Written by Tyler A. Donohue

At any given moment there are approximately 800 million people menstruating worldwide. Whether these menstruators are at home with running water in the UK, in a refugee in Uganda, or living in an informal settlement in India, they will all need to find some way to manage their menstrual health. 

Ensuring that all menstruators have access to safe spaces to manage their menstruation is a pressing, yet often overlooked, public health issue. However, the responsibility to ensure spaces are safe for menstruators spans far beyond public health experts. Waste management experts, WASH (water, sanitation, and hygiene) engineers, emergency response groups, and menstrual health professionals all have a critical role to play. 

In humanitarian settings, there can be a lack of safe, private, and accessible space for menstrual hygiene management (MHM). Menstruators living in these settings are uniquely challenged by latrines that are not built with safety (or menstruators) in mind, an increased risk of sexual violence around latrines and water access points, and a poor enabling environment due negative social norms about menstruation. The WASH spaces that are available, often neglect to meaningfully engage young women and girls in the design and implementation process. 

Meaningful engagement means using data-driven design and innovation to address the challenges faced by young people. Everything YLabs does is driven by the experiences, power and creativity of young people. Cocoon is no different. This project was designed by and for menstruators, taking into consideration the specific needs for safe spaces and managing menstruation in humanitarian settings. 

The Cocoon Mini is a space that provides security and shelter. But more than anything else, it is a place one goes to in times of transition. It is a place of reemergence. With that in mind, our team in Uganda worked with menstruators to design and pilot safe spaces and services for managing menstruation among displaced populations in the Bidi Bidi Settlement, the second largest refugee settlement in the world. 

YLabs partnered with Kuja Kuja, a real-time feedback system that tracks customers’ level of satisfaction with processes and services, and Alight, an international nonprofit organization that works with refugees and migrants globally, to alleviate the stress of MHM for displaced populations. In May 2021, they began a pilot for the Cocoon Mini, a semi-permanent latrine and bathing area that is built within household compounds, serving about 15-20 menstruators each. Along with the private latrine, the Mini includes areas for showering and laundering, with direct water access. The entire concept is meant to create a process which streamlines and safeguards the menstruators’ experience. 

Through the process of innovative design, iterative implementation, and rigorous data analysis, the YLabs team has determined the top five things every menstrual health and WASH space needs to be effective and make an impact: 

01 Designing with disposal solutions in mind is paramount  

One of the most pressing challenges with menstrual hygiene management is disposal. However, there is relatively little research or design that focuses exclusively on the impacts of menstrual waste disposal. In 2021, YLabs worked together with the Gates Foundation on Project Flow, a project that sought to map the barriers to the use and disposal of menstrual health products. The research showed that poor waste disposal can lead to:

• Physical health risks: the absence of appropriate and accessible disposal facilities often leads menstruators to overuse products, putting them at great risk for bacterial vaginosis, sores, and urinary or reproductive tract infections

• Loss of income and educational opportunity: menstruators only feel comfortable menstruating at home, where they know how to dispose of their menstrual products. This means that menstruators may miss hours or entire days of work or school rather than attempt to manage their menstruation in unsafe WASH facilities

• Environmental toxicity and chemical pollution: disposing of menstrual products has a significant impact on the environment, clogging sewage lines, and ending up in landfills where a single disposable pad takes between 500-800 years to decompose

• Psychological stress, anxiety, and social trauma: There are psychosocial consequences of menstruation, including fear of stigma, anxiety, shame, and embarrassment. A lack of disposal facilities can increase anxiety and stress, which is exacerbated by fear of their menstrual status or products being discovered by others.

The “where” and “when” of menstrual product disposal is constantly on the minds of menstruators, and in many cases leads to relentless psychological stress and anxiety. This is particularly true in contexts where menstruators fear discarded products will be found and taken to be used for witchcraft. It is not unusual for menstruators to believe their blood can be used to “bewitch” them and make them barren.

During the Cocoon Mini pilot, the YLabs team determined that infrastructure interventions could be used to improve waste disposal, which allowed women and girls to manage their menstruation on their own terms. The disposal systems were built within the structure, and were therefore easy to access at the menstruator’s convenience. The design of the Mini streamlined access to disposal areas, which in turn improved sanitation and prevented menstruators from discarding used products in the bush or latrine. 

