On November 16, 2023 Knowledge SUCCESS, in collaboration with the Contraceptive-Induced Menstrual Changes Community of Practice, hosted a webinar that highlighted the linkages between the fields of family planning and menstrual health and took participants through recently published programmatic guidelines for family planning-menstrual health integration.
A recording of this event is available in both English and French, and the presentation slides are available for download here.
Family planning and menstrual health are closely related fields that are often not effectively integrated, which can result in missed opportunities to improve the health, well-being, and dignity of individuals. Integrating family planning and menstrual health could help address challenges of stigma, misinformation, and navigating complex social and gender norms and increase the reach and impact of both fields. Recent work has brought together experts from the two fields. In breaking down silos, a growing interest in this topic of integration has emerged and experts agree that greater efforts should be made to proactively link family planning and menstrual health policies and programs including through provider training and capacity strengthening, community and school-based education and outreach, service provision, and program evaluation.
This event aimed to highlight the linkages between these two fields and offer practical guidance for integration. The webinar was moderated by Irene Alenga of Knowledge SUCCESS. It began with a discussion between Tanya Mahajan, menstrual health expert and Director at the Pad Project, and Dr. Marsden Solomon, an independent consultant and family planning expert, which highlighted the connections between the fields of family planning and menstrual health. Emily Hoppes of FHI 360 then took participants through recently published programmatic guidelines for family planning-menstrual health integration. All three presenters participated in a question-and-answer session and the event concluded with a group brainstorming activity.
This conversation began with panelists, Tanya and Dr. Solomon, reflecting on the key tenants of their respective fields. Dr. Solomon emphasized family planning’s roots in voluntarism and human rights, explaining that clients must be provided with everything they need to make an informed choice about the method that best fits their lives and that individuals or couples should make decisions about the number of children and timing of pregnancies for themselves without coercion from providers or anyone else. He also mentioned the multisectoral nature of the field of family planning and its connections to education and environment, among others. Tanya explained that the field of menstrual health is similar in its basis in human rights and multisectoral nature. She also described how menstrual health has been shaped by feminist approaches and by the voices of menstruators themselves. Tanya also emphasized the importance of advocating for body literacy across all aspects of menstrual health. A final aspect mentioned by Tanya was the importance of engaging a wide range of stakeholders, a concept that is also important to family planning.
The panelists were then asked to reflect on how their respective fields could learn from one another and benefit from integration. Dr. Solomon mentioned two key areas where the fields overlap during family planning practice: 1) when couples are being counseled through the use of fertility-based awareness methods, like the Standard Days Method, they are provided with education about how the menstrual cycle works and is related to fertility, and 2) in discussing contraceptive side-effects, clients should be educated about contraceptive-induced menstrual changes with a job aid like the NORMAL tool, to address these common concerns. Tanya agreed with Dr. Solomon and mentioned that menstrual health education and an understanding of the biology of menstruation is a key step in supporting the connections he discussed. She also emphasized the role of menstrual health in engaging people in conversations about reproductive health early in their reproductive life cycle, as well as later, as their reproductive years are ending. 
Tanya then reflected on how the field of menstrual health can learn from the field of family planning when it comes to offering full, free, and informed choice.
The conversation concluded with both Tanya and Dr. Solomon expressing their excitement about the potential for family planning-menstrual health integration to improve the of health people across the life course and the opportunity it provides to increase program effectiveness and reach.
A summary of the key concepts discussed in this panel are provided in the Ven diagram shown above.
In the second part of the webinar Emily Hoppes of FHI 360 presented a summary of the programmatic guidelines for family planning-menstrual health integration that were published in Global Health Science and Practice in October. She began by explaining how the guidelines are informed by and organized according to the socio-ecological model and life course approach. Emily then took participants through five examples of suggested activities and methods for integration:
The presentation was concluded with a call for more research on this topic in order to better understand which models of family planning-menstrual health integration are most effective and have the largest impact.
