Menstrual Health Management in the Context of Migration

Introduction. General context and the main objectives of the Analysis

This analysis is conducted with the aim of thoroughly examining the capacity for menstrual health management at both national and European levels, with a particular focus on the phenomenon of migration. Social, cultural, and religious restrictions represent significant barriers to the effective management of menstrual hygiene. Girls and women are often insufficiently prepared or informed about the menstrual cycle, which leads to numerous difficulties and challenges within the family environment, at school, and in the workplace, especially in disadvantaged areas. In most cases, women possess incomplete or inaccurate information regarding menstruation, which constitutes a major obstacle in managing potential risks related to personal health and hygiene (Kaur et al. 2018). These challenges are further compounded by limited access to sanitary products and to information on their proper use due to high costs.

In the following subchapters, I will present essential data concerning the definition of the core elements of menstrual health management, hygiene products, and institutional perspectives on this topic, which remains deeply stigmatized, with particular emphasis on the specific vulnerabilities of migrant and refugee women. Additionally, the report aims to discuss the recommendations proposed at the level of the European Union, which seek to harmonize developments in the field of menstrual hygiene, while analyzing, in a practical manner, their impact on populations experiencing mobility, especially within the national context of Romania. Finally, I will formulate a series of conclusions and recommendations intended to raise awareness of the issue and of its influence on the well-being, social inclusion, and equitable access to health services of migrant women.

Legislative Framework. Relevant National and International Legislation

In 2021, the Committee on Women’s Rights and Gender Equality of the European Parliament published a Proposal regarding the situation of sexual and reproductive health and related rights in the EU, in the context of women’s health, which emphasizes the need for safe, equitable, and circular access to menstrual hygiene products (European Parliament 2021). The report recognizes menstrual products as basic necessities for every woman and proposes a minimal set of solutions to improve universal access to them. When applied to migrant populations, these groups often face the inability to invest in menstrual health or to purchase products necessary for adequate hygiene. Furthermore, menstrual education programs are limited or entirely absent in educational institutions across the European Union, particularly in less developed states. In most cases, such initiatives are facilitated by international organizations such as the Red Cross, the World Health Organization (WHO), or UNICEF.

WHO commits to eliminating the stigma associated with menstruation and to making schools, healthcare facilities, and workplaces more receptive to new menstrual health initiatives (World Health Organization 2022). In 2022, the organization issued a statement on menstrual rights, calling for menstrual health to be recognized, framed, and addressed as a human rights issue rather than merely a hygiene issue (World Health Organization). Section 24 of the proposal “urges Member States to encourage the large-scale availability of non-toxic and reusable menstrual products” (European Parliament 2021). In this way, the resolution draws attention to the composition of menstrual products, which may cause irritation, allergies, or, in rare cases, toxic shock syndrome (TSS). It is particularly important to ensure that migrant and refugee women are informed about the risks associated with the use of disposable sanitary pads, which may contain harmful chemical substances (pesticides, dioxins, and synthetic compounds). Section 25 “calls on all Member States to abolish the tax on sanitary products,” advocating for the application of a 0% VAT rate to these essential goods for menstrual hygiene (European Parliament 2021). As such, menstrual products should be classified as essential and indispensable goods, which implies eliminating VAT in order to make them accessible even to individuals with minimal incomes. We observe an intensification of the phenomenon of menstrual poverty, particularly among women, particularly migrant and refugee women, referring to the difficulty or impossibility of affording menstrual hygiene products. Consequently, the European Parliament’s proposal seeks to harmonize the costs of hygiene products at the lowest possible level. Moreover, it aims to slow the perpetuation of a form of gender inequality. Given that the majority of consumers are women, maintaining VAT and, implicitly, high prices for menstrual products is interpreted as a form of economic discrimination.

While recommendations exist at the European Union level, Romania has demonstrated insufficient progress regarding menstrual education and access to hygiene products. Most information received by young women in Romania concerning menstrual hygiene comes from the family, with informal narratives often shaped by conservative and religious views (Plan International 2024, 17). Such information is rarely institutionalized, and the decision to address menstruation with pupils or students is left to the discretion of individual educational institutions. In this regard, a recent survey conducted by Plan International Romania on sexual and reproductive health and rights (SRHR) found that only 25% of the 300 respondents had received any information or support regarding menstruation in schools (2024, 18). While these data indicate a low level of education, they also invite further scrutiny: information may sometimes be delivered by untrained educators, potentially exacerbating the situation through the perpetuation of misinformation and harmful prejudices.

