Use our "Version selection tool" to support you to find right version for your work.
What is the MPNS?
The Menstrual Practice Needs Scale (MPNS) measures respondents' experience and perception of their menstrual practices and the environments used to manage their menstrual bleeding.
By measuring a person's perceptions, we learn how they feel, not only what they do and where they do it.
Items ask about respondents’ about their perceptions of comfort, satisfaction, reliability, and worries and concerns and produces a quantitative (number) estimate of the extent to which an individual's menstrual needs are being met.
Publication Development of the MPNS
This peer-reviewed publication describes the development and validation of the MPNS tool. This paper is for practitioners and researchers wanting to know more about the science behind the tool.
Publication Development of MPNS Short and Rapid Form
This peer-review publication reports on the science behind the short and rapid versions of the measure.
Is the MPNS right for your work?
The MPNS is designed to measure experiences and needs in menstrual blood management. Whether or not the MPNS is suitable for your project will depend on your goals and data collection methods. Refer to the User Guidance tab for more detailed information.
The MPNS is suitable for
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Needs Assessments
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Investigating associations
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Evaluation and monitoring
The MPNS is not suitable for
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Measuring other concepts (e.g., menstrual-related knowledge, menstrual practices)
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Qualitative research
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Key information survey or observational checklist
The MPNS was developed based on the experiences of women and girls in low- and middle-income countries (LMICs). Items may be used in high-income settings; however, the scales would require adaptation and validation for this context.
The original scale (MPNS-36) was developed with a focus on adolescent, school-going girls. The scale has since been validated among adult working women with an alternative sub-scale structure. In the future, further validations and adaptations may be developed for specific population groups, for example, humanitarian settings. If you have undertaken a validation in a new population group, please contact us.
The MPNS asks about experiences of the last menstrual period, so it is not suitable for girls prior to menarche. For surveys that include pre- and post-menarche participants, pre-menarche participants should skip the MPNS section of the survey.
The MPNS seeks to capture the current state of menstrual practice needs, which are assessed by asking participants about their last menstrual period. If a participant has not menstruated in a long time (for example due to pregnancy, contraceptive use, or menopause) it will be more difficult for them to recall their last period, and the data will not be recent. Thus, we recommend that the MPNS is used with participants who have had a menstrual period in the past six months.
If needed, you may wish to include an eligibility question in your survey, such as:
Have you had a menstrual period in the past six months? [Yes/No]
Where to place the MPNS in your survey
The MPNS will often be used as part of a larger survey.
Where the MPNS fits in the order of your survey will depend on your survey content and your population.
Our recommendations:
- If applicable, ask behavioural practices questions before perceptions of practices (the MPNS). For example, participants report first on the type of menstrual material they use, before being asked whether they had enough menstrual material and if these materials were comfortable.
- Delivering the MPNS as a whole allows respondents to familiarize themselves with the response options (on the 4-point response scale). For example, switching back and forth between questions with varying response options may lead to confusion.
Filtering and eligibility
Not all MPNS items will be relevant to all respondents.
The scale will be easier to complete if respondents are only presented with items that are relevant to them. Prior survey questions can test eligibility and filter the presentation of MPNS items. Our recommendations for pre-MPNS filtering are to the right.
Electronic surveys using Smartphone or Tablet Apps can be useful for survey filtering. Additionally, survey support such as reminders based on survey training can be input alongside items to support enumerators with delivery.
Programs such as ODK or Qualtrics are used to facilitate electronic surveys. Below we provide basic ODK coding and filtering (XLS form) for the MPNS, which you can upload to your preferred platform.
The MPNS disposal items are intended to capture experiences of disposing of both single-use (disposable) and multi-use (reusable) menstrual materials. However, it is possible that a respondent did not dispose of any reusable materials during their last period.
Below is an example of the type of eligibility question you could include:
Did you dispose of (throw away) any menstrual materials during your last period? [Note: includes single-use materials and reusable materials at the end of their life]
A subset of MPNS items asks about respondents’ menstrual experiences at school or work/outside of the home. However, some respondents may not have attended school or work during their last (most recent) menstrual period.