In order for waste disposal options to be effective, menstruators need to feel sure that any waste product they throw away is unable to be accessed. Locks must be included on the disposal bins to ensure that disposable pads would not be tampered with by children and community members. In the Cocoon Mini, this bin also serves as a drying bin for used disposable pads, so that after a few days, the bin’s contents may be taken for burning. 

MHM spaces that offer disposal options need to take into account that menstruators will not have peace of mind unless they are certain that their discarded products cannot be uncovered, seen or tampered with.  Proper disposal infrastructure solutions are of paramount importance in MHM spaces. 

Structures designed with the intention of supporting the safe and dignified practice of MHM must integrate seamless, discreet, and effective MH product disposal systems. All MH design must begin with disposal in mind. 

02 Let the light extend beyond the Cocoon  

A cocoon is defined as, “something that envelopes or surrounds, especially in a protective or comforting way.” The Cocoon Mini is designed to envelope and surround menstruators, in order to provide protection during menstruation. The protection that the Mini provides is significant. In fact, 95% of menstruators said that the Mini made MHM easier for them. 

However, the vulnerabilities faced by menstruators extend far beyond the latrine. One of our key findings was that the security provided by the Mini space must extend past its four walls. This can be accomplished with both infrastructure interventions, as well as social behavioral interventions. 

Permanent light fixtures were avoided when designing the Mini, because menstruators warned of the increased likelihood that solar panels and fixtures would be stolen. In lieu of permanent fixtures, the YLabs team provisioned portable solar lights to the Cocoon Mini supervisors, who ensured the Mini space was always well-lit. In theory, a well-lit space would enable menstruators to use the Mini at their convenience beyond daylight hours. Early on in the pilot, however, our team learned that deep fears persisted for menstruators when it came to the daunting task of walking from their homes to the Mini at nighttime. With our routine data collective and iterative design process, we were able to pivot to use these portable lights.

It became clear that light is a critical part of safety and security, not just within the Cocoon. Ensuring that pathways to and from a menstrual health space are critical to ensuring a MHM space can be used safely at night. We knew the importance of solar lights lasting longer than six hours and having a high luminosity, but we found that the brightness and duration of the portable solar lights were insufficient for seeing beyond the immediate surroundings.

Improving lighting is a key step in creating safe and dignified MHM facilities. Extending the security of the space past its four walls means providing bright, more durable, and extensive lighting to ensure menstruators safety during their journey to and from the space. 

This key finding also brings us to one of our major behavioral interventions that all MHM spaces must have – sensitization about MHM and educational forums on sexual/reproductive health for both men/boys and girls in order to prevent stigmatization and misinformation around MHM and general hygiene. Men and boys have a key role to play in ensuring menstruators safety when they are traveling to and from the Cocoon, or MHM facility. Program designs and interventions should draw men into the work of menstrual health,  and should be aimed at supporting the safe and dignified practice of MHM as a key metric for community health. 

03 Build privacy walls that have material longevity 

 Building infrastructure within a humanitarian context requires balancing the need for secure and safe facilities, with the ultimate goal for refugees to eventually reemerge and relocate. Ultimately, the Cocoon project provides a process for creating physically safe and materially sturdy spaces for menstruators, while also complying with the limitation of building for those in transition. 

One of the primary features used in the Cocoon Mini is the privacy wall, which stands at 1.7 meters (higher than the local standard) and spans the length of both the bath shelter and latrine. In our original prototype, plastic tarps were used for their cost effectiveness and availability. However, iron sheets would be a superior solution, as they can withstand material and elemental wear and tear. 

The Mini’s high privacy walls, alongside the locking doors, dramatically improved menstruators’ sense of privacy and safety from possible intrusion. However, there were persistent concerns about children tearing the plastic tarp and destroying the privacy walls, taking pads from the disposal bins, or watching menstruators bathe. There is no formal SRH or MHM curriculum for children living in humanitarian settings. In order to make a sizable impact, all menstrual health solutions, whether the MHM facilities or educational program, must involve all members of the community, including children. 

