What Is Menstrual Health?

Menstruation is a natural fact of life and a monthly occurrence for about 1.8 billion girls, women, transgender men, and non-binary persons of reproductive age. Menstrual health involves more than just an absence of medical problems related to the menstrual cycle—it includes a state of complete wellbeing. Menstrual health is a basic human right—everyone who menstruates should be able to manage their monthly menstrual cycle in a dignified, healthy way. This broad definition of menstrual health is aligned with the World Health Organization’s overall definition of human health and reflects the many ways the lives of those who menstruate can be negatively affected by social factors, i.e., outside the person [1].

Achieving menstrual health implies not only access to menstrual products like pads, tampons, and underwear, but that girls, women, and all other individuals who menstruate (menstruators) have the resources (information, supplies, running water, clean menstrual facilities, and supportive environments) to properly manage their menstrual health and fully participate in their normal daily activities during their menstrual cycles (Figure 1) [1–3].

Menstrual health can be divided into four main areas: (1) knowledge about menstruation before menarche; (2) the availability of menstrual materials to capture and contain menstrual blood, such as sanitary pads, cloth, tampons, or cups; (3) access to a private place to wash and change while at home; (4) the ability to participate in activities during menstruation, such as school, work, and social activities [4].

Menstrual health is central to fulfilling sexual and reproductive health and rights (SRHR) and several other human rights aligned with the Sustainable Development Goals (SDGs). “Sustainable” means that something can carry on forever; therefore, the SDGs aim to create better ways of life without destroying the environment and resources for the future. Menstrual health is important for the attainment of at least nine of the 17 SDGs adopted in 2015 by the United Nations General Assembly to be achieved by 2030, from Goal 3-Good Health and Wellbeing, meaning that people should be able to menstruate in a way that promotes their health, with the appropriate and healthy products of their choice and without pain and discomfort, to Goal 17-Partnerships for the Goals, that is collaborative approaches to address main menstrual health management issues, including social and cultural norms, access to water and sanitation, products, education, standards, human rights, and marginalized populations.

What Is Period Poverty?

Period poverty encompasses all the barriers that menstruating people face to accessing menstrual products, menstrual health educational materials, and clean, functional bathroom facilities. People all over the world can suffer from period poverty, particularly in low-income countries. One factor that contributes to period poverty is cost—many people may not be able to afford menstrual hygiene products such as pads or tampons, or related costs such as pain medication or underwear. Difficulty affording menstrual products can cause individuals to stay home from school and work, with lasting consequences for their education, work opportunities, and income.

Period poverty also includes the lack of menstrual health education and information, behavioral restrictions (such as the impossibility of maintaining certain practices, like those related to sports), stigma (negative attitudes toward the person) surrounding menstruation, and difficulties managing menstrual bleeding and pain.

Period poverty is not just an issue of money, but also a political and social issue. Efforts are growing in many countries to raise awareness of period poverty and break down the barriers preventing people from accessing menstrual products, running water, and bathroom/hygiene facilities. For instance, campaigns to remove sales taxes from menstruation products are part of a societal movement to address period poverty and the stigma surrounding menstruation in many places.

Menstruation and Environment: Is There a Link?

Although menstruation itself is not bad for the environment, some products used to manage menstruation, such as tampons and pads, often contain plastics and chemicals that are harmful to the environment. These products take centuries to decompose in a landfill—longer than a person’s lifespan. The manufacturing processes for producing menstrual products can also have environmental consequences.

Options that are more environmentally friendly include reusable products, such as menstrual cups and reusable or biodegradable pads. However, such alternative methods are not available or culturally acceptable in many places. It is crucial to allow people to make informed choices about which menstrual products are acceptable to them and fit their needs [5].

Menstrual Health: What Can Schools Do?

Schools can be a supportive environment for menstrual health, and they can provide students with the knowledge, sanitary products, and facilities to understand and manage their menstruation in a safe, private, accessible (available when needed), and gender-affirming manner (i.e., living according to authentic gender, according, or not, to what was defined at birth). Examples include private, clean bathrooms that can lock; sufficient handwashing facilities and soap; and proper, easily accessible places to dispose of sanitary products in bathrooms.

Schools can provide clear, easily understandable menstrual health education for children of all genders, abilities, cultures, and languages starting in primary school. Education that includes menstrual health as a positive part of being human, without shame, is essential for creating a future society free from all stigma surrounding menstruation. Schools can also promote better education and information on reusable menstrual products, to give students the freedom to choose which products they would like to use. This could help to drive the social acceptance of reusable menstrual products. Finally, schools can promote family and community engagement by being transparent and available for families, through open and broad communication about menstrual health and how to promote it, and by being available for dialog with families about each student’s menstrual health needs.

Menstrual Justice: Everyone Has a Role

As we have explained, many factors can lead to unmet menstrual health needs. We can achieve Menstrual Justice by working to eliminate the stigma surrounding menstruation and period taboo, building societies where people can discuss menstruation openly, and removing barriers to good menstrual hygiene.

Raising awareness about the challenges some people face accessing menstrual products, education about menstruation, and period-friendly bathroom facilities are steps forward in the journey to end period poverty. Menstrual Hygiene Day (https://menstrualhygieneday.org/) is an annual awareness day held on 28 May, because menstrual cycles average 28 days in length and people menstruate an average of 5 days each month (May is the fifth month of the year). Menstrual Hygiene Day seeks to highlight the importance of good menstrual hygiene management all over the world. Celebrating this day is a chance to emphasize the importance of menstrual health and hygiene care, raise awareness, and change harmful stigmas around menstrual health.

To reach the goal of menstrual justice, all people need to be engaged—especially young people—in the movement toward creating a menstrual-friendly environment.

Glossary

Menstrual Health: ↑ The ability of a menstruator to take care of their body during their monthly period. It means understanding what is happening and having access to the supplies needed to stay clean and comfortable.

Menstruators: ↑ Inclusive term to designate all people who menstruate and therefore have menstrual health and hygiene needs—including girls, women, transgender and non-binary persons.

Menstrual Facilities: ↑ Associated with safe and dignified menstruation, such as the ongoing provision of water, sanitation, hygiene, and disposal infrastructure in toilets, changing rooms, and other designated locations.

Menarche: ↑ The onset of menstruation, the time when a girl has her first menstrual period.

Period Poverty: ↑ Limited or inadequate access to menstrual products or menstrual health education because of cost or stigmas associated with menstruation.

Stigma: ↑ When people treat something, like menstruation, as embarrassing or shameful, which can lead to discrimination against people who menstruate.

Reusable Products: ↑ Products that can be used multiple times to catch or absorb cervical fluid and menstrual flow, such as cloth menstrual pads, menstrual cups, and period underwear.

Period Taboo: ↑ Social custom that prohibits discussion of a particular practice or condition, thus potentially isolating members of a community who might be associated with the given practice or condition.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.