Every month, 13-year-old Razia* wakes up before dawn to change her menstrual cloth in a toilet shared by eight other Rohingya families in Kutupalong, the largest and most densely populated refugee settlement in the world.
This is the experience of many Rohingya girls living in camps that sprawl across Bangladesh’s Cox’s Bazar district.
Myanmar’s violent and continued persecution of the Rohingya people forced 700,000 to seek refuge across the border into Bangladesh in 2017. Since then, numbers have swelled to nearly one million, straining water supply, sanitation, security, and basic services. These deteriorating conditions especially compromise the health and well-being of women and girls, including their ability to manage menstruation safely and comfortably.
Menstruation Beliefs and Divine Self-Care
Among the Rohingya, menstruation is defined by cultural and religious beliefs and practices grounded in Islam. Interpretations of the Quranic verse or Hadiths that mention menstruation are used to justify restrictions on the everyday activities of menstruating women and girls due to their perceived “spiritual impurity.” For Razia and many girls, these include not being able to engage in religious activities: “I cannot perform prayer, I am forbidden from sitting near any male members of my family, and I cannot touch [the] Quran.”
At the same time, many Rohingya girls describe menstruation as a state of ill health that demands self-care and attention including rest from household work, prayer, school, and other responsibilities. As Razia explains, “I feel a loss of zeal to work.”
However, taking a rest period is not perceived as an oppressive religious and cultural dictate, but rather a consequence of how girls feel and the realities of living in refugee camps where access to sanitation and education is limited and complicated. And then there are physical symptoms, “We often suffer from pain in the waist and whole body,” says Sayeka*, age 15. “That is why we don’t feel like working.”
Feminist Islamic scholars have challenged the basis of menstruation-related restrictions, noting that the Quran explicitly refers to menstruation only once in relation to abstinence, and supplies no reasons to support the premise of “spiritual impurity.” Instead, they argue that these texts infer divine recognition of the discomfort and harms that menstruation can bring. By extension, restrictions on worship and daily activities while menstruating are an expression of divine compassion and encouragement for self-care rather than shame and impurity.
Even in the context of challenging refugee realities related to privacy, insecurity, and sanitation, self-care, rest, and hygiene are prioritized. Minara’s* mother describes “making sure [her 17- year-old daughter] eats plenty, gets enough sleep, and is aware that she should not bleed too much or too little.” Mothers also teach their daughters to be cautious about their hygiene and the importance of “changing the cloth that [they use] five times a day.”
While these practices stem from an understanding of the stress that menstruation places on a woman's body, they are deeply intertwined with spiritual beliefs. Many women expressed how not practicing proper self-care and hygiene during menstruation puts them at risk of negative spiritual energy. One “auntie” described this energy as “a demon able to possess a girl who is menstruating, that makes her physically unwell with headaches and all other kinds of illnesses.” Another mother added, “going outside during a period is not righteous, and girls that do may be affected with spiritual energy and become mentally unwell or even speechless and senseless.”
As a consequence, many rituals around menstrual hygiene and rest take on a spiritual aspect. Sharmin*, age 13, explains how her mother insists “if hygiene is not maintained, we are not sacred.” Sayeka also described using pani pora (sacred water) from the hujur (religious guide in the Muslim community) when experiencing menstrual pain, which she said provided more relief than the pain medications supplied by a nearby health center.
In contrast to prevalent Islamic and western narratives of menstruation as a state of impurity or as an inconvenience that must be hidden or minimized, the perspectives of Rohingya girls and women reveal much more nuance and complexity. Practices of isolation and rest from daily life that are often interpreted as restrictive or even oppressive are seen in a different light when women’s narratives are heard. Influenced by patriarchy and passed down through generations, their stories illustrate the sacred nature of religiously ordained rest and self-care.
Bangladeshi anthropologist and menstrual hygiene management (MHM) expert Farhana Sultana says, “We need to approach local norms and practices with respect, recognizing their deep-seated historical and religious roots, and to address MHM challenges in a way that works for girls and women in their lives and context.”
