Perspectives on prior preparation for menstrual experience from women and female health workers in Malawi

Abstract

Background:

While studies have explored various aspects of menstruation, an evident gap remains in the literature concerning the perspectives of young women and female health workers. By shedding light on this unexplored terrain, the study provides novel insights that can inform targeted interventions and foster a more inclusive understanding of menstrual health. As such, this investigation stands at the forefront of academic endeavour in menstrual health research, making an original and valuable impact in the field.

Objectives:

The objective of this study was to explore the experiences of reproductive-aged women during menstruation in Malawi. The specific objectives were to examine the experiences of reproductive-age women related to menstrual preparation, identify factors influencing the choice of menstrual products for women in Malawi, and identify the public health implications of menstrual products.

Design:

This cross-sectional study employed qualitative research methods to explore the acceptance and implementation of menstrual cups as a feminine hygienic product for women in Malawi.

Methods:

The study involved focus group discussions and interviews with reproductive-age women aged 18–54 years and health providers at Bwaila and Mitundu family clinics and Lighthouse HIV management centres. Thematic content analysis was performed using NVivo 12. Ethical approval was obtained from the College of Medicine Research and Ethics Committee (P.08/21/3379).

Results:

Education on menstruation is provided as early as 10 years before menarche by sisters, friends, mothers, aunties and grandmothers. Parents remain silent on menstrual issues. Commonly used menstrual products include disposable pads, cloths, reusable pads and cotton wool. While a few mentioned using tampons, pieces of blankets and flex foam, the majority demonstrated widespread ignorance about menstrual cups. Mentors or counsellors, affordability, accessibility, comfort and disposal issues influence women’s choice of products being used.

Conclusion:

Parents need to break the silence on menstrual issues. Messages on menstruation and menstrual products are explicit in forming female adolescents what to expect with menarche, how to manage menses including health-related impacts, and ways of mitigating menses-related misconceptions, discrimination and stigma, and could be incorporated into the primary school curriculum. Safe menstrual products are accessible free of charge or at a subsidised cost.

Keywords

menstruation menarche education menstrual products health workers women

Introduction

The well-being and empowerment of women and teenage girls depends on menstrual health and hygiene. Globally, one-quarter of the population is menstruating; however, menstruation is not widely spoken in most societies because it is culturally and socially sensitive.^1,2 Globally, over 300 million women undergo menstruation on any given day. An estimated 500 million people worldwide lack access to menstruation products and sufficient facilities for managing period hygiene.³

Menstruation is a sensitive and sometimes frightening communication topic for young women as they lack prior education.^4,5 A cross-sectional study of 387 school-going girls in India reported that only 18.67% were informed of menstruation before menarche.⁶ Among the girls, 23.33% were scared, as they believed that menstrual blood was from the same pathway as urine. As many prepubescent girls were not exposed to menstruation information and training because of cultural silence, their first menstrual period was a terrifying experience.^7,8 A large body of recent research worldwide reveals the inadequate practical knowledge and needs of girls who menstruate sought access in preparation for menarche.^5,9,10

In Malawi, there remains limited evidence regarding the preparation of adolescent girls for menstruation before menarche for much attention is given to menstruating girls and menstrual hygiene management.¹¹ Much of the existing information on prior education in Malawi regarding girls’ menstrual experiences is derived from anecdotal evidence and grey literature, which primarily focuses on the challenges experienced by menstruating women and girls. There remains a need for research to focus on how young and adult women are prepared for menstruation before menarche from the perspective of women and health workers, both in the urban and rural settings of Malawi.

This study explored the experiences of reproductive-aged women in Malawi during menstruation. The specific objectives were to:

Examine the experiences of reproductive-age women related to menstrual preparation

Identify factors influencing the choice of menstrual products for women in Malawi

Identify the public health implications of menstrual products.

