London School of Hygiene & Tropical Medicine

In conversations about sexual and reproductive health (SRH) responses in crisis settings, I kept noticing how rarely menstrual health was mentioned. As a Sudanese woman who has worked on SRH responses in Sudan - during floods and, later, during the war - I had seen this absence firsthand. Across humanitarian contexts, menstrual health seemed to sit at the margins of the response. When it was mentioned, it was usually reduced to the provision of pads and treated as less urgent than other needs.

That gap stayed with me. I found myself wondering: do women and girls have a private toilet nearby? Is there enough water to wash? Somewhere safe to dispose of what they used? These questions led me to my MSc thesis, where I wanted to understand what menstrual health support actually looked like in humanitarian settings. My thesis mapped menstrual health interventions in humanitarian contexts, examining what support existed, how suitable it was for the women and girls it aimed to reach, and where gaps remained.

The most striking pattern was a mismatch between what was provided and what was needed. Many interventions focused on individuals, primarily through distributing menstrual products, while major challenges sat at higher levels: sanitation infrastructure, coordination, funding, and the wider conditions that allow women and girls to manage menstruation safely and with dignity. Even product-focused responses could fall short when products were culturally inappropriate, poor quality, or inconsistently distributed.

One of the clearest things the research reinforced for me was that dignity depends on practical conditions. In this context, dignity can mean having a toilet nearby with a working lock, enough water to wash, or products that are acceptable and usable. It can mean not having to choose between managing your period and protecting your safety.

I began my research expecting to learn mainly about existing services and gaps. While those questions remained important, I also began to think more deeply about how humanitarian responses decide what counts as a priority, and who has the power to define it. Menstrual health has often been treated as a secondary concern, and that deprioritisation reflects deeper questions about whose needs are centred in humanitarian response. Needs treated as less urgent are not necessarily minor; they are central to health, safety, and wellbeing.

Menstrual health does not fit neatly into one sector. Products, toilets, information, and safety can all sit in different parts of the humanitarian response. When they are not coordinated, the gaps fall on women and girls to navigate alone. A woman might receive reusable pads but have no access to clean water to wash them, or find that the only available toilets are shared, far away, or without privacy. Without clear coordination, menstrual health can become everyone’s responsibility and no one’s priority.

Coordination matters, but so does how responses are designed and by whom. In one setting, a washing space built specifically for women and girls went largely unused because women feared that spending time there would expose their menstrual status and lead to stigma or exclusion. In another, distributed sanitary pads were refused because of beliefs that they could cause infertility. Culture, beliefs, and social realities shape whether a response is used at all.

This research did not just deepen my knowledge of menstrual health responses in humanitarian settings. It showed me how easily a response can appear to address a need while still missing the conditions that make support suitable, dignified, and usable. The MSc Sexual and Reproductive Health Policy and Programming (online) met me where my questions already were and pushed them further, giving me frameworks to think more critically about how responses are designed, who they reach, and what they overlook. The questions I now carry into SRH, and wider public health work, are the same ones this research kept returning to: who helped define the problem, who helped shape the intervention, and who is still being overlooked? For me, equity in public health means more than addressing gaps; it means giving people the authority to define what they need and making their lived experiences central to how responses are designed.