Life-Course Menstrual Health Barriers and Period-Related Absenteeism in Cameroon: A Nationwide Mixed-Methods Survey

Background: Menstrual hygiene management remains a key barrier to gender equity, education, and workplace participation in low-resource settings, including Cameroon. Globally, an estimated 500 million women and girls face barriers to managing menstruation safely and with dignity, yet evidence integrating menstrual experiences across the life course remains limited. We assessed menstrual health barriers and period-related absenteeism across both school and workplace contexts among girls and women aged 16–65 years in Cameroon through a nationwide mixed-methods survey.

Methods: We conducted a nationwide mixed-methods survey to explore menstruation experiences, period-related absenteeism, and barriers to menstrual health. The survey was administered in French and English via both digital and paper formats. We used descriptive statistics, inferential tests (t tests, χ² tests), and regression models to examine associations and regional differences in barriers and absenteeism; open-ended responses were analyzed thematically to identify recurring domains shaping menstrual experiences. Bilingual open-text responses were analyzed using a structured purposive R-based sentiment scoring framework to capture emotional intensity and direction across seven categories, and GIS-based heat maps were used to spatially represent regional variation in regression-derived predicted probabilities for menstrual product access.

Findings: The nationwide survey of 1.008 women revealed that over half (51.7%) reported missing school or work during menstruation, mainly due to menstrual pain, lack of products, and inadequate facilities. A statistically significant relationship (p < 0.0001) was identified between those who experienced period poverty and school/work absenteeism. Individuals who experienced period poverty, or knew someone who has, were more likely to report missing school or work because of their period (χ² = 16.621, p-value < 0.001). Women overwhelmingly reported use of disposable sanitary pads (71.1%), after which reusable sanitary pads were most common (16.08%). There was a statistically significant association (χ² (15) = 64.64, p < 0.001) between region and difficulty accessing menstrual products. Regional disparities were evident, with women in Est, Littoral, and Ouest experiencing greater barriers to product access. Respondents from the Ouest region had 7.7 times higher odds (OR ≈ 7.7, p = 0.003) of having trouble accessing menstrual products of any kind. Qualitative sentiment analysis on the short-answer responses of the survey identified seven key thematic domains that repeatedly appeared in the open-ended responses: education, hygiene products, access to services, affordability, stigma, infrastructure, and policy/support, reflecting attitudes regarding a desire for change, challenging stigma around menstruation, and forward-thinking regarding policy change and advocacy. While many respondents identified stigma, financial constraints, and inadequate WASH infrastructure as persistent obstacles, there was also an emphasis on empowerment, optimism, and urgency for change.

Interpretation: The survey provided critical insights into menstrual health awareness, access to hygiene products, and the broader implications of menstruation on education and employment across the lifespan. At the same time, persistent challenges were noted, including maintenance of WASH infrastructure, cultural stigma, and the affordability of menstrual products pointing to key areas for sustained action. In particular, the regional differences are of note, given that there are not only differences in access to menstrual products but also differences in cultural practices regarding communication and comfortability discussing menstruation with family, friends, at work, and with healthcare providers. Given this, a one-size-fits-all approach will not sufficiently target the different characteristics of each region. Instead, this survey data suggests that all future programs must be multi-pronged and take into consideration specific needs of each region. This study benefits from the broad-spectrum survey, which captured experiences from women and girls, enables a deeper understanding of menstruating experiences as they evolve into adulthood and impact the full life course.