Understanding the Menstrual Health Landscape
Menstrual health is a critical component of public health and human development, with significant implications across various sectors. Every day, more than 300 million women and girls around the world are menstruating, yet an estimated 500 million lack access to the resources and facilities needed to manage their periods with dignity and safety.
The challenges faced by those who menstruate extend far beyond a basic lack of supplies or infrastructure. Menstruation is a normal, healthy biological process, but in many societies, it continues to be constrained by cultural taboos, discriminatory social norms, and harmful misconceptions. This lack of information and the resulting stigma surrounding menstruation lead to unhygienic practices, gender-based violence, and the exclusion of girls and women from educational, economic, and social opportunities.
The negative impacts of poor menstrual health and hygiene cut across sectors, from education and health to gender equality and economic development. To effectively address this multifaceted issue, a holistic, multi-sectoral approach is required – one that combines improvements in infrastructure, access to affordable menstrual products, and comprehensive menstrual health education, all within a supportive policy environment.
Prioritizing Research to Drive Progress
In 2014, an expert group identified research priorities for improving menstrual hygiene management (MHM) among schoolgirls in low- and middle-income countries (LMICs). This landmark exercise helped catalyze significant advancements in the field, with over 50% of all menstrual health literature published after 2015.
However, as the focus of efforts to address menstrual health has expanded beyond schoolgirls to include women and others who menstruate across the life course, there is a need to revisit and update the research priorities. To this end, a recent study led by the Global Menstrual Collective’s Research and Evidence Group utilized a modified version of the Child Health and Nutrition Research Initiative (CHNRI) approach to identify research priorities for menstrual health across the life course in LMICs.
The study engaged 82 diverse stakeholders from around the world, including policymakers, program implementers, researchers, and funders, to propose and prioritize research questions spanning four key domains:
- Understanding the Problem: Exploring the experiences, risk factors, and consequences of poor menstrual health.
- Designing and Implementing Interventions: Developing, evaluating, and scaling up effective menstrual health programs and products.
- Integrating and Scaling Up: Integrating menstrual health into broader health, education, and social services.
- Measurement and Research: Identifying optimal indicators and approaches for monitoring menstrual health over time.
Key Research Priorities Across the Life Course
The study identified several critical research priorities that can guide future investments and efforts to improve menstrual health and hygiene for all who menstruate.
Understanding the Problem
The top-ranked questions in this domain focused on understanding the specific experiences and challenges faced by underserved populations, such as those living with disabilities, HIV, or in humanitarian settings. Priorities also included exploring the relationships between menstrual health and mental health, as well as the socio-cultural drivers of menstrual stigma and norms.
Example Priority: What are the unique menstrual health experiences and needs of marginalized populations, such as those living with disabilities, experiencing homelessness, or in humanitarian settings?
Designing and Implementing Interventions
Key priorities in this domain centered on developing and evaluating the effectiveness of interventions to address menstrual pain, improve menstrual hygiene practices, and increase access to affordable and sustainable menstrual products. Priorities also highlighted the need to understand the acceptability, feasibility, and cost-effectiveness of different intervention approaches.
Example Priority: What is the effectiveness of different menstrual pain management interventions (e.g., pain medication, menstrual cups, pain-relieving exercises) in improving girls’ and women’s participation in school, work, and daily activities?
Integrating and Scaling Up
While fewer in number, the prioritized questions in this domain emphasized the importance of understanding how to effectively integrate menstrual health into broader health, education, and social service systems, as well as the systemic and policy-level changes needed to scale up comprehensive menstrual health programs.
Example Priority: What are the key barriers and facilitators to integrating menstrual health into existing health, education, and social service systems, and how can these be addressed to enable sustainable scale-up?
Measurement and Research
Notably, the top-ranked research priority overall was the identification of optimal indicators for assessing menstrual health over time. This reflects the recognized need for standardized, harmonized approaches to monitoring progress on menstrual health at national and global levels.
Example Priority: What indicators are optimal for assessing menstrual health over time (e.g., related to norms, education, health, rights, etc.)?
Tailoring Priorities to Diverse Stakeholder Needs
An interesting finding of the study was the differences observed in the top-ranked research priorities between academics and non-academics, as well as between participants from high-income countries (HICs) and LMICs.
For example, academics tended to prioritize questions related to designing and implementing interventions, while non-academics placed greater emphasis on understanding the problem. Similarly, participants from LMICs prioritized research on integrating and scaling up menstrual health programs, while HIC participants focused more on understanding the problem.
These differences likely reflect the varied perspectives and experiences of stakeholders working on the ground versus in research settings, as well as the unique contextual factors shaping menstrual health challenges in different regions.
This underscores the importance of fostering stronger collaboration and knowledge-sharing between academics, practitioners, policymakers, and diverse stakeholders to ensure research priorities and investments truly reflect the needs and realities of menstruators worldwide.
A Roadmap for Comprehensive Menstrual Health Programs
The research priorities identified through this study provide a roadmap for driving progress on menstrual health and hygiene, particularly for adolescent girls. Key focus areas include:
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Expand the Evidence Base: Address critical knowledge gaps through research that deepens our understanding of the lived experiences, needs, and barriers faced by diverse populations, and rigorously evaluates the effectiveness of different menstrual health interventions.
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Integrate Across Sectors: Integrate menstrual health into broader health, education, WASH, and social service systems, leveraging multi-sectoral collaboration to deliver comprehensive, holistic support.
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Strengthen Monitoring and Evaluation: Develop and adopt standardized indicators and approaches to monitor menstrual health outcomes over time, enabling data-driven decision-making and accountability.
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Foster an Enabling Environment: Address harmful social norms and policies that perpetuate menstrual stigma and inequities, empowering all who menstruate to manage their periods with dignity and confidence.
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Amplify Voices and Leadership: Elevate the voices and leadership of those directly affected by menstrual health challenges, ensuring their needs and perspectives guide the design and implementation of solutions.
By aligning efforts across these key areas and drawing on the wealth of evidence-based priorities identified through this study, the global community can make significant strides in scaling up comprehensive, inclusive, and sustainable menstrual health programs – unlocking the full potential of adolescent girls and all who menstruate.
Conclusion
Improving menstrual health and hygiene is essential for enabling women, girls, and all who menstruate to reach their full potential. The research priorities outlined in this article provide a roadmap for driving progress on this critical issue, guiding investments and efforts across diverse sectors and stakeholder groups.
Through a holistic, multi-sectoral approach that combines infrastructure improvements, access to affordable products, comprehensive education, and supportive policies, we can create a world where everyone who menstruates can manage their periods with dignity, safety, and confidence. By addressing the complex, intersecting challenges of poor menstrual health, we can unlock transformative benefits for individual wellbeing, gender equality, and sustainable development.
Now is the time to act. By aligning our efforts around the research priorities identified in this study, we can accelerate progress and ensure that the needs and experiences of all who menstruate are heard, understood, and addressed. Together, we can build a more just, equitable, and inclusive world.
