By: Maria Carmen Punzi Menstrual Health Focal Point, PSI Europe @psiimpact, Cristina Ljungberg Maverick Collective Founding Member @cjljungberg @caseforher
Menstruation is a critical but often overlooked component of girls’ sexual and reproductive health (SRH). Since 2016, PSI has joined forces with Maverick Collective member Cristina Ljungberg to make periods a priority in Nepal’s adolescent health landscape. The goal was to improve the health and lives of Nepali girls by designing innovative strategies addressing menstrual health and hygiene. From the start, the team was warned that no Nepali girl—especially no rural Nepali girl—would open up about her period. Within the first year, however, the team met over 100 girls who, in private, had many questions, about periods and sex. This raises the question: what role can—and does—menstrual health play in family planning (FP) and SRH work? Menstruation can be a conversation starter to familiarize youth with fertility and SRH. PSI’s work with adolescents repeatedly shows that adolescent girls don’t identify as sexually active and are uncomfortable in conversations about FP. Educating girls and boys about the bodily changes that come with puberty and menarche is an opportunity to introduce them to the concept of fertility.
The reproductive cycle can encourage girls to seek FP methods later in life. Dispelling myths around periods and side effects of contraceptives can kick-start a healthy journey down the SRH path. Contraceptives often change bleeding patterns, and young women need to be prepared. Contraceptives can affect menstrual patterns, including a heavier flow, spotting or stopping bleeding altogether. Often in developing countries, adolescent girls fear disclosing irregular menstruation, concerned about stigma related to infertility and marriageability. Period irregularity is a leading cause for contraceptive discontinuation. When addressing girls, we need to understand their fears and desires and use the proper counseling tools such as FHI 360’s NORMAL to inform them about menstrual bleeding changes. This insight can also help refine and strengthen the effectiveness of FP interventions, helping girls and young women feel confident about their contraceptive choices. Going forward, is menstruation key to SRH innovation? Period blood contains unique health data and can be used as a noninvasive method for early disease diagnosis and management. When girls and women
understand their cycle, they gain valuable insights about their fertility—and overall health—and are better equipped to report anomalies to their doctors and make consumer-powered decisions. As we keep working with, and not just for, girls and women, we cannot ignore the important role menstruation plays in their sexual and reproductive lives. Can we imagine a world in which, instead of managing menstruation, we see menstruation as a tool to improve the health of girls and women?
1. Maverick Collective is a philanthropic and advocacy initiative from PSI with a mission to build a community of strategic philanthropists and informed advocates who use their intellectual and financial resources to create change by investing in girls and women. 2. Insight from the PSI Adolescents 360 project in Ethiopia, Nigeria and Tanzania. 3. Sommer, M., Ackatia-Armah, N., Connolly, S., & Smiles, D. (2014). A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia. Compare: A Journal of Comparative and International Education, 45(4), 589-609. 4. Tolley, E., Loza, S., Kafafi, L., & Cummings, S. (2005). The Impact of Menstrual Side Effects on Contraceptive Discontinuation: Findings from a Longitudinal Study in Cairo, Egypt. International Family Planning Perspectives, 31(01), 15-23. 5. NORMAL counseling tool for healthcare providers, developed by PSI and FHI360.
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