Methodology

Design

This study adopted a descriptive cross-sectional design employing qualitative research methods to explore the acceptance of menstrual cups as feminine hygiene products for reproductive-aged women in Malawi. The Consolidated Criteria for Reporting Qualitative Research guidelines were used to ensure comprehensive and transparent reporting in qualitative research.¹²

Study population

Reproductive-age girls and women aged 18–54 were recruited through posted messages in Lighthouse HIV management centres in Blantyre, Zomba and Lilongwe and family planning clinics of Bwaila District Hospital and Mitundu Rural Hospital in Lilongwe. The inclusion criteria were reproductive-age women aged 18–54, with regular ongoing menstrual cycles, willingness to participate in the study, residing in Blantyre, Zomba and Lilongwe, and those who had been visiting the clinics for more than 3 months. Participants who were unwilling to participate in intermittent monthly periods of less than 18 years were excluded from this study.

Sampling strategy

Participants were recruited using a convenience sampling approach through open invitations by service providers, after explaining the purpose of the study. Those who were interested in participating in the study were asked to meet the researcher for detailed information and to obtain consent. The expected number of participants was 10 health workers (2 nurses per site, State Registered Nurse (SRN) or Nurse Midwife Technician [NMT]), 50 girls and women (10 per site) for interviews and 5 focus group discussions (6–8 people per group). However, the actual number of participants was determined based on data saturation, during which no new information was generated.

Data collection methods

Data were collected through focus group discussions and semi-structured interviews (Supplemental Appendix 1 Interview Guide) with reproductive-aged women (aged 18–54 years) and local healthcare providers in Malawi. A basic demographic questionnaire was administered to participants. A semi-structured interview guide was used to collect data on the feelings, thoughts, experiences and attitudes of participants regarding their menstruation from March to May 2022. Interviews facilitated in-depth exploration of knowledge, attitudes and experiences. Each interview took approximately 20–30 min. The tool was piloted at the Kamuzu University of Health Sciences with 10–15 participants. After about 30 interviews with girls and women, no new themes or insights emerged from additional data collection or analysis. Thematic saturation was reached through the interviews and focus group discussion. Analysed data indicated repetitions in the themes, and no new information emerged.

Data management

Interviews were conducted in either Chichewa or English depending on the participant’s preference. The interviews were recorded with the consent of the participants. Audio recordings were used to facilitate transcription and to ensure that the content was not missed. Interviews conducted in Chichewa were transcribed verbatim by language experts in order to mitigate bias and accuracy. To ensure data trustworthiness, the researcher read and re-read the transcripts to understand the experiences of adolescents and women using menstrual cups. Participant validation exercises were conducted through meetings with adolescents and nurses (separately for each participant category) after data collection. This enabled them to comment on whether the researcher’s interpretations were related to their personal experiences and facilitated discussions about emerging issues and themes.

Data analysis

Qualitative data were analysed using NVivo 12, Clarivate and content analysis was performed. Content analysis methods helped to complement, understand and triangulate the information collected from the interviews and focus group discussions. This was of critical importance to ensure that all the areas of interest were covered.

Consent

Permission for site access was obtained from the local health authorities prior to any research activities at the selected sites. Both verbal and written consent to participate in the study were obtained from all participants aged 18–54 years after providing them with detailed information about the study. Illiterate participants marked the consent form with a right thumbprint (see Supplemental Appendices 2A – Interview Guide for IDIs and 2B – Information Sheet and Informed Consent). Participants were assigned ID numbers. To maintain anonymity, all references to individual quotes during the analysis were linked to the participant’s ID. The participant ID list was stored in a secure password-protected electronic file. All study data were stored in a locked cabinet (printed materials) or secure password-protected electronic folder to maintain confidentiality. To maintain privacy, only the principal investigator and research assistants had access to the documents.

Results

Distribution of study participants by the institution

The study was conducted in three Lighthouse HIV management centres in Lilongwe: Blantyre (Umodzi Family Clinic), Zomba (Tisungane Clinic) and family planning clinics of Bwaila District Hospital and Mitundu Rural Hospital in Lilongwe (see Table 1).

Table 1.

Study participants.

