Cultural process usually exist practicss support culturla transition Menstrual health and cultural practices girls [ 34384243 ]. S2 File. Nepal Kanoon Patrika D Discussing the comprehensiveness of policy documents, we did not find any Chhaupadi-specific policy formulated in a holistic approach.

Menstrual health and cultural practices -

This approach is suitable for questions where literature uses various approaches and methodologies and is found in both peer-reviewed and grey literature.

The search strategy was designed to identify peer-reviewed scholarly publications and unpublished grey literature about the experiences of women at menarche and during menstruation in PICTs. Searches for peer-reviewed and grey literature were done initially between May and June, , and then repeated in July, using the same search strategy with the aim of capturing any additional literature.

A librarian assisted in the design of the search strategy and guided the process of extracting data. Search terms included relevant Medical Subject Headings MeSH terms corresponding to these search terms in each of the databases that had thesauri Table 1.

These search terms were identified to meet the aim of the review. Standard search terms were applied as per the review protocol for Google Scholar and institutional websites.

In such situation, the concept with the longest search string Concept 4 was divided into six parts with connector AND to search terms of concept 3 and connector OR thereafter until all search terms of concept 4 were completed. While the limitations of Google Scholar are widely known [ 22 , 23 , 24 ], due to timing constraints we limited the results to the first returns per search.

For the websites, where there were functions that allowed search strings to be entered, full search terms were entered. In situations where the search strings were lengthy and could not be accommodated, a number of searches were done.

All hits were scanned and 35 relevant articles retrieved. Relevant articles were manually downloaded and systematically grouped for analysis. All relevant hits were exported to Endnote library management software.

Based on the functionality of Google Scholar [ 22 ], some peer-reviewed literature not successfully retrieved from databases were retrieved from this source. Experts working in the field relating to MHH in various capacities were contacted for additional references.

This resulted in another 16 references gathered and screened. Grey literature was searched on the Google Scholar database and twenty-eight relevant websites of international and local organizations dealing with menstrual issues.

This includes evidence such as theses, organizational and government reports, policy papers, and conference proceedings [ 22 , 25 , 26 ]. The following inclusion and exclusion criteria were applied consistently throughout the search and analysis stage to find relevant literature that addressed the research question [ 27 ].

Were published between and year of the review was the year when UN General Assembly adopted the Convention on the Elimination of All Forms of Discrimination against Women [ 28 ]. A total of 2, articles were found with the initial search and were included in the initial screening by abstract and title Fig.

The first four phases of the PRISMA process were used to screen articles identified from databases and other sources [ 21 , 29 ].

A total of articles were included after duplicates were removed. In the screening phase, title and abstract screening were done by the first author resulting in 63 eligible articles for full text review. Fifty-two articles were excluded with reasons Fig. All blogs were excluded after quality assessment for lacking methodological rigour.

Full text screening was conducted independently by two authors EMG and MRM to determine the final articles for inclusion [ 21 , 29 ]. The two authors later discussed the findings to determine which articles to include or exclude based on the inclusion criteria, with support from Author Two SL.

This process resulted in 11 articles meeting eligibility for qualitative synthesis. Group discussion was necessary to resolve differences raised in assessments of full text of articles [ 21 , 29 , 30 ].

After the final list of articles for inclusion was agreed, the lead author reviewed the articles and extracted relevant data with cross-checking by other authors.

The articles included were original peer-reviewed research articles, research reports, review papers, program descriptions and reports, policy papers, discussion papers and commentaries. The Critical Appraisal Skills Program CASP quality assessment tool was used to assess the rigour, credibility and relevance of included articles using the relevant CASP assessment checklist [ 31 ].

Quantitative and qualitative CASP checklists were used in this assessment; ten studies were qualitative and one was quantitative Table 3. No articles were excluded on quality grounds at this stage.

