Access to Clean Water and Its Impact on Menstrual Hygiene Practices among Girls and Women: A Systematic Review Paper

Abstract

Menstrual hygiene management (MHM) and menstrual health (MH) are increasingly recognized as critical determinants of the health, education, and empowerment of women and girls globally. Despite growing research attention, evidence on menstrual outcomes remains limited and fragmented. To synthesize quantitative research on MHM and MH, map the range of investigated outcomes, and identify gaps, priorities, and directions for future work.  A systematic search was conducted in PubMed, JSTOR, Web of Science, and Google Scholar for studies published between January 2020 and September 2025. Eligible studies included peer-reviewed empirical research employing quantitative or mixed methods designs with inferential statistics. Excluded studies were qualitative-only, review papers, or non-peer-reviewed. Study populations included adolescent high school girls, school directors, and women of reproductive age. Marginalized groups (e.g., women in IDP camps and female sex workers) were rarely studied (<10%). The most frequently examined independent variables included socio-economic, demographic, and WASH-related factors (80%). The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Of the 40 screened articles, 23 met the inclusion criteria. Data were extracted on study design, theoretical framework, outcomes, populations, and geographic focus. Quality appraisal emphasized study design and reporting transparency. Most studies were cross-sectional studies (78.3%, n=18). The most frequently researched outcomes were MHM Practices and adequacy (39.1%, n=9), followed by socio-behavioral/experiential aspects and educational/empowerment outcomes (each at 21.74%, n=5). Health outcomes related to menstruation were least studied (17.4%, n=4). Studies were concentrated in India (55.6%, n = 10) and Ethiopia (44.4%, n = 8), with minimal representation from Nepal, Kenya, and Bangladesh (each 5.6%, n = 1). The majority lacked an explicit theoretical framework (77.8%). The most common independent variables were socio-economic, demographic, and WASH factors (80%), indicating that MHM is deeply embedded in broader societal contexts. Overreliance on cross-sectional designs, underrepresentation of marginalized populations and geographic regions, and inconsistent reporting of variables in abstracts hindered knowledge transfer.  Failure to clearly report variables in abstracts also hinders knowledge transfer. Future research should prioritize theory-informed longitudinal research and the inclusion of vulnerable populations to strengthen evidence for equitable WASH interventions and policies. No external funding was reported for this review.