Menstrual health in East Asia and the Pacific: regional progress review
Our study with UNICEF and the Burnet Institute in Australia reviews the progress made in policy and programming towards supporting menstrual health needs across the East Asia and Pacific region between 2016 and 2022.
Menstrual health is essential to gender equality and the wellbeing of everyone who menstruates. Positive momentum across the East Asia and Pacific region has prompted increased efforts to support menstrual health integration across water, sanitation and hygiene (WASH), health, gender, education and other sectors. However, many gaps remain. Increased and sustained attention is needed to ensure people who menstruate can achieve menstrual health.
With UNICEF and the Burnet Institute, we undertook a regional review to provide an updated overview of progress towards supporting the breadth of menstrual health needs in the East Asia and Pacific region from 2016 to 2022. In the overview, we share the lessons learned and highlight opportunities for advancement. The report has two aims:
- Document the current state of policy and programming to support menstrual health by collating lessons learned and stakeholder insights on barriers and enablers to effective action.
- Synthesise evidence for the effectiveness of policies and programmes by documenting the lessons learned and barriers to high-quality monitoring and evaluation.
Attention on menstrual health continues to increase. Since 2016, acknowledgement of the importance of menstrual health has increased across the East Asia and Pacific region, aligning with increased attention globally. In response, policy and programming initiatives have emerged across the region.
WASH and sexual and reproductive health policies increasingly integrate aspects of menstrual health. Menstrual health was included in national polices, action plans and guidelines over the past five years in most of the East Asian and Pacific countries covered in the review. At a minimum, menstrual health was recognised by national governments as an issue requiring consideration, although not always in a comprehensive manner.
Menstrual health policy advancements require clear institutional arrangements and adequate financing. Across East Asia, ministries of education and health took on leadership of menstrual health, even in the absence of policies that establish responsibility. Yet, for many countries, leadership was lacking and adequate funding for menstrual healthcare remained a barrier to progress.
Service delivery focuses on education, menstrual products and menstruation-friendly facilities within school settings. Governments and NGOs regularly delivered menstrual health activities as part of the WASH, health or sexual and reproductive health programming in school settings. Most commonly, service delivery focused on education, provision of menstrual products and ensuring WASH facilities in schools.
Stronger government-led coordination mechanisms can reduce duplication and gaps and increase capacity. We found that competing priorities, lack of capacity and under-funding by governments led to NGOs filling the gaps. Few opportunities for training of government staff in the region, coupled with the pervasive stigma surrounding menstrual health, resulted in a skills and capacity shortage in menstrual health expertise.
Monitoring, evaluation and evidence remains a gap and must be addressed to inform practice and provide accountability. Despite increases in attention to and action on menstrual health since 2016, monitoring remained a gap. Limited incorporation of menstrual health into national monitoring systems, mostly focused on WASH facilities in schools and surveys, meant that the needs were not well known.
The systematic review identified slow growth of evidence for effective menstrual health interventions. Studies testing interventions aiming to address a range of menstrual health requirements were identified, including improving access to information, resources and facilities as well as self-care strategies for pain mitigation and care.
Barriers to monitoring and evaluation should be addressed throughout phases of planning and data collection, use and analysis. Progress has been made towards integrating menstrual health indicators into monitoring activities; however, significant barriers persist, limiting the generation of evidence and the utilisation of this evidence for advocacy, programming and reporting.
The five requirements of menstrual health
Menstrual Health is "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity, in relation to the menstrual cycle." Achieving menstrual health implies that everyone who menstruates, throughout their life-course, has the following requirements fulfilled:
- Access to information and education: They are able to access accurate, timely, age-appropriate information about the menstrual cycle, menstruation and changes experienced throughout the life course, as well as related self-care and hygiene practices.
- Access to materials, facilities and services: They are able to care for their bodies during menstruation such that their preferences, hygiene, comfort, privacy and safety are supported. This includes accessing and using effective and affordable menstrual materials and having supportive facilities and services, including water, sanitation and hygiene services, for washing the body and hands, changing menstrual materials and cleaning and/or disposing of used materials.
- Non-discrimination and participation: They are able to decide whether and how to participate in all spheres of life, including civil, cultural, economic, social and political, during all phases of the menstrual cycle, free from menstruation-related exclusion, restriction, discrimination, coercion and/or violence.
- Supportive social environment: They experience a positive and respectful environment in relation to the menstrual cycle, free from stigma and psychological distress, including the resources and support they need to confidently care for their bodies and make informed decisions about self-care throughout their menstrual cycle.
- Care for discomfort and disorders: They are able to access timely diagnosis, treatment and care for menstrual cycle-related discomfort and disorders, including access to appropriate health services and resources, pain relief and strategies for self care.
- To achieve menstrual health for all, countries must address all five requirements comprehensively. The definition of menstrual health can serve as a framework to assess progress and identify gaps.
- Evidence is urgently needed to guide the selection of policy initiatives that work to improve menstrual health experiences and outcomes.
- Where policies and strategies are adopted, strong institutional arrangements and financing are essential.
- Investment in capacity strengthening for menstrual health across the ecosystem would enable greater progress.
- Improved monitoring of menstrual health at multiple levels – including national monitoring and integration into the monitoring and evaluation of individual programmes – is essential for accountability, to track progress and to inform better practices.
Read UNICEF and WaterAid's 2021 report on the status of menstrual hygiene in schools in South Asia