Introduction 

Last year, I was finally able to put the anthropologist in me to practice, while doing fieldwork for my Cultural Anthropology Master’s thesis in Indonesia. It was a special experience, in which my passion for traveling and academia merged. While visiting various islands of Indonesia, the anthropological fire in me was awakened, and I was inspired by the people I spoke to and the places I visited. My personal journey went beyond my thesis subject, the intersection between menstrual health and one’s environment, as I was amazed by the openness and sisterhood I encountered while talking about such a personal topic. The topic was, when talking about it with other menstruating people, not considered much of a taboo, despite my initial fears that it might be. Being able to openly discuss the topic, I found out how Indonesian women experience difficulties, challenges or discomfort, related to using dirty water, facing scarcity of water, or only having access to bad quality menstrual products. The resilience I encountered in these women was profound, as often women did not experience these factors as disabling for their menstrual health, even though they often could be considered as such. After being back from fieldwork, the topic kept my attention and coverage of menstrual health in the news increased (at least, maybe from my point of view). Late 2023, the war in Gaza broke out, and I came across an article on menstrual health during (Gaza) war time (Al Jazeera, 2023). Still, almost a year later, this is an urgent matter (CARE, 2024). This made me think about how menstrual health can be safeguarded (or not) during times of crisis, and how unstable environments cause additional disadvantages to menstruating people. Unfortunately, emergency responses often lack proper needs for and attention to menstruating people within these crisis situations (VanLeeuwen & Torondel, 2018).

Humanitarian crises, whether caused by conflict, natural disasters, or economic instability, profoundly impact the daily lives of affected populations. When a crisis strikes, the already precarious infrastructure needed to support menstrual health—clean water, private spaces, and access to menstrual products—often collapses, leaving people without basic necessities. The situation is worsened by the climate crisis, which disproportionately affects low-income and disaster-prone regions. In places such as Indonesia and Gaza, and in refugee camps worldwide, the effects of climate change, displacement, and inadequate government support contribute to poor menstrual health, physical and mental stress, and social exclusion (Artiyono, 2024; CARE, 2024, Ipas, 2024; Muhaidat, Karmi, Karam et al., 2024) However, these challenges also reveal the resilience and adaptability of communities, especially menstruating people, who find ways to manage despite difficult circumstances.

Climate Change and Menstrual Health

Climate change plays a significant role in exacerbating menstrual health issues in crisis-prone areas. Droughts, floods, and other extreme weather events destroy infrastructure and disrupt access to clean water, essential for managing menstruation. For instance, in Indonesia, floods have led to the destruction of water infrastructure in areas like Central Sulawesi, limiting the ability of women and girls to maintain menstrual hygiene (Ipas, 2024). Similar challenges are faced in other parts of the world, including Bangladesh and Kenya, where menstruating people in cyclone- or drought-prone areas lack the water needed for cleaning reusable products or for personal hygiene (Ipas, 2024).

Furthermore, climate change events, such as mudslides, hurricanes and extreme weather events, disrupt food systems via crop failures, and increase toxins and pollutants, which are usually buried in water and soil. When such climate change events happen, not only are livelihoods disputed, and menstrual practices and health accordingly, research even shows that it can alter the age of one’s first period, the menarche (Canelon and Boland, 2020). Earlier or later menarche can increase risk and/or burden of diseases for menstruating people in four distinct areas, namely “mental health, fertility-related conditions, cardiovascular disease, and bone health” (Canelon and Boland, 2020).

When the connection between menstrual health and climate change is made in academia or in development aid, it is oftentime done in relation to the physical world of menstruation, such as products (single-use), water (scarcity) and/or disposal practices, but scarcely in relation to the burden/disease aspect of the research above. However, the holistic and embodied concept of menstrual health is as important, together with the mental effect, as my research shows.

