How might we integrate Menstrual Health and Sexual and Reproductive Health? UNFPA’s latest technical brief details how.
By Odette Hekster, Managing Director, PSI-Europe
From menarche to menopause, menstruation constitutes a core part of consumers’ health journeys. Yet, all too often, sexual and reproductive health and rights (SRHR) programming fails to prioritize menstrual health.
Now is the time to act.
We’re responding to the UN Human Rights Council’s call for the international community to ensure that the holistic needs of menstruators are met, including their menstrual health. Menstrual health is a matter of human rights, and if it is mainstreamed into SRHR programming and policies, we can get closer to a world where every menstruator can take the power of health choice into the palm of their hands.
The Current Menstrual Health Landscape
“Menstrual health” (MH) is newly defined as a state of complete physical, mental and social well-being. Rather than merely the absence of disease or infirmity in relation to the menstrual cycle, this definition underscores the importance serving consumers’ health needs from a holistic approach.
When menstruators face challenges to managing their menstruation, it can negatively impact the realization of their human rights. The inability to take control over their bodies, as well as discriminatory cultural norms or practices can prevent menstruators from realizing not only their right to health, but also to education, information, work and participation in all spheres of life, including civil, cultural, economic, social and political.
There is a clear human rights imperative to integrate MH and SRHR. When the human rights, including sexual and reproductive rights, of girls, women and all people who menstruate are met, they are more likely to experience SRHR in a safe, healthy and dignified manner.
UNFPA’s latest technical brief, Technical Brief on the Integration of Menstrual Health into Sexual and Reproductive Health and Rights Policies and Programmes, details precisely how and provides evidence-based rationale and insights for the integration of MH and SRHR:
- MH and SRHR intersect in various ways and influence the experience and expression of sexuality, bodily autonomy and health-related decision-making. A full life cycle approach is critical to understanding these linkages and their impact on the SRHR of women, girls and all people who menstruate.
- Severely limited menstrual knowledge and widespread myths and misconceptions may contribute to a lack of bodily autonomy and limited capacity to negotiate safer sex and seek health care. Comprehensive sexuality education and puberty education can be effective channels to share accurate, age-appropriate education on MH and SRHR and address stigma among peers.
- Early menstruation is associated with child marriage, early pregnancy and some sexually transmitted infections in low- and middle-income countries. These linkages present a clear opportunity to integrate MH and SRHR to serve the needs of adolescent girls, especially young adolescents (10-14 years).
- Menstruation is frequently associated with feelings of shame, fear and distress, which can have negative effects on broader psychosocial wellbeing and mental health, some of which are associated with poor SRHR outcomes. Some data has shown that shame related to menstruation can influence sexual behaviors and risk-taking, so improving the menstrual experience could lead to a decrease in risky sexual behaviors.
- Contraception induced menstrual changes (CIMCs), which refers to changes in bleeding patterns resulting from the use of hormonal contraception are a critical intersection between MH and SRHR. While for some, CIMCs can be considered a benefit of hormonal methods, CIMCs are often linked to side effects that are cited as reasons for discontinuation. Improved contraceptive counseling to include menstruation and CIMCs could help contraceptive users better understand, prepare for or manage CIMCs and reduce discontinuation.
We’ve learned that when we start the SRHR conversation with MH, we can break down stigma around sexual health by leading with a neutral topic that even conservative communities can get behind. When PSI Zimbabwe and PSI Tanzania recruited health educators to reach girls with quality information on how to access SRHR services, they started the conversation about their bodies with the menstrual cycle, which then provided a safe space for girls to talk about their sexual health.
Similarly, when PSI Latin America promoted SRH through its digital self-counseling tool, they led with messaging around MH, which resonated with young girls across Central America as indicated by the increase engagement on menstruation-related content. This integrated approach allowed the program to bridge the information gap and leverage self-care interventions to address these young menstruators’ needs and enable them to become active agents of their own health.
We — the global public health community — have come a long way in breaking down the stigmas that prevent menstrual equity and agency. But the work continues, and together, we can build the bridges that enable menstruators to address the gamut of their SRHR needs, periods included.
We can start by adopting an integrated approach to MH and SRHR at both the policy and program level, including these steps listed in the UNFPA technical brief:
- Mobilize commitments from policy makers for MH and SRHR integration;
- Ensure access to quality MH education through comprehensive sexuality education programs for adolescents and young people;
- Ensure reproductive health and contraceptive counseling includes comprehensive information on the menstrual cycle and contraception-induced menstrual changes;
- Engage communities to create a supportive environment for MH and SRHR to shift gender and social norms around these topics.
After all, consumers have holistic health needs; it’s on us to ensure their SRHR services reflect that reality, too.
For more, read UNFPA’s technical brief “The Integration of Menstrual Health into Sexual and Reproductive Health and Rights Policies and Programmes,” and the “Making the Case for Investing in Menstrual Health and Hygiene” report jointly developed by PSI, PSI-Europe, Simavi, The Case for Her, WASH United in collaboration with the Global Menstrual Collective.