Türkiye: UNFPA – Menstrual Hygiene Management among Refugee Women and Girls in Türkiye – September 2022 [EN/TR] – Türkiye
A. INTRODUCTION
For the first time in the Council’s history, the 50th session of the United Nations (UN) Human Rights Council included “a panel discussion on menstrual hygiene management, human rights and gender equality” under a separate heading. In his opening remarks on June 21, 2022, the UN High Commissioner for Human Rights noted that menstrual health is an inseparable part of sexual and reproductive health and rights, and is an important determinant for the realization of all human rights of women and girls in all their diversity, ensuring gender equality and Sustainable Development Goals.
There was a good reason for this speech and panel discussion. Menstruation, which is a natural fact of life, affects billions of people. The number of menstruating women and girls and menstruating LGBTI+ people in the world reaches 1.9 billion every month; this means that 800 million people between the ages of 15 and 49 menstruate every day.
Gender inequality, discriminatory social norms, cultural and religious taboos, poverty and lack of basic services lead to unmet menstrual needs.
Menstruating people, especially those living in developing countries or under unusual circumstances, before and after menstruation begins, do not have access to adequate information, educational opportunities, menstrual products they need, water, sanitation and waste infrastructure, and the right to live this period in a positive environment without discrimination. It is therefore time to break the silence on menstruation and recognize it as a human right, a gender equality and a public health issue.
Apart from the reports of international organizations evaluating their own activities on the issue and the studies carried out by non-governmental organizations (NGOs) on their target groups, our knowledge is based on a limited number of studies. Although we can only see the tip of the iceberg above the water, there is increasing interest in menstrual hygiene management information. This is because, although not explicitly stated, menstrual hygiene management is closely linked to Sustainable Development Goals (SDGs) 3 “Health and Quality Life”, 4 “Quality Education”, 5 “Gender Equality”, 6 “Water and Sanitation”, 8 “Decent Work and Economic Growth” and 12 “Responsible Production and Consumption”.
It is known that in some societies, instead of using explicit terms for menstruation, expressions such as “cycle”, “period”, “poverty” and even “curse” have been used for a long time. Similarly, expressions such as “period”, “being sick” or “visit from my aunt” are being used in Türkiye. In many societies of the world, menstruation is a cause of stigmatization and discrimination. Issues related to menstruation are considered “shameful” and taboo; menstruating people are considered “dirty” or harbingers of bad luck.
Such that, the adjective equivalent of the word “dirty” is defined as “a woman who is menstruating” in the dictionary of the Turkish Language Association.6 In some rural areas of India, women are considered dirty and impure “untouchables” during their menstrual periods. For women and girls, this results in a loss of self-esteem and exclusion from many aspects of social and cultural life. The restrictions imposed -limiting cooking activities for menstruating women, denying access to certain foods and reducing interactions with male members of their families, restrictions on worship- are widespread. It is known that at least three out of every four girls face a religious restriction in India.
During menstruation, prayers are not performed and the Qur’an is not touched. Similarly, Hindu girls are forbidden to pray and are asked to refrain from pooja (oblations/rituals). These restrictions can be such that menstruating women and girls are not allowed to walk in their own homes. They are forced to spend this period in some kind of out-of-home space or “menstrual hut”. In India, this practice has resulted in deaths of many girls due to snakebites and other causes.
In Nepal, a similar practice called “chhaupadi”, which has recently been banned but is believed to continue in rural areas, routinely exposes women and girls to the cold and increased risk of sexual violence and animal attacks.
“Menarche”, defined as the first menstruation, is an important biological milestone. Although it varies from person to person, it usually starts between the ages of 10-16.10 Menstruation is a new stage in a girl’s life but it also means new sensitivities and vulnerabilities. Therefore, it is very important for girls to be informed on the issue before their first menstruation. In major studies and systematic reviews, it was found out that only half of the girls have been informed about menstruation before menarche. In majority of the cases studied the source of information about menstruation is expressed as the mother.
Later on, information is obtained from other women in the family such as older sisters, aunts, and aunts-in-law. The Internet is rapidly becoming one of the most important sources of information. In a study conducted in Türkiye in 2019, it was assessed that the young people frequently use the web pages to reach health-related information; but approximately one-fourth of the information about menstruation viewed on the web pages was accurate, and a large part of the information was insufficient.13 In order to ensure that young girls maintain a healthy reproductive life, they should be equipped with accurate information on safe and hygienic menstrual practices, and this information should be provided continuously in such a way to address possible concerns and questions.
One of the most important issues during menstruation is access to the material related to the blood absorption. There are many studies revealing that sanitary pads are the most preferred menstrual product for women and girls. However, what is available is not always what is preferred; and in many cases, there is a shortage of materials. Many low-income women and girls have problems when buying menstrual products. Described as “menstrual or period poverty”, this situation also refers to the increased economic vulnerability that women and girls face when trying to obtain essential items such as pads, tampons and underwear during their periods. A recent systematic review of data obtained in Ethiopia showed that young girls who do not receive an allowance from their parents are 49% less likely to manage menstrual hygiene well than their peers who do.
