Distribution of Menstrual Hygiene Management kits to female refugees in Greece


Sanitary pads are not life-saving items. However, their presence or absence can have a dramatic impact on women’s lives, especially during a time of crisis. Indeed, it has been argued that they can preserve a woman’s health and dignity, prevent some health issues, improve her overall wellbeing – making her more likely to be able to cope with a crisis situation. Unfortunately, feminine hygiene products are not yet systematically part of the hygiene kits distributed throughout the world by humanitarian organizations to populations affected by a crisis.

Women arriving in Europe from Syria[1] face a similar challenge. Many volunteers and aid workers have witnessed the needs of female refugees for feminine hygiene products, and some have tried to fulfill this need by setting up small independent distributions in gathering points, or “camps”. But nothing consistent and sustainable exists, especially for the women who are still travelling through Europe.

The project presented in this proposal aims to fill this gap in the humanitarian response offered to Syrian refugees arriving in Europe.


Women and children fleeing Syria now make up nearly 60% of refugee sea arrivals in Europe (UNHCRa). This number includes the female adolescent population (age 10-19[2]). Given the average menarche age worldwide is 13 years old (WHOb), many of these travelling adolescents will have to manage their first period while on the road. A lot of these women and adolescents travel alone or are accompanied by younger children, which increases their vulnerability to violence and its corollaries of injury, psychological trauma, and gynecologic/obstetric problems (Masterson et al. 2014).

According to most reports (see map below), Greece is the European country receiving the most refugees by sea. The main arrival sites are Lesvos (Moria), Samos and Chios (Vial, Souda). Refugees then usually go through pre-registration sites[3] on the Greek mainland.


Note: Despite Turkey being an important transit country for refugees fleeing the Middle East (some might spend several weeks in Turkey before reaching Greece), this project has decided to focus first on sea arrivals in Greece. We assume that: 1) by the time women reach Greece, it’s probably been several weeks since they’ve started their migration, which means that their supplies are likely running low, and/or they’ve experienced one or more menstruations while on the road 2) “sea arrivals” mean travelling with almost no luggage, which makes a distribution of supplies at arrival sites relevant.


Reproductive health (RH) problems are a leading cause of death and ill-health among women and girls of childbearing age; they increase during times of crisis due to system disruptions. There is a general agreement that RH care is an essential component of humanitarian response, which usually includes prenatal, emergency obstetric, newborn, family planning, safe abortion and response to Gender-Based Violence (GBV) services. However, evidence shows important gaps in implementation during times of crisis (Casey et al. 2015), and the menstrual hygiene aspect of RH is often neglected (Bayisabe 2013, Chapman & North 2015).

Research shows that providing women with basic sanitary supplies and education regarding menstrual hygiene management (MHM) can improve overall well-being, confidence, resilience, dignity, and prevent some reproductive health issues such as infections and GBV.

Education on MHM can not only prevent infections, such as vulvovaginitis (Attieh et al. 2016) and urinary tract infections (Das et al, 2015), but also improve overall health status of girls, self-esteem and sense of agency (Fakhri et al. 2012, Tegegne & Sisay 2014, Sommer et al. 2016).

Better understanding and ability to manage their menstrual hygiene has been shown to increase girls’ school attendance (Bayisabe 2013, Tegegne & Sisay 2014, Sommer et al. 2016) and focus on their studies – and decrease feeling of shame and overall stress (Tegegne & Sisay 2014, Sommer et al. 2016).

Providing segregated bathrooms, waste disposal facilities, proper supplies and private changing areas seem to decrease stress and bullying among adolescents (Fakhri et al. 2012, Tegegne & Sisay 2014, Sommer et al. 2016); in refugee camps, they also seem to lead to decreased GBV, as girls and women no longer wait until nightfall to use the bathrooms (Bayisabe 2013, Onyango 2013, Chapman & North 2015) or trade goods, foods, clothes, or sex for supplies (Bayisabe 2013, Onyango 2013, Tegegne & Sisay 2014, Chapman & North 2015, Sommer et al. 2016).

