Reducing period poverty through interventions, innovations, policies and multilevel barriers and facilitators: A systematic review

Period poverty is a persistent global inequity that undermines health, dignity, education and socioeconomic participation. Although increasingly recognised, evidence on effective responses remains fragmented. This systematic review synthesised menstrual health interventions, innovations and policies, and examined the multilevel barriers and facilitators across low- and middle-income and high-income countries. Following PRISMA 2020 and the SPIDER framework ProQuest Central, Scopus, MEDLINE and PsycINFO were searched for English-language studies from inception to 15 December 2024, identifying 8385 records. After screening, 49 studies were included, comprising interventions, other initiatives, innovations and policy analyses across school, community, workplace, humanitarian and policy contexts. Given substantial heterogeneity, a narrative synthesis was undertaken. Effective responses were multidimensional, combining product provision, menstrual education, stigma reduction and enabling infrastructure. Education improved menstrual literacy and confidence, while product-access strategies reduced absenteeism and social withdrawal in specific studies. Innovations including biodegradable and reusable products and community-managed pantries, expanded access but faced WASH constraints, stigma and cultural concerns about insertable products. Policy measures showed promise, but persistent funding and implementation gaps remained. Sustainable progress requires integrated, context-sensitive action combining education, product choice, infrastructure, stigma reduction and effective policy implementation.