Putting menarche and girls into the global population health agenda Original paper

What was reviewed?

This commentary reviewed the global neglect of menarche and menstrual health education within the population health agenda, emphasizing its significance for adolescent girls’ well-being, self-confidence, and long-term sexual and reproductive health. The authors highlight the widespread lack of education and support for girls experiencing menarche, noting that many begin menstruation uninformed, unprepared, and unsupported, which can result in fear, shame, and compromised self-esteem. The review synthesizes qualitative and quantitative evidence from diverse global contexts to illustrate the psychosocial and health consequences of inadequate support and information at menarche. It also examines current initiatives and interventions aimed at addressing these gaps, including educational booklets, school-based programs, community engagement, and international partnerships, while arguing for a standardized, global approach to menstrual health education as an entry point for broader sexual and reproductive health discussions.

Who was reviewed?

The commentary drew on research involving adolescent girls from a variety of cultural, socioeconomic, and geographic backgrounds, primarily in low- and middle-income countries but also referencing studies in high-income settings. The reviewed populations included school-aged girls in countries such as Tanzania, Ghana, Ethiopia, Cambodia, Nepal, Malawi, Rwanda, Guatemala, India, Iran, Kenya, Sierra Leone, and Bolivia. Parents, educators, healthcare workers, and community leaders were also referenced as stakeholders influencing girls’ experiences of menarche and the effectiveness of educational and support interventions. The cited studies encompassed both qualitative accounts—capturing girls’ emotional responses, experiences of stigma, and school absenteeism—and quantitative assessments of intervention impacts on knowledge, hygiene practices, and health outcomes.

Most important findings

The commentary’s most salient finding is the near-global deficit in menstrual health education and support for girls at menarche, which perpetuates cycles of shame, misinformation, and health risks. Girls commonly report confusion, fear, and embarrassment at the onset of menstruation, often concealing their experiences and missing school due to stigma or lack of menstrual materials. This inadequate support is linked to diminished self-confidence and competence, which can impair girls’ abilities to advocate for their sexual and reproductive health. Evidence also suggests that early menarche, especially when unsupported, is associated with increased risk behaviors such as early sexual debut and substance abuse, with downstream effects on adolescent pregnancy and psychosocial outcomes. The review catalogs a growing number of interventions demonstrating positive impacts, such as improved knowledge, confidence, and menstrual hygiene management when education and support are provided. For instance, community and school-based programs in India, Iran, Ghana, and other countries have shown that even modest educational efforts and access to hygiene products can significantly reduce school absenteeism and improve girls’ psychosocial well-being. International organizations and NGOs are increasingly integrating menstrual health into broader water, sanitation, hygiene (WASH), and reproductive health strategies.

Key implications

The primary implication is that public health programs must recognize menarche as a critical juncture for health education, providing girls with the knowledge, practical resources, and emotional support needed to manage menstruation confidently. Integrating menstrual health education at or before menarche could serve as a culturally acceptable entry point for ongoing, comprehensive sexual and reproductive health education. Standardizing this approach globally—through school curricula, community engagement, and health systems—would help dismantle stigma, promote gender equity, and potentially improve both psychosocial and biological health outcomes, including those related to the vaginal and reproductive tract microbiomes. The review advocates for moving beyond pilot initiatives to establish a global standard ensuring that every girl receives accurate, supportive, and timely information and resources.