COVID-19 and Menstruation – what are the challenges?

YOU CAN DOWNLOAD THIS FAQs HERE

This mini-FAQ is being updated as we get new information and comments. At this point, the scientific evidence is limited, so we also use informal sources such as media as well as our own observations in WoMena’s work.  Comments, questions, corrections are welcome.

• Health workers: an estimated 70% of 400 million health workers globally are women (WHO, 2019). In the Chinese province of Hubei, where Wuhan is the capital, 50% of the doctors and 90% of the nurses are women. They have reported challenges related to managing their menstruation while fighting COVID-19, e.g. following safety protocols removing and replacing protective suits to change menstrual products (Li, 2020). Some suppressed menstruation by using oral contraceptive pills, or bled directly into their protective suits (ibid).
  Initially, male hospital managers reportedly turned away donations of menstrual products to hospitals of menstrual products ( Reuters, 2020;  Li, 2020). This was reversed when there was a public outcry, and resulted in Chinese authorities sending menstrual products to hospitals for staff and patients as a part of their COVID-19 critical medical supplies ( UNFPA, 2020; Zhou, 2020).
• Panic buying of supplies: Around the world, there has been high profile ‘panic buying’ of toilet paper. Lower profile, there has also been bulk buying of menstrual products such as pads. Users are reported to be looking for more long-term solutions, such as washable menstrual pads and panties, or cups (New York Times, 2020; MSN, 2020; Lifestyle, 2020).
• Gender based violence (GBV): One finding from  WoMena projects is that GBV sometimes arises in the home because men think their partners are using too much money or other resources on getting menstrual products (WoMena, 2018; FAQ GBV, forthcoming). For example, a study from a refugee settlement in Uganda reported that women cut up distributed blankets to make pads, and this resulted in their partners beating them (CARE International & WoMena Uganda, 2018).

This might be exacerbated with COVID-19. There are widespread reports from around the world that, as couples are isolated in their homes in order to limit the spread of COVID-19, domestic violence is increasing dramatically (the Guardian). This includes women reporting that their partners are withholding access to hand sanitizer and soap, as an issue of control (The hotline, 2020). That is, violence of various forms is increasing, and this may be exacerbated as menstrual products become more scarce, and control becomes more possible.

• Disability: Likewise, special challenges may be faced by menstruators with physical or mental disabilities. Menstruators often need caretakers to help them change products, e.g. fathers who replace a daughter’s tampon or pad. Managing this close contact is already a challenge, and may be exacerbated (Rasanathan et al, forthcoming).
• Humanitarian situations: Until recently, attention to menstruation was often considered a low priority in humanitarian settings, but this is changing, and provision of menstrual products is now a minimum standard, at least in the early stages of an emergency (Tellier & Hyttel, 2018; Sphere, 2018 ). However, supply chains are challenged for all products, including menstrual products. Beyond products, the education/participation of communities is also interrupted. Humanitarian actors, as always, are finding ways to work around this (Farrington, 2020; Wilson-Smith,2020). See below for some of WoMena’s approaches.
• Menstrual irregularities – stress, food shortages: there is evidence that stress exacerbates menstrual irregularities. Such irregularities are a prime concern for menstruators (WoMena FAQ, 2018). COVID-19 is reportedly leading to increased levels of stress, in turn leading to increasing irregularities (National post, 2020).
  With respect to food, lack of food is a major reason for menstrual irregularities in low resource settings (WoMena FAQ, 2018, Jahangir, 2018). For example, WoMena has observed that women in the Karamoja Region of Uganda have difficulty accessing food, due to shortages and reduced incomes, and that this is leading to more irregular, if any, menstruation.
• WoMena’s contribution: WoMena works in a wide range of contexts in Uganda, including refugee settlements. In the COVID-19 crisis, we find the use of washable and reusable products such as cups or pads even more relevant, as they are less dependent on the supply chain.
  We are stepping up the use of distance learning and participation to work around the need for social distancing. We have of course instituted contingency plans for staff, consistent with Government guidelines.

The researchers for this article were Siri Tellier, with major input by Marianne Tellier and Andisheh Jahangir. Please direct any questions or comments to andisheh.jahangir@womena.dk

Full referencing has not always been possible.

• SuSana Forum
• Columbia University Period Posse: “What Do We Need To Consider During COVID-19”
• UNICEF Brief: Mitigating the impacts of COVID-19 on menstrual health and hygiene
• Global menstrual collective: COVID-related resources 
• Days for Girls COVID-19 response
• WASH United’s Global comic on Coronavirus for Kids
• Survey by MH Alliance India, RHSC and ACMHM on the impact of lockdowns on              

menstrual product supply

• Article on menstrual health needs of frontline workers
• Feminist responses to Covid19 by GADN
• Oxfam guidance on staff protection during COVID-19
• Period Poverty in Germany during COVID-19
• Putting equality, inclusion and rights at the centre of a COVID-19 water, sanitation and hygiene response
• MHM in Emergencies Toolkit
• The RHSC menstrual health workstream meeting (May 6) will be discussing COVID’s impact on supply chains
• Analysis of inclusion of disability during COVID

Forthcoming:

• Rasanathan Jennifer, J. K., Andisheh Jahangir, Mary Grace Sandy, Marianne Tellier, and Siri Tellier (WoMena). forthcoming. Doubly Left Behind at the Intersection of Disability and Menstruation. Manuscript submitted for publication.
• WoMena, forthcoming. FAQ- What are the links between menstrual health management (MHM) and gender-based violence (GBV)