Measuring What Matters for Menstruators

by Odette Hekster, Deputy Managing Director of PSI Europe

In the wake of the COVID-19 pandemic, the global community faces a shortage of basic necessities and supplies, including those related to essential sexual and reproductive health services and commodities that are central to women and girls’ health, empowerment, and dignity.

This includes menstrual health products.

Many women and girls lack access to materials to manage their menstruation, which is exacerbated in times of crisis. In the same way that pandemics affect all us, menstruation is part of the reality for women, girls, and all people who menstruate globally.

For years, public health researchers and practitioners have been conducting qualitative research to better understand people’s menstrual experiences. However, the lack of validated tools to use in quantitative studies was a major barrier in gathering data on the challenges women and girls face in managing their periods. In February 2020,  a team of researchers led by Dr. Julie Hennegan from Johns Hopkins Bloomberg School of Public Health, in partnership with Irise International, launched a new tool called the Menstrual Practices Needs Scale (MPNS-36) that could change the way public health researchers quantitatively capture people’s menstrual experiences.

The Menstrual Practice Needs Scale (MPNS-36) is an interactive tool that surveys women’s and girls’ responses to 36 statements that detail their menstrual experiences and needs.

Odette Hekster, Deputy Managing Director of Population Services International (PSI) -Europe, spoke with Dr. Hennegan and Wendy Anderson, co-founder of the philanthropic investment portfolio The Case for Her that co-funded the development of MPNS-36, to learn more about how this new tool is changing lives.

Odette Hekster: This new tool, the MPNS-36, is the first of its kind. What’s the significance?  

Dr. Julie Hennegan: It’s a first and significant step forward in improving research and monitoring and evaluation. It’s a much more sophisticated way of capturing menstrual experiences, and menstrual health and hygiene.

The tool was developed independently by myself and my colleagues. It’s based on existing research and provides practitioners and researchers a tool they can use to capture concepts that we’ve been talking about, but didn’t previously have the means to measure.

OH: It’s great to hear how you were both so motivated to move this forward. Why is there a need for the MPNS-36, and why now?  

JH: There was an appetite for new measures as an acknowledged research gap. The MPNS also offers a value-based response to this to saying, “Ok, we need established measures, but we also need measures that’ll accurately reflect multi-dimensional and complex concepts the field is thinking about and wants to  move the needle on—not just how many women and girls have products.”

Wendy Anderson: What I find interesting is how much bias and unconscious bias can be put into a survey. It’s so important to build these question sets and be willing to have your expectations challenged. An independent evaluation point is important so that we can make change as effectively and quickly as possible.

OH: How does The Case for Her see this tool as being integrated into program design moving forward?  

WA: We’re looking forward to seeing this tool implemented in intervention programs around the world. We see MPNS-36 as essential in designing menstrual health and hygiene solutions that are situationally appropriate and hold the menstruator’s whole lived experience in mind.

We’re still looking at a massive funding gap for menstrual health. What we’d like to see is for people to use this kind of tool to conduct research on target populations, design programs, and then measure successes against this baseline.

Click here to access the MPNS-36 report.

OH: International organizations like UNICEF and the World Bank have claimed for a while that periods are causing girls to be absent from school. Based on the validity test of the MPNS-36 in Soroti, Uganda, and the results of the survey, do you recommend that the international community revisits the wording of this claim? If yes, how? 

JH: We certainly do have a lot of qualitative studies and narratives that support this claim—that girls are either avoiding or disengaged in school during their period. Right now, we have a lack of quantitative evidence. An absence of evidence is not evidence of absence. We don’t have strong evidence to say that that’s the case, but we don’t have evidence that that’s not the case, either.

The MPNS-36 tool offers a way to assess one part of this, the menstrual management experience, and its relation to school attendance and other outcomes. The MPNS-36 tool will allow us to test these associations in a more holistic way.

OH: How do you think the MPNS-36 tool can contribute to achieving gender equality?

WA:  The underlying global issue is that stigmas associated with menstruation are rooted in gender inequality. Gender equality will not be achieved unless menstrual health is addressed across the board through policy, programming and funding.

The Global Menstrual Health and Hygiene Collective put together a joint statement at CSW64 on this. Tools like MPNS-36 will help us gather the evidence needed to demonstrate that interventions will have impacts on menstrual health issues and directly contribute towards reaching gender equality.

JH: There are plenty of arguments that can be made for why we should care about menstrual health and why it’s a gender equality issue. It’s overwhelmingly experienced by females, so the marginalization of this issue—and how it’s not addressed in society—is an issue of gender equality.

The MPNS will help practitioners and researchers provide better evidence of unmet menstrual needs and more thoroughly evaluate their programs. However, we still lack funding for research on this topic. People want effective, evidence-based policy and practice solutions— yet, they are hesitant to fund the development of the tools we need and evaluations and evidence-based development that are required to get there.

OH:  What’s still missing in the broader global health landscape to achieve success in increasing investment in menstrual health evidence and research?

WA: At The Case for Her, we’ve been discussing this a lot lately. Our primary goal is to find funding from whatever pockets are available—this isn’t a lot. Right now, I see three elements to this:

Firstly, we have a human rights-based argument, but we’ve come to the unfortunate conclusion that to release money we need to talk money—in particular, how financial investment in menstrual health education and interventions will improve the economies of families, communities and countries.

Secondly, we need to identify and advocate together with those organizations and countries who are investing in menstrual health and amplify their reasons for investment, their successes and their achievements.

Thirdly, we need to generate data on menstrual health and track progress by incorporating menstrual health-related indicators into national monitoring systems. The MPNS-36 tool is an example of one way we can gather data—but there must be global and national interest in evaluating and applying the evidence gained.

In order to make an impact, generating data on menstrual health and tracking progress on interventions through the incorporation of menstrual health-related indicators into program-level evaluations is key. The MPNS-36 tool is a great example. Check it out, use it and spread the word! You can access it online and can contact Dr. Julie Hennegan for inquires at jhenneg1@jhu.edu.

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