Article Text

I do what a woman should do’: a grounded theory study of women’s menstrual experiences at work in Mukono District, Uganda
  1. Julie Hennegan1,
  2. Simon P S Kibira2,
  3. Natalie G Exum1,
  4. Kellogg J Schwab1,
  5. Fredrick E Makumbi3,
  6. Justine Bukenya2
  1. 1The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, Kampala, Uganda
  3. 3Department of Epidemiology & Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
  1. Correspondence to Dr Julie Hennegan; jhenneg1{at}


Menstrual health has received increasing recognition as an essential issue for public health and gender equality. A growing body of research has elucidated adolescent girls’ menstrual needs and informed policy and practice responses. However, the experiences of adult women have received little attention, particularly in the workplace where many spend a significant proportion of their lives. To address this gap, we took a grounded theory approach to generate a nuanced understanding of working women’s menstrual experiences, and the impact of menstruation on their work and health in Mukono District, Uganda. In-depth interviews were undertaken with 35 women aged 18–49. This included 21 women working in markets, 7 teachers and 7 healthcare facility workers. Frequent collaborative analysis sessions throughout data collection, coding of interview transcripts, and generation of participant, workplace, and category memos facilitated analysis. Our core category and underlying theory, being a responsible woman’, underpinned women’s experiences. Being responsible’ meant keeping menstruation secret, and the body clean, at all times. These gendered expectations meant that any difficulty managing menses represented a failure of womanhood, met with disgust and shame. Difficulties with menstrual pain and heavy bleeding were excepted from these expectations and perceived as requiring compassion. Commercial menstrual products were expensive for most women, and many expressed concerns about the quality of cheaper brands. Workplace infrastructure, particularly unreliable water supply and cleanliness, was problematic for many women who resorted to travelling home or to other facilities to meet their needs. Menstruation presented a burden at work, causing some women to miss work and income, and many others to endure pain, discomfort and anxiety throughout their day. Our findings can inform norm and resource-focused responses to improve experiences and should provoke critical reflection on the discourse used in menstrual health advocacy in Uganda.

  • qualitative study
  • environmental health
  • public health
  • mental health & psychiatry
  • hygiene

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  • Handling editor Kerry Scott

  • Twitter @julie_hennegan, @NatalieGExum

  • Contributors JH: Conceptualisation; methodology; formal analysis; investigation; data curation; writing – original draft; visualisation; supervision; project administration. SPSK: Methodology; formal analysis; investigation; validation; writing – reviewing & editing; supervision; project administration. NGE: Methodology; validation; writing – reviewing & editing; project administration. KJS: Conceptualisation; validation; resources; writing – review & editing; supervision; project administration; funding acquisition. FEM: Methodology; validation; writing – review & editing; supervision. JB: Methodology; formal analysis; investigation; validation; writing – reviewing & editing; supervision. All authors have approved the final manuscript.

  • Funding This study was made possible by the Osprey Foundation of Maryland.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All participants provided written informed consent, including for audio recording, prior to interview. All interviews were conducted with auditory, and where possible, visual privacy. Participants were informed of their right not to discuss topics and to decline to answer any questions or end the interview. Workplace administrators (Headteachers, Health Care Facility Administrators and Market Chairpersons) permitted recruitment of participants from their workplaces. Approval for the study in the area was also provided by the Mukono district chief administrator’s office and the Mukono Municipality Town clerk’s office. Ethical approval was provided by Makerere University School of Public Health Higher Degrees, Research and Ethics Committee (HDREC: 739) and Johns Hopkins Bloomberg School of Public Health Institutional Review Board (IRB: 00010015). The Uganda National Council for Science and Technology (UNCST) approved the study (ref: SS 5143).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement This is a qualitative study and therefore the data generated are not suitable for sharing beyond that contained within the report and supplementary materials. Further information can be obtained from the corresponding author.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.