Epidemiology of menstrual-related absenteeism in 44 low-income and middle-income countries: a cross-sectional analysis of Multiple Indicator Cluster Surveys

BACKGROUND: Menstrual-related absenteeism from work, school, or social activities is an important functional indicator of poor menstrual health that disrupts women's and girls' daily lives and exacerbates gender inequality. We sought to estimate the prevalence of and factors contributing to menstrual-related absenteeism across low-income and middle-income countries. METHODS: statistic, and prediction intervals generated to reflect the variation in associations. FINDINGS: We included 673 380 women and girls aged 15-49 years in this analysis. The overall pooled prevalence of menstrual-related absenteeism was 15·0% (95% CI 12·7-17·3), with prevalence being highest in south Asia (19·7% [11·6-27·8]) and west and central Africa (18·5% [13·5-23·5]). After pooling data across surveys, girls aged 15-19 years were found to have a higher prevalence of menstrual-related absenteeism than those in older age groups, with overall pooled prevalence ratios ranging from 0·75 (0·68-0·82) in those aged 35-39 years to 0·92 (0·87-0·97) in those aged 20-24 years relative to the 15-19 years age group, with adjustment for area type (urban or rural). There was no association between menstrual-related absenteeism and household wealth or the use of menstrual materials. By contrast, having a private place to wash at home was associated with an increased prevalence of menstrual-related absenteeism (overall pooled prevalence ratio 1·25 [1·05-1·48], adjusted for wealth and area type). Menstrual-related absenteeism was less prevalent in women and girls using any contraceptives compared with those not using contraceptives (0·92 [0·87-0·96]), and for those using hormonal contraceptives compared with those using non-hormonal or no contraceptives (0·91 [0·84-0·99]), after adjusting for age, wealth, education level, parity, and area type. INTERPRETATION: Menstrual-related absenteeism is prevalent, especially in Asia and Africa and among adolescent girls. The age-independent protective effect of hormonal contraceptive use suggests that symptoms such as heavy menstrual bleeding or pain contribute to absenteeism. Future studies are urgently needed to better characterise these findings to inform relevant public health interventions.