Why aren’t feminine hygiene supplies not yet a part of the standard hygiene kits? Some would argue that MHM is still a very sensitive – even taboo – subject, making it more difficult to discuss openly for aid organizations and women. However, as described above, choosing to ignore the subject out of comfort can have disastrous impacts on women’s physical and mental health, both short and long-term. Jyoti Sanghera, Chief of the UN Human Rights and Economic and Social Issues Section, said “the stigma around menstruation and menstrual hygiene is a violation of several human rights, most importantly of the right to human dignity” (OHCHR).

What is generally considered appropriate MHM? Simple things: water, soap, privacy, space to change, hygienic sanitary products, and spare cotton underwear (Sommer et al. 2016). Travelers and military personnel are usually given similar recommendations: wash your hands, drink plenty of fluid, pee whenever you need to, change your sanitary pads every 6 hours, wear cotton underwear, use wipes to stay clean if no water is available for shower (Trego & Steele 2015). In terms of supplies, disposable pads are the most common solution. Menstrual cups[4] represent another option if they can be maintained clean; though they may require training, they represent an interesting (and sustainable) ecological and finance-friendly option. Tampons, especially with applicator, are a good hygienic option. However, they may not be the preferred option for every woman (age and cultural preferences) and, like pads, require specific instructions for handling and disposal. There’s no formal or religious interdiction to using tampons for Muslim women.

Syrian women’s MHM needs were identified by using data from other research projects, testimonies from volunteers working with women refugees in Greece, similar interventions in other contexts, and reports from individuals or organizations which attempted distributions during this crisis in Europe. Ideally, more thorough research directly involving the affected women should be conducted prior to designing or implementing any intervention, but due to the nature of the target population (moving), this project will be adjusted based on feedback from beneficiaries as it is being implemented (see “Monitoring”).

Given all these parameters, this project seeks to distribute two travel kits for free: kit 1 and kit 2. A third travel kit could be introduced later based on the level of success of the first two kits, as it would require additional instructions and follow-up. Each woman chooses either kit 1 or 2.

Travel kit 124[5] disposable sanitary pads (different absorption capacities[6]). Perfume-free moist wipes . Hand sanitizer + Soap . Small plastic bags for disposal of the used pads . 2 cotton underwear
. Leaflet of information in English and Arabic on how to use the supplies and dispose of them . Condoms
Travel kit 220[7] tampons (different absorption capacities) 20 disposable panty liners
Travel kit 31 menstrual cup 20 disposable panty liners

Disposable pads and tampons are used by women and Syria and are widely available throughout Europe. Reusable sanitary cloth pads have been successfully tested in other emergency settings (IFRC in Burundi, Nepal, Malawi for instance), as well as in some current refugee camps among Syrian women (Matharu 2015, Days for Girls International 2016). They might represent a culturally adequate option for some of the women refugees, but they have been judged impractical for a moving population without consistent access to water.

The project and its strategy

The project intends to deliver free feminine hygiene kits to women and adolescent girl refugees through aid organizations already active in the field. The distributions would take place at migrant arrival and gathering points. If deemed suitable, pre-registration sites could also be used as distribution points in a second phase. (see Annex 1)

Its main objective is to alleviate stress and discomfort related to menstrual hygiene constraints for women during their migration travel by providing them with culturally and contextually appropriate feminine hygiene supplies. The long-term goal is to strengthen the female refugees’ resiliency through increased well-being, confidence and sense of dignity – allowing them to focus on more important and immediate migration-related issues (food, shelter, care of their families, protecting themselves, etc).

Indicators will include qualitative and quantitative data, such as direct feedback from women and statistics from partnering aid organizations partnering. (see Annex 2 and “Monitoring & Evaluation”)

In addition to distributing the kits, this project also intends to coordinate with actors already active in the field to set up Water & Sanitation (watsan), education activities, and health consultations/referrals at gathering points or camps. As mentioned before, all these aspects have demonstrated a positive impact on MHM and women’s well-being.

