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ABSTRACT Objective To systematically review strategies to increase availability and access to sanitation facilities for menstrual health. Methods We searched four databases (PubMed, LILACS, CINAHL, EMBASE) and trial registries for peer‐reviewed studies evaluating the effectiveness of interventions providing and/or improving toilets, private washing facilities, or structures for safe disposal of menstrual materials. Outcomes were sexual/reproductive health knowledge/attitudes, gender‐based violence, self‐efficacy, quality of life, stigma, school/work attendance/performance, successful use and disposal of menstrual materials, and environmental impact. Eligible studies were included if they evaluated (1) intervention effectiveness, (2) end‐user values and preferences, and/or (3) intervention costs. We extracted data in duplicate and assessed risk of bias using ROBINS‐I and Risk of Bias 2.0. Results Eleven studies describing single or multi‐pronged interventions were included in the effectiveness component, most from low‐resource settings using observational designs. Studies found increased sexual and reproductive health knowledge and attitudes, self‐efficacy, quality of life, and successful use and disposal of menstrual materials among intervention participants. Evidence on environmental impact was limited, and school attendance and menstrual stigma findings were conflicting. Forty‐one studies included in the values and preferences component documented the importance of functional, clean, and safe facilities with features such as lockable doors and discreet disposal systems. Only two studies evaluated cost, limiting the assessment of facility‐related expenses beyond these settings. Conclusion Interventions that provide or improve sanitation facilities as part of multicomponent packages may enhance menstrual health and improve quality of life. PROSPERO Registration CRD42024617283.
Wallengren et al. (Mon,) studied this question.