Around the world, over 300 million women, girls, and other persons menstruate on any given day, making menstrual health and its management a crucial part of life. Despite this, menstruation is widely stigmatized and often considered ‘dirty’ or ‘taboo’, leading to discrimination, harassment, exclusion, and missed opportunities. 

In the Pacific, menstrual health has received limited research and attention to date. However, it is increasingly being addressed within urban, water, and sanitation projects. 

Considering menstrual health in project and development program design is particularly relevant for projects related to urban development, water, sanitation, and hygiene. Multiple studies have shown that poor access to safely-managed water and sanitation disproportionately impacts women and girls due to biological and cultural factors. 

 Good menstrual health can only be achieved if sanitation facilities support individuals to manage their menstrual health needs effectively, safely, and with dignity. Infrastructure in households, educational institutions, workplaces, and public places need to consider separate male and female facilities that are safe and private, in addition to the provision of water for toilets, washing, and handwashing; disability access; and solid waste management for used menstrual materials.

In urban development, water, sanitation, and hygiene contexts, practitioners must focus on what adequate sanitation means, especially for women and girls and other persons who menstruate. To be truly inclusive, adequate sanitation must fulfill menstrual health needs. 

It is a missed opportunity if menstrual health is not incorporated into these vital programs. Including menstrual health means that activities, facilities, policies, and education programs not only respond to menstrual health itself but are more inclusive, sustainable, and more beneficial in the long term.

Menstrual health needs to be mainstreamed into urban development, water, sanitation and hygiene programs and projects.

There are four ways projects and investments can immediately strengthen menstrual health in project design and implementation to reduce the barriers menstruating people face in managing their menses while continuing to participate fully in their day-to-day activities:

Strengthen data collection during project design – data on menstrual health and practices are becoming increasingly available, but some situations and issues remain poorly understood, including in the Pacific. In 2020, only three Pacific countries (Kiribati, Samoa, and Tonga) collected official data on menstrual health, meaning we have limited knowledge of menstruation and how it is managed across the region.

Improve menstrual health infrastructure – good menstrual health can only be achieved if sanitation facilities support individuals to manage their menstrual health needs effectively, safely, and with dignity. Public places such as schools, healthcare facilities, transport hubs, and marketplaces are key locations for improving water, sanitation, and hygiene infrastructure to ensure that people who menstruate can change their menstrual materials in private when needed.

Without supporting infrastructure, women, girls and other people who menstruate can find themselves effectively shut out of public life, including from earning an income.

Strengthen knowledge of menstrual health and shift attitudes – people of all ages and genders need accurate information on menstruation, bodies, and hygiene. Schools and other educational institutions are one of the places where information can be shared, as studies show that students who menstruate often miss several days of school every month due to their periods.

Develop a strong design and monitoring framework –  to ensure projects and interventions improve gender equality and social inclusion, project teams must incorporate gender design features into a project design and monitoring framework, including on menstrual health, to ensure it isn’t overlooked. Even seemingly ‘small’ elements, such as ensuring toilets built or renovated under a project are responsive to the needs of people who menstruate, can make a big difference to a project’s impact. 

 Menstrual health needs to be mainstreamed into urban development, water, sanitation and hygiene programs and projects. It can be incorporated through physical improvements that focus on infrastructure, water supply, sanitation, and menstrual materials. 

It can also be incorporated through non-physical activities, including research, educational or training activities to support knowledge and practices, campaigns to shift mindsets and attitudes, and the strengthening of enabling environments. 

The inclusion of both physical and non-physical menstrual health activities is critical to the long-term success and sustainability of urban development, water, sanitation and hygiene programs. This is vital for the health and well-being of women, girls and others who menstruate.