For watsan, this project will advocate for segregated and private bathrooms/changing areas with access to clean water at gathering points (camps, transit zones, etc). For education, this project will advocate for communication specialists and teaching professionals to set up education sessions for women and adolescents. The topics will cover basic physiology, hygiene measures, Sexually Transmitted Infections (STIs) prevention, pregnancy prevention, and GBV prevention. Women’s participation in educating other women/adolescents will be encouraged. For health, this project will advocate for a referral system for women disclosing symptoms of physical illness or psychological distress. Ideally, health professionals would also be able to offer pain relievers (for menstrual cramps), Emergency Contraception Pills (ECP), condoms, and restock the travel kits.

How will the kits be distributed?  Through organizations participating in the Menstrual Hygiene Day[8] project (specialized in one domain or several) and who are already active with refugees in Greece. If none of them can participate, the project will reach out to other multisectorial NGOs, such as Doctors of the World or Doctors Without Borders who have the capacity to cover all four aspects of the project (supplies, medical referrals, watsan and education). The main arrival sites, camps and pre-registration centers identified by the UNHCR (see Annex 1) will be used for data collection, additional distribution and follow-up of women and adolescent girls.

Distribution of MHM kits fits in the “Basic services and security” layer of the Intervention Pyramid for Mental Health and Psychosocial Support in Emergencies, since it addresses basic physical needs of women and female adolescents. If successful, this intervention will serve as an argument in favor of adding basic feminine hygiene supplies to any hygiene kit being distributed during an emergency situation. The proposed intervention seeks to “be established in participatory, safe and socially appropriate ways that protect people’s dignity, strengthen local social supports and mobilize community networks.” (IASC Guidelines 2007, pp.11-12)

As shown on the above representation, the project’s interventions primarily fit in the first layer of the pyramid, but also interact with the other layers through coordinated actions with partners. By doing so, all layers are covered, and the 6th Core Principle of the IASC Guidelines (Multi-layered supports) is respected.

Monitoring and evaluation

Based on the general objective of the project, data collected will be used to measure stress and comfort levels of women, and overall increased resilience.

We will use a mixed-method approach to gather feedback from beneficiaries and partner organizations; qualitative methods will include focus group discussions and face-to-face interviews, while quantitative methods will include statistics collected by each organization and questionnaires. Sample size will depend on the context in which data will be collected.

For example, self-administered questionnaires and face-to-face interviews conducted at distribution sites will provide baseline information. Feedback gathered through face-to-face interviews and focus group discussions at different moments of the women’s journey will be used to measure short-term and long-term impact of the project. (see Annex 3)

Comparisons will be made between the satisfaction levels of women having chosen kit 1 or 2, as well as between women having received a kit and those who have not yet. Another comparison will be made between the baseline feedback received when women received their first kit and feedback provided after using kits (short and long-term).

In order to ensure consistency, data collection and analysis will be handled by the authors of this proposal, in collaboration with the aid partners participating in the project. Findings will be shared with all the partners involved in the overall project.

If any data collection method proves to be inadequate or impossible to maintain, it will be reevaluated, and adjusted or removed. Everything will be available to the beneficiaries in their preferred language. Women will be made aware that their opinion regarding the distribution and supplies might be solicited at some point during their journey using FGDs, questionnaires, or interviews, but also that they are welcome to give their feedback at any moment. No one will be asked to give feedback unless proper support (psychosocial, health care, etc) is available. At evert encounter, women will be told where they can get refills, a new kit, and medical help. Any adjustment to the kits, distribution strategies, or data collection methods will be made collaboratively with the partners involved based on the women’s feedback.

These data collection methods should allow the project to measure its impact in the following ways:

Skills and knowledge: women and adolescent girls know how to find and handle the provided sanitary supplies and are able to pass on their knowledge. Health aid partners report a decrease in gynecological infections, unwanted pregnancies, and GBV acts.

Emotional wellbeing: women and adolescent girls report feeling more confident in their ability to cope with their situation, as well as being satisfied with the level of dignity experienced.

Social wellbeing: women report participating more in family/life activities, feeling freer to focus on other issues (children, health,…), and seeing improvement in the way they handle other migration-related issues.


