Menstruation, Gender & Sanitation


A number of areas requiring further investigation have been identified by the research team and their global collaborators related to menstruation, reproductive health, and girl's and women's water and sanitation needs.  This includes topical areas that have to date received minimal attention but are in need of resources for research, programming and policy in order to improve the lives and well-being of adolescent girls and women around the world.


Menstrual Hygiene Management in Emergencies

The program has conducted extensive research on the area of MHM in humanitarian emergencies, in collaboration with the International Rescue Committee and a range of global humanitarian actors. This initiative included a range of research activities and the development of a practitioner-focused toolkit resource.  Click here to learn more about the research learning and guidance resources developed on MHM in emergencies.

Photo: IRC health staff providing menstrual materials & supplies to Burundian refugees upon arrival to Tanzania.


Menstrual Hygiene Management in the Workplace

There is increased attention towards addressing the menstrual management related needs of girls and female teachers within schools in low-income contexts.  However there exists little attention to the MHM challenges confronting working girls and women, including those in both the informal and formal sectors in low- and middle-income countries. Women of reproductive age (~12 to 49 years) represent a significant and rapidly growing segment of the 1.2 billion women employed globally (International Labor Organization, 2009), with women representing nearly half of the global labor market (Aguayo-Tellez, 2012). This is a critical neglected issue that profoundly affects women’s inclusion within the global economy. Understanding the MHM-related water and sanitation realities of women working outside the home is essential for developing appropriate advocacy and policy to advance women’s human rights, improve their economic potential and capacity, and ensure their personal safety.


Schmitt, M., Clatworthy, D., Ogello, T., Sommer, M. (2018). Making the Case for a Female-Friendly Toilet. Water, 10(9), 1193. 

Sommer, M., Chandraratna, S., Cavill, S., Mahon, T., Phillips-Howard, P. (2016). Managing menstruation in the workplace: an overlooked issue in low- and middle-income countries. International Journal for Equity in Health, 15, 86.


Sommer, M. 'Why Female-Friendly Toilets Need To Become a Hot News Topic.' (2018). NewsDeeply. 

Sommer, M. ‘World Bankers: Please Study Menstruation Costs.’ (2015). Women’s e-news.


Beyond Menstruation: Other Types of Vaginal Bleeding

Girls and women experience numerous types of vaginal bleeding over their life course including bleeding related to menstruation, pregnancy and that occurring from specific health conditions such as fibroids or cancer.  Women are likely to experience episodes of bleeding for 4–6 weeks following a miscarriage and 4 weeks postpartum (Visness, Kennedy & Ramos, 1997). This has particular significance for women in low and middle-income countries with high fertility rates. It is also estimated that 5%–15% of women of reproductive age globally have abnormal uterine bleeding which can occur prior to menarche, and both before and after menopause (Harlow and Campbell, 2004). While significant taboos remain around menstruation, even more secrecy exists around the other types of vaginal bleeding that girls and women must manage, either in their homes and communities, and beyond that, rarely in research or practice.  Yet these various forms of vaginal bleeding, some needing more frequent management than others, require access to information, supplies and clean, safe, private water and sanitation facilities. There is an urgent need for increased research, policy and practice on this neglected topic as it can impact girls and women’s ability to confidently and comfortably conduct their daily activities of living, including participating in school or work, going to the market or fetching water. 


Sommer, M., Phillips-Howard, PA., Mahon, T., Zients, S. Jones, M., Caruso, BA. (2017). Beyond menstrual hygiene: addressing vaginal bleeding throughout the life course in low and middle-income countries. BMJ Global Health, 2 (2), e000405.