Menstruation in a Global Context: Addressing Policy and Practice

Explore menstrual health and hygiene comprehensively: Understand importance, key components, program design, and evidence-based approaches. Address gaps in practice, research, and policy.



Weekly Effort

4–6 hours





Course Description

Over the last decade, menstruation has attracted increased attention as an important public health issue. This has resulted in the proliferation of new research, programs, and policies aimed at tackling the menstrual health and hygiene (MHH) challenges faced by girls, women and others who menstruate. Global advocates are directly combating ongoing menstrual stigma and calling for an end to period poverty around the world.

The objective of this course is to provide learners with a foundation on the global menstruation movement that aims to ensure that the menstrual needs of everyone, everywhere are met. We will review cutting edge menstrual health and hygiene research, programming, and policies being implemented around the world. Through a series of lectures and examples from global experts, participants will gain knowledge and skills on approaches for MHH program design and implementation, research, monitoring and advocacy, with an emphasis on the needs of low-income and vulnerable populations around the world.

The course will seek to answer critical questions such as, why is menstrual health and hygiene important; what are the key components of menstrual health and hygiene (MHH); what are the best practices for designing and delivering MHH programs; what is the existing evidence base for addressing menstruation as a public health issue; what gaps remain in MHH practice, research, and policy. The course will equip students with knowledge on the various research methods being utilized to better understand the experiences of those who menstruate, and on the ways in which advocacy and evidence has served to shift attention to this fundamental issue. Students will also build practical skills related to the design and implementation of MHH programming across the three pillars: materials and supplies; sanitation facilities; and information. This includes exploring the gaps in current MHH research and practice.

What You Will Learn

By the end of this course, learners will be able to:

  • Understand key concepts and definitions related to menstruation and menstrual health and hygiene (MHH).
  • Describe why MHH is an important public health issue.
  • Explain how challenges like stigma and social norms shape the menstrual experiences of girls, women and people with periods.
  • Learn about the design and implementation of MHH programming across the three pillars: materials and supplies; sanitation facilities; and information.
  • Review research and monitoring practices in the field of MHH, including indicators, methods and measurement challenges.
  • Articulate why menstruation is a human rights and gender equality issue, its connections to other social movements, and new advocacy frontiers.
  • Analyze trends and progress in the global menstrual equity movement, including new legislation and policies.


Module Overview

Module 1: Menstruation as a Public Health and Human Rights Issue

Module 1 will provide an overview on the basics of menstruation, including examining its importance as both a public health and human rights issue. Additionally, this section will review the biological and physiological significance of menstruation. It will also discuss key concepts related to the menstrual cycle and menstrual disorders.

Module 2: Review of Menstrual Health and Hygiene (MHH) Evidence and Gaps

Module 2 will provide an overview of current evidence and existing research gaps in Menstrual Health and Hygiene (MHH)  across high-income countries (HIC) and middle-and-low-income countries (LMIC).  This section will also review a range of methods used for research, monitoring and evaluation of MHH programs in addition to the importance of monitoring at local, national, and global levels.  

Module 3: MHH Programming for Adolescent Girls

Module 3 will provide an overview of Menstrual Health and Hygiene (MHH) programming in schools, looking at the most common trends across the three pillars of programming response: 1) menstrual materials and supplies; 2) MHH supportive facilities; and 3) MHH education and information. 

Module 4: The MHH Experiences of Women in Low-Resource Settings

Module 4 will explore how menstrual health and hygiene issues impact women in low-resource settings, with a specific emphasis on workplace contexts. Additionally, it will explore key topics related to addressing menstrual disposal and waste management across cultures and contexts. 

Module 5: MHH Policy and Advocacy

Module 5 will explore key efforts to advocate for the topic of menstruation across and within countries. This includes highlighting different   types of advocacy  strategies being used to amplify policy making and awareness efforts.  In addition, it will examine current  menstrual health and hygiene policies being created across varying contexts, especially as they relate to the removal of taxes on period products. 

Module 6: MHH Response in Humanitarian Emergencies

Module 6 will provide an overview of guidance for responding to menstrual health and hygiene issues in emergency contexts, along with the state of evidence and gaps in what is known about best practices. In addition, it will review key programmatic areas related to designing menstrual hygiene kits, coordination across sectors, and integrating menstrual disposal in facility design. 