Site	In-depth interviews		Focus group discussions
Site	Women	Health workers	Young women (18–24 years)
Phase I
Tisungane Clinic – Zomba	10	2	1 (12 girls)
Umodzi Family – Blantyre	10	2	1 (9 girls)
Phase II
Lighthouse Clinic – LL	10	2	1 (12 girls)
Bwaila FP Clinic	10	2
Mitundu FP Clinic	10	2	2 (11 girls)

Women’s preparation for menstrual experiences

Regarding women’s preparation for their menstrual experience, two themes emerged from five sub-themes elaborating on diverse experiences regarding the preparation that women of reproductive age between 18 and 54 obtained and the commonly used menstrual hygiene products in Malawi (see Table 2). The themes included (1) preparation for menstruation and (2) factors influencing the choice of current menstrual products.

Table 2.

List of sub-themes and themes.

Experiences of young and adult women regarding their menstrual preparation
Sub-themes	Themes
Prior counselling on menstruation and menstrual products	Being prepared for menstruation
Timing of the menstrual education
Commonly used menstrual hygienic products in Malawi
Issues influencing the choice of the current menstrual products	Factors influencing the choice of the current menstrual hygienic products
Exposure influencing change in preference to alternate menstrual products

Being prepared for menstruation

Regarding preparation for menstruation, the participants reported being prepared differently through different modes of information. Although the timing of menstruation counselling sounded within similar ages, participants reported a diverse variety of feminine hygiene products being used depending on who counselled them at the time of menarche. This theme emerged from three sub-themes: (1) prior counselling on menstruation and menstrual products, (2) the timing of menstrual education and (3) commonly used menstrual hygiene products.

Prior counselling on menstruation and menstrual products

The majority of participants indicated being counselled for menstruation by sisters, friends, mothers, mothers’ friends, aunties, grandmothers and mother group members. They reported being informed of how their bodies function, manage menses and use them.

‘I acquired information about menstruation from my sister, my aunt, and mum’s friend before my first period, they counselled me about periods and how they manage the flow and what to use. At that time, I was around 12 years old’. 25-year participant, Tisungane Clinic

Few participants reported being informed by their friends who were experienced in menstruation, primary school teachers and officials from the Campaign for Female Education (CAMFED) in Malawi, as exemplified by the following statements.

‘. . . . My primary school teacher and friends, who were a bit older than me already menstruating, told me everything about periods. When I was in primary school, CAMFED officials came to our school to distribute the reusable pads. They separated us into two groups: those that had already started periods, and the pre-puberty group. So, in our pre-puberty group, they instructed us on how our bodies were developing and how we’ll notice our breasts getting bigger and starting to bleed from the vagina. They also demonstrated how to use menstrual hygiene products’. 21-year participant, Mitundu Rural Hospital

Three of the four health workers reported providing education during regular monthly meetings to adolescent girls on life skills and reproductive health, which included puberty and menstruation. They indicated that the training curriculum currently in use at the two Lighthouse sites provided sufficient information to educate girls on menstruation and proper menstrual hygiene practices. However, they stated that they had never heard of menstrual cups, and that their use was not incorporated into the training curriculum.

‘At Lighthouse HIV Centre working as a Youth Friendly Coordinator, one of the services is to educate young girls from ages to 10–12 on how they can manage the period in terms of what to use and also inform them that with the onset of the period, they can get pregnant if they engage in unprotected sex. . . . But I have never heard about menstrual cups and I do not teach them about the cups’. 29-year Health Worker, Lighthouse HIV Centre.

The study revealed that in some quarters of society, systems are in place to educate young girls before they begin menstruation. These structures are the initiation centres, schools, youth groups, churches, Civil Society Organisations and other networks focusing on girls’ and women’s empowerment/gender-based violence, such as the Malawi Girl Guide Association, CAMFED and Mother groups. Reported systems vary depending on the geographical setting (urban or rural).