Dr. Solomon: It is very common for DMPA (injectable contraceptives) to cause a pause in bleeding, which is referred to as amenorrhea, and this can cause a lot of anxiety in clients. This is because clients are used to having a monthly period and they wonder where the blood is going if it is not being released during menstruation. Providers need to be prepared to counsel and reassure clients that this is a completely normal effect of the method and that it is not harmful to their health.
Emily Hoppes: A lot of the work being done on this topic to-date has been focused on the issue of contraceptive-induced menstrual changes (CIMCs). The CIMC Research and Learning Agenda provides a list of research questions related to this topic specifically, as well as a few others related to family planning-menstrual health integration more broadly. There is also an opportunity to get involved in this work through the CIMC Community of Practice. Overall, there is a need for more research and funding.
Tanya Mahajan: There is a need to use (and gather more) data showing the unmet need for contraception amongst adolescents in Uganda and globally.
Emily Hoppes: Education and programs should be age-appropriate and tailored to the group that is being targeted.
Emily Hoppes: Family planning counseling should provide complete information about all methods available, including information about both the potential side effects and benefits of each of these methods and finding which product profile fits best within that person’s life. This includes providing information about side effects related to menstruation, for example an increase in bleeding or pain, as well as “side benefits” related to menstruation, for example reducing pain or helping to manage menstrual disorders like endometriosis.
Tanya Mahajan: There is a related situation that happens in the menstrual health world where providers often pushing products that are more readily available or emphasize the negatives of products that are unavailable due to supply chain issues. It is important that supply chains are developed so that providers area able to offer choice among a full range of products.
Tanya Mahajan: There have been some social marketing organizations and clinics stocking mostly disposable menstrual pads, usually at a subsidized price, but choice amongst a wide range of products is not usually made available.
Emily Hoppes: There are not a lot of great examples of this. Often this happens in humanitarian contexts where a packaged of SRH products are provided, which includes both family planning and menstrual health products. This is an area where we really need to implement and research programs to better understand how it might work.
Tanya Mahajan (in the chat): Here is another resource for integrating a basket of menstrual products in humanitarian settings.
Emily Hoppes: Funding sources are currently very siloed – some provide funding for family planning work while others provide funding for menstrual health, but they are rarely funded together. USAID funded the development of the FP-MH integration guidelines and currently funds the work of the CIMC Community of Practice. The Bill & Melinda Gates Foundation is also funding research related to CIMCs. We need to continue to talk about this topic and draw attention to it in order to attract more funders.
Dr. Solomon: Irregular periods are a common characteristic of the perimenopausal period (the stage at which one is approaching menopause). This stage is also associated with chances of conceiving (though the percentages can be as low as 2 %). If a client does not wish to conceive, they should be advised to use a family planning method. Perimenopausal women can use any method, subject to Medical Eligibility Criteria.
Dr. Solomon: Irregular periods are a common characteristic of the perimenopausal period (the stage at which one is approaching menopause). This stage is also associated with chances of conceiving (though the percentages can be as low as 2 %). If a client does not wish to conceive, they should be advised to use a family planning method. Perimenopausal women can use any method, subject to Medical Eligibility Criteria.
Emily Hoppes: In-line with the programmatic guidance, providers should also ensure that perimenopausal people have access to low-dose contraceptives as an option to relieve menopause symptoms.
In order to gather feedback and ideas for developing a more user-friendly version of the programmatic guidelines for family planning-menstrual health integration, webinar participants were encouraged to share their thoughts around a few key questions.
This question generated a number of interesting and exciting ideas, with examples across many countries, including Ethiopia, Ghana, Madagascar, Malawi, Nigeria, The Netherlands, and Uganda, including the following:
Participants shared a number of useful ideas for improving this resource, including:
This webinar and the publication of the programmatic guidance for family planning- menstrual health integration is an incredible start to what will hopefully be a growing area of work globally. The integration of family planning and menstrual health has the potential to address stigma and misinformation, while improving the health, well-being, and dignity of individuals, and optimizing the impact of both fields. If you are interested in using these guidelines to inform future work, please reach out to Emily Hoppes (ehoppes@fhi360.org).
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