Mapping the knowledge of Menstrual Health among Adolescent Girls in Low- and Middle-income Countries

Posted by Kimberley Meijers on April 5, 2017 at 1:26 pm

This paper is a just-published review on menstrual knowledge and hygiene management among adolescents in low- and middle-income countries. The review is based on papers from 21 countries in 5 of WHO’s 6 regions. Also attached is a slide set containing an overview of the review and here is a video describing the paper’s key messages.


The paper, ‘Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in low- and middle-income countries,’ can be accessed at the following link:

PowerPoint Presentation:

March 2017 – Menstruation review paper IL SVP VC



Menstruation is a natural physiological process that requires proper management. Unlike other normal bodily processes, menstruation is linked with religious and cultural meanings that can affect the perceptions of young girls as well as the ways in which the adults in the communities around them respond to their needs.


This review aims to answer the following questions: (1) how knowledgeable are adolescent girls in low- and middle-income countries about menstruation and how prepared are they for reaching menarche, (2) who are their sources of information regarding menstruation, (3) how well do the adults around them respond to their information needs, (4) what negative health and social effects do adolescents experience as a result of menstruation, and (5) how do adolescents respond when they experience these negative effects and what practices do they develop as a result?


Using a structured search strategy, articles that investigate young girls’ preparedness for menarche, knowledge of menstruation and practices surrounding menstrual hygiene in LMIC were identified. A total of 81 studies published in peer-reviewed journals between the years 2000 and 2015 that describe the experiences of adolescent girls from 25 different countries were included.


Adolescent girls in LMIC are often uninformed and unprepared for menarche. Information is primarily obtained from mothers and other female family members who are not necessarily well equipped to fill gaps in girls’ knowledge. Exclusion and shame lead to misconceptions and unhygienic practices during menstruation. Rather than seek medical consultation, girls tend to miss school, self-medicate and refrain from social interaction. Also problematic is that relatives and teachers are often not prepared to respond to the needs of girls.


LMIC must recognize that lack of preparation, knowledge and poor practices surrounding menstruation are key impediments not only to girls’ education, but also to self-confidence and personal development. In addition to investment in private latrines with clean water for girls in both schools and communities, countries must consider how to improve the provision of knowledge and understanding and how to better respond to the needs of adolescent girls.

Plain English summary

Our paper maps the knowledge, attitudes, beliefs and practices surrounding menarche, menstrual hygiene and menstrual health among adolescent girls in low and middle income countries in order to inform the future design of relevant policies and programming.

Our study of over 80 journal articles from a number of low and middle income countries confirmed that:

  • Many adolescent girls start their periods uninformed and unprepared

  • Mothers are the primary source of information, but they inform girls too-little and too-late and often communicate their own misconceptions

  • Because menstruation is widely seen as polluting and shameful, girls are often excluded and shamed in their homes and in their communities

  • Many do not have the means for self-care and do not get the support they need when they face problems, which hinders their ability to carry on with everyday activities and may also establish a foundation for life-long disempowerment

Efforts to respond to girls’ needs are fragmented and piece-meal. There is growing acknowledgement that efforts are more likely to be successful if they come together in a whole-of-community approach that involves schools, health facilities, and homes and communities to:

  • Educate girls about menstruation

  • Create norms that see menstruation as healthy and positive, not shameful and dirty

  • Improve access to sanitary products, running water, functional toilets and privacy for self-care

  • Improve care for and support by girls’ families when they have their periods

  • Improve access to competent and caring health workers when they experience menstrual health problems