Analysis of the Current Situation for the Target Population

According to data published by UNICEF in 2019, menstruation is a natural biological process for approximately 1.8 billion girls and women worldwide, millions of whom are deprived of the ability to manage their menstrual cycle in a dignified and healthy manner (13). Gender inequality, discrimination, and stigma are perpetuated across generations, while the inability to access pain relief methods, lack of knowledge regarding fertility periods, poverty, and the absence of fundamental health services often lead to unmet basic needs in terms of menstrual health. In the UNICEF guide on menstrual health management, a series of systemic factors are identified that could significantly improve the situation: accurate knowledge, universally available materials, adequately informed professionals, access to healthcare services, sanitary facilities, supportive social norms, the reduction of pollution generated by improper use of menstrual products, advocacy actions, and the development of policies aligned with the needs of girls and women (2019, 13).

Furthermore, at a broader level, the field of menstrual health aligns with several Sustainable Development Goals outlined in the 2030 Agenda. Stress and shame associated with menstruation can negatively affect mental health, while inadequate sanitary products may increase the risk of reproductive tract infections, thus hindering the achievement of Goal 3 (Good Health and Well-being). Girls may be inclined toward school absenteeism during menstruation due to insufficient institutional support, affecting Goal 4 (Quality Education) and, implicitly, Goal 8 (Decent Work and Economic Growth). Moreover, Goal 5 (Gender Equality) cannot be achieved when stigmatized ideas prevent women and girls from fully participating in societal activities. Additionally, the inability to develop markets for quality menstrual materials may impact Goal 12, which focuses on sustainable consumption and production patterns (UNICEF 2019, 15).

Political structures at the state level should pay greater attention to menstruation as part of a broader framework of sexual and reproductive health for internally displaced persons, individuals crossing borders to escape persecution, or those who migrate for various reasons (World Health Organization 2022). Governments and international organizations must include menstrual health education as an integral component of humanitarian responses, as the lack of adequate menstrual hygiene can profoundly affect self-esteem and mental health. In many cases, women and girls are isolated or excluded from everyday activities, perpetuating cycles of poverty and inequality among migrant and refugee populations and deepening existing social disparities related to migration.

Initiatives and Good Practices

The perpetuation of erroneous and misinformed beliefs can be reduced through adherence to European standards and by following models from states that have successfully implemented effective projects within educational institutions. Close collaboration with non-governmental organizations, composed of experienced individuals trained to support marginalized groups, is essential (Plan International 2024, 27). Relevant examples include Filia Centre, the Iele-Sânziene Association, and Pe Stop, the latter having implemented the project “A Drop of Dignity,” which involves distributing menstrual hygiene kits to women in disadvantaged areas (Pe Stop 2024). Pe Stop is committed to combating menstrual poverty by offering courses for individuals of all ages, regardless of income or community background (Pe Stop 2023, 3). Given that migrant and refugee women face heightened financial challenges, such civil society initiatives are crucial in improving their menstrual experiences. However, NGOs face limited resources, which can significantly constrain the scale of their impact.

A study conducted by Plan International highlights the persistence of systemic inequalities that have resulted in low levels of inclusion within appropriate healthcare services. More specifically, access to menstrual products in schools remains difficult due to bureaucratic obstacles hindering the development of menstrual hygiene management policies (2024, 29). Additionally, the stigmatization of this topic in the public sphere further exacerbates menstrual poverty, school absenteeism, and the perpetuation of gender inequalities.

One of the civil society initiatives aimed at generating change at the national level is the Absorbante Gratuite. Inclusive Schools platform, financed by the European Union and implemented by the Iele-Sânziene Association. This initiative was created in order to facilitate the access to menstrual products in public schools in Romania and to raise awareness of the importance of menstrual health. Nevertheless, the platform also highlights the limitations of civil society intervention, emphasizing that ensuring universal and sustainable access to menstrual products cannot fall solely on non-governmental organizations, but requires accountability from public authorities and the integration of this issue into national educational and social policies (Absorbante Gratuite n.d.). These limitations disproportionately affect migrant and refugee women, who already face economic vulnerabilities, language barriers, and restricted access to public services, thereby amplifying the risk of menstrual poverty and social exclusion.

Recommendations and Conclusions

Based on the analysis presented above, it can be concluded that the Romanian state authorities provide limited support in the field of menstrual health for both its own citizens and migrant and refugee women. Managing menstrual health in the context of migration requires new regulations and adaptation to contemporary realities. Given that migrant and refugee women experience multiple overlapping crises, where social, political, economic, and cultural factors are compounded by the necessity of displacement, it is essential to ensure that access to menstrual products is as facilitated as possible. Therefore, national institutions and health organizations, in partnership with civil society, should investigate women’s needs in this area and respond accordingly.

It is recommended to reduce the costs of menstrual products and to create designated spaces within educational institutions and workplaces where such products can be distributed free of charge. Furthermore, close collaboration between institutions and civil society is necessary in the field of menstrual education. Women affected by migration should be provided with basic training sessions within refugee camps or given the opportunity to participate in courses organized by non-governmental organizations in Romania. Additionally, non-discriminatory measures are required to ensure equal access to informational sessions and to menstrual health products, in order to prevent further isolation of migrant women. This also entails the need for translation services, which may increase costs but significantly enhance inclusivity.