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Doctor of public health student, World Health Organization outline ways to improve worldwide menstrual health

The stigma surrounding menstrual health can have an adverse impact on adolescents. In many cultures, the topic is seldom discussed or is considered taboo. These effects extend beyond a public health issue and can further gender inequality through limited access to information, resources and opportunities. Aditi Sharma, a Penn State College of Medicine doctor of public health student, partnered with the World Health Organization (WHO) to release a new report that offers insight and guidelines to address the problem.

Sharma, co-founder of Kalyani, a menstrual hygiene-related organization that helps underserved populations in Nepal, served as a youth advisor at the WHO’s first-ever Global Research Collaborative Meeting on Menstrual Health in 2018.

She joined members of the WHO’s Department of Sexual and Reproductive Health and Research and their Special Programme of Research, Development and Research Training in Human Reproduction, along with experts from the United Nations Development Programme, United Nations Population Fund and the United Nations International Children’s Emergency Fund for an inaugural meeting in Switzerland.

The meeting explored global viewpoints and practices regarding menstruation, specifically adolescent menstrual health in low- and middle-income countries. From those discussions, Sharma co-authored a report that examines the challenges many women in these countries face, along with the ramifications of this public health issue.

“This is an extremely useful and relevant paper on menstrual health in low- and middle-income countries with important recommendations for future action and research,” said Sharma. “I hope this information will be implemented globally.”

The group focused on nine key areas that impact menstrual health:

  • Awareness and understanding: What information is available, and how is information shared?
  • Stigma, norms and socio-cultural practices: What connotations are associated with menstruation? Do certain beliefs reinforce discrimination, shame and isolation?
  • Menstrual hygiene products: Are products readily available and utilized? Is there a financial burden?
  • Water and sanitation: Are there physically-accessible, safe options for affordable, clean water and sanitation?
  • Disposal: Can products be safely discarded? What is the impact on community health and the environment?
  • Empathy and support: What can communities do to address misconceptions and provide systems of support?
  • Clinical care: If health problems arise, are women and girls able to seek care? Are services and preventive care available? If so, what is the economic impact?
  • Integration with other programs: How can programs work together to contribute to solutions and deliver services?
  • Financing: What entities are investing in improving the situation? What are sustainable financing options for supporting needs related to menstrual health?

Next, looking at each of these key areas, the group posed the following questions:

  • What is the current situation?
  • What are the factors contributing to this situation?
  • What should change in next 10 years?
  • What actions are needed to achieve these goals?
  • What research is needed to achieve these goals?

According to the report, few people talked about menstruation, and researchers found that many adolescents lacked accurate information about their bodies and menstrual health. This was especially true in low- and middle-income countries, where details are usually passed down through family members. As a result, this information may have been incomplete or biased.

Because menstrual health is seldom a topic of conversation in academic or community settings, researchers said this lack of communication may impede progress in other key areas needed to improve global efforts.

According to the researchers, accurate and culturally-relevant information is an important first step. They propose that moving forward, information should be readily available and convey that menstruation is a healthy, biological process for women and adolescents. Improved education could help ensure that basic necessities are met.

Women and girls in developing countries not only require better access to hygiene products, clean water and sanitation, but many lack underwear and other clothing, which prevent them from attending work and school. Satisfying these fundamental needs may improve overall health and well-being and also support self-efficacy and help women and girls participate in daily activities.

In terms of clinical care, the researchers recommended establishing standards to help promote menstrual health. In order to be successful, health care systems should provide specialized training to workers. Low- and middle-income countries could benefit from providing school- and community-based programs and services that promote menstrual health.

While the group provided guidance for moving forward, additional research is needed to fully understand the best way to deliver services and determine the long-term economic impact of this advocacy work.

Read the report titled, “The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research”

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