There is growing recognition of the importance of menstruation in achieving health, education, and gender equality for all. New policies in high income countries HICs have responded to anecdotal evidence that many struggle to meet their menstrual health needs. Qualitative research has explored lived experiences of menstruating in HICs and can contribute to deing intervention approaches. To inform the growing policy attention to support people who menstruate, here we review and synthesise the existing research. Primary, qualitative studies capturing experiences of menstruation in HICs were eligible for inclusion.
Systematic database and hand searching identified records. Following screening and quality appraisal using the EPPI-Centre checklist, studies publications detailing the menstrual experiences of over individuals across sixteen countries were included.
We used the integrated model of menstrual experiences developed from studies in low- and middle-income countries LMICs as a starting framework and deductively and inductively identified antecedents contributing to menstrual experiences; menstrual experiences themselves and impacts of menstrual experiences.
Your data. your experience.
Included studies described consistent themes and relationships that fit well with the LMIC integrated model, with modifications to themes and model pathways identified through our analysis. The socio-cultural context heavily shaped menstrual experiences, manifesting in strict behavioural expectations to conceal menstruation and limiting the provision of menstrual materials.
Resource limitations contributed to negative experiences, where dissatisfaction with menstrual practices and management environments were expressed along with feelings of disgust if participants felt they failed to manage their menstruation in a discrete, hygienic way.
Physical menstrual factors such as pain were commonly associated with negative experiences, with mixed experiences of healthcare reported. Across studies participants described negative impacts of their menstrual experience including increased mental burden and detrimental impacts on participation and personal relationships. Positive experiences were more rarely reported, although relationships between cis-women were sometimes strengthened by shared experiences of menstrual bleeding. Included studies reflected a broad range of disciplines and epistemologies. Many aimed to understand the constructed meanings of menstruation, but few were explicitly deed to inform policy or practice.
Few studies focused on socioeconomically disadvantaged groups relevant to new policy efforts. We developed an integrated model of menstrual experience in HICs which can be used to inform research, policy and practice decisions by emphasising the pathways through which positive happy embarrassed girls reddit negative menstrual experiences manifest. Citation: Barrington DJ, Robinson HJ, Wilson E, Hennegan J Experiences of menstruation in high income countries: A systematic review, qualitative evidence synthesis and comparison to low- and middle-income countries.
This is an open access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: This manuscript made use of secondary data in the form of publications reporting on menstrual experiences in high income countries.
Table 2 and the Reference list provide the details of all publications included in this systematic review. Neither funder has had any role in study de, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. In high income countries HICsthere have been increasing efforts to understand and address menstrual disorders and pain [ 2 ], as well as the links between these and negative consequences for employment and education [ 5 ].
There has been a consequent overwhelming policy response to provide free menstrual materials.
For example, in Scotland, free menstrual materials will soon be available for all who want them [ 11 ] and in Victoria, Australia, it was announced in that all government schools will provide free menstrual p [ 12 ]. These multi-million-dollar programmes have rarely been based on robust research, even though several decades of research from a happy embarrassed girls reddit of social science disciplines have highlighted the negative constructions of menstruation throughout society, and feminist campaigners have conceptualised the issue as one of gender-based injustice [ 13 ].
In the UK Government announced its campaign to end period poverty and menstrual shame nationally by and globally by To do so they established a taskforce of public sector, private sector, not-for-profit and academic institutions and individuals [ 14 ]. This initiative and growing pressure for other HIC governments to act has highlighted the need for more evidence to inform policy development and the opportunity to learn from the rapidly growing body of research and advocacy work on this issue in low- and middle-income countries LMICs.
Population health research across LMIC settings has elucidated a wide range of contributors to menstrual experiences and impacts on health and well-being through a large body of qualitative research. Inthis work was brought together through a systematic review and qualitative evidence synthesis which developed an integrated model of menstrual experiences in LMICs [ 15 ]. This model has served as a useful framework for understanding menstrual health in LMICs and has helped to inform subsequent research and practice approaches. It is unclear the extent to which this model is applicable in HICs.
To inform the growing policy attention to support people who menstruate in HICs, through this review we identified and synthesised the existing research on menstrual experiences in these countries. We aimed to; 1 collate the existing body of qualitative research on menstrual experiences in HICs and appraise its happy embarrassed girls reddit 2 synthesise this evidence base and develop a model of menstrual experience relevant to HICs, to understand contributing factors, menstrual experiences themselves and the impacts of menstrual experiences on the lives of people who menstruate; and 3 compare findings to the integrated model of menstrual experience developed based on studies in LMICs, in light of differences in the study populations and research topics.
The search strategy was deed to capture all qualitative studies, or mixed method studies that included qualitative methods, reporting on experiences of menstruation Table 1. This yielded websites, which were hand-searched for relevant publications and updated in November for a full list of websites searched see S1 Text. Individual experts undertaking research focused on menstrual health names provided in S2 Text were contacted in October and November and asked to recommend any potentially eligible research.
Reference lists of review articles and eligible publications were hand-searched Fig 1. Every effort was made to obtain the full-texts of all potentially eligible publications, including contacting authors directly e. Full text copies were retrieved for all but 16 publications, all of which were theses.
Publications were eligible for inclusion where they 1 reported on primary, qualitative research; 2 captured the personal experiences of menstruation among people residing in a HIC, as defined by the World Bank as of [ 17 ]; 3 focused on the bleeding phase of the menstrual cycle i. Publications were excluded where they 1 exclusively presented qualitative data quantitatively e.
