Do Women Have Bodies with Problems? Menstrual Health, Period Poverty, and the Deprivation of Dignity

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

I was excited to read this paper because this work is central to my own research, and the title was provocative.

This paper should be published after some editing and slight reframing. In general, the paper is clear, and the organization effectively serves the paper’s goals. The author substantiates the main arguments well with citations.

Areas for revision:

The paper could benefit from some copyediting. The first line in the introduction is missing an article “a”. Menstruation is a biological process. There are also several areas in the paper where there are typos or missing nouns. The author uses “this” quite often, but it is not always clear what the subject of the pronoun is.

The main challenge with the article is its inability to present a convincing case for why menstrual health deserves more global attention. As I understand, the author aims to make two key points: (1) periods are a natural part of life, and (2) period poverty is a significant health issue that warrants global policy attention. The case for the first issue is solid and sound. The case for the second matter needs to be made more tightly.

Menstrual health continues to be ignored and lacks global attention because of precisely the way the author has laid it out.  The term period poverty divides the issue between “poor” and “non-poor” women.  Period poverty is often used synonymously with menstrual health, which obscures the broader reality: girls and women, regardless of economic status, are stigmatized for having periods. Period stigma drives period poverty, not the reverse. Stigma establishes a structural framework that shapes the allocation of resources to some matters and under-resources others.  Menstrual health concerns are not limited to poor women. Yet, because the conversation is so often framed primarily around period poverty, menstrual health becomes marginalized—viewed as a problem only for the poor or underserved—making it harder to garner broad, global support, and obstructing our understanding of how it affects all women.

Suggestion: The author reframes the case for why the lack of policy attention to menstrual health harms not only all girls and women, but also societies at large.

Other matters of note:

The methodology is not particularly strong, but it does adequately support the case. I think it would be best for the author to name all the organizations in Table 2 in the methods section. Table 1 does not include the Caribbean, where significant work is being done. The treatment of the US is also short-sided, and the author does not convincingly make the case that developing countries experience period poverty and/or need to be a part of this dialogue. The UK and Canada are missing entirely. Also, it is worth noting for revision that the paper could benefit from more than just citations. More data points would and could enhance the core argument.

Most recently, the GrassROOTS Community Foundation has published a white paper on menstrual equity, which includes references and data points that may be helpful to the author. See: https://grassrootscommunityfoundation.org/global-menstrual-equity-initiatives/#1740530304007-063602ee-115e

 

 

 

 

Author Response

Thank you so much for raising the issue of copyediting. We read the paper and managed to correct some grammatical errors.

We also reworked certain areas of the paper to better explain why menstruation should be seen as a global issue. As suggested, we reviewed literature on Caribbean countries and extended it to include Latin America. We found that period poverty affects these regions as well, which strengthens the case for viewing it as a global issue. Both developed and developing countries were included in the analysis. Furthermore, Table 1 now includes additional countries from the Caribbean, Latin America, the US, the UK, Africa, Asia, etc.

Thank you for your comments on the use of the terms menstrual health and period poverty. Our approach is as follows: menstrual health applies to all women, but women face different challenges regarding menstrual health. Some women experience poverty and therefore face period poverty, while others are not poor but still encounter discrimination and shame, resulting in a loss of dignity. Thus, we did not use the terms menstrual health and period poverty interchangeably. The study begins with menstrual health and then narrows down to specific issues, such as period poverty, stigma, and related challenges.

We also reworked the methodology to make it stronger. We explained it in detail and added additional studies that examined the Caribbean and other regions.

Reviewer 2 Report

Comments and Suggestions for Authors

This paper provides a very detailed international review of the literature on menstruation and "period poverty" and makes several well-supported recommendations for public policies. I think the paper should be improved in two ways:

1) A more detailed methods section: you need to explain in much more detail how you identified and selected literature for the review......if you used a search engine (i.e. pubmed) for identifying papers, describe the key words and limitations.....did you review some listing of UN documents to find the ones you cited? Were these limited to a time frame? Please provide some sense of how comprehensive your review is at each stage in presenting your argument ....are the examples of barriers and difficulties in Tables 1 and policies in Table 2, for example, only illustrative or are they most or all of the examples in the English lamguage literature published in the last 10 years (or whatever limits)....The paper seems like a scoping review (though you build an argument, not just an overview of the literature) but you might want to draw on one or more the standards established for scoping reviews (See for example: Tricco, AC, Lillie, E, Zarin, W, O'Brien, KK, Colquhoun, H, Levac, D, Moher, D, Peters, MD, Horsley, T, Weeks, L, Hempel, S et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018,169(7):467-473. doi: 10.7326/M18-0850

  2) I think in your discussion, you should offer some assessment of the development of health and policy science research on menstrution and period poverty.....I think your review underscores gaps in understanding cultural barriers to supportive policies and how they can be overcome and how women's experiences,coping patterns and outcomes differ across policy and cultural environments.

Author Response

Thank you for the comments.

We have reworked the methodology section and provided a detailed explanation of how the data were gathered and analyzed. The section was revamped to address the comment that was raised.

We also revised the discussion to address the development of health and policy science research on menstruation and period poverty.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Thanks so much for your work. You have raised an important issue that has received scant attention. You have presented a convincing set of facts and perspectives that underline the biases in current policies and the importance of underscoring the economic costs to individual from these biases. Period poverty ought to be something that all publi health students and practitioners take into account and your paper will provide an impetus for this.