The Socio-Ecological Framework SEF for MHM was used to identify and analyse the data used in this review [ 32 ]. This Framework was developed by UNICEF and Emory University to guide researchers globally to generate findings about factors that impact MHM.

The Framework is intended to guide study design, with the five key factors; biological, personal, interpersonal, environmental and societal factors considered relevant and useful to evaluate existing literature and reports on experiences about MHM Fig.

The five factors of the SEF were used to analyse, identify, extract and tabulate factors affecting menstrual health from the 11 included studies on a spreadsheet, as shown in Tables 2 and 3.

Publication year, authors name, country and study setting and the study aims were also extracted. Socio-ecological framework for menstrual hygiene management.

Source [ 32 , p. Key: KII Key Informant Interview; FGD Focus Group Discussions; IDI In-depth Interviews; WASH Water Sanitation and Hygiene; UNICEF United Nations International Children's Emergency Fund. Community includes any member of the community with whom the menstruating woman associates.

Environmental factors refer to menstrual issues relating to water, sanitation, hygiene and menstruation management material required to manage menstrual flow with dignity. These five thematic areas were considered relevant to systematically analyse and generate evidence relevant to the research question of this scoping review.

The literature search resulted in 11 studies that met the inclusion criteria. Nine of these studies were conducted in Melanesian countries Fiji, PNG and Solomon Islands , one Micronesian country Kiribati , and one in Polynesian countries Western Samoa and American Samoa.

The 11 included studies comprised five peer-reviewed articles and six grey literature documents. One of these six is a book chapter [ 32 ]. This review found limited literature on factors affecting MHH amongst women in PICTs. Of the 11 included works, only four [ 15 , 33 , 34 , 35 ] were peer-reviewed and published articles and out of the four scholarly articles, only one [ 15 ] is directly related to menstrual health and hygiene.

This paucity of evidence clearly demonstrates a need for research on MHH in the PICTs. The review identified and categorised factors affecting MHH under the five socio-ecological factors: biological, personal, interpersonal, environmental and societal. As presented in Table 2 , all 11 studies reported elements of societal factors and personal factors; nine studies [ 15 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 41 ] reported elements relating to environmental factors; ten studies [ 15 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ] found evidence relating to interpersonal factors and two studies [ 35 , 36 ] presented evidence linking to biological factors.

Data extracted from each of the 11 articles are categorised according to these factors Table 2 and each is presented in turn. Only two studies found elements relating to biological factors see Table 2. One study conducted in Western Samoa, American Samoa and Hawaiian Samoa reported behavioural changes such as dizziness and feeling lazy, sleepy and tired from pre-menstrual syndrome resulting in decreased activity [ 35 ].

While decreased activity was reported, the study did not report the implications of pre-menstrual syndrome for social participation, including school attendance for young women. The second study conducted in Fiji [ 36 ] reported evidence of menstrual pain and other physical symptoms such as feeling tired and dizzy.

Unlike the Samoan study [ 35 ], the study in Fiji reported effect of menstrual symptoms on social and physical activities and young women were unprepared to manage these symptoms [ 36 ]. All included studies reported evidence of personal factors knowledge, attitudes, skills and beliefs relating to pre-menarcheal awareness about menstruation and menstruation management skills.

Ten included studies—all except the study with Samoan women [ 35 ]—reported young women lacking comprehensive pre-menarcheal knowledge about menstruation, feeling scared, embarrassed and confused at menarche, and lacked skills to effectively manage menstruation.

However, evidence varied according to country and local contexts. Many young girls generally lacked knowledge about menstruation before menstruation, the timing of menarche and Sexual Reproductive Health SRH knowledge. A study conducted in PNG found that many girls lacked comprehensive knowledge around menstruation and were unprepared at menarche, with some girls having misconception of what menstruation.

A study in Kiribati [ 41 , p. The young girls exposed to information about SRH and menstruation were ready and knew how to manage menstruation. However, early exposure to menstruation knowledge varied between different countries and cultural context and were often limited.

