Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in low- and middle-income countries


By Venkatraman Chandra-Mouli and Sheila Vipul Patel
© 2011 A.M. Ahad, Courtesy of Photoshare

This paper maps the knowledge, attitudes, beliefs and practices surrounding menarche, menstrual hygiene and menstrual health among adolescent girls in low and middle income countries in order to inform the future design of relevant policies and programming.

The review produced three key findings:

Substantial numbers of girls in many countries have knowledge gaps and misconceptions about menstruation. This leaves them unprepared when they reach menarche and causes fear and anxiety.

Girls experience a variety of symptoms during menstruation—pain, headaches and fatigue. These symptoms combined with taboos result in their not being able to participate in household, school, or social activities.

Girls in poor urban and rural communities of LMIC are less likely to obtain and use sanitary pads. Instead, they use materials made at home with scraps of old cloth, cotton, paper, etc. Lack of privacy, access to clean water and functional toilets make it harder for them to manage their periods.

The findings point to how powerful and widespread the stigma around menstruation (a physiological condition) still is. Menstrual stigma does not kill like unsafe abortion but it blights health and development. It hinders girls’ abilities to carry out every day activities, weakens their self-esteem, and conditions poor health-care seeking.

By boldly calling for – and working for – change in three areas, we could end this unacceptable situation. Firstly, we must educate girls about puberty and menstruation. Secondly, we must improve their access to sanitary products (at the very least cloth that can be washed and reused), running water, toilets and disposal facilities. We must also assure girls of empathy and support when they have their periods, and access to a competent and caring health worker when they have menstrual health problems. Thirdly, we must change the narrative of menstruation from shameful, dirty and polluting to normal, healthy and positive.

The Global Strategy for Children’s Women’s and Adolescents’ Health calls for efforts to assure survival but to move beyond survival to enable individuals to thrive, and to transform communities and societies. Overcoming menstrual stigma and enabling girls to deal with their periods and take greater charge of their lives should be a key area of its focus.