Menstrual management in low-income countries: needs and trends
Access to appropriate facilities for menstrual hygiene and management (MHM) is recognized as a neglected need within the sanitation sector globally. However, little is known about the magnitude or trajectory of this need. Further, the particular services and facilities required to meet MHM needs depend on the practices and products employed by women and girls. We use nationally representative data from 58 low and lower-middle income countries to estimate that 800 million women in such countries menstruate regularly. Positive correlations between menstruation and nutritional status, as well as menstruation and household wealth, imply a growing need for menstrual management solutions as poverty declines, but both effects are dwarfed by the impact of declining fertility rates. Data on imports of disposable menstrual products reveal exponential growth in their use in low and especially lower-middle income countries. This trend is likely to continue as incomes grow and markets develop, making ever greater the need for provision of appropriate disposal facilities.Allen, L. (1997) ‘Pregnancy and iron deficiency: unresolved issues’, Nutrition Reviews 55: 91-101. <http://dx.doi.org/10.1201/9781420036787.ch2≯
Allen, L. and Casterline-Sabel, J. (2001) ‘Prevalence and causes of nutritional anemias’, in U. Ramakrishnan (ed.), Nutritional Anemias, Chapter 2, Boca Raton, FL: CRC Press
Bharadwaj, S. and Patkar, A. (2004) ‘Menstrual hygiene and management in developing countries: taking stock’ [online], Museum of Menstruation & Women's Health, <www.mum.org/menhydev.htm≯ [accessed 27 February 2013]. www.mum.org/menhydev.htm
Crofts, T. and Fisher, J. (2012) ‘Menstrual hygiene in Ugandan schools: an investigation of low-cost sanitary pads’, Journal of Water, Sanitation and Hygiene for Development 2: 50-58.
Garg, R., Goyal, S. and Gupta, S. (2012) ‘India moves towards menstrual hygiene: subsidized sanitary napkins for rural adolescent girls - issues and challenges’, Maternal and Child Health Journal 16 (4): 767-74. <http://dx.doi.org/10.1007/s10995-011-0798-5≯
Harlow, S.D. and Campbell, O.M.R. (2000) ‘Menstrual dysfunction: a missed opportunity for improving reproductive health in developing countries’, Reproductive Health Matters 8: 142-57. <www.jstor.org/stable/3775199≯ www.jstor.org/stable/3775199
Harlow, S.D. and Campbell, O.M.R. (2004) ‘Epidemiology of menstrual disorders in developing countries: a systematic review’, International Journal of Obstetrics and Gynecology 111: 6-16. <http://dx.doi.org/10.1111/j.1471-0528.2004.00012.x≯
Kjellen, M., Pensulo, C., Nordqvist, P. and Fodge, M. (2011) Global Review of Sanitation System Trends and Interactions with Menstrual Management Practices. Report for the Menstrual Management and Sanitation Systems Project, Stockholm: Stockholm Environment Institute.
Northern Cape Provincial Government (2010) ‘Premier launches sanitary towels/pads campaign’ [online], press release <www.northern-cape.gov.za/index.php?option=com_content&view=article&id=405:premier-launches-sanitary-towelspads-campaign&catid=42:latestnews&Itemid=91≯ [accessed 27 February 2013]. www.northern-cape.gov.za/index.php?option=com_content&view=article&id=405:premier-launches-sanitary-towelspads-campaign&catid=42:latestnews&Itemid=91
Oster, E. and Thornton, R. (2009) Determinants of Technology Adoption: Private Value and Peer Effects in Menstrual Cup Take-Up, National Bureau of Economic Research Working Paper 14828, Cambridge, MA: NBER.
Proctor & Gamble (2010) 2010 Annual Report [online] <http://annualreport.pg.com/annualreport2010/ touching-and-improving-lives/index.shtml≯ [accessed 27 February 2013]. http://annualreport.pg.com/annualreport2010/ touching-and-improving-lives/index.shtml
Scott, L., Dopson, S., Montgomery, P., Dolan, C. and Ryus, C. (2009) Impact of Providing Sanitary Pads to Poor Girls in Africa, Oxford: Oxford University Press.
Seymour, K. (2008) Bangladesh: Tackling Menstrual Hygiene Taboos, UNICEF Sanitation and Hygiene, Case #10, New York: UNICEF.
