How best to tackle the stigma of menstruation?

An Oxford University study says while many girls and women stay away from school and work because of the stigma attached to having periods, very little research has been done into whether programmes set up to tackle the problem are actually working.

Although current results are 'promising', the study concludes that policymakers need to carry out large, comprehensive reviews of such programmes, and also conduct research into any potentially damaging unintended consequences, such as 'outing' menstruating girls in cultures where such behaviour is still considered taboo.

The authors of study, published in the journal, PLOS One, carried out an exhaustive review of all available academic literature. They found some interventions appear to show positive effects for reducing absenteeism and combatting girls' feelings of shame and insecurity. However, worldwide, only eight trials have been conducted on the topic. Only three of these tested the value of providing sanitary products; two of these were small pilot studies.

The paper remarks that although governments, international organisations and local charities have invested money and resources into ways of helping girls cope with periods, without testing the programmes there is little evidence to support them as the most effective use of scarce funds.

Surprisingly perhaps, the researchers found no research published on the effectiveness of interventions for adult women in poor countries. The paper suggests that since the challenge presented by menstruation does not simply disappear for adult women, research into their experiences is sorely needed.

This review also highlights a series of studies across low-income and middle-income countries showing that at least half of the girls in the populations sampled did not receive adequate sanitary protection or advice on coping with periods. It also suggests that the proportion of girls affected in rural areas is likely to be even higher.

The research reviewed studies covering girls' experiences in Iran, Saudi Arabia, Zimbabwe, Ghana, Nepal and Kenya, with girls aged between 11 and 18 years old.

Senior author Professor Paul Montgomery, from the University's Centre for Evidence-Based Intervention, said: 'We know that menstruation is a problem for many women and girls, particularly in countries where there is stigma and feelings of shame associated with it. Yet exactly how it acts as a barrier to education, work and gender equality in poor countries has been largely neglected as a topic for research.

'Interventions such as the provision of sanitary products or education around puberty may be simple strategies that can increase girls' attendance at school and reduce the stigma surrounding periods. Such programmes may be a cost-effective way to target gender inequalities but we need proper evidence that can measure their effectiveness.'

Lead author Julie Hennegan said: 'One problem in gathering reliable evidence seems to be that menstruation is a taboo subject for many. Researchers may be failing to get an accurate picture of what is happening, or may find it difficult to give women and girls the information they need unless they take great care in working around the different cultural sensitivities around girls having periods.'