Menstrual health, food insecurity, and protection vulnerability among adolescent girls in internally displaced persons camps in Benue State, Nigeria: A focused ethnographic study

Adolescent girls living in internally displaced persons (IDP) camps manage menstruation amid food insecurity, inadequate water, sanitation and hygiene (WASH), disrupted education, gendered social norms and protection systems. These challenges are often addressed through separate humanitarian programmes, obscuring how they interact in girls everyday lives. This study explored menstrual-health experiences and perceived nutritional deprivation among adolescent girls in five IDP camps in Benue State, Nigeria. We conducted a focused ethnographic qualitative study in the International Market, Mega, Ortese, Uikpam, and Abagana camps. Twenty-five in-depth interviews with menstruating adolescent girls aged 13-19 years were complemented by focus group discussions with adolescent girls, adult women, adult men, and camp leaders, and structured WASH and food observations. Interviews and discussions were conducted in English, Tiv or both, transcribed verbatim and translated where necessary. Data were managed in MAXQDA and analysed using reflexive thematic analysis. Frequencies describe the distribution of 435 coded excerpts and are not participant prevalence estimates. Six themes and 20 subthemes were generated. Menstrual-health management and material constraints accounted for 95 coded excerpts (21.8%), followed by knowledge and lived experience (80; 18.4%), food insecurity and perceived nutritional deprivation (70; 16.1%), coping and adaptive agency (70; 16.1%), sociocultural beliefs and taboos (65; 14.9%), and self-reported symptoms and participation restrictions (55; 12.6%). Girls described irregular access to commercial pads, reliance on improvised materials, limited water and soap, and toilets that were unsafe or inaccessible at night. Dietary monotony, meal skipping, and hunger were perceived to intensify pain, weakness, and fatigue. Fear of staining, menstrual silence, and household restrictions contributed to withdrawal from school, livelihood, and domestic activities. Peer support was protective, but some girls undertook informal work to obtain menstrual materials, raising safeguarding concerns. Menstrual health in prolonged displacement is not an isolated hygiene issue but an outcome of interacting material, nutritional, sociocultural, educational, and protection constraints. Humanitarian responses should combine predictable access to acceptable menstrual materials with safe WASH facilities, adolescent-responsive food and nutrition support, confidential health services, community education and safeguarding mechanisms. Reported symptoms and nutritional experiences were not clinically measured.