Limitations of this project include the short-term nature of the intervention and its limited self-sustainability; beneficiaries are constantly moving (and may potentially cease to arrive), the distribution points might end up changing or disappearing, and kits will have to be regularly brought in from outside suppliers. This project represents a coordination challenge, as it involves multiple partners working together and sharing information. Accessing and approaching women to collect impact data might represent another challenge for the following reasons: multiple and continuously changing locations make it hard to keep track of people; survival of each individual is the priority, which means that the data collection 1) cannot get in the way of these aspects 2) will have to be stopped wherever these aspects are not ensured first. Ethically speaking, it might not be appropriate to harass refugees with surveys and requests for interviews when they have more important things to worry about. The data collected will be limited to MHM, as the questions will focus on menstruation-related concerns, and not on the overall migration experience (missed opportunity for the obtainment of valuable information on mental health issues?).

Finally, this project does not address the needs and role of men and boys, who should eventually be included in the project as well. For instance, including boys in basic sexual education can limit the bullying of girls regarding MHM issues (Sommer et al., 2016).

In conclusion

This project should be supported because it addresses a neglected aspect of reproductive health, and the needs of a usually neglected population: adolescents. Evidence shows that helping women manage their menstrual hygiene can positively affect their overall health and wellbeing, and ultimately the community they live in. The project takes all the IASC core principles (Human rights and equity, Participation, Do no harm, Build on available resources and capacities, Integrated support systems, Multi-layered supports) into consideration.

Because menstruation concerns matter in relation to several Sustainable Development Goals[9], MHM is slowly becoming discussed among (and sometimes integrated) aid organizations. This project, in addition to responding to proven needs, could be an innovative way to contribute to the global effort.

Annex 1 – Distribution strategy

Annex 2 – Objectives and indicators

ObjectivesIndicatorsSource of information 
How are we going about achieving this? Distribution of sanitary supplies through the intermediary of already working aid organizations   Long-term = systematic inclusion of menstrual hygiene management (MHM) kits in basic hygiene kitsWhat would success look like? S&K = kits are being distributed à how many? EWB = the need for MHM is being actively included in discussions and health/watsan projects = increase awareness and action in the aid community SWB = MHM kits have become a part of basic hygiene kits  How would you measure this? S&K = daily, weekly, monthly statistics from organizations taking part of the project EWB = weekly/report from organizations SWB = listing of what is included in an organization’s hygiene kitsOutputs
How will individuals be different at the end of the project? Women will have access to appropriate supplies, leading to improved hygiene and decreased gynecological infectionsWhat would success look like? S&K = % of women receiving a kit out of all the women arriving at one particular site will increase + number of infections will decrease (might increase in the first place due to increased access to proper healthcare) EWB = women will report being satisfied with the type and amount of supplies provided (including access to water and private changing areas) SWB = women and adolescent feel comfortable managing their period regardless of their current situation (report a decrease in the potential shame or physical discomfort experienced before)    How would you measure this? S&K = comparison of statistics collected by aid organizations EWB and SWB = feedback gathered by staff at different sites + through self-administered questionnairesOutcomes
What overall change do we aim for in individuals’ lives? Decrease overall stress related to menstrual hygiene management in order to strengthen the refugees’ resilienceWhat would success look like? S&K = women and female adolescents will know how to find and handle the provided sanitary supplies and are able to pass on their knowledge + health partners report a decrease in infections, unwanted pregnancies, and GBV acts. EWB = women report feeling more confident in their ability to cope with their situation + report being satisfied with the level of dignity experienced SWB = women report participating more in family/life activities + feeling freer to focus on other issues (children, health,…) + seeing improvement in the way they handle other migration-related issuesHow would you measure this? S&K = reports and statistics from aid organizations + feedback from women EWB = ideally, from direct feedback from women at different moments in their journey SWB = In a later phase of the project, ideally among refugees who have been able to resettle somewhere, from direct feedback    Impacts

