Policy makers must attend to menstrual stigma to improve wellbeing, study finds

May 16, 2019

Researchers have found that addressing attitudes to menstruation may be necessary to improve well-being in low and middle-income countries, far more than simply better access to sanitary products.

Period poverty - limited access to sanitary products - is known to negatively affect the wellbeing of young women and girls. This impacts physical and psychological health, social inclusion, and may cause young girls to miss school or leave education, hindering employment. Period poverty is especially concerning in low and middle-income countries as it creates a significant barrier between gender equality and health.

However, new research led by the Johns Hopkins University and University of Exeter Medical School has found that simply granting better access to products is unlikely to be enough.

The systematic review, published in PLOS Medicine, captured experiences of more than 6,000 participants from 35 countries, and considered studies from 45 Sub-Saharan Africa (including Kenya and Ethiopia), 21 from South Asia (including India), 8 from East Asia and Pacific, and 5 from the Middle East and North Africa.

The study found that interventions which focus on sanitary products could uphold stigma surrounding menstruation, and reinforce behavioural expectations such as the importance of concealing menses. Interventions such as these risk greater harms if access to reliable menstrual materials is unsustainable.

Instead, future interventions should address these precursors to menstrual experiences, such as knowledge of menstruation, social support and other restrictive behavioural expectations. This would work to combat internalised negative attitudes towards menstruation.

Menstrual experience is not simply a matter of hygiene practices. It comprises women's perceptions of these practices, their confidence to manage and engage, and experiences of shame about menstruation.

G.J. Melendez-Torres, Professor of Clinical and Social Epidemiology at the University of Exeter Medical School, said: "The world is rapidly waking up to the fact that menstrual health and hygiene is a major issue for health and human rights. Difficulties managing menstruation, a lack of supportive sanitation infrastructure and meaningful reproductive health education block the life chances of women and girls around the world, preventing their education and their livelihoods.

"Our study suggests key points that organisations who want to improve the lot of women and girls need to take forward to ensure they are not doing more harm than good."

The team also identified how these overarching themes interact, to create an integrated model which maps the impacts of biological and socio-cultural menstrual experience on health and well-being.

This model is intended to be used as a framework for program and policy development by highlighting crucial points for intervention to improve women's health and well-being.
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The paper is entitled 'Women's and girls' experiences of menstruation in low and middle income countries: a systematic review and qualitative metasynthesis'.

Menstrual Hygiene Day will be taking place 28 May 2019.

University of Exeter

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