Using Menstrual Hygiene and Health Data to Build a #PeriodFriendlyWorld


By: Katie Baczewski, Gender Equity & MEL Specialist II, USAID Water Security, Sanitation, and Hygiene Data & Analytics Activity

Each May, Menstrual Hygiene Day is observed around the world in order to break taboos and promote good menstrual health and hygiene (MHH) for all who menstruate. 

In 2024, we’re reflecting on what a #PeriodFriendlyWorld could truly mean.  

An estimated 1.8 billion people in the world menstruate–that’s 800 million per day!–and of those, approximately 500 million people face barriers in achieving optimal MHH. 

But how do we determine optimal MHH? How do we know how many people around the world truly have access to adequate menstrual products, access to safe water and sanitation services, education to make informed choices, and government policies that prioritize MHH? How do we know which people have the greatest gaps? And how do we even count how many people menstruate? 

The answer, of course, is data! Data can signal for us where there is the greatest need and allow us to understand the holistic picture in new and nuanced ways. At the same time, of course, data aren’t perfect. 

Global menstruation figures account for global population figures, estimated ages of population, and estimated age of menstruation (generally assumed to be 15-49). Although the majority of menstruators are women of reproductive age, not all people who menstruate are women, and not all women of reproductive age menstruate. Considering that many countries criminalize and discriminate against transgender and non-binary people, it is likely that the experiences of transgender and non-binary menstruators are undercounted. Additionally, in many countries around the world, children are starting their periods earlier than ever, with averages in the U.S. around 12 years old. If only women 15-49 are asked about their menstrual health and hygiene, the experiences of some younger menstruators may be missed. 

Bearing in mind these limitations (and there’s always a caveat with data, right?), we have more global data on MHH than ever before. And the results paint an important and fascinating picture. 

The WHO/UNICEF Joint Monitoring Program for Water Supply, Sanitation and Hygiene (JMP), which is partially funded by USAID, expanded its dataset in 2021 to include MHH indicators with data pulled from past national surveys. The JMP dataset now reports on four indicators related to MHH

  1. Awareness of menstruation before menarche (first period); 
  2. Use of menstrual materials to capture and contain blood, such as sanitary pads, cloth, tampons or cups;
  3. Access to a private place to wash and change while at home; and 
  4. Participation in activities during menstruation, such as school, work, and social activities. 

As of 2022, 53 countries had reported data on at least one indicator related to MHH. According to a JMP 2023 progress report with a special focus on gender, “since the 2021 progress update, the total number of countries with data on menstrual health has increased by more than a quarter, from 42 to 53. Most of the growth has been in lower-middle-income countries where the number of countries with data rose from 18 in 2021 to 25 in 2023.”  Across the indicators, there is significant variation by country. Digging into the data, and looking at them in combination, starts to tell us a lot about the lived experience of MHH. 

Only two countries have data on awareness of menstruation before menarche, although several other countries have relevant sub-national level data. An age-disaggregated analysis shows that girls and women who start their period later are more likely to have pre-existing awareness of menstruation than girls who start younger, especially for girls 11 and younger (for example, subnational data from Uganda in 2019 shows that 54 percent of girls and women who started their period at 15 or older knew about menstruation, while only 32 percent of girls and women who started at 11 or younger did).  

Data from Egypt casts light on why this knowledge is so important. The survey in Egypt asked girls and women about their reaction when they first got their period. Girls and women who had not known about menstruation before their first period were much more likely to have experienced significant distress, including shock, crying, and fear.

This information could be used to shape and tailor social and behavior change communications campaigns around menstruation, emphasizing the importance of reaching younger girls with key information about menstruation.  

Although use of menstrual materials is high in most countries reporting data, the picture is made more complex when enriched with additional data. 

For example, in Madagascar (2018), 94 percent of women and girls aged 15-29 who had menstruated in the previous year used menstrual materials. Of those, 73 percent used reusable materials. However, only 25 percent of girls and women who used reusable materials had a handwashing facility with soap and water available at home. This makes it much harder for girls and women to hygienically manage their periods.

The JMP 2023 report includes a combined analysis of the data available to estimate how many girls and women meet the criteria for menstrual health. This analysis shows that while many countries show relatively high coverage in terms of access to menstrual hygiene materials and private places for washing and changing, the overall participation in menstrual health management (MHM) activities and meeting comprehensive criteria is much lower in most countries. Additionally, coverage of the use of materials and a private place to wash and change was higher than participation, and, in some countries, the proportion of adolescent girls and women meeting all three criteria was significantly lower still.

Figure 1. Proportion of adolescent girls and women age 15-49 who used menstrual materials, had a private place to wash and change, and participated in work, school and social activities during their last period, JMP 2023 analysis of selected MICS 2016-2022 (%)

This type of combined analysis shows that although there may be successes on some indicators, the comprehensive picture may still have gaps–and there may be certain people left unreached or unserved. Using the available data, we can design targeted interventions and see where more data is needed. Often it is the most vulnerable–people in the lowest wealth quintile, in rural areas, adolescents, and people with disabilities–who are the least likely to have their MHH needs met. With data, we can learn where the gaps are, and how we can work towards a truly period-friendly world for all! 

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