Pilot Grants

Understanding the Barriers and Facilitators to Adolescent Menstrual Health Equity

Statement of Problem

Although there are cultures that celebrate menarche as an important event in a young women’s life, the actual act of menstruation is still perceived by many cultures as taboo, primary in low- and middle-income countries. However, the lived experiences around menstruation for those living in poverty in the U.S. are often similar to those communities within low- and middle-income countries, though few studies have explored the reality of these adolescents’ and young adults’ lives.


Using a qualitative, youth-centered approach, our team aimed to understand the experiences of adolescents and young adults who menstruate and live in poverty in the U.S., identify the barriers and facilitators to adequate menstrual health and hygiene, and recognize the impact of shame and stigma that exists within this community.

We recruited adolescents and young adults ages 13-21 from Children’s Hospital of Philadelphia’s Adolescent Specialty Clinic who have had at least one menstrual period and have screened positive on a menstrual access questionnaire, which was developed by our team and is used by adolescent medicine providers in our division to screen for unmet menstrual hygiene needs.

Our team then collected visual narratives, or video diaries, that illustrate their experiences with menstruation, including documentation of their daily lives and personal monologues regarding their observations.

We also conducted in-depth interviews using the video diaries as the basis for a visual elicitation exercise with the participants. We played the video diaries back during the first part of the interview as a prompt for further discussion. The remainder of the interview took a more traditional semi-structured format. We then coded the data we collected from the interviews and video narrative to validate our findings, and analyzed the evidence utilizing a grounded theory approach, which involves inductive reasoning and allows for ideas or concepts to emerge directly from the data.

Learn more about what youth shared during these interviews in this video.

As part of this study, we also recruited participants to take part in a youth advisory board, through which members assisted with interpretation of the study results and created and disseminated a short film that incorporates some of the video narrative footage. This film will hopefully be used to help inform policy and programs around menstrual equity.

Next Steps

Based on the findings from this study, our team hopes to generate ideas for future research and programmatic and policy change, such as the active proposal of sexual health education legislation and menstrual equity legislation in Pennsylvania and other states. To this end, the research team and youth advisory board will convene meetings with key stakeholders, including Philadelphia School District officials and state representatives involved in proposed legislation, to share our findings via the youth-produced video and an issue brief.

In addition to local and state policy impact, our findings also have important implications for clinical care and future research. The hypotheses generated here will help to inform future quantitative studies and quality improvement initiatives to develop and test appropriate screening tools in clinical and other settings that serve youth.

This pilot grant project was completed in June 2022.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Understanding the Barriers and Facilitators to Adolescent Menstrual Health Equity [Online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here]. 

Check out our Policy Tools View Policy Tools