Compared to studies conducted in PNG [ 15 , 40 ], Solomon Islands [ 15 , 39 ] and Kiribati [ 41 ], the studies conducted in Fiji [ 15 , 36 , 37 ] reveal evidence of more access to education and information about menstruation and hygiene practices—commonly learnt at school before menarche.

However, knowledge gaps relating to monthly menstruation cycles exist. Two studies conducted in Fiji reported menarcheal ceremonies, where young women are isolated and prepared by older female members of the family mothers, aunties and grandmothers for womanhood [ 34 , 42 ].

Lack of knowledge and understanding about menstruation reportedly led to fear, embarrassment and confusion at menarche. These responses were commonly reported by young girls who were not educated about menstruation before menarche.

Those who were educated had positive attitude at menarche by having the confidence of telling mothers, were prepared with menstruation materials and knew how to manage menstruation. Some girls in Fiji [ 36 , 37 ] and Kiribati [ 41 ] also reported learning about menstruation in SRH classes in schools whilst in Solomon Islands [ 39 ] and PNG [ 40 ] most young women lacked pre-menarcheal knowledge about menstruation and were unprepared for menarche, subsequently experiencing feelings of fear, confusion, shame and embarrassment [ 39 , 40 ].

Young women lack knowledge and skills on how to effectively manage menstrual blood and safely dispose of soiled pads. The studies in PNG [ 15 , 40 ] and Solomon Islands [ 15 , 39 ] commonly found women lacked pre-menarcheal knowledge and the ability to manage menstruation.

Young women with disability faced additional challenges because of lack of facilities to support disabled girls [ 36 , 37 , 39 , 40 ]. A disabled women from Fiji reported [ 37 , p.

Even though they try to make toilets very accessible for us, people with disability, especially wheelchair users. Shame and embarrassment around MHH was found to restrict social and economic activities in studies conducted in Fiji, SI, PNG and Kiribati [ 15 , 36 , 37 , 39 , 40 , 41 ].

Shame and embarrassment were also usually linked to teasing and bullying from males. Lack of knowledge about menstruation often resulted in teasing and bullying of young menstruating female students by male peers in schools.

This evidence was reported in a study conducted in Kiribati [ 41 ] where knowledge gaps about menstruation and sexual reproductive health in school-aged boys about menstruation led to teasing and bullying.

Lack of menstrual knowledge was commonly linked to taboo and secrecy resulting in limited communication, shame and embarrassment [ 15 , 36 , 37 , 39 , 41 , 42 ] and is further explained under societal factors. Interpersonal factors relating to relationships with families, teachers, peers and members of the community with whom the young women interact on a daily basis pose a variety of challenges.

All 11 studies reported challenges relating to pre-menarcheal awareness and preparation Table 2. Many young girls lacked awareness about menarche, timing of menarche and how to effectively manage MHH before the onset of menarche. Mothers are considered primary source of support for their daughters.

Other sources include female relatives, girlfriends and teachers. However, the studies found that some mothers were often reluctant to talk with their daughters about menstruation because of shame, taboo and their own lack of appropriate SRH knowledge.

However, these experiences are contextual and vary between different countries, and cultural, educational and religious background. Additionally, in Fiji, a health worker reported that mothers do not properly guide their children about menstruation [ 36 , p.

I was thankful to those health workers for properly explaining to the young girls at school about menstruating. In contrast, a study conducted in Fiji reported that menarche is celebrated and most i-Taukei Fijian indigenous Fijians women were able to talk to their daughters about menstruation and prepare them well by providing menstrual management products and taught them how to manage menstruation before the onset of menarche [ 42 ].

Menstruation topic was found to be a difficult topic to teach in schools. Most teachers lacked appropriate knowledge to effectively teach the subject and support young women in schools during menstruation.

Female teachers who are also considered important source of information and support about menstruation sometimes lack accurate and comprehensive understanding of the issue and perpetuate misconceptions [ 39 , 40 , 41 ]. A study conducted in Solomon Islands [ 39 , p.

