Title: Informational needs related to menstrual literacy among Dutch women: a focus group
study
Version: 1 Date: 16 Dec 2024
Reviewer:  Mriganka Dolui
Reviewer's report:
This manuscript is interesting and holds a valuable contribution to the scientific community.
The findings using focus group discussions provide detailed insights into the perceptions and
informational needs of Dutch women that can inform policy, educational reforms, and healthcare
practices to improve menstrual literacy. Following a comprehensive and critical evaluation, I
wish to bring attention to several findings that can enhance the clarity and impact of their research
work. And, I highly recommend publishing this article once the corrections are implemented.
Minor comments:
1. Abstract
-lines 23-24 need to be checked “the world’s population experiences it at some point in their
lives”.
-lines 23-24 are incomplete.
2. Introduction
- This study has Qualitative Depth in terms of the use of focus group discussions, which provides
detailed insights into the perceptions and informational needs of Dutch women. Still, a more
rigorous literature review is required regarding the Menstrual literacy gap among Dutch women
in the introduction.
- The study addresses a critical gap in menstrual health awareness and literacy, contributing
to global discussions about health equity but lagging global perspective, thus including some
recent literature from worldwide to show the importance of the topic and its relevance to the
global literature. The authors may consider the following studies-
• Chakrabarty, M., Singh, A., Let, S. et al. Decomposing the rural–urban gap in hygienic material
use during menstruation among adolescent women in India. Sci Rep 13, 22427 (2023). https://
doi.org/10.1038/s41598-023-49682-1
• Holmes, K., Curry, C., Sherry, Ferfolja, T., Parry, K., Smith, C., Hyman, M., & Armour, M.
(2021). Adolescent Menstrual Health Literacy in Low, Middle and High-Income Countries: A
Narrative Review. International Journal of Environmental Research and Public Health, 18(5),
2260. https://doi.org/10.3390/ijerph18052260
• Okello, E.S., Ayieko, P., Rubli, J. et al. Unmet menstrual needs and psychosocial well-being
among schoolgirls in Northern Tanzania: baseline results from the PASS MHW study. BMC
Women's Health 24, 522 (2024). https://doi.org/10.1186/s12905-024-03357-9
• Singh, A., Chakrabarty, M., Singh, S. et al. Menstrual hygiene practices among adolescent
women in rural India: a cross-sectional study. BMC Public Health 22, 2126 (2022). https://
doi.org/10.1186/s12889-022-14622-7
3. Methods
- The participants which included in this study that may hold potential bias because they were
predominantly from medium to highly educational or cultural backgrounds. The author did not
include women from diverse socio-economic, educational, and ethnic backgrounds to capture a
broader spectrum of informational needs, why?
- the manuscript throughout maintained confidentiality of the participants, but does not discuss
how cultural sensitivities were managed during focus group discussions. Elaborate on strategies
to ensure comfort and openness among participants, especially when discussing stigmatized
topics.
- The inclusion of personal experiences in informational resources received mixed feedback,
which was significantly valuable to some readers, while others expressed concerns about
reliability. Clarify how personal stories can be balanced with evidence-based information to
enhance the credibility of resources.
4.  Results
- The study was based on the women who lived in the Netherlands, and some of the respondents
reported they were born in another country or unknown region. Should it be relevant for the
study? What significance triggered the inclusion of them in this present study?
- The recommendation for a centralized online platform may not address accessibility issues for
the women with low digital literacy or limited internet access. Did the authors have any data or
explanation on receiving any alternative modes of information dissemination by the participants,
such as physical kits or workshops in schools and communities?
5.  Discussion
- The study emphasizes re-evaluating school education but provides limited specifics on what a
comprehensive curriculum should entail, need to discuss on school-based menstrual education,
including age-appropriate content and interactive teaching methods.
- The influence of cultural background was briefly mentioned, there is no in-depth exploration
of how cultural norms shape menstrual literacy. Include a separate section to analyze cultural
differences in informational needs and stigma.
- The study mentioned that the need to recognize abnormal symptoms but does not extensively
discuss specific disorders like PCOS or endometriosis. Authors may focus more on discussing
these disorders, as understanding their symptoms is critical for menstrual literacy.
- While clinicians are advised to consider patients’ limited menstrual literacy, practical steps for
healthcare providers to address these gaps are missing. Include a separate section with actionable
recommendations for clinicians to integrate menstrual health discussions into routine care.
- policy suggestions are very weak and need to be strengthened.
- The citation throughout the manuscripts is not uniformly placed, need to be checked.
6. Conclusion
-  the conclusion section needs to be sharpened and strengthened.