Sommer, M. (2010) ‘Putting menstrual hygiene management on to the school water and sanitation agenda’, Waterlines 29 (4): 268-78. <http://dx.doi.org.proxy-um.researchport.umd.edu/10.3362/1756-3488.2010.030≯
Sommer, M. (2011) Global Review of Menstrual Beliefs and Behaviors in Low Income Countries: Implications for Menstrual Hygiene Management, report prepared for Menstrual Management and Sanitation Systems, University of Maryland, College Park, MD: University of Maryland.
SWETA (2010) Operational Guidelines, Promotion of Menstrual Hygiene among adolescent girls (10-19 years) in Rural Areas, New Delhi, India: National Rural Health Mission.
Thomas, F., Renaud, F., Benefice, E., De Meeus, T. and Guegan, J-F. (2001) ‘International variability of ages at menarche and menopause: patterns and main determinants’, Journal of Human Biology 73: 271-90. <http://dx.doi.org/10.1353/hub.2001.0029≯
The Tribune (2011) ‘One-rupee sanitary napkin for rural girls: Phase I of the scheme will cover 1.5 cr girls in 152 districts of 20 states’ [online], Tribune News Service, <www.tribuneindia.com/2011/20110518/main8.htm≯ [accessed 27 February 2013]. www.tribuneindia.com/2011/20110518/main8.htm
WHO/UNICEF (2012) ‘Progress on drinking water and sanitation: 2012 update’, New York, NY: WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. <www.unicef.org/media/files/JMPreport2012.pdf≯ www.unicef.org/media/files/JMPreport2012.pdf
Allen, L. (1997) ‘Pregnancy and iron deficiency: unresolved issues’, Nutrition Reviews 55: 91-101. <http://dx.doi.org/10.1201/9781420036787.ch2≯
Allen, L. and Casterline-Sabel, J. (2001) ‘Prevalence and causes of nutritional anemias’, in U. Ramakrishnan (ed.), Nutritional Anemias, Chapter 2, Boca Raton, FL: CRC Press
Bharadwaj, S. and Patkar, A. (2004) ‘Menstrual hygiene and management in developing countries: taking stock’ [online], Museum of Menstruation & Women's Health, <www.mum.org/menhydev.htm≯ [accessed 27 February 2013]. www.mum.org/menhydev.htm
Crofts, T. and Fisher, J. (2012) ‘Menstrual hygiene in Ugandan schools: an investigation of low-cost sanitary pads’, Journal of Water, Sanitation and Hygiene for Development 2: 50-58.
Garg, R., Goyal, S. and Gupta, S. (2012) ‘India moves towards menstrual hygiene: subsidized sanitary napkins for rural adolescent girls - issues and challenges’, Maternal and Child Health Journal 16 (4): 767-74. <http://dx.doi.org/10.1007/s10995-011-0798-5≯
Harlow, S.D. and Campbell, O.M.R. (2000) ‘Menstrual dysfunction: a missed opportunity for improving reproductive health in developing countries’, Reproductive Health Matters 8: 142-57. <www.jstor.org/stable/3775199≯ www.jstor.org/stable/3775199
Harlow, S.D. and Campbell, O.M.R. (2004) ‘Epidemiology of menstrual disorders in developing countries: a systematic review’, International Journal of Obstetrics and Gynecology 111: 6-16. <http://dx.doi.org/10.1111/j.1471-0528.2004.00012.x≯
Kjellen, M., Pensulo, C., Nordqvist, P. and Fodge, M. (2011) Global Review of Sanitation System Trends and Interactions with Menstrual Management Practices. Report for the Menstrual Management and Sanitation Systems Project, Stockholm: Stockholm Environment Institute.
Northern Cape Provincial Government (2010) ‘Premier launches sanitary towels/pads campaign’ [online], press release <www.northern-cape.gov.za/index.php?option=com_content&view=article&id=405:premier-launches-sanitary-towelspads-campaign&catid=42:latestnews&Itemid=91≯ [accessed 27 February 2013]. www.northern-cape.gov.za/index.php?option=com_content&view=article&id=405:premier-launches-sanitary-towelspads-campaign&catid=42:latestnews&Itemid=91
Oster, E. and Thornton, R. (2009) Determinants of Technology Adoption: Private Value and Peer Effects in Menstrual Cup Take-Up, National Bureau of Economic Research Working Paper 14828, Cambridge, MA: NBER.