Moreover, it is known that problems regarding the price of materials are not unique to low-income countries. A study conducted in Spain revealed that respondents’ choice of menstrual products was often influenced by price.Another study conducted in the UK in 2017 revealed that one in 10 girls could not afford the products and more than 137,000 children missed school days due to period poverty. In a study conducted in Türkiye, only one in four respondents reported that they never had difficulty when purchasing menstrual products. Three out of four respondents had difficulty in accessing menstrual products, albeit with varying degrees.20 Difficulty in obtaining menstrual products can keep women and girls out of school or work; which can have persistent negative consequences on their education and economic opportunities.
The most important environment for young girls outside home is the school environment. However, studies on schools have shown that access to hygiene facilities such as water, soap and trash bins with lids, as well as security facilities such as lockable doors are problematic issues in schools.
A study conducted in Nigeria in 2015 showed that only 42% of restroom cabins had functional locks and only 25% of schools had handwashing sinks and soap, while most cabins had broken doors and ventilated poorly. Similar situations exist in many low and middle-income countries. Unhygienic sanitation facilities and inadequate recreational facilities are not the only problems girls face in the school environment. Situations such as experiencing physical discomfort, being teased and feeling distracted in class are also common. Inability to manage their menstrual hygiene at school results in absenteeism, and consequently a downturn in educational achievements and dropping out of school.
The association of use of unhygienic material with urogenital infections in women and girls has also been studied. In a hospital-based case-control study in India, it was found out that use of reusable absorbent pads was associated with more symptoms of urogenital infection. This result was attributed to unhygienic conditions for cleaning and drying the materials. Therefore, the environmental conditions in which women and girls spend their menstrual periods, and access to water, soap and other hygiene facilities are determinants of the process in menstrual hygiene management.
Another important aspect of menstrual hygiene management is the waste disposal. Disposal of pads, cloths and other menstrual products is done by flushing them down the toilet directly or wrapped in bags/paper, or by dumping them in an indoor or outdoor sanitary waste system and by burying or incinerating them. Community beliefs also influence the way the women and girls dispose of menstrual products. In some places women burn their menstrual pads to avoid disrespecting animals or nature. In some communities, women believe that menstrual products should be buried to prevent them from being used for black magic or to prevent attraction of evil spirits.
Some communities also believe that improper disposal of these products can cause infertility.
With a management process that begins with access to information, millions of menstruating people can manage their menstrual cycle in a dignified and healthy way. Building on the WHO definition of health as “a state of complete physical, mental and social well-being” (WHO, 1946), menstrual health is considered to be “an encompassing term that includes both menstrual hygiene management (MHM) as well as the broader systemic factors that link menstruation with health, well-being, gender, education, equity, empowerment, and rights”.
Menstrual hygiene management is especially critical during humanitarian crises, when maintaining privacy is often difficult and hygienic facilities are limited. In humanitarian crises, the focus is primarily on the most immediate vital needs such as food, shelter and health. Menstrual hygiene management needs are often neglected. Yet, especially when on the move or displaced, women and girls often do not change their culturally appropriate clothing and hygiene items and may not be able to seek basic services, including humanitarian assistance.27 In some cases, the affected group is very large. For example, UNFPA estimates that 1.4 million women and girls of reproductive age were affected by the earthquake in Nepal in 2015. When asked about their needs, these women cited the need for menstrual products immediately after food products. It is known that women who have been living in refugee camps for years in Uganda sell their food supplies to meet their needs for pad.It was found out that almost half (46%) of Venezuelan asylum-seeking women and girls who crossed the border of Brazil did not have any hygiene items, more than half (61%) could not wash their hands when they wanted to, and three-quarters (76%) did not feel safe to use the toilets.
Türkiye, as the world’s largest refugee hosting country, hosts nearly 4 million refugees and asylum-seekers, 3.6 million of these are Syrians under temporary protection. One fourth of refugees are women and girls of reproductive age.30 UNFPA’s directive on sexual and reproductive health and gender-based violence provides the organization with an unequaled expertise and comparative advantage in integrating effective menstrual hygiene management into emergency programming.
UNFPA Türkiye, in cooperation with both international and local institutions and organizations, carries out projects in different regions of Türkiye to meet the ever-increasing need in the biggest humanitarian crisis of recent times, reaching especially women, girls and the most vulnerable groups to increase their access to rights and services, and to enable them to lead more equal, healthy and safe lives. It provides various services to refugees especially in reproductive health by establishing Women and Girls Safe Spaces (WGSS), which operate as primary health centers with specific clinical and psychosocial services, and organize empowerment activities for women and girls, and distribute hygiene kits, maternity and reproductive health kits through these centers.31 In relation to menstrual hygiene management, UNFPA considers the needs of menstruating women and girls as a fundamental right issue and is committed to create a world where no woman or girl is prevented from accomplishing her potential due to her menstrual period.
