Research priorities for improving menstrual health across the life-course in low- and middle-income countries

Figures & data

Table 1. Criteria used to score the proposed research questions and their definitions.

	Understanding the problem	Designing and implementing interventions	Integrating and scaling-up interventions	Measurement & research
Novelty	Will the answer to this question fill a key gap?
Potential for implementation	Will the answer to the question contribute to tailored interventions?	Will the answer to the question result in an intervention that can be implemented?	Could the answer to the question be implemented?
Importance/impact	Will the answer to this question be important to know?	Will the answer to the question result in an intervention that would have an important impact?	Will the answer to the question have an important impact?

Table 2. Participant characteristics (n = 82).

		Participants of Phase 2 (n = 82)	Participants of Phase 3 (n = 66)
Age	18–24 25–34 35–44 45–54 55–64 65+	4 (4.9%) 27 (32.9%) 23 (28.0%) 15 (18.3%) 7 (8.5%) 6 (7.3%)	0 17 (25.8%) 16 (24.2%) 18 (27.3%) 6 (9.1%) 8 (12.1%)
Gender	Female Male Non-binary or gender not listed above	73 (89.0%) 9 (11.0%) 0	53 (80.3%) 12 (18.2%) 1 (1.5%)
Region of world where the participants reside	Europe North America Sub-Saharan Africa Asia Australasia Middle East Latin America	24 (29.3%) 19 (22.2%) 22 (26.8%) 8 (9.8%) 7 (8.5%) 2 (2.4%) 0 (0%)	21 (31.8%) 17 (25.8%) 11 (16.7%) 12 (18.2%) 2 (3.0%) 0 (0%) 3 (4.5%)
High or low-middle income country residence	HIC LMIC	50 (61.0%) 32 (39.0%)	40 (60.6%) 26 (39.4%)
Sector of work	Academia NGO International NGO International Agency Entrepreneur Funding Agency Government Other	29 (35.4%) 19 (23.2%) 16 (19.5%) 10 (12.2%) 7 (8.5%) 2 (2.4%) 2 (2.4%) 12 (14.6%)	22 (33.3%) 14 (21.2%) 11 (16.7%) 7(10.6%) 6 (9.1%) 7 (10.6%) 4 (6.1%) 7 (10.6%)
Region of world where the participants work	Sub-Saharan Africa Global Asia North America Europe Pacific Middle-East Latin America North Africa	38 (58.5%) 30 (36.6%) 29 (35.4%) 12 (14.6%) 12 (14.6%) 11 (13.4%) 8 (9.8%) 7 (8.5%) 7 (8.5%)	25 (37.9%) 26 (39.4%) 20 (30.3%) 11 (16.7%) 12 (18.2%) 6 (9.1%) 0 (0%) 8 (12.1%) 0 (0%)
Areas of expertise*	SRH Adolescent Health/Development WASH Gender Policy/Advocacy Education Mental Health Other	51 (62.2%) 39 (47.6%) 35 (42.7%) 32 (39.0%) 30 (35.6%) 26 (31.7%) 11 (13.4%) 17 (20.7%)	43 (65.2%) 33 (50.0%) 27 (40.9%) 24 (36.4%) 21 (31.8%) 20 (30.3%) 6 (9.1%) 11 (16.7%)
Years of experience working on menstrual health	<12 m 1-3y 4-6y 7-9y 10y+	5 (6.1%) 18 (22.0%) 28 (34.1%) 16 (19.5%) 15 (18.3%)	1 (1.5%) 11 (16.7%) 19 (28.8%) 12 (18.2%) 22 (33.3%)

*More than one area of expertise could be answered.

Table 3. Overview of the proposed research questions.

Domain	Total number of research questions proposed	Number of participants that proposed at least one research question	Average number of research questions proposed per participant
Understanding the problem	521 (45.9%)	82	6.4
Designing and implementing interventions	451 (39.7%)	69	6.5
Integrating and scale-up	145 (12.7%)	54	2.7
Other	18 (1.6%)	15	1.2
Total	1135		13.8

Table 4. Overview of the consolidated list of research questions.

Domain	Sub-domain	Number of research questions
Understanding the problem	Experiences related to menstrual health	7
	Factors affecting menstrual health	10
	Impact and consequences	8
	Total	25
Designing and implementing interventions	Discovery of new interventions	12
	Developing and testing the effectiveness of interventions/programmes	19
	Evaluations of the costs of interventions/programmes	6
	Evaluations of the delivery (including acceptability, adoption, appropriateness, feasibility, fidelity, coverage, and reach) of interventions/programmes	10
	Evaluations of the sustainability of interventions/programmes	6
	Total	53
Integrating and scale-up	Integration	6
	Scale-up	5
	Total	11
Measurement & Research		5
Grand Total		94

Figure 1. Research priority scores and overall rank.