Full text screening was undertaken by DJB. Study quality was appraised using the EPPI-Centre checklist [ 18 ], developed for assessing the reliability of qualitative research based on rigor in sampling, data collection, analysis and reporting, and the usefulness of the study according to its breadth and depth, the extent to which it happy embarrassed girls reddit the perspectives of those most crucial to the review, in this case, those who menstruate, and the extent to which it details relevant to the review question.
Where studies used mixed methods, we appraised the quality based only on the qualitative data collection methods, analysis and reporting. DJB appraised the remaining studies, with input from JH on any difficult cases. Study quality ratings and justifications are detailed in S1 Table. We used a combination of line-by-line coding and thematic network mapping to identify overarching themes and develop our final synthesis [ 19 ]. The model of menstrual experience developed through synthesis of studies in LMICs [ 15 ] served as the preliminary framework and starting point for deductive and inductive identification of themes.
Aligned with the LMIC review, we sought to go beyond description and interpret findings across studies to extend our conceptual understanding of menstrual experiences [ 20 ].
Studies contributed parts to an integrated scheme, modelling menstrual experience in HICs [ 21 ]. The final model and themes are contrasted against findings from the review of LMIC studies in the Discussion, facilitated by the process of coding against these themes during our analysis. The authors are women who menstruate and live in HICs. Throughout the study they employed self-critical epistemological awareness [ 23 ], considering how their own experiences influence their interpretation of findings, privileging the voices of study participants and attempting to set aside their own biases to maximise rigour in the analysis.
Prior to beginning this study, the authors had all undertaken research on menstrual health in LMIC contexts. Most of the publications included in this review were unknown to them, allowing the model to be developed from the experiences of the study participants rather than work the authors were familiar with.
Only in new york: actor jeff goldblum serenades newly married couple at brooklyn carousel
This ignores the differences between biological sex and self-identified genders. Not all people identifying as women and girls menstruate, and not everyone who menstruates identifies as a woman or girl. Although most included studies used the language of girls and women exclusively, the genders of participants may have been assumed because the participants were people who menstruate.
We reviewed five studies all published since that specifically recruited participants who menstruate but do not identify as a woman or girl, here referred to as non-binary or transgender people who menstruate [ 24 — 28 ]. We thus use gender neutral pronouns throughout the paper, except in cases where the finding is specifically linked to gender identity or is only relevant to cis-gendered, non-binary or transgender menstruators, in which cases we use the gendered terms and pronouns found in the original publications.
Table 2 reports study characteristics and the overall trustworthiness and relevance ratings from quality appraisal. The included studies involved over participants. Eighty-three studies included women 18 years of age and older24 studies included girls below 18 years of ageand five studies included adult menstruators who identified as transgender or non-binary 18 years of age and older.
Included studies spanned many decades, and frequently included retrospective reports of menarche experiences from many years prior to data collection.
Table 2 provides an estimate of the time period when participants reached menarche based on their age and the date of the study. In 9 studies participants had reached menarche during the early 20 th Century C defined here as —the mid th C defined here as — in 46 studies, the late 20 th C defined here as — in 61 studies and the early 21 st C defined here as after in 44 studies.
We could not determine the approximate timespan of menarche for 22 studies.
Six studies specifically recruited low-income status participants. Eighty-six studies collected data using individual interviews 85 verbally, 1 written23 used group interviews including focus group discussionsseven written narratives, seven written questionnaires, two direct observations, two written diaries and one creative writing. Four studies involved interventions which aimed to improve experiences of menstruation. Included studies were situated within the disciplines of population health, sociology or gender studies. Study quality was varied, with 36 studies rated as high, 48 as medium, and 20 as low trustworthiness detailed in S1 Table.
Lower-quality studies were characterised by small, convenience samples and limited details on data collection and analysis. Twenty studies were rated as highly relevant, 59 as medium, and 25 as low. Most studies rated as high relevance had findings which were reflective of a large proportion of the population e. Fig 2 presents the final integrated model of menstrual experience in HICs, summarising the major themes and the relationships between them.
Table 3 details which studies contributed to each theme. Boxes 1 — 3 provide quotations which support the findings for each theme. Bolded text represents major themes, unbolded text describes sub-themes. Arrows depict directional and bidirectional relationships between themes. I know you have a problem, go home.
Like I was really upset that we had to bring it out to the main trash can. But I used to live in [a nearby village]. There was a little local shop opposite and there was a man in there, and he was quite old and I had to go and buy some. I was really embarrassed.
It was silly but I felt really sort of oh gosh! The majority of studies highlighted the importance of the socio-cultural context in shaping menstrual experiences [ 8924262832333638 — 40424346 — 495153 — 6163 — 6567 — 7378 — 8184 — 9092 — 98,—, ——, —, ]. The construction of menstruation as polluting or dirty conflicted with gendered expectations that women and girls should be clean and feminine.
Menstruation was thus embarrassing and required concealment. The socio-cultural context of menstrual stigma and gender norms across all studies manifested in strong behavioural expectations for menstruation. For most participants this invoked negative emotional responses, but some reported positive emotions associated with growing up. Included studies described a range of expectations that influenced how participants experienced and behaved during menstruation, and the impact on their lives.
Many studies outlined expectations to keep menstruation secret through hiding menstrual materials, concealing odour, buying products discreetly or not speaking about menstruation [ 838425154566063646680818689949597,, ]. This was commonly enforced through instructions from mothers on how to hide menstruation and to not speak about it [ 38426063869495—, ].
Mothers also placed other restrictions on the participation of daughters in a variety of activities once they had begun menstruating, further discussed in the section describing impacts on participation.