Indicators for National and Global Monitoring of Girls' Menstrual Health and Hygiene: Development of a Priority Shortlist

Julie Hennegan; Bethany A Caruso; Garazi Zulaika; Belen Torondel; Jacquelyn Haver; Penelope A Phillips-Howard; Jonathan Valdez; Caitlin Gruer; Neville Okwaro; Therese Mahon; Marni Sommer

doi:10.1016/j.jadohealth.2023.07.017

Indicators for National and Global Monitoring of Girls' Menstrual Health and Hygiene: Development of a Priority Shortlist

J Adolesc Health. 2023 Dec;73(6):992-1001. doi: 10.1016/j.jadohealth.2023.07.017. Epub 2023 Sep 20.

Authors

Affiliations

¹ Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
² Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
³ Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
⁴ Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
⁵ Department of Education and Child Protection, School Health and Nutrition Program, Save the Children US, Washington, D.C.
⁶ Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York.
⁷ Ministry of Health, Nairobi, Kenya, Nairobi, Kenya.
⁸ International Programmes Department, WaterAid, London, United Kingdom.
⁹ Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York. Electronic address: marni.sommer@columbia.edu.

Abstract

Purpose: Despite the importance of menstrual health and hygiene (MHH) for adolescent girls' health, education, and gender equality, few countries monitor MHH. MHH needs remain underprioritized, and progress achieved through policies, programs, or investments go unmeasured. This article reports the systematic development of an indicator shortlist to monitor adolescent girls' MHH at the national and global levels across low- and middle-income countries.

Methods: A core group of MHH researchers and practitioners collaborated with stakeholders from three countries with demonstrated commitment to monitoring MHH (Bangladesh, Kenya, and the Philippines), measures experts, and a global advisory group. The approach included the following: (1) define domains for monitoring MHH; (2) review and map existing indicators and measures; (3) iteratively shortlist indicators through appraising quality, feasibility, and stakeholder input; and (4) refine the shortlist and develop guidance for use.

Results: The shortlist comprises 21 indicators across seven domains covering menstrual materials, water, sanitation, and hygiene facilities, knowledge, discomforts and disorders, supportive social environments, menstrual health impacts, and policies. Indicators are accompanied by measures that have been tested or are expected to provide reliable data, alongside justification for their selection and guidance for use.

Discussion: The shortlisted indicators reflect the multisectoral collaboration necessary for ensuring girls' MHH. Uptake requires integration into monitoring systems at national and global levels. Future work remains to evaluate the performance of the indicators over time and to support their widespread use. Governments and stakeholders can use these indicators to track the progress of programs and policies, monitor unmet MHH needs, identify disparities, and set targets for improvement.

Keywords: Adolescent girls; Education; Gender; Health policy; Measurement; Menstrual health; Menstruation; Monitoring; WASH.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adolescent Health
Female
Health Knowledge, Attitudes, Practice
Humans
Hygiene*
Menstruation*
Policy
Schools