Development of MSF’s Menstrual Health Management (MHM) Toolkit

Médecins Sans Frontières (MSF) is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, natural disasters, and exclusion from healthcare. Through its Inclusive Innovation team, MSF has been working to strengthen menstrual health management (MHM) support across diverse humanitarian settings.

Menstrual health is more than hygiene, it is fundamentally tied to dignity, health, protection, and participation. Yet in humanitarian contexts, it remains widely overlooked. Periods do not pause in crises, but access to the resources, facilities, and knowledge needed to manage them safely often does. Across many MSF settings, menstruation is highly stigmatised, and women and girls lack access to safe, private facilities and practical information, limiting their ability to move freely and participate fully in daily life.

In response, MSF’s Inclusive Innovation team has taken a holistic and participatory approach to MHM that goes beyond simply providing MHM products to address the full spectrum of needs, including stigma, knowledge, infrastructure, and community dynamics. This work has been grounded in seeking to understand the lived experiences of women and girls.

Since 2018, MSF have implemented 11 MHM projects across eight countries, including the Democratic Republic of Congo, Mali, Sierra Leone, India, Bangladesh, Iraq, Ethiopia, and Bhutan. These projects have explored a range of approaches, including community-based participatory methods, menstrual underwear (MU) distribution, hygiene kit provision, Water, Sanitation, and Hygiene (WaSH) facility assessments, and health promotion activities. Together, these experiences represent a growing but previously fragmented body of operational knowledge within MSF.

In January 2026, MSF’s Inclusive Innovation team produced the MSF MHM Synthesis Report, a comprehensive consolidation of this body of work. The report brings together qualitative and quantitative insights from across projects to identify common patterns, context-specific differences, and recurring operational challenges. It captures three core areas of learning:

From this analysis, the report presents 44 structured recommendations across five key implementation domain - context, organisational systems, project design, project delivery, and individuals - supported by an evidence confidence framework. While the report provides a strong evidence base, it is primarily a technical and analytical document and is not designed for direct use in implementing integrated MHM interventions as part of MSF operations.

This synthesis serves as the foundation for MSF’s forthcoming MHM Toolkit: a practical, field-oriented resource designed to translate evidence into action. The toolkit is intended to support MSF teams at project and coordination levels to design, adapt, and implement MHM interventions in diverse humanitarian settings.

The toolkit will function as a decision-support and implementation resource, bringing together:

Importantly, the toolkit is not intended to be a static guidance document, but rather a modular, user-centred resource that supports teams to make context-specific decisions and adapt approaches in real time.

While the synthesis report provides evidence, the toolkit is the means of translating that evidence into practice. A central component of the toolkit will be a suite of Health Promotion (HP) and Information, Education, and Communication (IEC) materials that make complex insights accessible, actionable, and relevant for different users and contexts. These materials will play a critical role in supporting community engagement, behaviour change, and the practical delivery of MHM activities.