Perspectives on menstrual policymaking and community-based actions in Catalonia (Spain): a qualitative study

BackgroundMenstrual research and policymaking have become imperative worldwide. It is necessary that these are informed by women and people who menstruate (PWM) alongside expert professionals and activists.MethodsThe main aim of this study was to identify and propose policies and community-based actions to address menstrual inequity and promote menstrual health in Catalonia (Spain). This study consisted of two qualitative studies: (a) 34 individual photoelicitation interviews with women and PWM, (b) a World Cafe study with 22 professionals and activists. Sampling for both studies was purposive and selective. Recruitment was conducted through healthcare centres, social media, key contacts, and snowball sampling techniques. Data were collected in December 2020-September 2022, and analysed using Framework Analysis.ResultsParticipants considered the implementation of menstrual policies that address the taboo and stigma of menstruation to be crucial. They stressed the need for menstrual education, which should be integrated into formal education curricula. Participants, and especially women and PWM, highlighted the need to improve the access and quality of healthcare services, so that the menstrual cycle and menstruation are seen as health indicators. Health professionals should encourage agentic informed decisions, hence why both participant groups considered menstrual health education amongst health professionals to be pivotal. Taking action to improve the access and affordability of menstrual products was also imperative for participants, especially for socioeconomically vulnerable populations. Participants agreed on guaranteeing fully equipped menstrual management facilities, and and professionals discussed gender-neutral and sex-segregated bathrooms. Workplace menstrual policies to accommodate and ensure menstrual self-care were also suggested.ConclusionsOur study highlights the need for multi-dimensional menstrual policies. These should include actions to address menstrual taboo and stigma, to promote menstrual education that goes beyond the hegemonic biomedical prism, to improve the access and quality of menstrual health services, along with policies ensuring adequate menstrual management facilities in public spaces and the access to menstrual products. Policymaking should also focus on how to ensure menstrual management and care in workplaces. Menstrual policies and community-based actions should be framed within intersectionality, to consider how societal structures of power and oppression influence menstrual experiences. Research has shown the growing importance of understanding and creating policies related to menstruation worldwide. In Catalonia, Spain, a study was conducted involving both women and individuals who menstruate, as well as experts and activists to uncover the best ways to address menstrual-related issues. Through interviews and group discussions, participants shared their thoughts on how to improve menstrual health and reduce inequities. They highlighted the urgency of tackling societal taboos surrounding menstruation and incorporating menstrual education into school curricula. There was a call for better healthcare services that view menstrual health as an indicator of overall health. Participants felt strongly about improving access to menstrual products, especially for those with financial difficulties. There was also consensus on the need for well-equipped public facilities to manage menstruation, including discussions on gender-neutral and separate bathrooms. Suggestions were made to have policies in workplaces that support individuals during their menstruation. The study concludes that comprehensive policies are needed to address a range of menstrual concerns, from education to public facilities, with an emphasis on understanding the diverse experiences and challenges individuals face due to societal structures. IntroduccionSiendo la investigacion y la implementacion de politicas menstruales imprescindibles, es necesario que estos procesos esten informados por mujeres y personas que menstruan (PM), asi como por profesionales expertas y activistas.MetodosEl objetivo principal de este estudio fue identificar y proponer politicas y acciones comunitarias para abordar la inequidad menstrual y promover la salud menstrual en Cataluna (Espana). Este estudio consistio en dos estudios cualitativos: (a) 34 entrevistas individuales de fotoelicitacion con mujeres y PM, (b) un World Cafe con 22 profesionales y activistas. El muestreo para ambos estudios fue intencional y selectivo. El reclutamiento se realizo a traves de centros de salud, redes sociales, contactos clave y tecnicas de bola de nieve. Los datos se recogieron entre diciembre de 2020 y septiembre de 2022 y se analizaron mediante Framework Analysis.ResultadosLas participantes consideraron crucial la implementacion de politicas menstruales para abordar el tabu y el estigma menstrual. Destacaron la necesidad de una educacion menstrual, que deberia integrarse en los curriculums escolares. Las participantes, y especialmente las mujeres y PM, resaltaron la necesidad de mejorar el acceso y la calidad de los servicios de salud, de manera que el ciclo menstrual y la menstruacion sean consideradas indicadores de salud. Mencionaron que el personal sanitario debe fomentar las decisiones informadas, de ahi que ambos grupos de participantes consideraran fundamental la educacion sobre la salud menstrual entre los profesionales de la salud. Tambien, para las participantes fue imperativo asegurar el acceso y asequibilidad de productos menstruales, especialmente para las poblaciones socioeconomicamente vulnerabilizadas. Las participantes estuvieron de acuerdo en la necesidad de garantizar espacios equipadas para el manejo menstrual, y se llevaron a cabo debates entre las profesionales sobre los banos inclusivos y segregados por sexo. Tambien se sugirieron y debatieron politicas menstruales en entornos laborales, para adaptar y garantizar el autocuidado menstrual.ConclusionesNuestro estudio destaca la necesidad de politicas menstruales multidimensionales. Estas deberian incluir acciones para abordar el tabu y el estigma menstrual, promover una educacion menstrual que vaya mas alla de la perspectiva biomedica hegemonica, mejorar el acceso y la calidad de los servicios de salud menstrual, junto con politicas para garantizar la disponibilidad de instalaciones adecuadas para el manejo menstrual en espacios publicos, asi como el acceso a productos menstruales. La creacion de politicas tambien deberia centrarse en como garantizar el manejo y los cuidados menstruales en entornos laborales. Finalmente, estas politicas menstruales y acciones comunitarias deben enmarcarse desde la interseccionalidad, para considerar como las estructuras y poderes sociales operan e influyen en las experiencias menstruales.