ArticleThe Lancet. Global health2025
Epidemiology of menstrual-related absenteeism in 44 low-income and middle-income countries: a cross-sectional analysis of Multiple Indicator Cluster Surveys.
Article in The Lancet. Global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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8 citing papers in PubMed.
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- Self-reported menstrual-related physical and psychological symptoms and health-seeking behaviour among rural school-going adolescent girls in Bangladesh.BMC women's health · 2026Article
- Menstrual hygiene management and social exclusion among women in Afghanistan: insights from a national survey.BMC women's health · 2026Article
- Menstruation Is Associated with Dietary Diversity among Adolescent Girls: The Role of Social Eating Norms and Menstruation-Related Norms from a Mixed-Methods Study in Bangladesh.The Journal of nutrition · 2026Article
- Decoding menstrual health across the lifespan: a scoping review of digital health tools in research.medRxiv : the preprint server for health sciences · 2026Article
- Mapping the social impact of menstrual stigma in Spain.BMC women's health · 2026Article
- Decoding menstrual health across the lifespan: a scoping review of digital health tools in research.npj women's health · 2026Article
- Heavy menstrual bleeding and association with menstruation-specific resources: A multinational cross-sectional study in low- and middle-income countries.Health & place · 2025Article
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Abstract
backgroundMenstrual-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.
methodsWe analysed cross-sectional data from 47 nationally or subnationally representative Multiple Indicator Cluster Surveys from 2017 to 2023, which comprised 3 193 042 individuals from 555 869 households across 44 countries; those with available information on the outcome of interest were included in our analysis. The outcome of interest was menstrual-related absenteeism from work, school, or social activities during the respondent's last menstrual period. Independent factors included age, household wealth index, use (vs no use) of menstrual materials (eg, pads, tampons, or cloth), availability of a private place to wash at home during menstruation, and contraceptive use (hormonal and other). Univariable and multivariable associations between each factor and menstrual-related absenteeism were analysed using log-binomial models. Prevalence ratios, estimated from the log-binomial models, represent the relative prevalence of menstrual-related absenteeism across different levels of the independent variables. Prevalences and associations were pooled by geographical region and overall across all surveys using a random-effects meta-analysis. Heterogeneity was assessed using the I
findingsWe 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.
interpretationMenstrual-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.
fundingNational Health and Medical Research Council, Australia.
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