Socio-cultural implications for women’s menstrual health in the Pacific Island Countries and Territories (PICTs): a scoping review

Abstract

Background

Globally, experiences of menarche and subsequent menstruation are embedded in social and cultural beliefs, norms and practices. Menarche is an important developmental milestone in sexual and reproductive health (SRH) for females. Menarche is intertwined with socio-cultural norms, beliefs and practices, which can impact on women’s ability to manage menstruation with dignity. This paper reviews the social and cultural factors that affect women’s ability to effectively manage their menstrual health and hygiene (MHH) in Pacific Island Countries and Territories (PICTs).

Methods

A scoping review was conducted following PRISMA scoping review guidelines and inclusion/exclusion criteria. An online search was conducted for peer-reviewed publications in Medline/OVID; Medline/PubMED; PsycINFO; CINAHL; Scopus and JSTOR, and Google Scholar. A search for grey literature was conducted in Google Scholar and websites of international and local organizations. Experts in the field also contributed additional references. Extracted data were summarised in an Excel spreadsheet. Searches were conducted between May and June, 2019, and then repeated in July, 2020.

Results

A total of 11 studies were included; 10 qualitative and one mixed methods study. Studies were conducted in Melanesian (n = 9), Polynesian (n = 1) and Micronesian (n = 1) PICTs. All 11 studies reported elements of societal and personal factors; ten studies reported evidence relating to interpersonal factors; nine studies reported elements relating to environmental factors; and two studies presented evidence linked to biological factors. Managing menstrual health with dignity is challenging for many women and girls because menstruation is associated with menstrual taboos and shame.

Conclusion

This review found that the MHH experiences of women in PICTs are affected by social and cultural beliefs, norms and practices. Beliefs, norms and practices about menarche need to be incorporated in SRH planning, programs and education in order to be relevant to diverse village and urban settings.

Plain language Summary

Globally, menarche is an important developmental milestone for females. Experiences of menarche and subsequent menstruation are embedded in socio-cultural norms and practices which can impact women’s ability to manage menstruation with dignity. This paper reviews social and cultural factors that affect the ability of women to effectively manage their menstrual health and hygiene (MHH) in Pacific Island Countries and Territories (PICTs). Peer-reviewed and grey literature were searched systematically, using the PRISMA extended scoping review methodology. Eleven studies met the inclusion and exclusion criteria: 10 qualitative studies and one mixed methods study. Included studies had been conducted in Melanesian (n = 9), Polynesian (n = 1) and Micronesian (n = 1) states of PICTs. Factors affecting MHH were identified and categorised using the Socio-Ecological Framework categories: biological; personal; interpersonal; environmental and societal. All 11 studies reported elements of societal and personal factors; ten studies reported evidence relating to interpersonal factors; nine studies reported elements relating to environmental factors; and two studies presented evidence linked to biological factors. MHH experiences of women in PICTs are shaped by socio-cultural norms and practices. These norms and practices need to be incorporated into sexual and reproductive health planning, programs and education in order to be relevant to diverse village and urban settings in PICTs.