HELP A GIRL, MESSY MENSTRUATION– FEMME INTERNATIONAL
New study highlights the complexity of menstruation in the Global South.
New research draws on women’s and girls’ narratives to understand their experiences of menstruation. A team of researchers from Johns Hopkins Bloomberg School of Public Health, University of Exeter, and menstrual health NGO, Femme International, systematically reviewed 76 qualitative studies. Included studies had undertaken interviews or focus group discussions about menstruation with over 6,000 women and girls from 35 low- or middle-income countries.
The review, published in the journal PLOS Medicine, found studies reported negative effects of poor menstrual experiences on physical health, wellbeing, education and their participation in daily life. Findings echoed recent resistance to an overemphasis on the provision of menstrual products, such as sanitary pads, as the ‘solution’ to menstrual difficulties. Dr. Julie Hennegan from Johns Hopkins Bloomberg School of Public Health, said: “Our findings underscore the need to embrace complexity in understanding menstrual experiences and when developing policies or programs.”
Authors identified a broad range of factors that influenced women’s and girls’ experiences. This included the comfort and availability of menstrual products, but also knowledge of menstruation, access to social support structures and the expectations placed on females. Such expectations could be explicit, such as banning menstruating women and girls from cooking or engaging in religious activities, or implicit, where women felt pressure to keep evidence of menstruation hidden and secret. Water and sanitation infrastructure were also important as the availability of safe, supportive environments at home and in schools and work places shaped experiences.
The integrated model of menstrual experience is comprehensive and directional in nature, a solid, evidence-based basis to inform menstrual health programme or intervention design. Moreover, it can easily be adapted to serve as the foundation for rigorous M&E regardless of whether the intervention is comprehensive or only a few thematic areas.
By integrating across the reviewed studies, authors developed a model of menstrual experience which offers a framework to consider the range of influences on women and girls. Authors suggest that identified contributors should be considered even when they are not the primary focus of a program, as they are likely to influence outcomes. “Women and girls are embedded within social and physical environments, these influences deserve more attention,” notes Dr. Hennegan.
“Periods are about more than the practices undertaken to manage them, they are about individuals’ satisfaction with their practices, their confidence in undertaking them or participating in daily life during their period. Menstrual experiences might also involve the shame or fear experienced and worries about leaking.”
“We do not suggest that programs need to address all of these contributing factors simultaneously, but they need to be considered even when they are not the primary focus.”
“Water and sanitation infrastructure are essential. Women and girls need safe, supportive spaces to change, wash and manage their periods.”
*Citation: Hennegan, J., Shannon, A.K., Rubli, J. Schwab, K.J., & Melendez-Torres, GJ. (2019). Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PLOS Medicine, 16(5), e1002803. doi.org/10.1371/journal.pmed.1002803
