Experiences of menstrual inequity and menstrual health among women and people who menstruate in the Barcelona area (Spain): a qualitative study.

Introduction: Menstrual health and menstrual inequity have been neglected in social, economic, healthcare and political spheres. Although available evidence is scarce, it already suggests a link between experiencing menstrual inequity (which refers to the systematic disparities in accessing menstrual health and education, menstrual products and spaces for menstrual management, among other aspects) and menstrual health outcomes. The aim of this study was to explore experiences of menstrual health and menstrual inequity among women and people who menstruate aged 18–55 in Barcelona and surrounding areas (Spain). Methods: A qualitative study, using a critical feminist perspective, was conducted. Sampling was purposeful and selective. Recruitment was through sexual and reproductive health centres, social media and snowball sampling techniques. Thirty-four semi-structured photo-elicitation interviews were conducted between December 2020 and February 2021. Interviews took place in sexual and reproductive health centres, public spaces, and by telephone. Data were analysed using Reflexive Thematic Analysis. Results: Three themes were identified: "Systemic neglect of menstruation and the menstrual cycle", "When "the private" becomes public: menstrual management" and "Navigating menstrual health: between medicalization and agency". Experiences of menstrual inequity appeared to be widespread among participants. They referred to the impact of having to conceal menstruation and the barriers to managing menstruation in public spaces. Choosing menstrual products was often influenced by price and availability; several participants reported menstrual poverty. A general lack of menstrual education was described. Menstrual education was usually gained through personal experience and self-learnings, or through families and friends. Menstruation and the menstrual cycle had a significant impact on participants' day-to-day. Accessing and navigating the healthcare system was challenging, as participants mostly reported feeling dismissed and almost exclusively offered hormonal contraception as a panacea to address menstrual health. Conclusions: The impact of menstrual inequity appears to be far-reaching. Multidimensional structural policies should promote agency in individuals and communities to enable opportunities for menstrual education, access to menstrual products, healthcare services and adequate menstrual-management facilities. Health professionals' training is also necessary to improve access to and quality of menstrual healthcare. Policies need to be inclusive of non-binary and trans people, and vulnerable populations. Plain language summary: There is a lack of research on menstrual health and menstrual inequity. However, we already know that menstrual inequities may have a negative effect on menstrual health. Yet, politicians, policymakers and healthcare professionals rarely pay attention to menstrual inequity and menstrual health. This study had the objective to collect experiences of menstrual inequity and menstrual health among women and people who menstruate (trans and non-binary people) between 18 and 55 in the Barcelona area (Spain). Thirty-four participants took part in interviews between December 2020 and February 2021. We used photographs during the interviews to deepen discussions with participants. We did the interviews in sexual and reproductive health centres, in public spaces and over the phone. Participants shared a variety of experiences of menstrual inequity and health. For instance, some participants explained that they had experienced financial issues to buy menstrual products. Others, that it was often difficult to find adequate spaces to change menstrual products at schools, workplaces and public spaces. Participants told us that they mostly learned about menstruation through their own experiences and talking to family and friends. They had little information on menstruation. Also, when participants sought medical help they usually found that health professionals usually only offered hormonal contraception to treat menstrual issues. They felt frustrated and dismissed. In general, they thought that menstruation affected their daily lives. Therefore, it is very important to train professionals, continue research and put policies for menstrual inequity and health in place. [ABSTRACT FROM AUTHOR]