To avoid unnecessary missing data due to school holidays, we suggest that those who were not at school or work during their last menstrual period answer questions related to the last menstrual period that they experienced at school (within a 6 month window). If a respondent has not attended school/work during menstruation in the past 6 months, these items should be skipped. In observational research and intervention studies, we suggest capturing whether a participant attended school/work within the past menstrual period, past 3 months, or past 6 months to allow for sensitivity analyses. These response categories could be adapted to the past school term or other reference points relevant to your work.
Below is an example of the type of eligibility questions you could include to support this:
Did you attend any school/work during your last menstrual period? [Yes; No]
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If No: “Did you attend any school/work during your menstrual period in the past 3 or 6 months?” [Yes, past 3 months; Yes, past 6 months; No]
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If No: Respondent should skip school/work MPNS items
A few MPNS items ask about changing menstrual materials at school, work, or outside of the home. These items ask about the participant's experience of privacy and safety while changing their menstrual materials.
We recommend adding the following survey question to filter items:
The last time you attended school during your menstrual period, did you change your menstrual materials at school? [Yes; No]. *Note that this question should only be asked of respondents who attended school during menstruation in the past 6 months. Alternatively, an additional response option could be added to items that ask about changing materials at school or work [e.g., “I did not attend school during menstruation in the past 6 months”].
Some MPNS items are only relevant to those respondents who are reusing menstrual materials. If a respondent only uses disposable products, these questions should be skipped. Below is an example of the type of eligibility question you could include:
Did you wash and reuse any menstrual materials during your last period?
Code
ODK coding and filtering
We provide an ODK file (XLS) for the survey, which includes basic filtering. The four filtering items described above have been included in this file.
Download User Guide
Everything you need to know about the MPNS in one PDF, including suitability and version selection, as well as how to implement, train, and score the MPNS. An appendix provides information on the development of the scale.
Features of the MPNS
The section on the right steps through the key features of the MPNS.
Respondents’ are asked to recall their last menstrual period when responding to each item, that is, their most recent menstrual period. Answers will reflect recent experiences, which is important when considering changes over time.
Menstruation is experienced throughout the day and night, and research has highlighted that the difficulties posed by managing menstruation can vary based on the location. For example, it may be more difficult to manage menstruation at school than at home.
Menstrual experiences likely impacted by location have been separated in the scale, specifically to capture experiences at home and at school (for adolescents) or at work (for adults)
We have developed a pre-amble that could be added to your survey to further explain the locations of the MPNS to respondents.
The measure uses a 4-point response scale (Never, Sometimes, Often, Always) or (Never, less than half the time, more than half the time, always).
Using a different response scale that differs from 4 points will mean your findings are not aligned with the validity tested for the MPNS.
A pre-survey activity is available to familiarize respondents with the response options. We recommend using this activity, particularly among populations who may be less familiar with Likert-style responses.
Download Pre-survey activity
A pre-survey activity is available to familiarise respondents with the response options. We recommend use of this activity, particularly among populations who may be less familiar with Likert-style responding.
Download Visual response tools
We have developed a series of visual response tools that can be incorporated into paper surveys, electronic delivery, or that enumerators can use to remind respondents of the response options and support responding.
Key Terminology
The MPNS has several key terms, that are used in many of the individual items. These key terms are important to understand, as they impact the meaning of a word and may be interpreted differently in different contexts. Understanding the meaning of these terms will assist you in translating the measure if you need to do so.
Refers to all the materials or products that may be used to collect or absorb menstrual blood. Individuals may use multiple different materials during a single period. The MPNS uses “menstrual materials” to avoid terms like “menstrual products” which may bias participants to think about commercial products, or feel judgement if they use a collection of other materials.
Satisfaction means a participant is happy or contented with a location and finds it acceptable. Everyone has different individual standards for what they consider to be a satisfactory space for menstrual management, for example, based on their own perceptions of cleanliness and privacy. This means participant responses may differ, even if they are using the same location. Most MPNS items discussing satisfaction have incorporated examples that can be added to the question, highlighting satisfaction with cleanliness and the available resources.
