College of Public Health, Medical and Veterinary Sciences

Publish Date

12 August 2019

Empowering women in crisis

Many female humanitarians are unsung heroes; they are the first to respond to crises and the last to leave, often risking their own lives to save others.

Over the past 20 years, JCU Senior Lecturer Sandra Downing has done humanitarian work in emergency, conflict and natural disaster settings across the world.

Currently, Sandra is collaborating with the Vanuatu Red Cross Society and the Vanuatu Red Cross Society to create a menstrual hygiene management (MHM) kit for women to manage their menstruation with safety and dignity in emergencies.

“Vanuatu is one of the most natural disaster-prone countries in the world,” Sandra said. “When women are displaced, they need access to sanitary materials and other commodities that will help them manage menstruation in a dignified and safe manner. The Vanuatu Red Cross Society is committed to developing a MHM kit for women, ready for distribution when an emergency happens.”

Curating a crisis response

Vanuatu is made up of more than 80 small islands that regularly experience natural disasters, including volcanic eruptions, cyclones, earthquakes, tsunamis, storm surges, coastal flooding, and landslides.

According to Sandra, the urgent need for a MHM kit was recognised by a Vanuatu Red Cross health coordinator after the most recent series of natural disasters.

“The Vanuatu Red Cross Society has a very good health coordinator who recognised the need to support displaced women in managing their menstrual hygiene,” Sandra said.

“Currently, family kits that do contain some sanitary materials are distributed to displaced and impacted families, but it’s not a targeted approached. You could have a family with no menstruating women or a family with six daughters who are menstruating both receiving the same kit.

“The Vanuatu Red Cross is aiming to prepare menstrual hygiene kits so that when a disaster occurs, the kits are ready to be distributed to each individual menstruating woman,” Sandra said.

“Before putting the kits together, it is important to talk to women about what should be included.”

Sandra is leading a research project to determine the sanitary protection needs and preferences of women and girls in Vanuatu. She will also explore the socio-cultural aspects of menstruation likely to impact menstrual hygiene management in disaster settings.

“We have recruited nearly 200 women in a range of age groups and marital statuses across four locations. Those women have been given one of four different sanitary products, two re-usable and two disposable, to trial for us over two months.”

This month, Sandra will travel to Vanuatu and work with Vanuatu Red Cross Society staff and volunteers to conduct a number of focus groups with participants.

“Apart from sanitary product preferences, we will be asking the participants about other items that should be included in an MHM kit and things that may impact on their ability to manage menstrual hygiene in the context of a disaster,” Sandra said.

“We will also be talking to a number of women and girls with disabilities so that their unique needs are also captured in the study.  The outcomes of this research will not only inform the content of the MHM kits but will also identify opportunities for the Vanuatu Red Cross Society to strengthen their programming and interventions to support girls and women in the safe and dignified management of menstruation in an emergency setting."

“When women are displaced, they need access to sanitary materials and other commodities that will help them manage menstruation in a dignified and safe manner.”
Sandra Downing, Senior Lecturer

Five people holding rainbow umbrellas and walking along a path surrounded by green rainforest.
Satellite view of a tropical cyclone showing a swirl of white and grey clouds.

Primarily, humanitarian organisations focus on providing water and sanitation during crises, and menstrual hygiene remains a neglected area of disaster preparation and management.

“Menstrual hygiene management is part of many aspects of the disaster management cycle. You need to consider access to private and safe female-friendly toilets and bathing facilities and disposal options for used sanitary materials or washing and drying of re-usable products.

“Education and practical information on menstrual hygiene management is important, particularly for adolescent girls who may have very limited knowledge about menstruation due to societal taboos, secrecy and embarrassment. Understanding the socio-cultural aspects of menstruation prior to a disaster is vital so that responses are appropriate and supportive.”

The results of the study are published in "Menstrual hygiene management in disasters: the concerns, needs, and preferences of women and girls in Vanuatu".

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Sandra Downing

Senior Lecturer

Sandra Downing is a registered nurse, midwife and field epidemiologist with particular interests in public health in emergency settings, women’s and children’s health in low resource settings, and sexual and reproductive health.

As a field epidemiologist, Sandra works with the World Health Organisation (WHO) in outbreak responses and training/capacity building through the Global Outbreak and Response Network (GOARN). She has also worked in humanitarian emergencies with Medecins sans Frontieres (MSF) implementing mortality and communicable disease surveillance, responding to outbreaks and conducting food and livelihood security surveys.

Recent research includes a collaboration with the Australian and Vanuatu Red Cross to support menstrual hygiene management in disaster preparedness and response activities. Current research collaborations include an exploration of unintended pregnancy prevention and care education in undergraduate nursing and midwifery programs, women’s experiences of abortion care in north Queensland and improving access to unintended pregnancy care in the region.