Smile, even though it hurts: A photovoice study exploring menstrual care in Spain

Abstract Background Menstrual distress (the range of physical, emotional, and social challenges associated with the menstrual cycle) significantly affects the wellbeing and emotional health of women and people who menstruate (PWM). Care strategies for menstrual distress remains inadequately addressed within health care, public policies and research. This study explores the strategies, experiences and spaces for care of emotional health in women and PWM experiencing menstrual distress. Methods Photovoice, a qualitative participatory-action research method, was conducted across 5 regions of Spain. It consisted of 6 in-person sessions per region and 1 online session with all participants. 41 women and PWM (18 years of age or older) participated. Recruitment and data collection took place at healthcare centers, civic and social organizations, and universities. Data analysis was carried out collaboratively with the participants in each region, followed by a synthesized analysis of all data. Results Factors contributing to menstrual distress were experienced as inadequate menstrual education, social expectations to remain unaffected, and insufficient solutions to menstrual distress in the healthcare system. In response, menstrual care was described as a need to withdraw from the demands of daily life with bodily and menstrual (self-)knowledge as a fundamental prerequisite. Pain management and rest were emphasized as essential care practices. Collective care involving a sex-affective partner, friends, family or support networks were also mentioned as important forms of menstrual care. Menstrual care was considered important not only for personal wellbeing but was also perceived as a form of menstrual agency. Conclusions The study found that the structural neglect of the menstrual cycle complicates and hinders menstrual care practices and aggravates menstrual distress. It highlights the urgency of addressing menstrual care and provides a basis for future menstrual policies. Key messages • The study emphasizes the urgent need to improve menstrual care in healthcare, education, and public policies, highlighting gaps in support for those experiencing menstrual distress. • The study reveals how the structural neglect of the menstrual cycle aggravates menstrual distress and sustains menstrual inequties.