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
ARTICLE HIGHLIGHTS
Research background

Period poverty is an international health concern, impacting thousands of women and girls, especially those in underdeveloped regions or those struck with conflict and disaster. Due to issues with menstrual education and access to menstrual hygiene products, many females compromise their daily routines (e.g., not attending school or going to work). There is a lack of a comprehensive evidence synthesis in relation to period poverty hence the PLatform for the Analysis, Translation, and Organization of large-scale data project (PLATO) was developed with this systematic review and meta-analysis as the first stage.

Research motivation

Period poverty influences various health and social factors to varying degrees, dependent on the geographic location and other risk factors – this effect is amplified in low- and middle- income countries. To better understand the impact of period poverty, research exploring and highlighting current gaps in knowledge in key. Following this, improved legislation and policies for women and girls will enable better access to menstrual hygiene products and accurate menstrual education.

Research objectives

Due to the sheer lack in period poverty research, especially in low- and middle- income countries, this systematic review and meta-analysis aimed to explore current understandings and highlight any areas for future research. The primary outcomes included factors associated to menstrual hygiene products, such as accessibility and affordability, but also menstrual hygiene management and education. Variations in relation to age, location, religion, and parental and individual education was also explored.

Research methods

A systematic review and meta-analysis were conducted to explore period poverty with all related observational and randomised clinical trials included in this report. Studies published in English, between the 30th of April 1980 and the 30th of April 2022 were included. An extraction template was specifically developed in line with the objectives of the study to ensure that research aims were addressed comprehensively.

Research results

Overall, 80 studies were included in the systematic review and 38 in the meta-analysis and various statistically significant findings were uncovered. Sanitary pads were used a lot more in non-Low- and Middle-income countries, with women in rural areas being 0.7 times less likely to have good menstrual hygiene and management practices. School girls who reported irregular menstrual cycles experienced severe menstrual pain and those with severe pain were almost 5 times more like to miss out on school.

Research conclusions

This study demonstrates correlations between severity of dysmenorrhea and school absenteeism among girls with and without regular menstruation. It also explored how period poverty is the associated mental health impact, with evidence to suggest a link between menstruation and prevalence of stress, anxiety, and depression. This study has indicated that the majority of the evidence on period poverty is within low-middle-income countries and middle-low-income countries. It is possible that the findings of this study could have been exacerbated due to the coronavirus disease 2019 pandemic.

Research perspectives

Period poverty is an under-researched area despite is being a global social and health issue. This research has outlined current understandings of period poverty but also where the gaps lie. Following on from this, policies and practices can be introduced and developed to ensure women and girls are supported across the globe in relation to menstrual products, information, and healthcare providers.