Endometriosis is a condition characterized by the growth of the endometrium, or the tissue that lines the uterus, outside of the uterus, and it is diagnosed through the presence of endometriotic lesions in the pelvic region. The disease is most often associated with abnormal and painful vaginal bleeding. Currently, minimal literature exists concerning the management of endometriosis in low and middle-income countries (LMICs), which may influence the lack of a cultural competent understanding of menstruation in LMICs and, therefore, a lack of evidence-based policies concerning menstruation.

On 5 April 2018, the documentary Period. End of Sentence. premiered at the Cleveland International Film Festival in Cleveland, Ohio. In the documentary, Rayka Zehtabchi, the director of the film, documents the stigma surrounding menstruation in India and follows a group of women in Kathikhera, a rural village in the Hapur district of India, as they manufacture and distribute sanitary pads. A group of high school students at Oakwood High School in Los Angeles, California, raised money to produce the documentary after one student was inspired by her visit to the United Nations Commission on the Status of Women in New York City, New York, which focused on the stigma surrounding menstruation in low-income countries. Period. End of Sentence. draws attention to the obstacles impeding proper menstrual health management in low-income contexts by documenting the women of Kathikhera’s journey to manufacture and sell sanitary pads.

In July 2015, Marni Sommer and colleagues published “Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue,” hereafter “Defining MHM,” in American Journal of Public Health. The authors discuss that growing interest in the gender gap in education raised awareness about girls’ obstacles to managing menstruation, especially in low-income countries. Increased focus on MHM pushed menstruation to be redefined as a public issue rather than a private one. That transition made MHM the responsibility of national governments instead of just the responsibility of young girls, because it became more widely recognized that girls could only appropriately manage menstruation if they had access to the necessary resources through public infrastructure. “Defining MHM” outlines how defining MHM as a public health issue brought much-needed attention to the obstacles to MHM young girls face and emphasizes that other underrepresented public health issues could use similar tactics as the MHM movement to gain global attention and funding.

Menstrual hygiene management, or MHM, is a concept that concerns girls' and women’s access to the appropriate information and resources to manage menstruation. In December 2012, the Joint Monitoring Program, or JMP, was one of the first organizations to define MHM as a global development goal. Since then, other organizations like WaterAid and the United Nations have expanded MHM’s definition to include menstrual education that is biologically accurate and free of taboo and stigma. Many women in low-income countries lack those necessities for MHM due to high prices of menstrual sanitary products, lack of access to clean water and sanitation facilities, and social stigma surrounding menstruation that prevents it from being talked about. However, as more organizations began to frame MHM as an issue of public concern rather than a woman’s private problem, more researchers, organizations, and governmental bodies have begun to address issues at the root of inadequate MHM.

In 2008, Celeste Mergens founded the organization Days for Girls to address obstacles impeding women’s and girls’ access to sustainable hygiene and health education by enlisting volunteers around the world to construct reusable menstrual hygiene products for girls in low-income countries. Mergens founded Days for Girls in the US in 2008 after learning that an orphanage she was working with in Kenya did not have resources for girls to manage their menstrual cycles. She provided those girls with reusable sanitary pads, and later that year, she decided to provide Days for Girls Kits, or DfG Kits, that volunteers from around the world made for women and girls in parts of the world lacking access to menstrual hygiene products. By 2012, Mergens launched chapters across the United States to allow volunteers to hand-sew the DfG Kits, and by 2019, the organization expanded to include chapters in Zimbabwe, Ghana, and Uganda. Days for Girls provides women and girls with education and resources necessary to manage menstruation, which can help reduce the instances of absenteeism for girls in schools and reduce the risk of contracting infectious diseases.