Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Jun 18, 2023; 11(5): 196-217
Published online Jun 18, 2023. doi: 10.13105/wjma.v11.i5.196
Exploratory systematic review and meta-analysis on period poverty
Gayathri Delanerolle, Xiao-Jie Yang, Heitor Cavalini, Om P Kurmi, Camilla Mørk Røstvik, Ashish Shetty, Lucky Saraswat, Julie Taylor, Sana Sajid, Shanaya Rathod, Jian-Qing Shi, Peter Phiri
Gayathri Delanerolle, Heitor Cavalini, Sana Sajid, Shanaya Rathod, Jian-Qing Shi, Peter Phiri, Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
Gayathri Delanerolle, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7JX, United Kingdom
Xiao-Jie Yang, School of Statistics and Mathematics, Yunnan University of Finance and Economics, Kunming 650221, Yunnan Province, China
Xiao-Jie Yang, Ashish Shetty, University College London, London WC1E 6BT, United Kingdom
Om P Kurmi, Centre for Intelligent Healthcare, Institute of Health and Wellbeing, Coventry University, Coventry CV1 5LB, United Kingdom
Camilla Mørk Røstvik, Centre for Contemporary Art, University of St Andrews, Scotland KY16 9AJ, United Kingdom
Ashish Shetty, Pain Management Centre, University College London Hospitals NHS Foundation Trust, London W1T 4AJ, United Kingdom
Lucky Saraswat, Aberdeen Centre for Women’s Health, University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
Julie Taylor, School of Nursing, University of Birmingham, Birmingham B152TT, United Kingdom
Jian-Qing Shi, Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
Peter Phiri, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
Author contributions: Delanerolle G conceptualised the PLATO project as part of the ELEMI program which includes three work-packages; Delanerolle G, Cavalini H, Shi JQ and Phiri P developed the systematic review protocol and embedded this within the PLATO project’s work package 1; Delanerolle G and Shi JQ designed the statistical analysis plan; Yang XJ, Delanerolle G, and Shi JQ completed the analysis; Sajid S and Phiri P completed the risk of bias and Newcastle-Ottawa Scale; All authors critically appraised and commented on previous versions of the manuscript; All authors read and approved the final manuscript.
Conflict-of-interest statement: Peter Phiri has received a research grant from Novo Nordisk and other, educational from the Queen Mary University of London, other from John Wiley & Sons, other from Otsuka, outside the submitted work. Shanaya Rathod reports other from Janssen, Lundbeck and Otsuka outside the submitted work. All other authors report no conflict of interest. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health and Social Care Research, the Department of Health and Social Care or the Academic institutions.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2020 Checklist, and the manuscript was prepared and revised according to the PRISMA 2020 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Peter Phiri, BSc, PhD, RN, Director, Senior Research Fellow, Senior Researcher, Department of Research & Innovation, Southern Health NHS Foundation Trust, Tom Rudd Unit Moorgreen Hospital Botley Road West End, Southampton SO30 3JB, United Kingdom. peter.phiri@southernhealth.nhs.uk
Received: February 17, 2023
Peer-review started: February 17, 2023
First decision: April 13, 2023
Revised: April 18, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: June 18, 2023
Processing time: 118 Days and 19 Hours
Abstract
BACKGROUND

Period poverty is a global health and social issue that needs to be addressed. It has been reported that many females compromise their education, employment, and social commitments during their menstruation days due to a number of reasons, including lack of access to toilets or menstrual products.

AIM

To provide a comprehensive understanding on period poverty, including outcomes associated with menstruation.

METHODS

All observational and randomised clinical trials reporting menstruation challenges, menstrual poverty and menstrual products were included. Our search strategy included multiple electronic databases of PubMed, Web of Science, ScienceDirect, ProQuest and EMBASE. Studies published in a peer review journal in English between the 30th of April 1980 and the 30th of April 2022 were included. The Newcastle-Ottawa Scale was used to assess the risk of bias of the systematic included studies. Pooled odds ratios (ORs) together with 95% confidence intervals (CIs) are reported overall and for sub-groups.

RESULTS

A total of 80 studies were systematically selected, where 38 were included in the meta-analysis. Of the 38 studies, 28 focused on children and young girls (i.e., 10-24 years old) and 10 included participants with a wider age range of 15-49 years. The prevalence of using disposable sanitary pads was 45% (95%CI: 0.35-0.58). The prevalence of menstrual education pre-menarche was 68% (95%CI: 0.56-0.82). The prevalence of good menstrual hygiene management (MHM) was 39% (95%CI: 0.25-0.61). Women in rural areas (OR = 0.30, 95%CI: 0.13-0.69) were 0.70 times less likely to have good MHM practices than those living in urban areas.

CONCLUSION

There was a lack of evidence, especially from low- and middle- income countries. Further research to better understand the scope and prevalence of period poverty should be considered. This will enable the development of improved policies to increase access to menstrual products and medical support where necessary.

Keywords: Period poverty; Menstruation; Mental health; Menstrual education; Menstrual hygiene

Core Tip: Period poverty is an important health issue, impacting social and psychological wellbeing. Issues are predominantly seen in low- and middle- income countries, affected by conflicts, disasters, and economic struggles. Evidence showed a link between menstruation and prevalence of stress, anxiety, and depression. Whilst menstruation is a physical health issue, there are clear associations with mental health. Despite the global scale of period poverty, it is under-researched and is not well understood. Further research in this area will help to form healthcare policies and support for women and girls.