‘I got educated on menstruation at church when I joined a youth group in town. There was a certain woman, who normally counsel young girls around menstruation’. 24-year participant, Lighthouse Clinic

‘My grandmother took me to an initiation ceremony (known as Chiputu) where we were told about vaginal bleeding as we grow. . . . . .and what to use and how to use it. . .’ FGD participant Mitundu Rural Hospital

The absence of formal training in menstrual management for young women coupled with parents who were not ready to discuss menstrual issues was highlighted. Most participants acknowledged that they had never had a personal conversation with their mother about menstruation but rather were referred to their aunt, grandmother or mother’s friend.

‘Since I started menstruating, mum has never spared time to discuss with me issues surrounding menstruation, so am not sure whether she gets embarrassed or she is just not interested to do it or it is culturally sensitive so she referred me to her friend, or grandma or aunt’. 24-year participant, Umodzi Family clinic

As the participants accounted for exemplify, feelings of shame and embarrassment might sometimes manifest as self-silencing, resulting from a lack of supportive counselling around menstruation.

Messages about self- or other-silencing were also part of the early menstrual communication that the women recalled. Participants expressed feeling as though they had to either mute or quiet themselves (self-silencing) or that someone else explicitly told them to keep their period quiet or hidden, creating fear of any visible marker of menstruation. For example, one participant indicated that:

‘I had to make sure that there was no stain on my dress, you know the counselling from all corners was kind like, I should make sure that males should not know that am menstruating, need to keep it to myself till I finish’. FDG participant Tisungane Clinic

Timing of education on menstruation

Most participants mentioned being prepared for menstruation for approximately 10–12 years. By this time, the majority had not reached menarche. This timing has been reported across all study settings.

‘When I developed breasts at the age of 10, My mother started briefly counselling me by telling me signs of menstruation and how to take care of myself during the period before I started at about 11 years old’. 19-year participant, Mitundu Rural Hospital

‘When I was in Primary school, Mother group members held counselling sessions with girls aged 10–12 years around menstruation and how we were to take care of ourselves if we noticed blood coming out of our private parts’. FGD participant, Umodzi Family Centre

The commonly used menstrual products

The majority of the participants mentioned the following menstrual products as currently being used in order of popularity: disposable pads, cloth, reusable pads, cotton wool (particularly health workers who take advantage of the availability of cotton wool in health facilities) and menstrual cups (particularly Lighthouse participants). The least mentioned products for managing menstruation were tampons, a blanket or a flexafoam.

‘With lack of money I mostly use cloth, for I simply tear old pieces of wrappers (zitenje) I was introduced to it when I first started menstruation, so I have gotten used to it and is economical because it is reusable, I do not dispose it after a single use and rarely I use flexafoam, . . . . . . .’ 22-year participant, Tisungane Clinic

‘Most of us young women use disposable or reusable pads because it is what most of us were first introduced to. Reusable pads are easily accessible to young women in schools or communities. For the tampons it depends on the type of clothing I am about to wear; for instance, when I want to put on a G-string type of underwear and a pair of trousers, I prefer using tampons because they are not visible’ 27-year Health Worker, at Light House Clinic

Participants mentioned several factors that influenced their choice of current menstrual hygiene products and cited reasons for the change in their preference for menstrual products.

Factors influencing choice of the current menstrual products

The participants reported seven main factors that influenced their choice of current menstrual hygiene products. The majority of the participants were influenced by their mentors (women who counselled them at their first menses).

‘My mum first introduced me to disposable pads and that has influenced my choice mostly’. 34-year participant, Bwaila FP Clinic.

‘My sister and aunt introduced me to the use of cloth and thus what I use up to now’. FGD participant, Zomba.

Others indicated that they were influenced by friends, accessibility, efficiency, affordability, comfort and disposal.

‘I use what is available like cloth, or a piece of blanket, I cannot afford to access the other modern products like disposable pads. I have never seen one, I only heard about them’. 29-year participant, Mitundu Rural Hospital.

‘The cloth and cotton wool are easy to resource as they do not require money. I get the cotton wool from the hospital’. 28-year Health Worker, Zomba

Hygienic issues, freedom from the embarrassment of a bad smell, stress of leakage/staining clothes, disposal facilities and side effects were also found to influence the choice of products.