Worry means that a participant feels concerned or anxious. In the MPNS, we ask about participants’ worries about being seen or able to enact menstrual management practices when needed. Worrying about something does not mean that it has happened. For example, a participant may worry about someone seeing them while they change their menstrual materials, even if it has not happened.
The scale uses both physical and emotional understandings of the term "comfortable", which means relaxed and at ease. This may or may not be applicable in your language and should be considered during translation. You may need to use different translations for emotional and physical comfort.
Different items in the scale ask if a participant was able to undertake tasks when they "needed to" or when they "wanted to". It is important to note how this impacts the meaning of the statement. Being able to do something when you want to implies control, agency and choice. In contrast, doing a behaviour when needed means when that action becomes necessary (which may or may not be at the time someone wants to do that practice).
Subscales
The MPNS includes sub-scales that reflect unique dimensions of menstrual practice experiences. The main difference between the adult and adolescent versions of the scale is the different sub-scales.
The MPNS-36 and SF for adolescents both contain the same six sub-scales. Four sub-scales are applicable to all respondents, and a further two apply to those who washed and reused menstrual materials. The MPNS-R contains no sub-scales (due to the short length).
The survey's ordering is designed to aid the flow of delivery. The sub-scales are not grouped together. Items relating to different sub-scales are dispersed throughout the survey. The tables below indicate which MPNS items fit into each sub-scale.
These items capture the extent to which respondents were satisfied (had their needs met) in relation to their menstrual materials, preferred disposal, and environments (spaces) they used to manage their menstruation at home.
A group of three items fit together to capture respondents worries about the quality of their menstrual materials (that they would leak, that they would run out of materials, or that materials would move out of place)
This group of items captures the extent to which respondents’ needs were met in relation to transporting materials, and changing materials at school (or work).
This group of items reflects respondents worries and concerns that they would not be able to change or dispose of materials when they needed to, and their concerns about privacy and safety while managing menstruation both at home and at school (or work).
These items apply to those who reused materials and capture concerns around washing and drying materials.
These items apply to those who reused materials and capture the extent to which respondents were satisfied with (had their needs met) in relation to washing and drying materials.
Where to place the MPNS in your survey
The MPNS will often be used as part of a larger survey.
Where the MPNS fits in the order of your survey will depend on your survey content and your population.
Our recommendations:
- If applicable, ask behavioural practices questions before perceptions of practices (the MPNS).
- For example, participants report first on the type of menstrual material they use, before being asked whether they had enough menstrual material and if these materials were comfortable.
- For example, participants report first on the type of menstrual material they use, before being asked whether they had enough menstrual material and if these materials were comfortable.
- Delivering the MPNS as a whole allows respondents to familiarize themselves with the response options (on the 4-point response scale).
- For example, switching back and forth between questions with varying response options may lead to confusion.
Filtering and eligibility
Not all MPNS items will be relevant to all respondents.
The scale will be easier to complete if respondents are only presented with items that are relevant to them. Prior survey questions can test eligibility and filter the presentation of MPNS items. Our recommendations for pre-MPNS filtering are to the right.
Electronic surveys using Smartphone or Tablet Apps can be useful for survey filtering. Additionally, survey support such as reminders based on survey training can be input alongside items to support enumerators with delivery.
Programs such as ODK or Qualtrics are used to facilitate electronic surveys. Below we provide basic ODK coding and filtering (XLS form) for the MPNS, which you can upload to your preferred platform.
The MPNS disposal items are intended to capture experiences of disposing of both single-use (disposable) and multi-use (reusable) menstrual materials. However, it is possible that a respondent did not dispose of any reusable materials during their last period.
Below is an example of the type of eligibility question you could include:
Did you dispose of (throw away) any menstrual materials during your last period? [Note: includes single-use materials and reusable materials at the end of their life]
A subset of MPNS items asks about respondents’ menstrual experiences at school or work/outside of the home. However, some respondents may not have attended school or work during their last (most recent) menstrual period.