Male teachers often feel uncomfortable talking about menstruation, and need training and tools to assist them in this task [ 39 , 40 , 41 ]. Although menstruation is taught in both rural and urban schools in PNG, teachers acknowledge lacking knowledge about menstruation, MHH and challenges associated with menstruation [ 40 ].

Studies in Fiji, PNG and SI [ 15 , 36 , 37 , 39 , 40 ] found teachers lacked comprehensive knowledge in teaching SRH topics, resulting in them feeling uncomfortable when talking about menstruation to young female students. This resulted in girls receiving inadequate information about SRH including menstruation.

These challenges also lead to female students lacking knowledge about menstruation and leaving school due to the inability to manage their menstruation [ 15 , 37 , 39 , 40 , 43 ]. Menarche is viewed as an important transition to womanhood. Cultural process usually exist to support this transition of girls [ 34 , 38 , 42 , 43 ].

Menarche ceremonies—the traditional ways of preparing and celebrating young women for womanhood were reported in Fiji [ 34 , 42 ]. These studies reported that menarcheal ceremonies were an important juncture through which girls are informed directly about SRH and gender roles and responsibilities.

While menstruation is considered taboo, the levels of secrecy and discretion vary according to religious and cultural background and prevailing attitudes and beliefs [ 36 , 37 ].

For example for i-Taukei Fijians menarche is often viewed as a time for celebration while Fijians of Indian origins exclude girls from social activities such as accessing mosque or praying due to perception that menstrual blood is polluting [ 36 , 37 ].

Girls are teased by some men and boys during menstruation. reported that teasing from males commonly led to girls feeling ashamed and embarrassed. Teasing was linked to lack of understanding about menstruation on the part of boys and men. The study also reported that the girls felt ashamed when they are mocked by fellow students—especially boys when menstrual blood leaks through their skirts [ 41 ].

Environmental factors related to WASH were found to exert a significant impact on the ability of young women to manage menstruation effectively and with dignity at home, in schools, at workplaces and public places [ 31 ].

Lack of these facilities impacted on school attendance, work, community participation and economic activities in studies conducted in Fiji [ 15 , 36 ], SI [ 39 ], PNG [ 40 ] and Kiribati [ 41 ].

Comparing the adequacy of WASH facilities between countries, the studies in Fiji [ 15 , 36 , 37 ] consistently revealed that WASH facilities were better when compared to PNG [ 15 , 40 ], Solomon Islands [ 15 , 39 ] and Kiribati [ 41 ].

Further comparison found that the urban squatter settlements in PNG, Solomon Islands and Kiribati have poorer WASH facilities than Fiji.

Working women reported leaving work and school girls reported leaving schools due to challenges in managing menstruation in workplaces [ 15 , 37 , 39 , 40 ]. Study on menstruation conducted in PNG [ 40 , p. Cost, supply chain and material choices in managing menstruation were generally more challenging for girls and women in Solomon Islands compared to PNG, Fiji and Kiribati [ 36 , 37 , 39 , 40 , 41 ].

Access to cash played a bigger part in the determining the type of materials girls and women were able to acquire to help them manage menstruation. In all PICTs access to menstrual products was even more challenging for women living in rural areas compared to the urban areas [ 15 ].

Traditional and cultural beliefs related to restrictive practices are linked to longstanding perceptions about the harmful nature of menstrual blood. These restrictive beliefs and practices were found to be common in studies conducted in PNG [ 15 , 38 , 40 ], Solomon Islands [ 15 , 39 ] and Kiribati [ 41 ] and less common in Fiji [ 15 , 36 , 37 ].

However, within Fiji the practices varied according to religious and cultural background commonly among the main ethnic groups: i-Taukei and Indo-Fijians [ 34 , 36 , 37 ]. The i-Taukei people are indigenous Fijian while Indo-Fijians are predominantly Hindu or Muslims [ 36 ].

