There is a better way to measure menstrual health, researcher says

A training session on menstrual health and hygiene is conducted in Kenya. Photo by: Water and Sanitation Collaborative Council / CC BY

MISSOULA, Mont. — The barriers preventing women from comfortably managing their periods are well documented in narratives, but they are less understood from a data perspective. A new tool aims to change that.

“We have a lot of claims around girls missing school because of their period or claims that women are not at work. But if we want to make strong claims about that, we need data.”

— Julie Hennegan, research associate, Johns Hopkins Bloomberg School of Public Health

The Menstrual Practice Needs Scale, a set of 36 statements to which women can indicate one of four responses to best reflect their experience, seeks to fill the gap in quantitative data by moving beyond measuring menstrual pad use.

“Everyone wants to know how you measure menstrual hygiene. We had this qualitative research and some great trials happening. But if we wanted to put numbers on unmet needs or equip practitioners to actually be able to monitor if their programs were working, there was really nothing for them to use to measure progress on what I think is one of the key aspects of capturing if women and girls are having their needs met during their period,” said Julie Hennegan, research associate at Johns Hopkins Bloomberg School of Public Health, who is leading work on the scale.

That key aspect, she said, is to ask whether development practitioners are improving girls’ and women's holistic menstrual experiences.

Globally, 2.3 billion people live without basic sanitation services, and only 27% of people in least developed countries have adequate hand-washing facilities at home. Not being able to use these facilities makes it harder for women and girls to manage their periods safely and with dignity.

Donors and social enterprises are increasingly interested in addressing poor infrastructure and costly products that lead to period poverty — particularly considering news coverage and emerging research about impacts on school attendance and social participation.

“But we haven't had any way of capturing that in a quantitative way,” Hennegan said. “We have a lot of claims around girls missing school because of their period or claims that women are not at work. But if we want to make strong claims about that, we need data. And we also need data linking that they're having a negative time during their menstruation to those outcomes.”

The majority of studies that have tried to do that so far have examined issues such as whether sanitary pad use is associated with school attendance. But a limited scope and a lack of consistent measurement of menstrual health practices have made it difficult to determine whether both the product and environment needs of a specific population are being met — and even harder to evaluate those changes over time.

Biased surveys are also a concern, according to Wendy Anderson, co-founder of The Case for Her, a philanthropic investment portfolio that funded the Menstrual Practice Needs Scale.

“So many of the existing surveys were typically done to serve a purpose, in that either they're going to hook in further donor support for a specific program or for a product. … So they're written consciously or unconsciously with a bias, typically an expectation that a menstrual product — a pad, in particular — is going to keep a girl in school or that a menstrual pad is the desired end product, and it doesn't really reflect a girl's lived experience.”

Hennegan wants the new scale to shed light on how providing pads might improve one aspect of a woman or girl’s life but cause stress in another. “So we gave a bunch of girls pads, and now they're not worried about leaking, but are they worried about disposal and about carrying those pads around and storing them? So the scale gives you a mechanism to check across all of those domains,” she said.

Statements included in the scale to glean this information were informed by a review of 76 studies of menstruation in low- and middle-income countries, representing experiences from over 6,000 women and girls.

In partnership with Irise International, a U.K.- and Uganda-based organization that educates girls about menstrual and reproductive health, Hennegan tested the scale’s performance in a survey of more than 500 menstruating girls in Soroti, Uganda — helping to weed out questions that weren’t working. Now, Hennegan is looking to revalidate the tool by testing it in a separate study with adult women in Uganda in a different local language.

In the meantime, she hopes other researchers and NGOs adopt the scale — already publicly available — into their larger surveys, needs assessments, or program evaluations.

Anderson, whose organization solely funds menstruation and female sexual health initiatives, still finds herself “having difficult conversations with donors about why this is important,” she told Devex. The Menstrual Practice Needs Scale represents an opportunity for an entire community of organizations involved in menstrual health to build consistent, comparable data, she added.

“One argument that we do know that donors have is that it's like comparing apples to oranges when every organization has its own survey for its own purpose, which makes it very difficult to collect global data,” Anderson said. “So we need to move into an opportunity to collect global data so we can serve a global purpose.”

Devex, with support from our partner UN Women, is exploring how data is being used to inform policy and advocacy to advance gender equality. Gender data is crucial to make every woman and girl count. Visit the Focus on: Gender Data page for more. Disclaimer: The views in this article do not necessarily represent the views of UN Women.

About the author

  • Kelli Rogers

    Kelli Rogers has worked as an Associate Editor and Southeast Asia Correspondent for Devex, with a particular focus on gender. Prior to that, she reported on social and environmental issues from Nairobi, Kenya. Kelli holds a bachelor’s degree in journalism from the University of Missouri, and has reported from more than 20 countries.