Epidemiology of menstrual-related absenteeism in 44 low and middle-income countries
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2024
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medRxiv
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Melbourne Authors
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Clinical Research Support (MISCH)
Obstetrics and Gynaecology
Melbourne School of Population and Global Health
Melbourne School of Population and Global Health
Obstetrics and Gynaecology
Melbourne School of Population and Global Health
Melbourne School of Population and Global Health
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Preprint
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Starr, M., Harding, R., Ataide, R., VonDinklage, N., Sinharoy, S., Jayasinghe, Y., Manda-Taylor, L., Fisher, J., Braat, S. & Pasricha, S. -R. (2024). Epidemiology of menstrual-related absenteeism in 44 low and middle-income countries. medRxiv, https://doi.org/10.1101/2024.05.07.24307016.
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Abstract
Background Menstrual-related absenteeism from work, school, or social activities is an important functional indicator of poor menstrual health that disrupts women and girls’ daily lives and exacerbates gender inequality. We sought to estimate the prevalence and factors contributing to menstrual-related absenteeism across low- and middle-income countries (LMICs).
Methods We analysed cross-sectional data from 47 nationally representative Multiple Indicator Cluster Surveys from 2017-2023 comprising 3,193,042 individuals from 555,869 households across 44 countries. The outcome of interest was menstrual-related absenteeism from work, school, or social activities during the respondent’s last menstrual period. Independent factors included women’s age, household wealth index, use of menstrual materials (e.g. pads, tampons, or cloth), availability of a private place to wash at home during menstruation, and contraceptive use (hormonal and other). Univariable and multivariable associations between each factor and menstrual-related absenteeism were obtained using log binomial models. Prevalences and associations were pooled by geographical region and across all surveys using a random effects meta-analysis.
Findings We included 673,380 women and girls aged 15-49 years in this analysis. The pooled global prevalence of menstrual-related absenteeism was 15·0% [95% CI: 12·7-17·3], with the highest prevalence in South Asia (19·7% [11·6-27·8]) and West and Central Africa (18·5% [13·5-23·5]). After pooling data across surveys, girls aged 15-19 years were found to endure a higher prevalence of menstrual-related absenteeism compared to older age-groups. There was no association between menstrual-related absenteeism and household wealth or the use of menstrual materials. In contrast, having a private place to wash at home was associated with an increased prevalence of menstrual-related absenteeism (global adjusted Prevalence Ratio [PR]: 1·25 [1·05-1·48]). Menstrual-related absenteeism was less prevalent in women and girls using contraception (global adjusted PR any contraception vs no contraception: 0·86 [0·82-0·90]), including those using hormonal contraception (global adjusted PR hormonal contraception vs non-hormonal or no contraception: 0·85 [0·78-0·93]).
Interpretation Menstrual-related absenteeism is prevalent, especially in Asia and Africa, and particularly in adolescent girls. The age-independent protective effect of hormonal contraception suggests symptoms such as heavy menstrual bleeding or pain drive absenteeism. Improving access to private wash facilities outside the home and medical solutions for menstrual symptoms may reduce menstrual-related absenteeism, but further prospective research is urgently needed.