For example, for i-Taukei Fijians, menarche is celebrated and observed as a passage of girls to womanhood while Indo-Fijians tend to socially exclude girls when they are menstruating [ 36 ]. The traditional cultural beliefs and practices around menstruation vary between countries and context due to education, influence from religion and changes in traditional lifestyles due to Westernisation.

The Last Taboo studies [ 15 , 39 , 40 ] conducted in PNG and SI, reported restrictive practices are more commonly practiced in rural than urban areas while in Kiribati [ 41 ], the traditional beliefs and practices are strong in both urban and rural settings. In two Fijian studies [ 34 , 42 ] and one in Samoan countries [ 35 ] the restrictive practices were reported to be uncommon in both urban and rural areas.

Restrictive practices were found to affect women socially and psychologically including their ability to manage menstruation effectively. In a study conducted in Fiji, PNG and SI, Mohammed et al.

Key Informant Interview, Female Health Worker, PNG. The significance of ceremonies marking menarche was reported in two anthropological studies [ 34 , 42 ] conducted in Fiji. These authors reported the menarcheal ceremonies or rituals facilitate gender identity and preparation of girls for womanhood.

Apart from preparation of womanhood, Jenkins explicitly explained that due to the belief that open communication about sexuality may pique curiosity leading to earlier or greater experimentation with sex , menarcheal rituals or initiations are traditionally used by parents to control the flow of information about sexuality, sex and reproduction to young women [ 38 , p.

This ceremony typically involves mothers, grandmothers and aunties in teaching and advising young girls about SRH topics.

However, this ceremony no longer occurs regularly due to changes in the traditional ways of life and education [ 34 , 38 , 42 ]. Some women continue to observe traditional beliefs around menstruation which exclude them from community, social participation and sexual activities.

The study in Samoa reported that menstruation is not considered a taboo concept or polluting and the restrictive belief systems and resulting changes in behaviour are individual choices [ 35 ].

While menstruating women paid attention to personal hygiene there was no elaborative evidence about MHM. However, men perceived that pre-menarcheal coitus is a pre-requisite for menarche to begin and coitus after childbirth for resumption of postpartum menstruation. No study explicitly reported major policy issues such as policy review, budget provisions or minimum standards for addressing MHH practices.

Quality assessment of the 11 studies on Table 3 resulted in four studies meeting the criteria, five partially meeting the criteria as far as were reported and two did not meet all criteria as outlined in the CASP tools. This review found that research on MHH is very limited in the PICTs, certainly beyond the anthropological literature about beliefs and practices around menarche and subsequent menstruation.

This finding is consistent with a recent unpublished literature review on menstrual hygiene in the Pacific [ 44 ]. This review found that research on MHH in the PICTs is largely externally driven and lacks critical indigenous and epistemological perspectives from Pacific Islanders.

Furthermore, the research lacks approaches that empower participants with lived experience to have control over the research agenda, the process and actions to address their felt issues [ 45 ].

Despite different settings and populations, the synthesis of descriptive evidence from a few countries PNG, SI, Fiji, Kiribati and Samoa reflects common themes relating to MHH with manifestations that differ in response to context between and within countries.

Using the Socio-Ecological Framework SEF , this synthesis highlights multiple challenges faced by women in PICTs at menarche and throughout their reproductive life relating to MHH.

These challenges have important implications for addressing sexual and reproductive health issues specifically those relating to menstruation in the PICTs. These implications are now discussed at individual, institutional and societal levels [ 46 ].

Pre-menarche girls generally lacked menstrual knowledge, and menstruation management skills—often leaving them unprepared for menstruation in both urban and rural areas. Mothers are considered a primary source of support for their daughters, however many of them lacked proper knowledge about menstruation and menstrual health.

Consequently, mothers felt ashamed and lacked confidence to assist their daughters resulting in fear, shame and confusion. Women living in rural and isolated communities with limited access to education tend to face more difficulties [ 46 , 47 , 48 , 49 ].

