Table 1 Progress and gaps identified related to priority 1

1. New indicators and tools in use and under development for intervention research and monitoring in relation to MHM and WASH in schools

New indicators and tools

a. Indicators and data collection efforts for monitoring at global levels:

 Joint Monitoring Programme (JMP) to track progress related to SDG targets 6.1, 6.2 and 4a

 UNICEF’s Multiple Cluster Indictor Survey (MICS) added questions on menstruation

 Inclusion of MHM (WASH and menarche) questions in the Demographic and Health Survey

b. Indicators and data collection efforts for research and monitoring at regional and national levels:

 Bangladesh National Hygiene Baseline Survey

 WaterAid and UNICEF’s analysis of MHM in schools in South Asia

 Grand Challenges Canada’s comparative analysis of MHM innovative enterprises

Performance Monitoring and Accountability (PMA) 2020 (Johns Hopkins) produced MHM country-specific reports of household level data on women over age 15 in select countries

2. New tools being developed and tested (reaching beyond school-based activities)

 Menstrual self-efficacy (Johns Hopkins Bloomberg School of Public Health and International Center Diarrheal Disease Bangladesh (ICDDRB)); Menstruation ENgagement, Self-efficacy, and Stress (MENSES) (Save the Children)

 Global monitoring experts in health (sexual and reproductive / psychosocial), gender, education, and WASH identified outcome/impact measures for addressing menstrual health and hygiene among girls globally (Columbia University; WSSCC)

Expansion of evidence

More expansive inquiries and collaborative efforts between academic institutions, intergovernmental organizations, global and local nonprofit organizations, and the private sector

 Research in Kenya, Uganda, Zambia, Gambia, Bangladesh, Bolivia, Bhutan, Fiji, Mongolia, and Pakistan among others (Muthengi, Farris, and Austrian 2017; Hennegan et al. n.d.; Department of School Education of Bhutan and United Nations Children Fund 2018; Johnson et al. 2016; Miiro et al. 2018; Chinyama et al. 2019; Alam et al. 2017; WaterAid Australia 2017; Mumtaz, Sommer, and Bhatti 2016) on the MHM-related challenges faced by girls and female teachers, toilet needs within religious backgrounds

 Feasibility studies, impact evaluations, effectiveness and cost-effectiveness trials (Zulaika et al. 2019; Sommer 2010; Hennegan and Montgomery 2016; Alexander et al. 2015; Miiro et al. 2018; Sommer et al. 2018; Emdadul Haque et al. 2014; Muthengi, Farris, and Austrian 2017)

 Research analyzing the impact of the MHM and education policy landscape (Sommer et al. 2017)

 MHM among people with disabilities (Wilbur et al. 2019), boys and men’s perceptions of MHM for schoolgirls (Mason et al. 2017), MHM in emergency contexts (Sommer et al. 2018)

Cross-sector Collaboration

New efforts to mobilize research networks and synergies, including

 The Global Challenges Research Fund (GCRF) seed grant among researchers in Kenya, Uganda, Tanzania, and Zimbabwe to strengthen MHM research capacity with a particular focus on schools

 MHM in Emergencies toolkit (27 co-publishing humanitarian response organizations), with inclusion of MHM in education sector response (Sommer et al. 2018)

Recommendations to advance the agenda

 Longitudinal research on the consequences of poor MHM, and the synergistic impact of combined MHM interventions for schoolgirls, including the long-term effect of such interventions

 More inclusive studies, involving men and boys, parents, teachers, and marginalized groups such as girls with disabilities and transgendered youth

 Systematic reviews evaluating MHM interventions and outcomes across differing geographies, cultures, population groups

 Financial modeling for and cost-effectiveness of MHM programmes and policies in schools to promote uptake of evidence-based research, dissemination, cross-sectoral engagement, and implementation

 ‘Natural experiments’ to understand impact of policies and funding for MHM programmes in schools, including those that provide menstrual products to girls in high, middle, and low- income countries

 Implementation research to understand how programmes and policies are delivered, adapted, and scaled