Experiences of menstruation in high income countries: A systematic review, qualitative evidence synthesis and comparison to low- and middle-income countries

Abstract

Background There is growing recognition of the importance of menstruation in achieving health, education, and gender equality for all. New policies in high income countries (HICs) have responded to anecdotal evidence that many struggle to meet their menstrual health needs. Qualitative research has explored lived experiences of menstruating in HICs and can contribute to designing intervention approaches. To inform the growing policy attention to support people who menstruate, here we review and synthesise the existing research. Methods and findings Primary, qualitative studies capturing experiences of menstruation in HICs were eligible for inclusion. Systematic database and hand searching identified 11485 records. Following screening and quality appraisal using the EPPI-Centre checklist, 104 studies (120 publications) detailing the menstrual experiences of over 3800 individuals across sixteen countries were included. We used the integrated model of menstrual experiences developed from studies in low- and middle-income countries (LMICs) as a starting framework and deductively and inductively identified antecedents contributing to menstrual experiences; menstrual experiences themselves and impacts of menstrual experiences. Included studies described consistent themes and relationships that fit well with the LMIC integrated model, with modifications to themes and model pathways identified through our analysis. The socio-cultural context heavily shaped menstrual experiences, manifesting in strict behavioural expectations to conceal menstruation and limiting the provision of menstrual materials. Resource limitations contributed to negative experiences, where dissatisfaction with menstrual practices and management environments were expressed along with feelings of disgust if participants felt they failed to manage their menstruation in a discrete, hygienic way. Physical menstrual factors such as pain were commonly associated with negative experiences, with mixed experiences of healthcare reported. Across studies participants described negative impacts of their menstrual experience including increased mental burden and detrimental impacts on participation and personal relationships. Positive experiences were more rarely reported, although relationships between cis-women were sometimes strengthened by shared experiences of menstrual bleeding. Included studies reflected a broad range of disciplines and epistemologies. Many aimed to understand the constructed meanings of menstruation, but few were explicitly designed to inform policy or practice. Few studies focused on socioeconomically disadvantaged groups relevant to new policy efforts. Conclusions We developed an integrated model of menstrual experience in HICs which can be used to inform research, policy and practice decisions by emphasising the pathways through which positive and negative menstrual experiences manifest. Review protocol registration The review protocol registration is PROSPERO: CRD42019157618.

Experiences of menstrual inequity and menstrual health among women and people who menstruate in the Barcelona area (Spain): a qualitative study

“…This is inherently associated with the gender research (or data) gap and androcentric and patriarchal systems [ 7 , 10 , 24 , 38 , 39 ]. Most research on MH, menstrual poverty and menstrual management has been conducted in the Global South, investigating menstrual health and menstrual inequity in the Global North is also imperative [ 31 , 40 ]. This study aimed at exploring experiences of menstrual health and menstrual inequity among women and PWM aged 18–55 in the Barcelona Metropolitan area.…”

Period poverty: The perceptions and experiences of impoverished women living in an inner-city area of Northwest England

“…Until recently, efforts to improve MHH have largely focused on the needs of schoolgirls, and to a lesser extent women, in LMIC, with the assumption that the challenges for girls and women in high-income countries (HIC) are fewer and perhaps less significant [ 2 ]. However, increasing divisions in wealth disparity among populations in HIC have highlighted possible struggles for some sections of society to maintain basic levels of MHH [ 4 ]. The term ‘period poverty’ has been widely adopted, denoting an individual’s need for menstrual products without adequate funds to purchase them [ 4 ].…”

“…However, increasing divisions in wealth disparity among populations in HIC have highlighted possible struggles for some sections of society to maintain basic levels of MHH [ 4 ]. The term ‘period poverty’ has been widely adopted, denoting an individual’s need for menstrual products without adequate funds to purchase them [ 4 ]. Relying largely on anecdotal evidence to provide impetus, media campaigns have been established to generate awareness of period poverty to improve access to affordable menstrual products for all menstruators as a basic human right.…”

“…A recent systematic review highlighted that most research on menstruation in HIC was designed to “understand the constructed meanings of menstruation” rather than informing practice or policy. Just six qualitative studies were identified that targeted participants of low-income status, with the authors concluding that to date there is insufficient evidence on the needs of marginalized and impoverished women [ 4 ]. The few studies conducted, mostly with a US focus, suggest a substantial proportion of respondents reports period poverty on occasion, with a core group unable to purchase sufficient menstrual products every month.…”

Re-validation and adaptation of the Menstrual Practice Needs Scale to measure the menstrual experiences of adult women working in Mukono District, Uganda

“…[4][5][6] To support these objectives, a growing body of evidence is emerging to understand menstrual health needs and investigate programme effectiveness. [7][8][9][10] However, more research is needed and funding has been scarce. 8 11 12 Quantitative studies have been limited by a lack of high quality measurement tools.…”