Inability to effectively manage menstruation due to lack of skills and menstrual management materials were also reported in Sierra Leone leading to shame and embarrassment [ 43 ].

Restrictive practices can also potentially impact on a range of personal factors such as pre-menarcheal awareness and preparation, self-esteem and psychological wellbeing, and MHH practices [ 14 , 50 , 51 ]. This review found lack of proper WASH facilities in schools, workplaces and communities in both urban and rural areas.

This finding is consistent with many studies conducted on WASH and MHH in the urban and rural areas in LMICs [ 50 , 51 , 52 , 53 , 54 , 55 , 56 ]. Lack of WASH facilities often left women feeling ashamed and embarrassed. This review found girls absenting from schools as a result of lack of proper toilet and sanitation facilities.

The structural challenges at school such as inadequate bathrooms also cause difficulties for girls to manage menstruation effectively in school [ 52 , 53 , 54 , 55 ].

Although the review found disparity in menstrual beliefs and practices between countries and between rural and urban areas, the findings suggest that these beliefs are ingrained in the cultural beliefs and perceptions of menstruation including menstrual blood [ 57 , 58 , 59 ] and may continue to influence MHH practices of women in the PICTs.

Curiosity, shame and gender-bound secrecy were also found to influence behavioural practices such as bullying and teasing from male figures, and the inability of male teachers to effectively support female students during menstruation in schools.

Inadequate knowledge of boys about SRH and menstruation have been found to help promote and perpetuate stigma, acts of teasing, and bullying of women during menstruation [ 47 , 63 , 64 , 65 ].

Taboo and stigma against menstruating women leading to restricted SRH communication and menstruation, social and community participation, education and work, are considered forms of gender-based violence induced by patriarchal perceptions of menstrual blood [ 64 , 66 ].

Stigma, shame and secrecy around menstruation are linked to menstrual taboos [ 7 , 58 , 67 , 68 , 69 ]. Myths and rumours about menstruation found in this review lead to fear, shame and self-isolation [ 41 ]. They were also found in studies conducted in India [ 70 ] and Ghana [ 71 ], leading to psychological distress in menstruating women.

The use of the Socio-Ecological Framework in this analysis has highlighted important challenges and multiple focus areas for interventions. A multi-level approach is required in order to facilitate and create a supportive environment for a positive menstruation experience.

The majority of evidence related to the implications of traditional social and cultural norms, beliefs and practices on MHM.

Policy related evidence relating to MHH was minimal; this may infer lack of evidence informing practice or a mere lack of consideration for gender-specific issues due to subordination of women, cultural taboos, shame and secrecy.

Negative norms, beliefs and practices that condition the experiences of women and girls at menarche result from the predominant patriarchal social and cultural environment within PICTs.

Despite disparities in experience between countries, rural and urban contextual settings, following actions are recommended; planning to include males in SRH education programs in an effort to influence their perceptions about menstruation is paramount [ 8 , 19 , 36 , 37 , 38 , 39 , 40 , 41 , 61 ].

WASH facilities should be considered beyond schools to include work environments, public spaces, rural and urban settings [ 19 , 36 , 37 , 38 , 39 , 40 , 41 ]. The menarcheal ceremonies provide an important alternative to SRH communication due to taboo and secrecy relating to menstruation and menstrual blood.

The menarcheal ceremonies reported in Fijian are traditional cultural systems practices by i-Taukei Fijian group to prepare young women for womanhood. These practices assist young women to assume gendered roles and responsibilities required in the society they belong to [ 34 ].

These menarche ceremonies are also found among the Navajo tribe of America [ 72 ], and Maasai and Bemba tribes Rhodesia of Africa to prepare girls for womanhood [ 73 , 74 ]. The elements of the menarche ceremonies could be explored further to inform the development of an alternative communication strategy for menstruation and SRH for girls in transition to womanhood.

