Overview of MHM Research Challenges

Significant strides have been made on many MHM topics in recent years.  Study designs and sample sizes, on the whole, seem to have gotten more robust, with more attention to managing the many challenges that can make it difficult to conduct research in this domain. In our database of menstrual hygiene research studies, we display citation information, abstracts, and other information from an array of relatively recent studies about topics pertaining to MHM.

Still, the current state of research on issues pertaining to menstrual hygiene management in the developing world seems to best be characterized by the word, “opportunity.”

To draw conclusions about the effects of menstrual products and/or menstrual education, there seems to be a great need for:

A broader range of dependent variables

  • The effects of different types of products (i.e., self-sewn washable pads vs. commercial pads vs. disposable pads vs. menstrual cups vs. a variety of traditional methods) need to be examined.
  • Research needs to examine the effects of different types of teachers (i.e., external professional trainers vs. trained classroom teachers vs. parent training, plus gender of teacher) on learning regarding MH topics.
  • The effects of different types of educational curricula (i.e., long vs. short, just-the-fact vs. entertaining, delivered content vs. interactive, etc.) would benefit from greater study.

A broader range of independent variables

  • Do we care more about school attendance (which is what is usually measured as the outcome, or “dependent” variable), or do we care more about school performance and/or graduation rates, which are virtually never studied?
  • School attendance is not the only kind of attendance that might matter. Absenteeism from the workplace in adulthood and/or employment in the paid workforce would also seem to be a critical outcome, yet there is almost no research on it to date.
  • “Softer” outcomes (i.e., confidence, happiness, well-being, mental health, aspirations for school completion, etc.) are too rarely studied as outcomes in MHM research. That needs to change.

More control

  • A wider variety of control variables to disaggregate different aspects of menstrual hygiene management are needed. For example, to what extent do other factors like pain management, parent communication, bathroom quality, school quality, socio-economic level, age, etc. drive the outcomes of interest?
  • Fully randomized, large-N experiments and surveys can control for measurable factors of that nature; however, many experiments fall short of full randomization, while many studies have limited sample sizes.

More interaction effects

  • More than just controlling away variation, understanding how key factors interact with product availability and/or education would be useful.
  • How to educational program quality and product quality and access interact? How does educational quality interact with income level? How does product availability interact with school bathroom WASH quality? and so on.

Longer interventions

  • Time is money in the research world, so most interventions tend to be short.
  • Research time and site visits can be costly, while natural respondent attrition over time (people moving, etc.) requires larger sample sizes, and greater cost. Moreover, some supply interventions (i.e., disposable pads) cost more in supplies for each additional month of a study.
  • Some topics can be studied well with relatively short interventions (i.e., some health consequences, some aspects of user satisfaction, etc.) However, many of the bigger questions of interest that pertain to the long-term effects of sanitary products and/or education on outcomes are inherently long-term in nature (i.e., school performance, school completion, hygiene practices as kids age, continued use of products after the initial novelty of them has worn off, etc.)

Triangulation in more countries

  • What works poorly on one cultural and physical context (one school or one region in one country on one continent) may have little to do with how that same intervention might work across the world.
  • To be able to draw conclusions about the effects of menstrual product availability and/or menstrual education quality on important outcomes much beyond a single country’s borders, findings need to be replicated in a critical mass of other geographic locations.