To avoid unnecessary missing data due to school holidays, we suggest that those who were not at school or work during their last menstrual period answer questions related to the last menstrual period that they experienced at school (within a 6 month window). If a respondent has not attended school/work during menstruation in the past 6 months, these items should be skipped. In observational research and intervention studies, we suggest capturing whether a participant attended school/work within the past menstrual period, past 3 months, or past 6 months to allow for sensitivity analyses. These response categories could be adapted to the past school term or other reference points relevant to your work.
Below is an example of the type of eligibility questions you could include to support this:
Did you attend any school/work during your last menstrual period? [Yes; No]
-
If No: “Did you attend any school/work during your menstrual period in the past 3 or 6 months?” [Yes, past 3 months; Yes, past 6 months; No]
-
If No: Respondent should skip school/work MPNS items
A few MPNS items ask about changing menstrual materials at school, work, or outside of the home. These items ask about the participant's experience of privacy and safety while changing their menstrual materials.
We recommend adding the following survey question to filter items:
The last time you attended school during your menstrual period, did you change your menstrual materials at school? [Yes; No]. *Note that this question should only be asked of respondents who attended school during menstruation in the past 6 months. Alternatively, an additional response option could be added to items that ask about changing materials at school or work [e.g., “I did not attend school during menstruation in the past 6 months”].
Some MPNS items are only relevant to those respondents who are reusing menstrual materials. If a respondent only uses disposable products, these questions should be skipped. Below is an example of the type of eligibility question you could include:
Did you wash and reuse any menstrual materials during your last period?
Download ODK coding and filtering
We provide an ODK file (XLS) for the survey, which includes basic filtering. The four filtering items described above have been included in this file.
Training research team members is critical for the effective and consistent delivery of any survey tool, including the MPNS.
Whether the survey is to be self-completed by respondents, or delivered by an interviewer, research teams should understand the key features and terminology used in the scale and how to support respondents where needed. Trainers themselves should also ensure they are familiar with the MPNS, to support the effective delivery of training.
On this page we provide downloadable training manuals, and annotated surveys to support you to train your team to use the MPNS. To support trainers in understanding the MPNS, we also provide brief videos that provide an overview of the MPNS, the key features of the measure and key terminology used. These will support you to undertake training.
Training manuals
Below, we provide two training manuals: one for the trainer to use during the sessions and one for the enumerators (data collectors) to have with them while they undertake the training. The manuals can be edited and adapted to suit your context and training needs.
Word copies on the training manuals are available if you would like to translate the content for your team. Contact us if you would like these.
Download Trainer Training Manual
Use this manual to support you as you train your team. The manual includes instructions for running training sessions, including key information to present and additional information on discussion points.
Download Enumerator Training Manual
Use this manual for your data collection team. Print off one copy for each team member to follow along and take notes. It will be a useful resource for them to refer to if needed, in between or after training.
Download Activity Deck
A supplementary document to the Training Manuals. The Activity Deck has print-outs (or slides to display with AV equipment) to support the activities throughout the training. Use of the Activity Deck is optional, all activities may be completed without print-outs.
MPNS Key Features
In this video we talk though the key features of the MPNS.
Watch a presentation on the AMEHC study
If you are unable to watch the video, the section on the right steps through the key features.
Detailed information can also be found in the User Guide.
Respondents’ are asked to recall their last menstrual period when responding to each item, that is, their most recent menstrual period. Answers will reflect recent experiences, which is important when considering changes over time.
The measure uses a 4-point response scale (Never, Sometimes, Often, Always) or (Never, less than half the time, more than half the time, always).
Using a different response scale that differs from 4 points will mean your findings are not aligned with the validity tested for the MPNS.
A pre-survey activity is available to familiarize respondents with the response options. We recommend using this activity, particularly among populations who may be less familiar with Likert-style responses.
Menstruation is experienced throughout the day and night, and research has highlighted that the difficulties posed by managing menstruation can vary based on the location. For example, it may be more difficult to manage menstruation at school than at home.
