FOR MENSTRUAL HYGIENE

TOOL 13
IN HUMANITARIAN CONTEXTS

Overview
This checklist outlines broad key actions to ensure an effective and comprehensive MHM response in an emergency or
humanitarian crises. Use it as a guide or as a tool to reflect on.

1 Staff and volunteers (both male and female) have been trained on MHM, and have capacity and
confidence to discuss MHM and identify practical actions to improve menstrual hygiene management
for women and girls.
2 Staff and volunteers (both male and female) who are involved with MHM programming have been
trained gender, age, disability, on how to communicate respectfully with persons with disabilities and
older people and referral mechanisms for sexual and gender based violence disclosures.

3 Women and girls, including those with disabilities or from vulnerable/minority groups, are continuous-
ly consulted on their needs and preferences, the challenges they face, cultural and social norms and
the WASH facilities/items/support provided.
4 Based on feedback collected from women, girls, boys and men, MHM related activities are revised or
adapted as needed.

5 Data are disaggregated at least by sex, age and disability and other context-specific variables, to
provide an understanding of and access to the most marginalized.

6 Menstrual hygiene management actions are well-coordinated both between sectors (e.g. WASH, PGI
and health) and between actors (e.g. RCRC, UN, government etc.).

7 Women and adolescent girls have access to and use appropriate sanitary materials (based on their
preferences and context).

8 MHM kits or dignity kits (which contain sanitary materials) include all the minimum items for menstrual
hygiene – including items to support washing, drying and disposal.

9 Demonstration of use, care and disposal of menstrual hygiene items, and hygiene promotion linked
with sexual and reproductive health is provided at the same time as distribution.
10 Latrines, bathing areas and solid waste management facilities are ‘MHM-friendly’ and meet the
minimum requirements (including being gender-segregated and a proportion [target = 10%] accessib-
le to those with disabilities) so that women and girls (including those with disabilities) have private, safe
facilities that they feel comfortable using day and night to manage their menstruation.

11 Latrines, bathing areas and solid waste management facilities are regular cleaned and well-maintained,
and people who handle menstrual waste have wear appropriate PPE.

12 Schools and institutions (e.g. health clinics) in emergency contexts have appropriate and MHM-friendly
water, sanitation and hygiene facilities to help girls manage their menstruation.
13 Schoolteachers in emergency contexts have been trained to support girls with their menstruation.

14 Opportunities have been created in emergency contexts for adolescent girls and boys to learn about
menstruation.

International Federation
of Red Cross and Red Crescent Societies
www.ifrc.org Saving lives, changing minds.
The fundamental principles of the international
Red Cross and Red Crescent movement

Humanity The international Red Cross and Red Independence The movement is independent. The
Crescent movement, born of a desire to bring assistance National Societies, while auxiliaries in the humanitarian
without discrimination to the wounded on the battlefield, services of their governments and subject to the laws
endeavours, in its international and national capacity, to of their respective countries, must always maintain their
prevent and alleviate human suffering wherever it may be autonomy so that they may be able at all times to act in
found. Its purpose is to protect life and health and to accordance with the principles of the Movement.
ensure respect for the human being. It promotes mutual Voluntary service It is a voluntary relief movement not
understanding, friendship, cooperation and lasting peace prompted in any manner by desire for gain.
amongst all peoples.
Unity There can be only one Red Cross or Red Crescent
Impartiality It makes no discrimination as to nationality, Society in any one country. It must be open to all. It must
race, religious beliefs, class or political opinions. It carry on its humanitarian work throughout its territory.
endeavours to relieve the suffering of individuals, being
Universality The international Red Cross and Red
guided solely by their needs, and to give priority to the
Crescent movement, in which all societies have equal
most urgent cases of distress.
status and share equal responsibilities and duties in
Neutrality In order to enjoy the confidence of all, the helping each other, is worldwide.
Movement may not take sides in hostilities or engage at
any time in controversies of a political, racial, religious or
ideological nature.
For more information on this IFRC publication, please contact:

International Federation of Red Cross and

Red Crescent Societies
WASH Unit
Health and Care Department
Email: wash.geneva@ifrc.org