The following anecdote from my research will illustrate my line of thought described above. One place I often visited in Indonesia was the province called East Nusa Tenggara. It is a group of islands, in the most eastern part of Indonesia, directly on the border with Timor Leste and almost vertically above Darwin, Australia. During my third trip there, I revisited the area of Darat Pantai. I especially wanted to see Fatima again, a girl whom I met on my second field trip and who had then showed me her house. Fatima lives with her two sisters, one of whom is disabled, and her mother, in a house without electricity, running water or a nearby toilet. A few years ago, the family had moved to this house uphill because of the rising sea levels and threat of tsunamis at their old house. The area around Maumere, where Darat Pantai is located, experienced a tsunami in 1992. Ever since, the water levels have fluctuated heavily, especially in the last few years. Upon my arrival in the village that particular day, I learned that Fatima was unfortunately not present, so I talked to her mother Raina and sister Ayla. I met them at their new house and together we walked for about five minutes to their old one, near the coast. Their old house, like their new one, is a traditional stick house, elevated about 1.5 meters above the ground. In 2020, a local project, in collaboration with the International Money Fund (IMF), provided new toilets and water pipes for the area. However, in 2022 heavy rains and high tides threatened the house and Raina and her family moved to their new house uphill. Interestingly, when talking longer about this situation with Raina and Ayla, I learned that in truth their move was not so much voluntary, as they were forced by the government to move. As the area of their old house is considered by the Indonesian government as a ‘conservation place,’ based on the proximity near the mangroves and water, people are not allowed to live near the shore anymore. Disappointed, and with a hint of concern in her voice, Raina told me: 

“The property [of the old house] is mine, I bought it, and now I have to move. I do not get any compensation from the government, so I built and financed my new house all by myself. I had to buy new land and materials. I am a widow, I miss my old house, I have good memories of it. Even though I feel comfortable and secure at the new house, I miss it [the old house], and I want to go back.”

The lack of government support did not end with the move, however, but is still experienced on an everyday basis – or at least once a month. For their new house, the government has not provided infrastructure yet, such as plumbing or a new toilet. Consequently, as Ayla expressed:

“When we [have to] go to the toilet, we walk to our old house and use the toilet there. During my period, when I need to change my menstrual pad in the dark, I walk with my cousin or with a friend, because I am scared, and worry something will happen and I feel fear. If this is not possible, I change my pads in my house and throw them away the next day.”

As this new situation of living in a house without proper infrastructures creates a lot of stress for the family, Ayla also admitted that her period has become irregular. Taking these stories in, I realized the paradoxical situation these women were in. On one hand, living uphill provides Ayla and her family a safer environment, even without access to running water, or a functioning toilet. On the other hand, relocating to the house by the sea area would restore access to basic facilities, but would also mean having to contend with concerns about water safety and potentially oppose government policies. Raina left me with the message that in an ideal situation, she would move back, but “I have no choice but to stay.”

In Indonesia’s East Nusa Tenggara region, rising sea levels and extreme weather have caused families, like Fatima’s, to relocate to higher ground, losing access to the basic infrastructure—such as toilets and running water—that was available at their original homes. The stress of this move is felt deeply, as Raina, Fatima’s mother, explains the struggles they face after being forced to leave their home by the coast due to government regulations and safety concerns related to climate change. Without proper support from the government, Raina and her daughters endure the challenges of living without adequate sanitation. This situation is not unique to Indonesia but mirrors the conditions faced by families displaced by environmental disasters globally. 

Social Exclusion and Mental Health

Menstrual health is also tied to issues of social exclusion, where cultural taboos and stigmas surrounding menstruation prevent people from fully participating in society. In conservative communities and crisis settings, menstruating individuals often feel isolated, particularly when sanitary products and private spaces are unavailable. This exclusion can lead to mental stress, as people are forced to hide their menstruation or manage it in unsanitary conditions. For instance, in Gaza, where conflict has devastated infrastructure, menstruating people frequently lack access to clean water or appropriate sanitation facilities, leading to feelings of shame and discomfort (CARE, 2024). Similarly, in refugee camps across the Middle East, women often have to manage menstruation in overcrowded settings without privacy, intensifying their vulnerability and isolation (Muhaidat, Karmi, Karam et al., 2024). 

Poor conditions to safely execute one’s menstrual health needs can lead to absenteeism among girls in schools, particularly in low-resource settings with long walking distances and where access to sanitary products, clean facilities, and adequate health education is limited. This, in turn, affects their academic performance, limiting their opportunities for further education and skill development (Sommer & Sahin, 2013). As education is a key driver of economic empowerment, girls who miss out on schooling due to menstrual health issues, can face long-term economic disadvantages, including fewer job opportunities and lower income potential (UNESCO, 2019).

Moreover, societal taboos and stigma around menstruation can lead to social exclusion, reinforcing gender inequalities. In some cultures, menstruating individuals are considered impure, limiting their participation in social, religious, or familial activities (Bobel, 2019). This exclusion contributes to feelings of shame and isolation, further marginalizing those affected. Improving menstrual health through education, accessible hygiene products, and policy interventions can promote social inclusion, enhance educational attainment, and empower women economically. By addressing menstrual health holistically, societies can foster gender equity and reduce social disparities, creating more inclusive communities (Kirk & Sommer, 2006).