Menstrual experiences likely impacted by location have been separated in the scale, specifically to capture experiences at home and at school (for adolescents) or at work (for adults)
We have developed a pre-amble that could be added to your survey to further explain the locations of the MPNS to respondents.
Download Pre-survey activity
A pre-survey activity is available to familiarise respondents with the response options. We recommend use of this activity, particularly among populations who may be less familiar with Likert-style responding.
Download Visual Response Tools
We have developed a series of visual response tools that can be incorporated into paper surveys, electronic delivery, or that enumerators can use to remind respondents of the response options and support responding.
Key Terminology
The MPNS has several key terms, that are used in many of the individual items. These key terms are important to understand, as they impact the meaning of a word and may be interpreted differently in different contexts. Understanding the meaning of these terms will assist you in translating the measure if you need to do so.
Refers to all the materials or products that may be used to collect or absorb menstrual blood. Individuals may use multiple different materials during a single period. The MPNS uses “menstrual materials” to avoid terms like “menstrual products” which may bias participants to think about commercial products, or feel judgement if they use a collection of other materials.
Satisfaction means a participant is happy or contented with a location and finds it acceptable. Everyone has different individual standards for what they consider to be a satisfactory space for menstrual management, for example, based on their own perceptions of cleanliness and privacy. This means participant responses may differ, even if they are using the same location. Most MPNS items discussing satisfaction have incorporated examples that can be added to the question, highlighting satisfaction with cleanliness and the available resources.
Worry means that a participant feels concerned or anxious. In the MPNS, we ask about participants’ worries about being seen or able to enact menstrual management practices when needed. Worrying about something does not mean that it has happened. For example, a participant may worry about someone seeing them while they change their menstrual materials, even if it has not happened.
The scale uses both physical and emotional understandings of the term "comfortable", which means relaxed and at ease. This may or may not be applicable in your language and should be considered during translation. You may need to use different translations for emotional and physical comfort.
Different items in the scale ask if a participant was able to undertake tasks when they "needed to" or when they "wanted to". It is important to note how this impacts the meaning of the statement. Being able to do something when you want to implies control, agency and choice. In contrast, doing a behaviour when needed means when that action becomes necessary (which may or may not be at the time someone wants to do that practice).
MPNS item explanation
More information about each MPNS question to help you and your team. Ensuring your team understand the meaning of each item and any special considerations is a crucial part of implementing the MPNS. This information will also be helpful as additional context when translating the scale into other languages.
Word copies of these resources are available if you would like to translate training content for your team. Contact us if you would like these.
Download Item explanation slides
These PowerPoint slides explain each MPNS item one by one. They explain why each item is asked and provide an additional explanation of its meaning (with some examples from girls' responses in past surveys). Any special considerations are also explained. This resource can be used during training to provide detailed information and context for each item with your team.
Download Annotated MPNS
This is an annotated version of the MPNS. It contains the same content as the walk-through slides (in a more printable format). This resource is helpful if you only have access to paper-based training and can be used in training to support your team as you go through the survey. It also provides a written copy of the item explanations for your team to refer back to.
The MPNS is free to use. You do not need permission, as long as you cite the measure in your work.
The measures do not need to be printed in the forms provided. Questions can be incorporated as part of a wider survey. They can be loaded into an electronic software for smartphone or table use.
Measure MPNS-36
It is best suited for needs assessments and research in new settings. It is also appropriate for cross-sectional or evaluation research. This download provides the full MPNS with 36 items for use with adolescents and the adapted scoring for use in adult populations.
Measure MPNS-SF
MPNS with 18 items. Best suited for use where a shorter measure is needed, such as in research involving multiple measures, intervention trials, programme evaluations, or NGO data collection.
Measure MPNS-R
MPNS with 9 items. Best suited for research or monitoring in which menstrual health is not the primary focus, such as studies of broader water, sanitation, and hygiene (WASH) or sexual and reproductive health (SRH).
Not sure which version is best for your work?
Selecting the right version
Several versions of the MPNS are available. It is important to choose the most appropriate version for your project. Use the information on the right to guide your selection.
