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      Menstrual health: a definition for policy, practice, and research

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          Abstract

          The term “menstrual health” has seen increased use across advocacy, programming, policy, and research, but has lacked a consistent, self-contained definition. As a rapidly growing field of research and practice a comprehensive definition is needed to (1) ensure menstrual health is prioritised as a unified objective in global health, development, national policy, and funding frameworks, (2) elucidate the breadth of menstrual health, even where different needs may be prioritised in different sectors, and (3) facilitate a shared vocabulary through which stakeholders can communicate across silos to share learning. To achieve these aims, we present a definition of menstrual health developed by the Terminology Action Group of the Global Menstrual Collective. We describe the definition development process, drawing on existing research and terminology, related definitions of health, and consultation with a broad set of stakeholders. Further, we provide elaboration, based on current evidence, to support interpretation of the definition.

          Résumé

          Le terme de « santé menstruelle » est de plus en plus utilisé dans le plaidoyer, la programmation, les politiques et la recherche, mais il lui manque une définition cohérente et indépendante. Ce domaine de recherche et de pratique enregistrant une croissance rapide nécessite une définition complète pour 1) garantir la priorisation de la santé menstruelle comme objectif unifié dans les cadres de la santé mondiale, du développement, des politiques nationales et du financement, 2) préciser l'étendue de la santé menstruelle, même lorsque différents besoins peuvent faire l'objet de priorités dans différents secteurs, et 3) faciliter un vocabulaire commun avec lequel les parties prenantes peuvent communiquer au-delà des cloisonnements pour partager l'apprentissage. Pour parvenir à ces objectifs, nous présentons une définition de la santé menstruelle préparée par le groupe d'action sur la terminologie du collectif mondial sur les menstruations (Global Menstrual Collective). Nous décrivons le processus d'élaboration de la définition, fondé sur la terminologie et les recherches existantes, les définitions apparentées de la santé, et des consultations avec un large éventail de parties prenantes. De plus, nous fournissons des justifications, sur la base des données actuelles, à l'appui de l'interprétation de la définition.

          Resumen

          El uso del término “salud menstrual” ha aumentado en las áreas de promoción y defensa, programas, políticas e investigación, pero se carece de una definición sistemática y autocontenida. En un campo de investigación y práctica que continúa creciendo rápidamente, se necesita una definición integral para (1) garantizar que la salud menstrual sea priorizada como objetivo unificado en los marcos de salud mundial, desarrollo, políticas nacionales y financiamiento, (2) dilucidar la amplitud de la salud menstrual, aun cuando diferentes necesidades sean priorizadas en diferentes sectores, y (3) facilitar un vocabulario común con el cual las partes interesadas puedan comunicarse entre silos para intercambiar conocimientos. Para lograr estos objetivos, presentamos una definición de salud menstrual formulada por el Grupo de Acción en Terminología de la Colectiva Menstrual Mundial. Describimos el proceso de formulación de la definición, basándonos en investigaciones y terminología existentes, en definiciones de salud relacionadas y en consulta con una gran variedad de partes interesadas. Además, proporcionamos elaboración, basada en la evidencia actual, para apoyar la interpretación de la definición.

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          Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher– Lancet Commission

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            A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management

            Background Differing approaches to menstrual hygiene management (MHM) have been associated with a wide range of health and psycho-social outcomes in lower income settings. This paper systematically collates, summarizes and critically appraises the available evidence. Methods Following the PRISMA guidelines a structured search strategy was used to identify articles investigating the effects of MHM on health and psycho-social outcomes. The search was conducted in May 2012 and had no date limit. Data was extracted and quality of methodology was independently assessed by two researchers. Where no measure of effect was provided, but sufficient data were available to calculate one, this was undertaken. Meta-analysis was conducted where sufficient data were available. Results 14 articles were identified which looked at health outcomes, primarily reproductive tract infections (RTI). 11 articles were identified investigating associations between MHM, social restrictions and school attendance. MHM was found to be associated with RTI in 7 papers. Methodologies however varied greatly and overall quality was low. Meta-analysis of a subset of studies found no association between confirmed bacterial vaginosis and MHM (OR: 1.07, 95% CI: 0.52–2.24). No other substantial associations with health outcomes were found. Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in management methods reduce school absenteeism. Conclusion The management of menstruation presents significant challenges for women in lower income settings; the effect of poor MHM however remains unclear. It is plausible that MHM can affect the reproductive tract but the specific infections, the strength of effect, and the route of transmission, remain unclear. There is a gap in the evidence for high quality randomised intervention studies which combine hardware and software interventions, in particular for better understanding the nuanced effect improving MHM may have on girls’ attendance at school.
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              Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis

