“…Thirty-three studies had information pertinent to this topic, including six in Africa [ 43 , 47 , 87 , 104 , 107 , 122 ], nine in the Americas [ 44 , 46 , 57 , 103 , 133 – 137 ], five in Asia [ 45 , 63 , 64 , 83 , 114 ], nine in Europe [ 51 , 52 , 60 , 67 , 88 , 97 , 109 , 110 , 138 ], two in Oceania [ 106 , 139 ], and two in multi-country studies [ 50 , 140 ]. In studies across multiple countries, including Mali, Kenya, South Africa, Brazil, Spain, the Dominican Republic, Canada, the US, and the UK, regular menstruation was viewed by many women as a marker of health and fertility, as well as providing reassurance of not being pregnant [ 47 , 50 , 51 , 57 , 87 , 103 , 133 – 135 , 137 , 138 ]. Women in South Africa, Mali, and Brazil, adolescents in South Africa and the US, rural housewives in India, and poor urban women in Turkey perceived that menstruation cleansed the body of “dirty blood” or toxins [ 44 – 47 , 63 , 87 , 122 ].…”