Or use our "Selecting the Right Version" tool.
Age group
Adolescents
What it offers
Provides the most comprehensive assessment of menstrual management experiences and needs. Individual items provide unique insights into the greatest challenges and needs of the individual or population.
The total score provides the greatest explanatory power across the versions of the MPNS.
Best for
- Needs assessment and research in new settings
- Programme evaluation and observational research where survey length is available
Note: the scale was reduced to 28 items for adults.
Age group
Adult working women (capturing experiences at home and work)
What it offers
Provides the most comprehensive assessment of menstrual management experiences and needs among adult women. Individual items provide unique insights into the greatest challenges and needs of the individual or population.
The total score provides the greatest explanatory power across versions of the MPNS.
Best for
- Needs assessments and research in new settings
- Programme evaluation and observational research where survey length is available
Age group
Adolescent girls * this measure has not yet been investigated among adults
What it offers
Halves the length of the MPNS-36, while continuing to provide the same valid sub-scale scores. We have found that the sub-scale and total scores reflect the relationships observed for the full scale MPNS-36, with slight attenuation. Provides balance in reducing the MPNS-36 items while maintaining insights from individual items and sub-scales. Note that concepts related to transporting and storing menstrual materials are lost in the short form.
Best for:
- Trials or programme evaluations with multiple outcomes
- Observational studies: research to understand menstrual health risk factors or consequences of poor menstrual health
Age group
Adolescent girls
Adults* *based on past research we anticipate the total score generated from the Rapid form will be appropriate for adults.
What it offers
Provides a rapid assessment of menstrual practice experiences and needs that can be used when survey space is highly limited. The Rapid form no longer offers valid sub-scales. The total score and individual items offer insights. The rapid form maintains relationships with related concepts, but with some attenuation of explanatory power from the MPNS-36 and MPNS-SF.
Best for:
Data collection in which menstrual health is not the primary focus, such as studies of water, sanitation, and hygiene (WASH) or sexual and reproductive health (SRH).
Available translations
Here you can download all available translations of the scale.
We have provided links to the source of each translation and citations for the study where this translation was used (if relevant). Translations have been provided to us with consent for their free use as long as the publications (where applicable) are cited. Responsibility for the accuracy of translations lies with the organizations who provided them or the team publishing the linked research.
Note: MPNS-36 translations can be used for shorter versions by selecting only the relevant items.
Translating the MPNS
We continue to translate and test the MPNS in other languages. If your language is not yet available, you will need to translate it into the required language. Our User Guide provides useful information to help you develop your own translations. Our learning tools, such as the "annotated survey", provide additional information on each item to support accurate translation.
We are always willing to review back-translated surveys and would love to share your translation when it is complete; contact us here.
Understanding the language and cultural context of your intended population is crucial. The translated content should accurately convey the original meaning of the item while being contextually sensitive and comprehensible to the target population.
Back-translation is best performed by a second translator. By translating a document back into the original language, discrepancies or misunderstandings can be identified and corrected, ensuring the integrity of the translated content. Our team is always willing to review back-translations and offer feedback. Get in touch if you would like support.
By using language and terms that are familiar to the audience, the translated content becomes more accessible, relevant and engaging. Not considering this could lead to misunderstandings, confusion, or disinterest among the audience which, in turn could impact the data collected.
Pre-testing helps refine your translation, and survey delivery. It tests how understandable your translated items are, and provides a way to check contextual relevance and usability. It provides the opportunity to identify and address any issues before starting data collection.
In cognitive interviews a small sample of participants similar to the target population complete the survey, or a sub-set of questions, with an interviewer. Interviewers can ask participants to explain their answers (to check understanding and identify usability issues) and to rephrase questions in their own words to assist in identifying contextually relevant terminology.
Calculating scores
Scores are calculated in the same way for all versions of the scale—by calculating the mean of all answered items. Each item is scored between 0 and 3. It is important to note that some items or sub-scales are reverse-scored (from 3 to 0). Scoring guidance for each version of the MPNS is attached to each measure.