A life course approach that looks at vaginal bleeding as more than a monthly period and addresses the needs of girls and women across the life course is urgently required, say the authors.
Without this, girls and women will continue to be unable to tell the difference between healthy and abnormal bleeding, and to take care properly of their own bodies and those of their dependents, the authors emphasise.
The average woman can expect to have around 2400 menstrual bleeding days between the ages of 12 and 51. And on any given day, more than 800 million girls and women of reproductive age will be having their period.
But there are many other circumstances in which women can experience vaginal bleeding: after birth (post partum) haemorrhage; miscarriage; as a result of conditions such as endometriosis, growths (polyps and fibroids), and womb (cervical) cancer.
They may experience particularly heavy and painful periods (menorrhagia) or irregular bleeding during peri menopause and menopause. Prolonged or heavy bleeds can cause anaemia, which may be particularly critical for those who are malnourished or have other underlying conditions, such as HIV, say the auhors.
Yet societal taboos around open discussion of vaginal bleeding mean that many young women are not even told that they will bleed every month, let alone be able to manage it hygienically and with dignity, due to the absence of clean water, sanitation, and supplies of soap and sanitary products, say the authors.
Sparse sanitation may make it harder for them to be able to take part in routine daily activities such as going to school or work, going to the market or fetching water, they add.
And many women in low and middle income countries are unlikely to be able to access factual information either in schools, online, or in adequately resourced health clinics run by appropriately trained staff.
"Though international development priorities have, to some extent, targeted adolescence and reproductive health related to childbearing, there is a marked silence around vaginal bleeding that girls and women experience over 40-50 years of the life course," write the authors.
"This silence hinders attention to the significant information and WASH [Water, Sanitation and Hygiene]-related needs that they face to manage bleeding, and may hinder the seeking out of healthcare as needed."
They call for national and global policy and programming that is grounded in evidence and designed to meet women's needs, including health promotion, as well as improved availability of sanitation and clean water, infrastructure, and supplies.
And they suggest that health systems and health workers' capacity need to be strengthened to improve women's health alongside educational/awareness campaigns to help women understand the difference between normal and abnormal bleeding.
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Journal
BMJ Global Health