Table 5. Top 10-ranked research questions, by research priority score.

Rank	RPS	Question	Domain	Unique ID
1	0.956	What indicators are optimal for assessing menstrual health over time (e.g. related to norms, education, health, rights, etc.)?	Measurement and research	M1
2	0.932	What are the experiences of girls, women, and others who menstruate in relation to menstrual pain and disorders (e.g. what proportion experience them, what are their perceptions about them, how do they manage them, and what support do they seek and receive for them)?	Understanding the problem	U1
3	0.93	What new interventions could be developed to address harmful attitudes, norms and stigma and improve communication related to menstruation?	Designing and implementing interventions	D1
4	0.924	Are girls, women, and others who menstruate able to access and afford their preferred menstrual product/materials; what is the quality of these products/materials; where do they obtain them; and how do they use and dispose of them?	Understanding the problem	U2
5	0.921	What is the impact of unmet menstrual health needs (e.g. products/materials, WASH infrastructure/services) on the participation and engagement of girls, women, and others who menstruate in school and work and their self-esteem and agency?	Understanding the problem	U3
6	0.919	What are the experiences and challenges of girls, women, and others who menstruate with particular needs and circumstances (e.g. those living with HIV, those with disabilities, those who are incarcerated, those experiencing homelessness, those who have experienced FGM, trans and gender non-binary persons) in relation to their menstrual health?	Understanding the problem	U4
7	0.915	What characteristics of menstrual health interventions/programmes enable them to be sustained over time?	Designing and implementing interventions	D2
7	0.915	How can interventions to address menstrual health (e.g. education, social norm change, distribution of menstrual products/materials, improvements in WASH infrastructure/services, provision of health services for menstrual pain and disorders) be scaled up with quality and equity?	Integrating and scaling up	I1
9	0.913	What new interventions could be developed to manage menstrual pain?	Designing and implementing interventions	D3
10	0.913	What are the impacts of unconditional and conditional cash transfer interventions on the menstrual health of girls, women, and others who menstruate, and consequently on their education, work, and social participation?	Designing and implementing interventions	D4

Table 6. Top five-ranked research questions in each domain, by research priority score.

Domain	Rank within domain	Overall rank	RPS	Question	Unique ID
Understanding the problem (n = 25)	1	2	0.932	What are the experiences of girls, women, and others who menstruate in relation to menstrual pain and disorders (e.g. what proportion experience them, what are their perceptions about them, how do they manage them, and what support do they seek and receive for them)?	U1
	2	4	0.924	Are girls, women, and others who menstruate able to access and afford their preferred menstrual product/materials; what is the quality of these products/materials; where do they obtain them; and how do they use and dispose of them?	U2
	3	5	0.921	What is the impact of unmet menstrual health needs (e.g. products/materials, WASH infrastructure/services) on the participation and engagement of girls, women, and others who menstruate in school and work and their self-esteem and agency?	U3
	4	6	0.919	What are the experiences and challenges of girls, women, and others who menstruate with particular needs and circumstances (e.g. those living with HIV, those with disabilities, those who are incarcerated, those experiencing homelessness, those who have experienced FGM, trans and gender non-binary persons) in relation to their menstrual health?	U4
	5	18	0.895	How do financial barriers impact the ability of girls, women, and others who menstruate to manage their menstruation?	U5
Designing and implementing interventions (n = 53)	1	3	0.93	What new interventions could be developed to address harmful attitudes, norms and stigma and improve communication related to menstruation?	D1
	2	7	0.915	What characteristics of menstrual health interventions/programmes enable them to be sustained over time?	D2
	3	9	0.913	What new interventions could be developed to manage menstrual pain?	D3
	4	10	0.913	What are the impacts of unconditional and conditional cash transfer interventions on the menstrual health of girls, women, and others who menstruate, and consequently on their education, work, and social participation?	D4
	5	11	0.913	What are the impacts of providing free/subsidized menstrual products/materials on menstrual health?	D5
Integrating and scaling up (n = 11)	1	8	0.915	How can interventions to address menstrual health (e.g. education, social norm change, distribution of menstrual products/materials, improvements in WASH infrastructure/services, provision of health services for menstrual pain and disorders) be scaled up with quality and equity?	I1
	2	14	0.902	How can information on menstruation be integrated into existing formal and non-formal educational curricula, health services (e.g. contraceptive services, HPV vaccination, FGM support, psychosocial support), social norms, and gender equality interventions/programmes?	I2
	3	15	0.902	How can considerations for the menstrual health needs of girls, women, and others who menstruate with particular needs and circumstances (e.g. those with disabilities and their caregivers, those living in urban/rural settings, those who have experienced FGM, those in indigenous communities, those in humanitarian settings) be integrated into existing policies and interventions/programmes?	I3
	4	17	0.897	How can governments integrate menstrual health across sectors (e.g. education, health, WASH, gender) and achieve multi-sectoral coordination?	I4
	5	32	0.876	How can integration of menstrual health across sectors be optimally monitored and evaluated?	I5
Measurement and research (n = 5)	1	1	0.956	What indicators are optimal for assessing menstrual health over time (e.g. related to norms, education, health, rights, etc.)?	M1
	2	19	0.890	What tools/instruments/approaches/measures are optimal for assessing the impact of interventions to address menstrual health at various programmatic levels (e.g. local, national, global)?	M2
	3	37	0.868	What is the definition of a meaningful improvement in menstrual health, and how can it be measured?	M3
	4	78	0.785	How can lessons learned from the delivery of menstrual health interventions be optimally documented and shared?	M4
	5	89	0.724	What support is needed to encourage relevant, timely, and rigorous research on menstrual health, and which actors need to be engaged in the research process?	M5