S&K: skills & knowledge, EWB: emotional wellbeing, SWB: social wellbeing

Annex 3 – Data collection

 Quantitative methods
Which methodQuestionnaires (administered by trained staff)Self-administered questionnairesStatistics from partners
Why?. Could allow the use of more specific measure tools, such as the HSCL25[10] to measure psychological distress . Used if self-administered questionnaires don’t provide enough quality data. Practical, could be distributed with each kit. Will have direct access to the women, either through the distribution of kits or specialized services
Sample size At least 80 for baseline data and 80 having used the kitsN/A
Sample selection Available menstruating women and adolescent girls (cluster sampling)N/A
Where will it be administered?   . At distribution sites à baseline data . At gathering sites à comparison before/afterWeekly and monthly statistics and activity reports
Examples of questions   . Menstruation-related stressors . Basic mental health measures (anxiety, depression, psychological distress, etc) and history of mental disorder . Grading of current comfort level regarding MHM . Other concerns?. Number of kits distributed . Referrals (kinds, numbers, etc) . Number of diagnosed gynecological infections
 Qualitative methods
MethodFocus Group Discussions (FGDs)Face-to-face interviews
Why?. Most appropriate for group feedback and indicators of wellbeing . Might create new ties among the participants . Limit the obtrusiveness of questions . Allow to gather women by age groups if needed  . Allow to go deeper into individual stories and obtain insight on the “whys” . More private than focus groups
Sample sizeUntil saturation is reachedUntil saturation is reached
Sample selectionSnowballing samplingSnowballing sampling
Where will they be administered?. At gathering sites . Can include both women who have received a kit and some who haven’t . Short term impact (<3 mo) . Long term impact (>3 mo). At distribution sites . Baseline, when they receive their 1st kit. At gathering sites . After using the kits . Short term impact (<3 mo) . Long term impact (>3 mo)
Examples of questions. Definition of wellbeing . What strategies have you found to manage your menstrual hygiene? . What would you focus on if you didn’t have to worry about MHM? . Feedback on leaflet, supplies, distribution strategies, education, watsan, etc . Reasons for choosing kit 1 or 2 . Evolution of migration-related concerns. Comfort level . Stress level . Personal definition of well-being . (Migration-related) concerns . Expectations

Annex 4 – Menstrual Hygiene Management



ATTIEH, E., MAALOUF, S., ROUMIEH, D., ABDAYEM, P., ABITAYEH, G., and KESROUANI, A., 2016.  Feminine hygiene practices among female patients and nurses in Lebanon. Reproductive Health [online]. May, 13:59. [viewed 18 June 2016]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876556/pdf/12978_2016_Article_182.pdf

CASEY, S.E., CHYNOWETH, S.K., CORNIER, N., GALLAGHER, M.C., and WHEELER, E.E., 2015. Progress and gaps in reproductive health services in three humanitarian settings: mixed-methods case studies. Conflict and Health [online]. February, 9 (suppl 1);S3. [viewed 18 June 2016]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4331815/pdf/1752-1505-9-S1-S3.pdf

DAS, P., BAKER, K.K., DUTTA, A., SWAIN, T., SAHOO, S., DAS, B.S., PANDA, B., NAYAK, A., BARA, M., BILUNG, B., MISHRA, P.R., PANIGRAHI, P., CAIRNCROSS, S., and TORONDEL, B., 2015. Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India. PLos One [online]. June, 10(6). [viewed 18 June 2016]. Available from:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488331/pdf/pone.0130777.pdf

Days for Girls International, 2016. Reusable feminine hygiene for Syrian refugees. Global Giving [online]. [viewed 23 June 2016]. Available from: https://www.globalgiving.org/projects/reusable-feminine-hygiene-for-syrian-refugees/

FAKHRI, M., HAMZEHGARDESHI, Z., HAJIKHANI GOLCHIN, N.A., and KOMILI, A., 2012. Promoting menstrual health among persian adolescent girls from low socioeconomic backgrounds: a quasi-experimental study. BioMed Central Public Health [online]. March, 12:193. [viewed 18 June 2016]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348061/pdf/1471-2458-12-193.pdf

Inter-Agency Standing Committee (IASC), 2007. IASC Guidelines on Mental Health and Psychosocial Support in Emergency Situations. Geneva: IASC.

