The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research

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Abstract

In recognition of the opportunity created by the increasing attention to menstrual health at global, regional, and national levels, the World Health Organization’s Department of Sexual and Reproductive Health and Research and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction convened a global research collaborative meeting on menstrual health in adolescents in August 2018. Experts considered nine domains of menstrual health (awareness and understanding; stigma, norms, and socio-cultural practices; menstrual products; water and sanitation; disposal; empathy and support; clinical care; integration with other programmes; and financing) and answered the following five questions: (1) What is the current situation? (2) What are the factors contributing to this situation? (3) What should the status of this domain of adolescent menstrual health be in 10 years? (4) What actions are needed to achieve these goals? (5) What research is needed to achieve these goals? This commentary summarizes the consensus reached in relation to these questions during the expert consultation. In doing so, it describes the state of adolescent menstrual health in low- and middle-income countries and sets out suggestions for action and research that could contribute to meeting the holistic menstrual health needs of adolescent girls and others who menstruate worldwide.

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A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management

Colin Sumpter, Belen Torondel (2013)

Background Differing approaches to menstrual hygiene management (MHM) have been associated with a wide range of health and psycho-social outcomes in lower income settings. This paper systematically collates, summarizes and critically appraises the available evidence. Methods Following the PRISMA guidelines a structured search strategy was used to identify articles investigating the effects of MHM on health and psycho-social outcomes. The search was conducted in May 2012 and had no date limit. Data was extracted and quality of methodology was independently assessed by two researchers. Where no measure of effect was provided, but sufficient data were available to calculate one, this was undertaken. Meta-analysis was conducted where sufficient data were available. Results 14 articles were identified which looked at health outcomes, primarily reproductive tract infections (RTI). 11 articles were identified investigating associations between MHM, social restrictions and school attendance. MHM was found to be associated with RTI in 7 papers. Methodologies however varied greatly and overall quality was low. Meta-analysis of a subset of studies found no association between confirmed bacterial vaginosis and MHM (OR: 1.07, 95% CI: 0.52–2.24). No other substantial associations with health outcomes were found. Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in management methods reduce school absenteeism. Conclusion The management of menstruation presents significant challenges for women in lower income settings; the effect of poor MHM however remains unclear. It is plausible that MHM can affect the reproductive tract but the specific infections, the strength of effect, and the route of transmission, remain unclear. There is a gap in the evidence for high quality randomised intervention studies which combine hardware and software interventions, in particular for better understanding the nuanced effect improving MHM may have on girls’ attendance at school.

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Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis

Julie Hennegan, Alexandra Shannon, Jennifer Rubli … (2019)

Background Attention to women’s and girls’ menstrual needs is critical for global health and gender equality. The importance of this neglected experience has been elucidated by a growing body of qualitative research, which we systematically reviewed and synthesised. Methods and findings We undertook systematic searching to identify qualitative studies of women’s and girls’ experiences of menstruation in low- and middle-income countries (LMICs). Of 6,892 citations screened, 76 studies reported in 87 citations were included. Studies captured the experiences of over 6,000 participants from 35 countries. This included 45 studies from sub-Saharan Africa (with the greatest number of studies from Kenya [n = 7], Uganda [n = 6], and Ethiopia [n = 5]), 21 from South Asia (including India [n = 12] and Nepal [n = 5]), 8 from East Asia and the Pacific, 5 from Latin America and the Caribbean, 5 from the Middle East and North Africa, and 1 study from Europe and Central Asia. Through synthesis, we identified overarching themes and their relationships to develop a directional model of menstrual experience. This model maps distal and proximal antecedents of menstrual experience through to the impacts of this experience on health and well-being. The sociocultural context, including menstrual stigma and gender norms, influenced experiences by limiting knowledge about menstruation, limiting social support, and shaping internalised and externally enforced behavioural expectations. Resource limitations underlay inadequate physical infrastructure to support menstruation, as well as an economic environment restricting access to affordable menstrual materials. Menstrual experience included multiple themes: menstrual practices, perceptions of practices and environments, confidence, shame and distress, and containment of bleeding and odour. These components of experience were interlinked and contributed to negative impacts on women’s and girls’ lives. Impacts included harms to physical and psychological health as well as education and social engagement. Our review is limited by the available studies. Study quality was varied, with 18 studies rated as high, 35 medium, and 23 low trustworthiness. Sampling and analysis tended to be untrustworthy in lower-quality studies. Studies focused on the experiences of adolescent girls were most strongly represented, and we achieved early saturation for this group. Reflecting the focus of menstrual health research globally, there was an absence of studies focused on adult women and those from certain geographical areas. Conclusions Through synthesis of extant qualitative studies of menstrual experience, we highlight consistent challenges and developed an integrated model of menstrual experience. This model hypothesises directional pathways that could be tested by future studies and may serve as a framework for program and policy development by highlighting critical antecedents and pathways through which interventions could improve women’s and girls’ health and well-being. Review protocol registration The review protocol registration is PROSPERO: CRD42018089581.

