Young women

In the U.S. and globally, young women typically get little education about menstruation — a gap that public health practitioners are working to fill. Photo by Christopher Futcher, courtesy iStockphoto

Women and girls in the U.S. and around the world are provided very little, if any, education and support about their menstrual cycles.

Tuesday’s APHA Annual Meeting session on menstrual health made it clear that there is much work to be done. In fact, even in public health, there are huge gaps and little data. Today, sexual reproductive health workers often don’t provide education on menstruation in their programs, despite the obvious connections, session presenters explained.

Much of the work around menstrual health is done in developing countries and is typically aimed at educating teenagers on menstrual hygiene management. In 2012, as public health workers began to advocate for more menstrual hygiene management programs, they realized they didn’t have a common definition of what such programs should entail, said Marni Sommer, associate professor of sociomedical sciences at Columbia University’s Mailman School of Public Health. So, they wrote one, which, Sommer pointed out, needs an update to include more inclusive language. The current definition is:

“Women and adolescent girls are using a clean menstrual management material to absorb or collect menstrual blood that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and have access to facilities to dispose of used menstrual management materials. They understand the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort and fear.”

In 2014, UNICEF and Columbia University organized the MHM in Ten meeting, which mapped out a 10-year agenda for menstrual hygiene management in schools worldwide. In addition, there have been grassroots efforts in the U.S. and globally to address the menstrual needs of incarcerated women and low-income girls and to fight the tampon tax — an effort to exempt feminine hygiene products from states’ sales tax.

Sommer said there has been an explosion of menstrual products globally, but there’s little monitoring to know what works and in which settings.

“I don’t want to quell the advocacy…but I think the public health community needs to catch up with the advocates a little and help provide a firmer foundation of empirical data,” Sommer told attendees.

Advocacy programs show that young women know very little about their periods, what to expect, what is “normal” and how to detect a problem — in fact, the natural process is often associated with fear or shame. Even in the U.S., menstruation is often viewed negatively.

Presenter Evelina Sterling, assistant professor of sociology at Kennesaw State University in Georgia, recalled how a chronic disease association asked her to review menstruation information in its new brochure. When she asked the brochure creators where they gathered the health information, they said they “Googled it.”

Sterling also searched online for information about menstrual health in the U.S. On government websites, for instance, the information about menstruation typically focused on problems such as premenstrual syndrome and bleeding disorders.

“They all focused on very negative messages, what’s wrong, that menstruation is something bad,” she said.

At girlshealth.gov, there were a lot of facts, but the information was vague and not very encouraging, Sterling said.

Penelope Phillips-Howard, a public health epidemiologist at the Liverpool School of Tropical Medicine in the United Kingdom, told session attendees that the existing literature on menstrual health illustrates how little data there is on the issue. The long list of gaps that public health needs to learn more about and gather data on include:

  • gaps in infrastructure: providing adequate, private, sanitary toilets and hot water and soap;
  • gaps in products: improving access and affordability, developing environmentally friendly disposal systems, and understanding better cultural and religious acceptance of various products;
  • gaps in programs: providing psychosocial support and education in schools; and
  • gaps in delivery channels: understanding the needs of people with disabilities, female sex workers, incarcerated women, refugees and orphans.

To read more about this story, visit the January 2019 issue of The Nation’s Health.