However, despite these challenges, many women and menstruating people exhibit incredible resilience. During my research in Indonesia, I encountered women who openly discussed their menstruation and demonstrated a profound sense of sisterhood. During my fieldwork, I realized that menstruation was not considered much of a taboo when spoken about within their communities, despite initial fears that it might be. Women shared stories of overcoming difficulties—like using dirty water or relying on low-quality menstrual products—without seeing these obstacles as entirely disabling. 

As I visited Fatima’s home in East Nusa Tenggara, I saw first hand how environmental changes, compounded by government neglect, affected not only physical access to sanitary infrastructure but also the mental and emotional well-being of her family. Fatima’s sister, Ayla, spoke about walking long distances in the dark to use the toilet at their old house, highlighting the fear and stress these conditions cause during menstruation. Ayla’s menstrual cycle had even become irregular due to the anxiety caused by the inadequate living conditions at their new home. This story echoes the experiences of women in many crisis-affected areas, where menstruating individuals must adapt to their environments and find creative ways to manage, despite the hardships they face. Of course, I acknowledge that the situation of my research is different than in an urgent, humanitarian crisis. However, such situations show that crises, or abrupt changes of one’s environment, have the ability to disrupt one’s menstrual practices and health, and can cause social and gender inequalities. 

Resilience and Adaptation in Menstrual Health

While the challenges menstruating people face during crises are undeniable, the resilience they demonstrate is equally striking. Women like Fatima, Raina, and Ayla adapt to the changing environments caused by climate change and the lack of governmental support by modifying their menstrual practices. Their ability to adjust is a testament to their strength. The fact that many women in Indonesia continue to manage their menstrual health in ways that work for them, despite limited access to clean water or safe, sanitary products, demonstrates that menstrual health is a dynamic concept that shifts according to environmental, social, and political factors.

Globally, women and girls in refugee camps, displaced by conflict or climate disasters, show similar resilience. They organize makeshift hygiene spaces and support one another in managing menstruation in difficult conditions. In Jordanian refugee camps, for example, NGOs have begun to provide menstrual hygiene kits, and women themselves often lead initiatives to distribute products and educate others on menstrual health (Humanitarian Coalition, 2016). These community-driven efforts highlight the agency and power menstruating people have in addressing their own needs, even when systems around them fail. 

A Holistic Approach to Menstrual Health

Menstrual health is a holistic concept that goes beyond the physical aspects of menstruation, as explained above. It encompasses social, emotional, and mental well-being, and is deeply affected by the environment. Whether in the hills of East Nusa Tenggara, the refugee camps of Jordan, or conflict zones like Gaza, menstruating individuals are not passive victims of their circumstances. They are active agents, navigating the complexities of their environments, managing their health, and supporting one another in times of crisis.

Addressing menstrual health in humanitarian contexts must involve a multi-dimensional approach. This includes improving access to water and sanitation infrastructure, breaking down cultural stigmas, and providing education and resources. Crucially, governments and international organizations need to work closely with local communities to ensure that menstrual health management is sustainable, culturally sensitive, and empowers menstruating individuals to live with dignity and resilience in the face of adversity.

While focussing on these aspects, it became clear to me that menstruating people are not merely ‘externally’ affected by a changing environment, but that this becomes something embodied too, as demonstrated by Raina and Ayla’s internalization of the stress and fear. Products and water scarcity can be something menstruating people have to deal with, but it is equally important to recognize that this is internalized in the body and mind of people. Practicalities on how to manage one’s menstrual health become embodied, and therefore, menstrual health as “lens to the world”, becomes an element which has the ability to internally affect and disadvantage people. 

Moving Forward: Menstrual Health as a Human Right

As the effects of the climate crisis worsen, the need to address menstrual health in humanitarian responses becomes increasingly urgent. Climate-induced crises like those in Indonesia illustrate that menstrual health management is not merely a hygiene issue but also a matter of dignity, gender equality, and human rights. By integrating menstrual health into broader disaster response strategies, governments and humanitarian organizations can help mitigate the long-term social and health impacts of these crises on women and girls. 

Menstruators must be able to practice sustainable menstrual health with dignity and safety, wherever they live. Addressing menstrual health in humanitarian settings is key to reducing gender inequality and ensuring that no one is left behind during emergencies—whether they are caused by conflict, economic downturns, or the growing threat of climate change.