Overall, there were no safety incidents reported during the 3 month pilot program. Menstruators expressed a more dignified and secure MHM experience while using the Mini, in large part due to the locks and privacy walls. For implementation of similar processes, our team recommends employing stronger aggregate, timber, and mesh reinforcements for latrine pits to improve the structural integrity of pit walls and enhance the structures longevity. In addition to user-centered SRH and MHM curricula for children. 

04 Use locks to ensure menstruators feel safe  

The smallest detail can make the biggest difference when designing a space for menstruators. Using a human-centered design (HCD) approach, meant that menstruators and the community were at the center of our design process. Early on in the iterative design process, participants shared the absolute necessity of locks on the Cocoon doors and disposal bins. 

When designing the Mini, stronger door frames and locks were fitted to the doors. Users of the bath shelter and the latrines reported increased feelings of ease in using the facilities, knowing that they would not face intruders. 

When we can imagine all menstrual health spaces as cocoons, then we can understand them as spaces for safety and security, places one goes to during times of transition. One of the key components of privacy is dignity. Locks – whether on the doors or the disposal bins – are critical to creating a physically and psychologically safe MH space where the menstruators can reemerge from, anew, protected, and more confident. 

05 Provide consistent and communal access to water 

Menstrual health is the nexus between various development goals, from gender equality to sustainability. One of the most notable and impactful components of menstrual health is water access. The Cocoon Mini, or any other menstrual health space cannot sustainably and successfully function without direct water access. This is because its usage, and benefit, spans far beyond the singular space. When MH spaces are created with the community buy-in in mind, they can be built to mutually benefit all – particularly when it comes to community water access for domestic tasks. 

Impact on the Community

When the Cocoon Mini was implemented in the  Bibi Bibi Resettlement, it became clear that the impact of the space would ripple throughout the community. During the pilot, trenches were dug by local laborers, main water lines were exposed, and pipes were laid and tapped to each Mini site. The increased water access points aided greatly in the site’s adoption and popularity within the community. Men and boys were also interested in utilizing the Mini’s water source. More members of the settlement were able to address their hygiene needs with ease. This boosts overall community buy in, which is essential for sustainability. 

The introduction of water access points benefited all community members, as they removed the need to search out and fetch water from afar. Menstruators were able to use the space as a multipurpose area in which they could conveniently perform domestic tasks along with washing pads and bathing. Domestic tasks include the cleaning of cookware, fetching water for livestock, washing laundry, and watering gardens. These benefits also extend beyond the menstruators to other community members who utilize the Mini’s water source. 

When designing menstrual health spaces, it is critical that the benefits extend beyond menstruators to the community at large. This will boost community buy in, and encourage ownership over the process and space. 

The Impact on Menstruators 

In humanitarian settings, menstruators’ hygiene practices are severely limited by frequent and long-lasting water shortages. Distributed water access and waste disposal allows for menstruation management on one’s own terms. In order to be confident participating in everyday activities, menstruators repeatedly relayed the importance of managing their hygiene by having water access for bathing and washing menstrual products. 

By having water access closer to bathing areas, menstruators are now able to save valuable time and energy that they otherwise would spend by traveling long distances to fetch water and wait in long lines. Menstruators were able to reliably care for their hygiene and reported having more confidence due to trust that water will be consistently available and that they have access to any Cocoon Mini in their community – thereby increasing their mobility around the settlement. Collectively, distributed water access increased confidence, saved time, and improved hygiene. With consistent water access, menstruators experienced increased privacy and safety and were able to manage their menstruation on their own terms because of the Mini. 

What’s Next? 

People who menstruate make up half the population. Creating products and processes that make a meaningful impact means including the beneficiaries in the design process. 

We all have a role to play in ensuring that all MH facilities are well-equipped and built with the menstruators in mind. In order to make an impact, we recommend ensuring that every facility has the five following things: disposal, light, privacy walls, locks, and water. With these tools, menstruators can feel assured to manage their menstruation with ease, and to know that it is not something to be ashamed of, but rather a natural, and very important part of their lives. 

Cocoon is one of several menstrual health projects in YLabs’ global portfolio, To find out more about the Cocoon Project or our wider menstrual health portfolio, get in touch with our team at contact@ylabsglobal.org 

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