Exploring menstrual poverty and its impact on adolescent mental health

BACKGROUND: Menstrual poverty (MP) defines the lack of access to menstrual health management (MHM) due to financial barriers, and there are limited data regarding its effects on youth mental health. The purpose of this study was to assess MHM practices among adolescents, determine the prevalence of MP according to socioeconomic status and examine its association with depressive symptoms (DS). METHODS: We conducted a survey on a nationally drawn sample (N = 1241) of adolescents aged 10-19 years. Data were collected from 12 provinces, which were classified into three (Tiers 5-6 having the lowest ranking) based on socioeconomic development rankings. Information regarding demographics, use and knowledge of menstrual products, menstrual hygiene, and MP was collected. The PHQ-9 scale was used to assess DS. RESULTS: Overall, 15% of the cohort encountered challenges in obtaining MH products due to financial constraints, with a higher proportion in Tiers 5-6 (25%). Overall percentages of using improvised menstrual products (toilet paper, diapers, handmade pads, cloth etc.), MP-related school absenteeism, longer use due to an unsuitable school environment, and feeling ashamed to purchase menstrual products were 17.4%, 8.9%, 52% and 10.7%, respectively, with significantly higher proportions in Tiers 5-6. Individuals with MP were three times more likely to experience moderate-to-severe DS. CONCLUSIONS: The study indicates the significance of MP in relation to MHM across all socioeconomic levels, especially lower tiers, and its link with DS. It is imperative to establish cost-effective and sustainable health policies to improve the accessibility of MHM for menstruating individuals, starting with adolescents in poor socioeconomic conditions.