The Pandemic and Everyday Struggles of Menstrual Hygiene
With a stomach ache and pounding head, Sayeka trudges up and down the steep muddy hill to the toilet, careful not to spill the water from the heavy aluminum jar she is carrying back to her home. This is the journey she makes four times a day to wash her menstrual cloths when she is on her period, with no well or piped water closer to where her family lives.
“It is difficult, [but] it is a must, because, if we are wearing those cloths, we have to wash them, and to do that, we need to fetch water,” Sayeka says.
Despite the centrality of hygiene and self-care in the Rohingya’s cultural and religious beliefs surrounding menstruation, up to 75 percent of Rohingya adolescents are unable to meet their menstrual hygiene needs. From inadequate privacy and infrastructure to pandemic-related pauses in the sanitary supply chain, the challenges of managing menstruation have become even more difficult.
“There is one washroom, but we are 13 families here, it is always crowded,” says one mother. Umme*, age 14, also describes the “laborious” process of traveling long distances to shared washrooms, especially during her period. Many Rohingya women and girls feel uncomfortable and unsafe making these journeys, especially at night, with reports of abuse and harassment becoming more widespread.
Inside their homes, issues also arise. The one-room tarpaulin tents that make up the refugee camps shelter a population that is six times denser than New York City. Finding a private space or moment is virtually impossible. Once menstrual cloths are washed, girls must find somewhere discreet but with enough sunlight to dry them. Sayeka resorts to the plastic roof of her house, but the rainy season makes this challenging. As Sharmin says, “The rain delays (drying) but…if we use any wet cloth, it may lead to disease.”
NGOs have previously supplied sanitary napkins to health posts and households in the camps, which helped relieve some of the issues related to the use of menstrual cloths, but the COVID-19 pandemic has resulted in supply chain disruptions and delays. Some girls report they haven’t received supplies in months. Select stores are selling them in the camps but as Sharmin’s mother says many families like hers “don’t have enough money that we can buy [sanitary napkins] all the time” and must go back to using cloths.
Even when sanitary napkins were reliably supplied, Minara’s mother explains how some people didn’t know how to use them so sold them or threw them away. Rehena*, age 12, says the supply provided by NGOs was not sufficient for her heavy flow. Others note the issues around disposing of used napkins, having to bury them, or risk “being affected by spiritual energy.”
“The fact that essential services for women and girls including MHM are often the first to be deprioritized in crisis conditions is a massive injustice,” says Sultana.
Based at icddr,b an international health research institute in Dhaka, Bangladesh, Sultana is pioneering novel strategies to support menstrual rights and dignity for women and girls. First and foremost, she says, “women and girls’ voices must be heard.” She goes on: “Only then can you adapt solutions that work for them in their particular context.”
Sultana’s MHM research has highlighted the limitations of technological fixes that overlook cultural and infrastructural realities or are dependent on imported materials. For instance, “Programs often promote use of sanitary pads without considering the cost on the environment or the [out-of pocket] costs for women,” Sultana says.
Sultana’s recent research on the development of local and sustainable sanitary products made of jute cellulose may be a promising solution to ensure a reliable supply of pads in Rohingya camps. To support the safe use of traditional menstrual cloths, which Sultana emphasizes are “not unhygienic,” she has also designed Washer and Dryer Bags that would allow Rohingya women to clean and dry their clothes discreetly and hygienically.
There is a growing recognition that a renewed approach to MHM should respect the values and religious practices of women within and across cultural communities and enable their agency in managing their menstruation with dignity. For Rohingya women and girls, who have been historically persecuted for their beliefs and religious practices, it is even more crucial to avoid dismissing complex values around menstruation as simply ‘stigmatizing’ or ‘restrictive.’
Sultana argues that “more listening and contextualizing is needed” in efforts to achieve menstrual justice and meet women in the way they want to manage their menstruation. Given the shifting infrastructural, cultural, and other realities that define the lives of Rohingya refugee women and girls, it is only through listening that locally relevant and feasible MHM innovations will emerge.
*Some names have been changed to protect the identity of the girls who were interviewed.