‘I had a difficult time using the cloth because I thought it was not hygienic causes rash in the groins (ukweche), fills up quickly when washed not dry up well and produces a bad odour, as culturally it is not proper to be drying outside on the clothesline. I switched to pads and cotton wool because when changed at frequent times, there was no stress of leakage or staining of your skirt or dress. Pads are more comfortable and easier to dispose of than menstrual cups which require that you change in a toilet where water is available all the time’. 28-year participant, Umodzi Family Centre.

A minority of the participants reported changing preferences later in life and were exposed to more hygienic and comfortable menstrual products. For instance, some of those who were initially exposed to the use of clothes, blankets or flexafoams reported switching to disposable sanitary pads after learning from friends. Others who used menstrual cups also switched to disposable pads because of inaccessibility and comfort issues, as exemplified in the following statements.

‘When I went to secondary school, I saw my friends using disposable pads; that’s how I got influenced to be using the pads rather than cloth or cotton wool which was feeling very uncomfortable when soaked with blood’. 38-year Health Worker, Zomba

The majority of participants tried alternative methods after being dissatisfied with the current method or after being referred by friends or parents to try new/better methods. A pattern of fulfilment with the current method was observed in patients using disposable pads. Participants who tried other menstrual products cited the following reasons.

‘I choose to use disposable pads because they are readily available and also affordable unlike the menstrual cup which I once used, we were given at Lighthouse to try out how they work, but I no longer have access to the menstrual cup – don’t know where they are sold’. 25-year participant, Lighthouse Clinic

‘I have tried the cloth for menstrual care – use of a piece of cloth or blanket, fastened with a string around the waist but I felt it was not hygienic. I also tried using the menstrual cup, but I stopped because it is not easily accessible and is also expensive; the one I was using was a donation from the Lighthouse Clinic. Now I have switched to disposable pads which am comfortable though I wished I had the cups’. 24-year participant, Lighthouse Clinic

‘I have tried reusable pads before. We were taught by Girl Guides Association to make reusable pads but I stopped because I needed to wash them after every use which was becoming a challenge when I wanted to dry them so I switched to disposable pads’. 24-year participant, Tisungane Clinic

The findings of this study highlight the current experiences of menstruation and menstrual products among women of reproductive age (18–54 years) in Malawi. The prior education they receive, the factors influencing their choices of menstrual products and the challenges they encounter with current menstrual hygiene products have been highlighted.

Discussion

The discussion on perspectives on prior preparation for menstrual experiences, as perceived by women and female health workers on a global scale, illuminates the complex interplay of cultural, social and health-related factors that shape the experiences of menstruating individuals.^8,13
–15 By examining the viewpoints of both women and female health workers, a comprehensive understanding emerges, shedding light on the nuances that influence menstrual preparation practices and their global implications for menstrual health.

From the perspective of women, it is evident that the approach to menstrual preparation is deeply rooted in cultural and societal norms.¹³ The diversity of these perspectives across different regions highlights the importance of acknowledging and respecting cultural variations when addressing menstrual health. Some women may view menstruation as a natural and manageable aspect of their reproductive health, while others may face challenges and stigmas associated with cultural taboos.¹⁶ Understanding these perspectives is crucial for tailoring effective educational programmes and interventions that align with the cultural contexts of specific communities.

The results of the current study revealed that informal education on menstruation was provided as early as 10 years before menarche by sisters, friends, mothers, mothers’ friends, aunties, grandmothers and mother group members.^17
–19 Several studies have indicated that not many people talk about menstruation.^1,14,20 Although not explicit on timing, women learn about menstruation through communication, which also helps them make sense of it for themselves and for other individuals who menstruate, as well as develop attitudes towards it.^21,22 However, the current study highlights the absence of formal communication on menstrual management for women and female adolescents, coupled with parents not being ready to discuss menstrual issues.