              Background Attention to women’s and girls’ menstrual needs is critical for global health and gender equality. The importance of this neglected experience has been elucidated by a growing body of qualitative research, which we systematically reviewed and synthesised. Methods and findings We undertook systematic searching to identify qualitative studies of women’s and girls’ experiences of menstruation in low- and middle-income countries (LMICs). Of 6,892 citations screened, 76 studies reported in 87 citations were included. Studies captured the experiences of over 6,000 participants from 35 countries. This included 45 studies from sub-Saharan Africa (with the greatest number of studies from Kenya [n = 7], Uganda [n = 6], and Ethiopia [n = 5]), 21 from South Asia (including India [n = 12] and Nepal [n = 5]), 8 from East Asia and the Pacific, 5 from Latin America and the Caribbean, 5 from the Middle East and North Africa, and 1 study from Europe and Central Asia. Through synthesis, we identified overarching themes and their relationships to develop a directional model of menstrual experience. This model maps distal and proximal antecedents of menstrual experience through to the impacts of this experience on health and well-being. The sociocultural context, including menstrual stigma and gender norms, influenced experiences by limiting knowledge about menstruation, limiting social support, and shaping internalised and externally enforced behavioural expectations. Resource limitations underlay inadequate physical infrastructure to support menstruation, as well as an economic environment restricting access to affordable menstrual materials. Menstrual experience included multiple themes: menstrual practices, perceptions of practices and environments, confidence, shame and distress, and containment of bleeding and odour. These components of experience were interlinked and contributed to negative impacts on women’s and girls’ lives. Impacts included harms to physical and psychological health as well as education and social engagement. Our review is limited by the available studies. Study quality was varied, with 18 studies rated as high, 35 medium, and 23 low trustworthiness. Sampling and analysis tended to be untrustworthy in lower-quality studies. Studies focused on the experiences of adolescent girls were most strongly represented, and we achieved early saturation for this group. Reflecting the focus of menstrual health research globally, there was an absence of studies focused on adult women and those from certain geographical areas. Conclusions Through synthesis of extant qualitative studies of menstrual experience, we highlight consistent challenges and developed an integrated model of menstrual experience. This model hypothesises directional pathways that could be tested by future studies and may serve as a framework for program and policy development by highlighting critical antecedents and pathways through which interventions could improve women’s and girls’ health and well-being. Review protocol registration The review protocol registration is PROSPERO: CRD42018089581.
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                Author and article information

                Journal
                Sex Reprod Health Matters
                Sex Reprod Health Matters
                Sexual and Reproductive Health Matters
                Taylor & Francis
                2641-0397
                29 April 2021
                2021
                : 29
                : 1
                : 1911618
                Affiliations
                [a ]Research Fellow, Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Adjunct Research Associate, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
                [b ]Lecturer in Human Rights, Institute for the Study of Human Rights, Columbia University , New York, NY, USA
                [c ]Professor, Women’s, Gender, and Sexuality Studies, College of Liberal Arts, Department of Women’s, Gender, and Sexuality Studies, University of Massachusetts Boston , Boston, MA, USA
                [d ]Founder & Executive Director, Menstrual Health Hub / MH Hub , Berlin, Germany
                [e ]Co-Founder, Menstrual Cup Coalition , Nairobi, Kenya
                [f ]Co-Founder and Managing Director, The Case for Her , Stockholm, Sweden
                [g ]Scientist, UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization , Geneva, Switzerland
                [h ]Consultant, UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization , Geneva, Switzerland
                [i ]Regional Programme Manager South Asia, WaterAid , London, UK.
                Author notes
                Author information
                https://orcid.org/0000-0003-2011-1595
                https://orcid.org/0000-0001-5878-4387
                https://orcid.org/0000-0002-2712-894X
                https://orcid.org/0000-0002-5654-1880
                https://orcid.org/0000-0002-9825-9701
                https://orcid.org/0000-0002-9241-8505
                https://orcid.org/0000-0001-6937-4842
                https://orcid.org/0000-0003-3224-618X
                https://orcid.org/0000-0002-5996-2664
                Article
                1911618
                10.1080/26410397.2021.1911618
                8098749
                33910492
                2fe1ee7c-4518-4443-b7c7-30955e19234e
                © 2021 World Health Organization. Published by Informa UK Limited, trading as Taylor & Francis Group

                This is an Open Access article distributed under the terms of the Creative CommonsAttribution IGO License ( http://creativecommons.org/licenses/by/3.0/igo/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. There should be no suggestion that the World HealthOrganization endorses any specific organization, products or services. This notice shouldbe preserved along with the article's original URL.

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                gender equality,health,menstrual cycle,menstrual health,human rights

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