Proctor & Gamble (2010) 2010 Annual Report [online] <http://annualreport.pg.com/annualreport2010/ touching-and-improving-lives/index.shtml≯ [accessed 27 February 2013]. http://annualreport.pg.com/annualreport2010/ touching-and-improving-lives/index.shtml
Scott, L., Dopson, S., Montgomery, P., Dolan, C. and Ryus, C. (2009) Impact of Providing Sanitary Pads to Poor Girls in Africa, Oxford: Oxford University Press.
Seymour, K. (2008) Bangladesh: Tackling Menstrual Hygiene Taboos, UNICEF Sanitation and Hygiene, Case #10, New York: UNICEF.
Sommer, M. (2010) ‘Putting menstrual hygiene management on to the school water and sanitation agenda’, Waterlines 29 (4): 268-78. <http://dx.doi.org.proxy-um.researchport.umd.edu/10.3362/1756-3488.2010.030≯
Sommer, M. (2011) Global Review of Menstrual Beliefs and Behaviors in Low Income Countries: Implications for Menstrual Hygiene Management, report prepared for Menstrual Management and Sanitation Systems, University of Maryland, College Park, MD: University of Maryland.
SWETA (2010) Operational Guidelines, Promotion of Menstrual Hygiene among adolescent girls (10-19 years) in Rural Areas, New Delhi, India: National Rural Health Mission.
Thomas, F., Renaud, F., Benefice, E., De Meeus, T. and Guegan, J-F. (2001) ‘International variability of ages at menarche and menopause: patterns and main determinants’, Journal of Human Biology 73: 271-90. <http://dx.doi.org/10.1353/hub.2001.0029≯
The Tribune (2011) ‘One-rupee sanitary napkin for rural girls: Phase I of the scheme will cover 1.5 cr girls in 152 districts of 20 states’ [online], Tribune News Service, <www.tribuneindia.com/2011/20110518/main8.htm≯ [accessed 27 February 2013]. www.tribuneindia.com/2011/20110518/main8.htm
WHO/UNICEF (2012) ‘Progress on drinking water and sanitation: 2012 update’, New York, NY: WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. <www.unicef.org/media/files/JMPreport2012.pdf≯ www.unicef.org/media/files/JMPreport2012.pdf
Allen, L. (1997) ‘Pregnancy and iron deficiency: unresolved issues’, Nutrition Reviews 55: 91-101. <http://dx.doi.org/10.1201/9781420036787.ch2≯
Allen, L. and Casterline-Sabel, J. (2001) ‘Prevalence and causes of nutritional anemias’, in U. Ramakrishnan (ed.), Nutritional Anemias, Chapter 2, Boca Raton, FL: CRC Press
Bharadwaj, S. and Patkar, A. (2004) ‘Menstrual hygiene and management in developing countries: taking stock’ [online], Museum of Menstruation & Women's Health, <www.mum.org/menhydev.htm≯ [accessed 27 February 2013]. www.mum.org/menhydev.htm
Crofts, T. and Fisher, J. (2012) ‘Menstrual hygiene in Ugandan schools: an investigation of low-cost sanitary pads’, Journal of Water, Sanitation and Hygiene for Development 2: 50-58.
Garg, R., Goyal, S. and Gupta, S. (2012) ‘India moves towards menstrual hygiene: subsidized sanitary napkins for rural adolescent girls - issues and challenges’, Maternal and Child Health Journal 16 (4): 767-74. <http://dx.doi.org/10.1007/s10995-011-0798-5≯
Harlow, S.D. and Campbell, O.M.R. (2000) ‘Menstrual dysfunction: a missed opportunity for improving reproductive health in developing countries’, Reproductive Health Matters 8: 142-57. <www.jstor.org/stable/3775199≯ www.jstor.org/stable/3775199
Harlow, S.D. and Campbell, O.M.R. (2004) ‘Epidemiology of menstrual disorders in developing countries: a systematic review’, International Journal of Obstetrics and Gynecology 111: 6-16. <http://dx.doi.org/10.1111/j.1471-0528.2004.00012.x≯
Kjellen, M., Pensulo, C., Nordqvist, P. and Fodge, M. (2011) Global Review of Sanitation System Trends and Interactions with Menstrual Management Practices. Report for the Menstrual Management and Sanitation Systems Project, Stockholm: Stockholm Environment Institute.