Module 7: Inclusive MHH Programming and Policies

Session 7 will examine a range of issues related to inclusive menstrual health and hygiene programming, with a specific focus on girls and women experiencing physical and mental disabilities and their caregivers. In addition, the second part of the module will focus on the importance of integrating boys and men into menstrual programming, advocacy, and design. 




Marni Sommer
Marni Sommer
Professor, Mailman School of Public Health and Executive Director of the GATE Program

Dr. Marni Sommer is a globally recognized expert on menstruation, gender and sexual and reproductive health, and adolescent health research and practice. Dr. Sommer directs the Gender, Adolescent Transitions and Environment (GATE) Program at Columbia University, which explores the intersections of gender, health, education and the environment for girls and boys transitioning into adulthood in low-income countries and in the United States (USA). GATE also generates research and practical resources focused on improving the integration of menstrual hygiene management (MHM) and gender supportive sanitation solutions into global humanitarian response. Her work includes leading the development of the MHM in Emergencies Toolkit and Menstrual Disposal, Waste Management and Laundering: A Compendium, in partnership with the International Rescue Committee and the humanitarian response community, as well as collaborating with UNICEF and global partners to establish a 10-year agenda, MHM in Ten, focused on establishing priorities for menstrual equity in schools.

Dr. Sommer is an Associate Professor at Columbia University’s Mailman School of Public Health where she teaches menstruation and global health topics, and is a Senior Editor of the journal Global Public Health. Currently, her research focuses on a broad range of menstruation issues, including the experiences of those who are homeless, young people transitioning through puberty in the USA, displaced girls and women in humanitarian emergencies, and girls and their families growing up in low- and middle-income countries. Dr. Sommer is also the founder of Grow and Know, a small non-profit focused on developing puberty books with content on menstruation, with over two million copies of books published in nine countries worldwide.

Maggie L. Schmitt
Maggie L. Schmitt
Former Associate Director, GATE Program

Maggie Schmitt was the Associate Director for the GATE Program. Ms. Schmitt was at Columbia University from 2009 to 2012, working on a range of menstrual health and hygiene (MHH), Water, Sanitation and Hygiene (WASH), adolescent health and health systems strengthening research programs in low-income and humanitarian settings. Since 2015, she’s worked on menstruation issues in humanitarian emergencies, including on a range of research and capacity development initiatives, in collaboration with the International Rescue Committee. This includes publishing two practitioner-focused resources for integrating menstruation into humanitarian programming: The MHM in Emergencies Toolkit and The Compendium on Menstrual Disposal, Waste Management and Laundering in Emergencies.

Ms. Schmitt supported a series of USA-based research projects, including on the puberty and menstruation experiences of low-income American adolescent girls, the emergence of menstrual equity policies, and the impact of COVID-19 on menstrual product insecurity. In addition, research conducted with American adolescent girls was utilized to support the creation of a new puberty education book, entitled A Girls’ Guide to Puberty and Periods. Ms. Schmitt received her MPH from Columbia University Mailman School of Public Health, Department of Population and Family Health, with a concentration in Forced Migration and Health.

Caitlin L. Gruer
Caitlin L. Gruer
Former Program Manager, GATE Program

Caitlin Gruer was a Program Manager for the GATE Program at Columbia University’s Mailman School of Public Health. Her work focused on the use of participatory research methods to understand the lived experiences of women and girls related to menstruation, puberty, and sanitation. This included translating research into practical resources for girls and women, implementing organizations, and policy makers, including publishing the Guidance Note on Integrating MHM into Ebola Response. Previously, she worked at Plan International USA and Helen Keller International Cambodia leading initiatives related to menstrual health and hygiene (MHH), and water, sanitation and hygiene (WASH).

Ms. Gruer supported a portfolio of global and USA-based research projects exploring a range of menstruation issues, including the experiences of those who are homeless, menstrual considerations during an Ebola epidemic, and innovative methodologies for disseminating puberty content to adolescent girls. In addition, she coordinated the Period Posse Presents webinar series which brings together experts in menstrual health and hygiene from across research, policy and practice to discuss key emerging issues. Ms. Gruer received her MPH from Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, with a concentration in Global Health.

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