Instead, female health workers, serving as key stakeholders in promoting menstrual health, bring a unique perspective grounded in professional experiences. Their insights provide valuable information on the challenges women face in accessing adequate information, resources and healthcare services related to menstruation. Moreover, the experiences and observations of female health workers underscore the need for comprehensive and culturally sensitive training programmes that equip them with skills to address the diverse needs of menstruating individuals.

In contrast, prior findings on menstruation indicate that provision and receipt of information-supportive communication can assist young women in navigating menarche and early menstruation.^23
–25 Earlier study findings concur with the current study that even as some menstrual taboos get reduced, menstruation continues to be a stigmatised, embarrassing and generally taboo communication topic for many.^26
–35 Because of their taboo status, young women who menstruate may be taught to hide their menstruation and engage in self-silencing behaviours.^22,36,37

On a global scale, disparities in access to menstrual products and hygiene facilities have emerged as significant considerations.^38
–41 Women in resource-poor settings face greater challenges in obtaining quality menstrual products, contributing to health risks and social inequalities.⁴² Female health workers operating in these contexts often find themselves at the forefront of initiatives to improve access to menstrual hygiene resources and education, emphasising the importance of global commitment to menstrual equity.

A critical observation was that culturally, parents remain silent on menstrual issues.^1,13 The silence surrounding menstrual hygiene requirements in this study was demonstrated by the limited number of parents who discussed menstrual problems with their children. Instead, the majority of young women were counselled by significant others including aunts, sisters and friends.¹⁷ However, previous studies have shown that girls whose mothers prepared them for menstruation before menarche had more positive attitudes towards this period.^5,10 This signifies that communication between the mother and daughter before and during menarche develops familial discourse patterns that affect how menstruation and other elements of reproductive health are discussed in cultural and gendered contexts.^43
–45 Mother-daughter communication before, during and after menarche is crucial to a girl’s positive attitude towards reproductive health milestones, since the majority of girls believe they could discuss menstruation with their mothers.^5,46
–48 From this perspective, mothers continue to be the most influential source from which young women seek assistance when making significant health choices.

The current study revealed that commonly used menstrual products include disposable pads, cloth, reusable pads and cotton wool. A few mentioned using tampons, pieces of blankets or flexafoams. Mentors or counsellors, affordability, accessibility, comfort and disposal issues influence women’s choice of products. While the current study revealed a high level of satisfaction with the use of disposable sanitary pads, prior studies that investigated people with disabilities’ preferences for menstrual products reported low levels of satisfaction with the use of the same, stating that they found the products uncomfortable and difficult to use.^20,49

In summary, perspectives on prior preparation for menstrual experiences from both women and female health workers underscore the need for a holistic and culturally sensitive approach to menstrual health on a global scale. Tailoring interventions to respect and incorporate diverse cultural norms and collaborating with female health workers to bridge gaps in information and resources are essential steps towards achieving menstrual equity worldwide. By fostering a deeper understanding of these perspectives, stakeholders can contribute to the development of inclusive policies and programmes that prioritise the well-being and dignity of menstruating individuals across different sociocultural contexts.

Recommendations

The findings of this study provide practical recommendations for health professionals to develop effective and timely messages related to menarche and menstruation across their lifespans. Messaging should inform women about what they expect from menarche, menstruation management and health-related impacts. Therefore, this study makes a threefold recommendation. Therefore, the current study makes a threefold recommendation:

Parents need to break their silence on menstrual issues.

Messages on menstruation and menstrual products are explicit in forming female adolescents what to expect from menarche, how to manage the menses including health-related impacts, and could be incorporated in the primary school curriculum; and

Safe menstrual products are accessible free of charge or at a subsidised cost.

The authors contend that if recurrent, approachable menstrual education and training are consistently provided to young women before menarche, they may gain a deeper comprehension of social and cultural norms and be better equipped to manage their menstruation on their own by using products of their own choice.