Northern Cape Provincial Government (2010) ‘Premier launches sanitary towels/pads campaign’ [online], press release <www.northern-cape.gov.za/index.php?option=com_content&view=article&id=405:premier-launches-sanitary-towelspads-campaign&catid=42:latestnews&Itemid=91≯ [accessed 27 February 2013]. www.northern-cape.gov.za/index.php?option=com_content&view=article&id=405:premier-launches-sanitary-towelspads-campaign&catid=42:latestnews&Itemid=91
Oster, E. and Thornton, R. (2009) Determinants of Technology Adoption: Private Value and Peer Effects in Menstrual Cup Take-Up, National Bureau of Economic Research Working Paper 14828, Cambridge, MA: NBER.
Proctor & Gamble (2010) 2010 Annual Report [online] <http://annualreport.pg.com/annualreport2010/ touching-and-improving-lives/index.shtml≯ [accessed 27 February 2013]. http://annualreport.pg.com/annualreport2010/ touching-and-improving-lives/index.shtml
Scott, L., Dopson, S., Montgomery, P., Dolan, C. and Ryus, C. (2009) Impact of Providing Sanitary Pads to Poor Girls in Africa, Oxford: Oxford University Press.
Seymour, K. (2008) Bangladesh: Tackling Menstrual Hygiene Taboos, UNICEF Sanitation and Hygiene, Case #10, New York: UNICEF.
Sommer, M. (2010) ‘Putting menstrual hygiene management on to the school water and sanitation agenda’, Waterlines 29 (4): 268-78. <http://dx.doi.org.proxy-um.researchport.umd.edu/10.3362/1756-3488.2010.030≯
Sommer, M. (2011) Global Review of Menstrual Beliefs and Behaviors in Low Income Countries: Implications for Menstrual Hygiene Management, report prepared for Menstrual Management and Sanitation Systems, University of Maryland, College Park, MD: University of Maryland.
SWETA (2010) Operational Guidelines, Promotion of Menstrual Hygiene among adolescent girls (10-19 years) in Rural Areas, New Delhi, India: National Rural Health Mission.
Thomas, F., Renaud, F., Benefice, E., De Meeus, T. and Guegan, J-F. (2001) ‘International variability of ages at menarche and menopause: patterns and main determinants’, Journal of Human Biology 73: 271-90. <http://dx.doi.org/10.1353/hub.2001.0029≯
The Tribune (2011) ‘One-rupee sanitary napkin for rural girls: Phase I of the scheme will cover 1.5 cr girls in 152 districts of 20 states’ [online], Tribune News Service, <www.tribuneindia.com/2011/20110518/main8.htm≯ [accessed 27 February 2013]. www.tribuneindia.com/2011/20110518/main8.htm
WHO/UNICEF (2012) ‘Progress on drinking water and sanitation: 2012 update’, New York, NY: WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. <www.unicef.org/media/files/JMPreport2012.pdf≯ www.unicef.org/media/files/JMPreport2012.pdf
Allen, L. (1997) ‘Pregnancy and iron deficiency: unresolved issues’, Nutrition Reviews 55: 91-101. <http://dx.doi.org/10.1201/9781420036787.ch2≯
Allen, L. and Casterline-Sabel, J. (2001) ‘Prevalence and causes of nutritional anemias’, in U. Ramakrishnan (ed.), Nutritional Anemias, Chapter 2, Boca Raton, FL: CRC Press
Bharadwaj, S. and Patkar, A. (2004) ‘Menstrual hygiene and management in developing countries: taking stock’ [online], Museum of Menstruation & Women's Health, <www.mum.org/menhydev.htm≯ [accessed 27 February 2013]. www.mum.org/menhydev.htm
Crofts, T. and Fisher, J. (2012) ‘Menstrual hygiene in Ugandan schools: an investigation of low-cost sanitary pads’, Journal of Water, Sanitation and Hygiene for Development 2: 50-58.
