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Swe ZY, Mon NO, Than KK, Azzopardi PS, Kennedy EC, Davis J, Burns LJ, Hennegan J. Adolescent girls' experiences of menstruation and schooling in monastic schools in Magway Region, Myanmar: A mixed-methods exploration. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:893266. [PMID: 36303647 PMCID: PMC9580682 DOI: 10.3389/frph.2022.893266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background Despite increasing recognition that menstruation matters for adolescent girls' health and education, few studies have investigated menstrual health challenges and impacts in Myanmar. In this study we aimed to (1) understand the menstrual experiences of girls attending monastic schools in Magway Region, Myanmar and (2) explore the associations between their reported unmet menstrual health needs and school absenteeism. Methods We undertook a mixed-methods exploration across 16 Monastic schools in rural and semi-rural areas. In-depth interviews with 10 adolescent girls, 10 Focus-Group Discussions (FGDs) with girls, 10 FGDs with boys, 5 FGDs with mothers, along with 24 key-informant interviews were analyzed using a framework approach to explore girls' menstrual experiences and challenges in school settings. A cross-sectional survey of 421 post menarche girls (mean-age-14 years) was used to describe the prevalence of menstrual health challenges and test associations with self-reported school absenteeism. Results Girls described a range of menstrual health challenges including access to information and social support, behavioral restrictions, stigma surrounding menstruation, difficulties managing menstrual bleeding and pain. Girls also described fear and distress associated with menstruation and impacts on school attendance and participation. Of girls surveyed, 12.8% had missed school due to their last period. In multivariable analysis, grade level (aOR = 0.76 95%CI 0.60–0.97), menstrual pain (aOR = 2.10 95%CI 1.10–4.00), and heavy bleeding (aOR = 3.33 95%CI 1.51–7.34) were associated with absenteeism. Knowledge about menstrual biology was not related to absenteeism, but a more negative attitude toward menstruation may have predicted greater absences (aOR 1.34 95%CI 0.99–1.80). Confidence to talk to friends or teachers about menstruation was not associated with absenteeism, nor was using a disposable-pad or feeling confident to manage menses at school. However, feeling confident to ask a teacher for a pad was associated with greater absenteeism and may have indicated that girls more regularly needing to request products had lower attendance (aOR = 1.93 95%CI 1.06–3.54). Conclusions Adolescent girls in Magway face substantial challenges during menstruation, adversely impacting on their education and wellbeing. Providing age-appropriate education and addressing shame and taboos are important components of a comprehensive menstrual health response. In addition, our study highlights the need to ensure access to menstrual resources and WASH facilities, along with access to adequate menstrual pain relief.
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Affiliation(s)
- Zay Yar Swe
- Myanmar Country Program, International Development Discipline, Burnet Institute, Yangon, Myanmar
- *Correspondence: Zay Yar Swe
| | - Nwe Oo Mon
- University of Maryland School of Public Health, College Park, MD, United States
| | - Kyu Kyu Than
- Myanmar Country Program, International Development Discipline, Burnet Institute, Yangon, Myanmar
| | - Peter S. Azzopardi
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Adolescent Health and Wellbeing Program, Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Department of Paediatrics, School of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Elissa C. Kennedy
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jessica Davis
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Independent Consultant, Melbourne, VIC, Australia
| | - Lia J. Burns
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- ChildFund Vietnam, Hanoi, Vietnam
| | - Julie Hennegan
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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