Table 7. Top five research questions ranked by individual scoring criteria.

Individual scoring criteria	Rank within criteria	Overall rank	Question	Overall RPS	Unique ID
Novelty	1	16	How long should menstrual cups be worn, how should they be cleaned between use, and how often should they be replaced?	0.901	D8
	2	17	How can governments integrate menstrual health across sectors (e.g. education, health, WASH, gender) and achieve multi-sectoral coordination?	0.897	I4
	3	1	What indicators are optimal for assessing menstrual health over time (e.g. related to norms, education, health, rights, etc.)?	0.956	M1
	4	6	What new interventions could be developed to manage menstrual pain?	0.913	D3
	5	10	What are the impacts of providing free/subsidized menstrual products/materials on menstrual health?	0.913	D5
Potential for implementation	1	1	What indicators are optimal for assessing menstrual health over time (e.g. related to norms, education, health, rights, etc.)?	0.956	M1
	2	4	Are girls, women, and others who menstruate able to access and afford their preferred menstrual product/materials; what is the quality of these products/materials; where do they obtain them; and how do they use and dispose of them?	0.924	U2
	3	3	What new interventions could be developed to address harmful attitudes, norms and stigma and improve communication related to menstruation?	0.930	D1
	4	2	What are the experiences of girls, women, and others who menstruate in relation to menstrual pain and disorders (e.g. what proportion experience them, what are their perceptions about them, how do they manage them, and what support do they seek and receive for them)?	0.932	U1
	5	6	What are the experiences and challenges of girls, women, and others who menstruate with particular needs and circumstances (e.g. those living with HIV, those with disabilities, those who are incarcerated, those experiencing homelessness, those who have experienced FGM, trans and gender non-binary persons) in relation to their menstrual health?	0.919	U4
Importance/impact	1	1	What indicators are optimal for assessing menstrual health over time (e.g. related to norms, education, health, rights, etc.)?	0.956	M1
	2	2	What are the experiences of girls, women, and others who menstruate in relation to menstrual pain and disorders (e.g. what proportion experience them, what are their perceptions about them, how do they manage them, and what support do they seek and receive for them)?	0.932	U1
	3	5	What is the impact of unmet menstrual health needs (e.g. products/materials, WASH infrastructure/services) on the participation and engagement of girls, women, and others who menstruate in school and work and their self-esteem and agency?	0.921	U3
	4	23	What is the impact of unmet menstrual health needs (e.g. information, products/materials, WASH infrastructure/services) the health and wellbeing of on girls, women, and others who menstruate across the life course?	0.888	U6
	5	3	What new interventions could be developed to address harmful attitudes, norms and stigma and improve communication related to menstruation?	0.930	D1

Table 8. Average research priority scores, by domain, stakeholder group, and country of origin.

Domain	Total number of research questions	Average Research Priority Scores
		All participants	Academics	Non-academics	HIC	LMIC
Understanding the problem	25	0.850	0.843	0.853	0.843	0.860
Designing and implementing interventions	53	0.833	0.841	0.830	0.814	0.865
Integrating and scaling up	11	0.862	0.850	0.867	0.854	0.875
Measurement and research	5	0.845	0.815	0.857	0.821	0.886

Figure 2. Comparison of the top ranked research questions, among academics vs. non-academic.

Figure 3. Comparison of the top ranked research questions, among participants from HICs vs. LMICs.