The Need for Solutions

Poor menstrual health exacts a tremendous human and financial toll. A growing body of global research links menstruation with school absenteeism, engagement in transactional sex for money to buy sanitary pads, and lost workplace productivity. Menstrual care also presents unique challenges for women in humanitarian and fragile contexts and among women with disabilities.

Studies in Kenya, Ghana, Malawi, Uganda, Lebanon, and elsewhere point to a positive association between the challenges of managing menstruation and girls’ performance and attendance in school. Research in Ghana showed that puberty education, coupled with provision of menstrual pads, significantly increased school attendance among girls between 12 and 18 years old. Recognizing that some research has also shown a weak association with school attendance, new studies also measure additional indicators, such as self-esteem, comfort, and classroom participation. Investment in further research is needed.

I had my first period at school. My teacher said that I must tell them at home and do not come to school the following day. I sat and did not go to school for the whole week…
— PATH study participant, South Africa, 2012

Not surprisingly, there are also indications that menses-related absenteeism in the workplace leads to lost wages for women and lower productivity for businesses. A qualitative study in Pakistan revealed that female garment factory workers missed up to three days of work each month during their periods as a result of infections, embarrassment, and pain. Here too, research is needed to inform workplace policies and interventions.

In addition, because sanitary napkins are prohibitively expensive in many low-resource settings, some women are reduced to using unhygienic alternatives, such as old rags, strips of mattress, leaves, or soil. Among other health concerns, emerging evidence suggests that these practices and poor menstrual hygiene, may be linked to bacterial vaginosis, which affects thousands of women in low-resource settings. The infection raises their risk of sexually transmitted infections, including HIV; miscarriage; preterm labor; and other negative health outcomes.