There is growing global momentum around addressing menstruation as an important health, education and gender equality issue. However, a critical barrier to making progress on addressing menstruation and the range of girls’ needs around this issue, is the lack of adequate validated measures related to measuring menstruation within global health and development. Measures are most needed that are aligned to five priority areas (sexual and reproductive health, psychosocial health, education, WASH, gender). The absence of measures as standards by which to assess progress on addressing menstruation-related interventions, limits both assessment of important outcomes and the creation of programs to change them. Further, menstrual health and hygiene1 -related indicators have yet to be incorporated within these five areas, despite the potential influence of menstruation on their respective outcomes, including reaching associated Sustainable Development Goal (SDG) targets.
In March 2019, a multi-sectoral group of researchers, practitioners, and monitoring and evaluation specialists convened to identify priority indicators across key sectors (or priority areas) within global health and development, and assess alignment of the identified priority indicators with menstruation. The focus of the meeting was on the menstruation-related issues impacting girls in and out of school, as they represent the population for which there exists the strongest existing body of evidence. This Green Paper briefly details the meeting justification and background, key discussions, and proposed next steps. Similar approaches and analyses are needed in the future that engage a much broader population and realm of menstruation-related topics, particularly the needs of menstruators in workplace contexts, a significantly overlooked issue.
Overall, findings highlight the complexity of addressing menstruation in societies around the world that have ongoing menstrual restrictions and taboos that are relevant for the design of interventions. In addition, there continue to be significant gaps in what is known, such as an understanding of the bleeding patterns of adolescents in low-income contexts, including timing of menstrual onset, the implications of menstruation for anemia, and the existence and quality of teacher sensitivity training on the topic for girls’ successful classroom engagement. Despite these gaps, participants underscored the critical role of menstruation influencing the five identified areas to achieve their respective goals. For example, to reduce child marriage, countries need to ascertain if the onset of menses increases girls’ vulnerability to marriage at a young age. The analyses identified the important role of menstruation-focused interventions to influence outcomes and impacts across sectors but with contributions occurring lower down on the results chain. Hence, indicators may need to capture the availability of female friendly toilets in schools as a necessary input for improving completion rates. Or, examine if providing girls with adequate supplies of sanitary pads and information about their bodies during puberty reduces the likelihood of adolescent pregnancy, a priority for the sexual and reproductive health global agenda.
Although key priority indicators that align with menstruation were identified and analyzed across the five areas, further work is needed to move forward the measurement agenda. A key outcome of this initial effort was the consensus to submit a question during the open window of the Demographic and Health Survey (DHS) submission period that recommended data be captured at the national level about awareness of menstruation prior to the participant’s first menstrual period. Recommendations for next steps include to create a knowledge-sharing platform; support the validation of key indicators of relevance to the five areas in relation to menstruation; improve tools available for countries to monitor menstruation and mark progress; and support translation of research findings for country uptake.
Read the full Green Paper here.