Menstrual Equity: Research and Action

In recent years, the menstrual hygiene management challenges facing schoolgirls in low-income-country contexts have gained global attention. We applied Gusfield's sociological analysis of the culture of public problems to better understand how this relatively newly recognized public health challenge rose to the level of global public health awareness and action. We similarly applied the conceptualization by Dorfman et al. of the role of public health messaging in changing corporate practice to explore the conceptual frames and the news frames that are being used to shape the perceptions of menstrual hygiene management as an issue of social justice within the context of public health. Important lessons were revealed for getting other public health problems onto the global-, national-, and local-level agendas.

Incarcerated women around the globe are predominantly of reproductive age. Most of these women have been pregnant before, and many want to be sexually active and avoid pregnancy upon release. Yet few of these women are on a regular method of contraception. Providing contraceptive services for women in custody benefits individual and public health goals of reducing unintended pregnancy. This policy briefing reviews evidence for an unmet need for family planning in the correctional setting, and policy implications for expanding services. The paper aims to discuss these issues.

Women's health concerns are generally underrepresented in basic and translational research, but reproductive health in particular has been hampered by a lack of understanding of basic uterine and menstrual physiology. Menstrual health is an integral part of overall health because between menarche and menopause, most women menstruate. Yet for tens of millions of women around the world, menstruation regularly and often catastrophically disrupts their physical, mental, and social well-being. Enhancing our understanding of the underlying phenomena involved in menstruation, abnormal uterine bleeding, and other menstruation-related disorders will move us closer to the goal of personalized care. Furthermore, a deeper mechanistic understanding of menstruation-a fast, scarless healing process in healthy individuals-will likely yield insights into a myriad of other diseases involving regulation of vascular function locally and systemically. We also recognize that many women now delay pregnancy and that there is an increasing desire for fertility and uterine preservation. In September 2018, the Gynecologic Health and Disease Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development convened a 2-day meeting, "Menstruation: Science and Society" with an aim to "identify gaps and opportunities in menstruation science and to raise awareness of the need for more research in this field." Experts in fields ranging from the evolutionary role of menstruation to basic endometrial biology (including omic analysis of the endometrium, stem cells and tissue engineering of the endometrium, endometrial microbiome, and abnormal uterine bleeding and fibroids) and translational medicine (imaging and sampling modalities, patient-focused analysis of menstrual disorders including abnormal uterine bleeding, smart technologies or applications and mobile health platforms) to societal challenges in health literacy and dissemination frameworks across different economic and cultural landscapes shared current state-of-the-art and future vision, incorporating the patient voice at the launch of the meeting. Here, we provide an enhanced meeting report with extensive up-to-date (as of submission) context, capturing the spectrum from how the basic processes of menstruation commence in response to progesterone withdrawal, through the role of tissue-resident and circulating stem and progenitor cells in monthly regeneration-and current gaps in knowledge on how dysregulation leads to abnormal uterine bleeding and other menstruation-related disorders such as adenomyosis, endometriosis, and fibroids-to the clinical challenges in diagnostics, treatment, and patient and societal education. We conclude with an overview of how the global agenda concerning menstruation, and specifically menstrual health and hygiene, are gaining momentum, ranging from increasing investment in addressing menstruation-related barriers facing girls in schools in low- to middle-income countries to the more recent "menstrual equity" and "period poverty" movements spreading across high-income countries.

Promoting menstrual period equity. Period poverty, or inadequate access to feminine hygiene products due to poverty, may not be frequently discussed, but it affects a significant portion of the U.S. and global female population. According to the Alliance for Period Supplies, one-quarter of all menstruators in the United States had difficulties affording period products in 2019.

Lack of access to sanitary products can mean that some people have no option but to use unclean rags, or nothing at all, to absorb their menstrual flow, putting them at risk of reproductive or urinary tract infections. Cora/ZanaAfrica Foundation The decision was the result of a legal campaign led by the organisation Free Periods, which argued that period poverty was denying some students the right to an education and that the government was required to comply with its obligations under the Equality Act to ensure that all children had equal access to an education. University student Amika George, who began the Free Periods campaign from her bedroom in 2017 to end period poverty in the UK, told The Lancet she believed the provision of free sanitary products in schools would have a huge impact on boosting school attendance. According to such rules, women are barred from entering the temple and the kitchen and are not allowed to touch other students during their period.

Weiss-Wolf explains why the menstrual equity frame—which makes the case for an agenda that advances systemic solutions to address the societal and financial impact of menstruation—is distinct in its direct linkage to core principles of democratic participation, citizen engagement, gender parity, and economic opportunity. She describes a social movement that has coalesced in the United States and details recent policy advocacy in which momentum has been both unusually bipartisan and swift. She also shows how related tools can be leveraged—in particular, law and litigation, coupled with extensive use of traditional and social media. Finally, Weiss-Wolf concludes with a preview of policy proposals ripe for further advocacy.

This open access handbook, the first of its kind, provides a comprehensive and carefully curated multidisciplinary genre-spanning view of the state of the field of Critical Menstruation Studies, opening up new directions in research and advocacy. It is animated by the central question: ‘“what new lines of inquiry are possible when we center our attention on menstrual health and politics across the life course?” The chapters—diverse in content, form and perspective—establish Critical Menstruation Studies as a potent lens that reveals, complicates and unpacks inequalities across biological, social, cultural and historical dimensions. This handbook is an unmatched resource for researchers, policy makers, practitioners, and activists new to and already familiar with the field as it rapidly develops and expands.