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A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools

Marni Sommer, Bethany A. Caruso, Murat Sahin … (2016)

Marni Sommer and colleagues reflect on priorities needed to guide global, national, and local action to address girls' menstrual hygiene management needs in schools.

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Author and article information

Contributors

Marina Plesons:

ORCID: http://orcid.org/0000-0003-3224-618X

plesonsm@who.int

Journal

Journal ID (nlm-ta): Reprod Health

Journal ID (iso-abbrev): Reprod Health

Title: Reproductive Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1742-4755

Publication date (Electronic): 8 February 2021

Publication date PMC-release: 8 February 2021

Publication date Collection: 2021

Volume: 18

Electronic Location Identifier: 31

Affiliations

[1 ]GRID grid.3575.4, ISNI 0000000121633745, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, , World Health Organization, ; Geneva, Switzerland

[2 ]GRID grid.420315.1, ISNI 0000 0001 1012 1269, Gender, Human Rights and Community Engagement Department, , UNAIDS, ; Geneva, Switzerland

[3 ]Regional Bureau for Education for the Asia-Pacific, UNESCO, Bangkok, Thailand

[4 ]GRID grid.466905.8, Health Promotion Bureau, , Ministry of Health, ; Colombo, Sri Lanka

[5 ]Foreign, Commonwealth and Development Office, London, UK

[6 ]GRID grid.189967.8, ISNI 0000 0001 0941 6502, Hubert Department of Global Health, Rollins School of Public Health, , Emory University, ; Atlanta, USA

[7 ]Save the Children El Salvador, San Salvador, El Salvador

[8 ]United Nations Population Fund, Dar es Salaam, Tanzania

[9 ]Save the Children USA, Washington, DC USA

[10 ]WoMena Knowledge Management Team, WoMena Denmark, Copenhagen, Denmark

[11 ]GRID grid.413355.5, ISNI 0000 0001 2221 4219, African Population and Health Research Center, ; Nairobi, Kenya

[12 ]GRID grid.11194.3c, ISNI 0000 0004 0620 0548, African Centre for Systematic Review and Knowledge Translation, , College of Health Sciences, Makerere University, ; Kampala, Uganda

[13 ]GRID grid.48004.38, ISNI 0000 0004 1936 9764, Department of Clinical Sciences, , Liverpool School of Tropical Medicine, ; Liverpool, UK

[14 ]GRID grid.29857.31, ISNI 0000 0001 2097 4281, Department of Public Health Sciences, College of Medicine, , Pennsylvania State University, ; State College, USA

[15 ]GRID grid.21729.3f, ISNI 0000000419368729, Department of Sociomedical Sciences, , Mailman School of Public Health, ; New York, USA

Author information

Marina Plesons http://orcid.org/0000-0003-3224-618X

Article

Publisher ID: 1082

DOI: 10.1186/s12978-021-01082-2

PMC ID: 7869499

PubMed ID: 33557877

SO-VID: 318e865f-d970-442b-a24b-7efadb0ae131

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 24 November 2020

Date accepted : 18 January 2021

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: menstruation,menstrual health,menstrual hygiene,menstrual hygiene management,adolescent health,adolescent sexual and reproductive health

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: menstruation, menstrual health, menstrual hygiene, menstrual hygiene management, adolescent health, adolescent sexual and reproductive health

The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research

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Advocacy for Maternal and Women’s Health

Most cited references 73

A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management

Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis

A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools

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