Menstruation requirements: A significant barrier to contraceptive access in developing countries

A review of surveys from Ghana, Kenya, Cameroon, Jamaica, and Senegal suggests that the requirement that women seeking hormonal contraception and IUDs should present for family planning services when menstruating represents a significant but unrecognized barrier to contraceptive access. Non-menstruating clients are instructed to return to the family planning facility at the onset of menses and often are not provided with a provisional barrier method. The time and money involved in a return trip to the clinic may prevent poor women from making another visit and others may become pregnant while awaiting their menses. A total of 10 studies conducted in these 5 developing countries found that 41-92% of non-menstruating family planning clients were denied contraceptive services. Providers cited 4 rationales for this practice: 1) the presence of menstruation is a cheap, effective proxy for a pregnancy test; 2) methods such as the IUD and oral contraceptives are best initiated during menses; 3) menstruation requirements prevent the use of contraceptives for self-induced abortion; and 4) most clients know they should present for services when they are menstruating. Although some aspects of the menstruation requirement are rooted in a concern for women's health, the overall effect of such a restriction is to deny women the right to contraception and to place them at risk of an unwanted pregnancy. Simple checklists aimed at ruling out the possibility of pregnancy could be used in non-menstruating women.