Developing menarcheal ceremonies into a contemporary learning hub for teaching SRH topics to adolescent females in the Pacific holds promise. Country-specific research around menstruation is a necessary first step for PICTs and the author has gone onto conduct relevant MHH research in PNG [ 19 ].

Furthermore, because menstruation is deeply embedded in the social and cultural context of PICTs, research done by local researchers using socially and culturally situated approach is important to ensure the knowledge that is created is relevant.

Leaders in PICTs must prioritise research that promotes an understanding of local socio-cultural norms around menstruation because menstrual experiences are contextual; given the diversity of social and cultural contexts in the PICTs, local contextual knowledge is paramount. Consistent with indigenous epistemological standpoints, this review was led by a Pacific Island research scholar as part of her PhD studies.

Conducted from an Australian university, this review had good access to peer-reviewed and grey literature and relevant worldwide websites. The author group included researchers conducting research on menstruation in PICTs and with international organizations.

Most research about MHM in PICTs apart from anthropological studies mostly commenced only a few years ago. Hence, the number of studies conducted thus far is insufficient to fully understand the factors influencing MHM and the broader implications of menstruation on the wellbeing of girls and women.

Articles published in languages other than English were excluded, which may have excluded relevant literature from French-speaking Pacific islands and territories. Menstruating girls and women have the right to manage menstruation effectively and with dignity.

It is evident from this review that societal, environmental, interpersonal and personal factors impact on the experiences of girls and women around menstruation.

Of these four factors, socio-cultural norms, beliefs and practices appear to be extremely important underlying determinants that require locally-relevant action. Furthermore, because menstruation is deeply embedded in the social and cultural context of PICTs, research done by local researchers must use socially and culturally situated approaches to ensure the knowledge that is created is relevant.

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Indeed, on any given day some million women and girls are menstruating. But they often do it in shame and secrecy, while many lack access to water, sanitation, hygiene facilities and products so they can manage their menstruation with dignity.

And a recent documentary film as well as new podcasts are shining a light on the taboos, stigmas and costs of menstruation. These social and financial constraints remain particularly stark in low-income countries, forcing girls to miss school and marginalizing women in their own families and communities.

Canada supports global programs focused on maternal and child health that address cultural norms and practices surrounding menstruation and their impact on individuals and societies.

Sumi is the founder and secretary of the Adolescent Girl Power Group in Thakurgaon, Bangladesh. Adolescent Girl Power Groups AGPGs bring together young women to learn about sexual and reproductive health and menstruation. They also develop life skills and carry out projects that better their communities.

Sumi, 18, founder and secretary of the AGPG in the remote community of Thakurgaon in northern Bangladesh, says its teenage members develop small businesses and save money for their school fees, health needs and unexpected expenses. They also speak up on issues, for instance fiercely advocating against child marriage.

She says the biggest value of girls learning about menstrual health is they can speak to their families about it. The AGPG also led a mass signature campaign to stop sexual and gender-based violence. Adolescent girls in Kigutu, a rural village in southern Burundi, are learning about menstrual health and hygiene through the Mutima Integrity project, under the All Mothers and Children Count program.

There are many cultural cultugal surrounding how societies Mnstrual menstruation. Different cultures cultura menstruation in Mensfrual ways. The basis of many conduct Menstrual health and cultural practices and communication about menstruation in western industrial societies is healt belief Cultufal menstruation should remain hidden. Dance fueling strategies for dancers menstrual taboo is any social taboo concerned with menstruation. In some societies it involves menstruation being perceived as unclean or embarrassing, inhibiting even the mention of menstruation whether in public in the media and advertising or in private among friends, in the household, or with men. Many traditional religions consider menstruation ritually uncleanalthough anthropologists say that the concepts 'sacred' and 'unclean' may be intimately connected. The terms menstruation and menses are derived from the Latin mensis 'month'which in turn is cognate with the Greek mene 'moon' and the roots of the English words month and moon.