UK armed forces female hygiene in the austere environment

Abstract: Women in the United Kingdom Armed Forces (UKAF) face unique challenges in undertaking the same roles and working in the same environments as their male counterparts.1 Ambitious targets to increase the proportion of women in the UKAF, from 11.5% to over 30% by 2030,2 mean support are required to meet these challenges. The Servicewomen Health Improvement Focus Team (SHIFT)3 introduced a series of measures, including a menopause policy, a Servicewoman’s Guide to Health,4 a urinary support device (USD), menstrual waste pouches and emergency sanitary provision for deployment and exercise. Here, we evaluate knowledge and experience of female hygiene products among deployed UK servicewomen and how effectively the above measures have impacted women on the frontline. The UK evacuation of Sudan provided an opportunity to assess the knowledge of and opinions about female hygiene (urinary and menstrual health management) support while serving in an inhospitable environment. This setting had limited access to rudimentary toilet and handwashing facilities overwhelmed by volume of evacuees. A survey was circulated to all deployed women (n=15) to explore understanding of the range of sanitary options available, personal preferences, knowledge or experience of military-issue items and their experience of menstruating while deployed. Overall, all respondents knew about hormonal control of menstruation and 91% about disposable sanitary products, but only 55% about short-term menstrual delay. 27%–36% would consider trialling different products, especially if supported or funded by the military. The austere environment posed an array of challenges including access to washing facilities and sanitary products, personal comfort and disposal. Sixty-four per cent of participants would choose different products in this environment versus everyday life with 82% stating a preference for hormonal control or delay. Of 73% would have liked the option of a USD, which were reportedly not provided on this deployment. This was a very specific environment with a limited sample. Further work in contrasting settings, such as the extreme cold or during a submarine deployment, will provide a more complete view of service personnel’s experiences and perceptions of managing menstruation in remote and austere environments. Work is required within defence to ensure that the SHIFT outcomes are available to service personnel, known about by chain of Command, and embedded into deployment logistics planning. Beyond this, there is scope for the development of innovative and sustainable options to support menstruation in the deployed spaces, which can be informed by those with relevant experience. Although a small study, the findings in the UKAF are relevant to international partners and may be useful to women in other austere or remote environments such as expeditions, endurance events or among displaced people.