Brazil's national menstrual health program-Progress, gaps, and pathways to equity: A concept note (PLATO WP1)

Brazil recently implemented a national menstrual health program within its public health system (Sistema Único de Saúde [SUS]), representing a significant policy shift toward recognizing menstrual dignity as a public health and human rights issue. The distribution of menstrual products has expanded rapidly; however, this alone is insufficient to address the structural inequalities affecting menstrual health. The aim of the present study was to analyze the implementation of the menstrual health program in Brazil, identify existing inequalities and operational barriers, and propose a research and data framework capable of strengthening monitoring, policymaking, and global collaboration. The study is part of the PLATO project (Work Package 1), integrating public health, gender equality, and implementation science. A narrative analysis was conducted using government and legal documents, demographic and WASH data, and international literature on menstrual equity. Despite strong legislation and intersectoral governance, substantial gaps remain in access, digital inclusion, infrastructure, and participation of marginalized groups. Brazil lacks standardized indicators, interoperable data systems, and monitoring strategies to assess real outcomes. A logic model and equity-centered research architecture are proposed to address these gaps by integrating product provision, WASH, data systems, community participation, and global integration. Brazil has made fundamental progress in menstrual health policy. However, achieving menstrual dignity requires moving beyond product distribution to integrated data collection, infrastructure, equity monitoring, and participatory governance. This framework offers a model applicable to Brazil and other low- and middle-income countries.