Garg, R., Goyal, S. and Gupta, S. (2012) ‘India moves towards menstrual hygiene: subsidized sanitary napkins for rural adolescent girls - issues and challenges’, Maternal and Child Health Journal 16 (4): 767-74. <http://dx.doi.org/10.1007/s10995-011-0798-5≯
Harlow, S.D. and Campbell, O.M.R. (2000) ‘Menstrual dysfunction: a missed opportunity for improving reproductive health in developing countries’, Reproductive Health Matters 8: 142-57. <www.jstor.org/stable/3775199≯ www.jstor.org/stable/3775199
Harlow, S.D. and Campbell, O.M.R. (2004) ‘Epidemiology of menstrual disorders in developing countries: a systematic review’, International Journal of Obstetrics and Gynecology 111: 6-16. <http://dx.doi.org/10.1111/j.1471-0528.2004.00012.x≯
Kjellen, M., Pensulo, C., Nordqvist, P. and Fodge, M. (2011) Global Review of Sanitation System Trends and Interactions with Menstrual Management Practices. Report for the Menstrual Management and Sanitation Systems Project, Stockholm: Stockholm Environment Institute.
Northern Cape Provincial Government (2010) ‘Premier launches sanitary towels/pads campaign’ [online], press release <www.northern-cape.gov.za/index.php?option=com_content&view=article&id=405:premier-launches-sanitary-towelspads-campaign&catid=42:latestnews&Itemid=91≯ [accessed 27 February 2013]. www.northern-cape.gov.za/index.php?option=com_content&view=article&id=405:premier-launches-sanitary-towelspads-campaign&catid=42:latestnews&Itemid=91
Oster, E. and Thornton, R. (2009) Determinants of Technology Adoption: Private Value and Peer Effects in Menstrual Cup Take-Up, National Bureau of Economic Research Working Paper 14828, Cambridge, MA: NBER.
Proctor & Gamble (2010) 2010 Annual Report [online] <http://annualreport.pg.com/annualreport2010/ touching-and-improving-lives/index.shtml≯ [accessed 27 February 2013]. http://annualreport.pg.com/annualreport2010/ touching-and-improving-lives/index.shtml
Scott, L., Dopson, S., Montgomery, P., Dolan, C. and Ryus, C. (2009) Impact of Providing Sanitary Pads to Poor Girls in Africa, Oxford: Oxford University Press.
Seymour, K. (2008) Bangladesh: Tackling Menstrual Hygiene Taboos, UNICEF Sanitation and Hygiene, Case #10, New York: UNICEF.
Sommer, M. (2010) ‘Putting menstrual hygiene management on to the school water and sanitation agenda’, Waterlines 29 (4): 268-78. <http://dx.doi.org.proxy-um.researchport.umd.edu/10.3362/1756-3488.2010.030≯
Sommer, M. (2011) Global Review of Menstrual Beliefs and Behaviors in Low Income Countries: Implications for Menstrual Hygiene Management, report prepared for Menstrual Management and Sanitation Systems, University of Maryland, College Park, MD: University of Maryland.
SWETA (2010) Operational Guidelines, Promotion of Menstrual Hygiene among adolescent girls (10-19 years) in Rural Areas, New Delhi, India: National Rural Health Mission.
Thomas, F., Renaud, F., Benefice, E., De Meeus, T. and Guegan, J-F. (2001) ‘International variability of ages at menarche and menopause: patterns and main determinants’, Journal of Human Biology 73: 271-90. <http://dx.doi.org/10.1353/hub.2001.0029≯
The Tribune (2011) ‘One-rupee sanitary napkin for rural girls: Phase I of the scheme will cover 1.5 cr girls in 152 districts of 20 states’ [online], Tribune News Service, <www.tribuneindia.com/2011/20110518/main8.htm≯ [accessed 27 February 2013]. www.tribuneindia.com/2011/20110518/main8.htm
WHO/UNICEF (2012) ‘Progress on drinking water and sanitation: 2012 update’, New York, NY: WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. <www.unicef.org/media/files/JMPreport2012.pdf≯ www.unicef.org/media/files/JMPreport2012.pdf
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