Study limitations

While the current study makes a significant contribution to the growing body of knowledge on prior preparation for menstrual experiences in Malawi, there is a limitation that needs to be mentioned. The participants’ ages ranged from 18 to 54 years old. There could be certain differences between the categories of participants who had already menstruated and those who had not yet experienced menarche. Although the perspectives of those already menstruating are worth considering, future research should assess the perspectives of those who have not yet reached menarche to understand how they feel about menstrual preparation as they approach menarche.

Conclusion

This study provides valuable insights into the multifaceted experiences of reproductive-aged women during menstruation in Malawi. Through a comprehensive exploration of specific objectives, this research sheds light on various dimensions of menstrual health, including preparation practices, factors influencing the choice of menstrual products, and broader public health implications associated with menstrual hygiene. The first objective, which focused on examining the experiences of reproductive-aged women related to menstrual preparation, revealed a nuanced understanding of the challenges and strategies employed by women to ensure a smooth and dignified menstruation experience. These findings underscore the importance of context-specific interventions to address the unique needs and circumstances faced by women in Malawi. The second objective included the factors influencing the choice of menstrual products for women in Malawi. By identifying and analysing these factors, this study contributes to the existing body of knowledge on menstrual health practices, highlighting the importance of accessibility, affordability and cultural considerations in shaping women’s preferences for specific products. This information is instrumental for policymakers and stakeholders seeking to implement targeted interventions that align with the preferences and needs of local populations. The third objective was to determine the public health implications of menstrual products. By elucidating the potential health consequences and societal impacts of menstrual hygiene practices, this study provides a foundation for evidence-based policy formulation and intervention strategies. Understanding these implications is crucial for developing sustainable and culturally sensitive public health initiatives aimed at promoting menstrual health and wellbeing. In summary, this research has not only deepened our understanding of the experiences of reproductive-aged women during menstruation in Malawi, but also highlights actionable insights for public health practitioners, policymakers and researchers. It is imperative to leverage these findings to develop targeted interventions that address the unique challenges faced by women in Malawi, ultimately contributing to the enhancement of menstrual health outcomes and overall well-being in the region.

Supplemental Material

sj-docx-1-whe-10.1177_17455057241286245 – Supplemental material for Perspectives on prior preparation for menstrual experience from women and female health workers in Malawi

Supplemental material, sj-docx-1-whe-10.1177_17455057241286245 for Perspectives on prior preparation for menstrual experience from women and female health workers in Malawi by Gertrude Mwalabu, Safari Mbewe, Annie Namathanga, Rodney Masese, Charity Kabondo, Leah Katuya, Pammla Petrucka and Patrick Mapulanga in Women’s Health

Supplemental Material

sj-docx-2-whe-10.1177_17455057241286245 – Supplemental material for Perspectives on prior preparation for menstrual experience from women and female health workers in Malawi

Supplemental material, sj-docx-2-whe-10.1177_17455057241286245 for Perspectives on prior preparation for menstrual experience from women and female health workers in Malawi by Gertrude Mwalabu, Safari Mbewe, Annie Namathanga, Rodney Masese, Charity Kabondo, Leah Katuya, Pammla Petrucka and Patrick Mapulanga in Women’s Health

Supplemental Material

sj-docx-3-whe-10.1177_17455057241286245 – Supplemental material for Perspectives on prior preparation for menstrual experience from women and female health workers in Malawi

Supplemental material, sj-docx-3-whe-10.1177_17455057241286245 for Perspectives on prior preparation for menstrual experience from women and female health workers in Malawi by Gertrude Mwalabu, Safari Mbewe, Annie Namathanga, Rodney Masese, Charity Kabondo, Leah Katuya, Pammla Petrucka and Patrick Mapulanga in Women’s Health

Footnotes

Acknowledgements

We would like to express our sincere gratitude to the Lighthouse Trust for their invaluable guidance and support throughout the course of this research. We also extend our appreciation to the participants, who generously dedicated their time and shared their insights. Their contributions are integral to this study’s success. The researcher wishes to express gratitude to the Kamuzu University of Health Sciences for funding the study.

Declarations

ORCID iD

Patrick Mapulanga

Supplemental material

Supplemental material for this article is available online.

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