International Federation of Red Cross and Red Crescent Societies (IFRC):

KANE, J., 2015. Here’s how much a woman’s period will cost her over a lifetime. Huffington Post [online]. [viewed 2 July 2016]. Available from: http://www.huffingtonpost.com/2015/05/18/period-cost-lifetime_n_7258780.html

MASTERSON, A., USTA, J., GUPTA, J., and ETTINGER, A.S., 2014. Assessment of reproductive health and violence against women among displaced Syrians in Lebanon. BioMed Central Womens Health [online]. February, 14:25 [viewed 22 June 2016]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929551/pdf/1472-6874-14-25.pdf

MATHARU, H., 2015. The sanitary pad missionary bringing dignity and employment to Syria’s female refugees. Independent [online]. [viewed 1 July 2016]. Available from: http://www.independent.co.uk/news/uk/the-sanitary-pad-missionary-bringing-dignity-and-employment-to-syrias-female-refugees-a6760741.html

Menstrual cup:

Menstrual Hygiene Day:

SOMMER, M., CARUSO, A.B., SAHIN, M., CALDERON, T., CAVILL, S., MAHON, T., and PHILLIPS-HOWARD, P.A., 2016. A time for Global Action: addressing girls’ menstrual hygiene management needs in schools. Plos Medicine 13(2) [online]. [viewed 18 June 2016]. Available from: http://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1001962

Sustainable Development Goals (SDGs), 2016. 17 Goals to transform our world [online]. [viewed 3 August 2016]. Available from: http://www.un.org/sustainabledevelopment/sustainable-development-goals/

TEGEGNE, T.K., and SISAY, M.M., 2014, Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia. BioMed Central Public [online]. September, 14:1118. [viewed 18 June 2016]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232635/pdf/12889_2013_Article_7224.pdf

TREGO, L., and STEELE, N., 2015. Maintaining Women’s Health During Deployment, Tips for the female Soldier. US Army [online]. [viewed 22 June 2016]. Available from: https://www.army.mil/article/149411/Maintaining_Women_s_Health_During_Deployment__Tips_for_the_female_Soldier

United Nations Office of the High Commissioner Human Rights (OHCHR), 2016. Every Woman’s right to water, sanitation and hygiene, 2014 [online]. [viewed 22 June 2016]. Available from: http://www.ohchr.org/EN/NewsEvents/Pages/Everywomansrighttowatersanitationandhygiene.aspx

United Nations High Commissioner for Refugees (UNHCR):

World Health Organization (WHO):

[1] Target population, but intervention is not limited by the criteria of origin. Any woman refugee would be included.

[2] According to WHO, adolescents are young people between the ages of 10 and 19 years (WHOa).

[3] The pre-registration exercise was launched on 8 June by the Greek Asylum Service, with UNHCR and EASO’s support. It aims to preregister applications for international protection, as well as to pre-identify potential candidates for family reunification or relocation. (UNHCRb)

[4] The menstrual cup (Mooncup, DivaCup) is designed to be folded and inserted into the vagina, then removed, rinsed and reinserted up to every 8 hours. It can be used overnight and when travelling, swimming or exercising.

[5] Amount of pads required on average to allow a change at least 3 times a day for 5-6 days, regardless of the menstruation’s intensity.

[6] In order to fit most women’s cycle variations and cultural preferences

[7] Average amount of tampons required per cycle (Kane 2015)

[8] Initiated by WASH United in 2014, Menstrual Hygiene Day builds awareness of the fundamental role that good menstrual hygiene management plays in helping women and girls reach their full potential. WASH United has forged an alliance of currently 380 partners worldwide – including Mooncup, WaterAid, Save the Children and USAID. (MHDa)

[9] SDGs 3 (Good Health and Well-being), 4 (Quality Education), 5 (Gender Equality), 6 (Clean Water and Sanitation)

[10] The Hopkins Symptom Checklist-25

All papers are written by ENL (US, UK, AUSTRALIA) writers with vast experience in the field. We perform a quality assessment on all orders before submitting them.

Do you have an urgent order?  We have more than enough writers who will ensure that your order is delivered on time. 

We provide plagiarism reports for all our custom written papers. All papers are written from scratch.

24/7 Customer Support

Contact us anytime, any day, via any means if you need any help. You can use the Live Chat, email, or our provided phone number anytime.

We will not disclose the nature of our services or any information you provide to a third party.

Assignment Help Services
Money-Back Guarantee

Get your money back if your paper is not delivered on time or if your instructions are not followed.

We Guarantee the Best Grades
Assignment Help Services