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Bhoda K, Burgoa S, Zerrouki Y, Jhumkhawala V, Lobaina D, Knecht M, Kitsantas P, Sacca L. Examining Menstrual Health and Hygiene Educational Initiatives for American Middle and High School Menstruating Students: A Scoping Review. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00233-X. [PMID: 38897447 DOI: 10.1016/j.jpag.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/26/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
According to the American Medical Women's Association, period poverty refers to "inadequate access to menstrual hygiene tools and education, including but not limited to sanitary products, washing facilities, and waste management." A component of period poverty in the US can be attributed to the neglect of menstrual education and lack of menstrual health and hygiene tools in schools. This scoping review aims to examine the educational methods employed to improve menstrual knowledge in middle and high school menstruating students in both school and clinical settings. It also highlights gaps and barriers in equitable access to menstrual hygiene products. The five-stage framework by Arksey and O'Malley (2005) and the updated Joanna Briggs Institute (JBI) guide were used to guide the review. Six studies were retained for analysis. Two-thirds of menstruating students reported using at least one of the school's resources to obtain period products, and one-third of the participants reported missing school due to a lack of period products. Nearly half of the students needed period products at least once in the past school year but lacked the financial resources to purchase such products. Menstruating students reported embarrassment and a need for secrecy when accessing school bathrooms since the social and physical environments of school bathrooms heightened their discomfort while menstruating. Although a majority of adolescent students had basic knowledge of menstrual periods prior to menarche, the depth of their understanding of menstruation was limited. Findings from this review can inform the future development of evidence-based educational interventions to improve the overall menstruation experience for US menstruating adolescents.
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Affiliation(s)
- Keerthi Bhoda
- Department of Biosciences, Rice University, Houston, Texas
| | - Sara Burgoa
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Yasmine Zerrouki
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Vama Jhumkhawala
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Diana Lobaina
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Michelle Knecht
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Panagiota Kitsantas
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Lea Sacca
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida.
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Potter K, Beal-Stahl J. A pharmacist's role in increasing access to menstrual products: an education and advocacy approach. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1364698. [PMID: 38827820 PMCID: PMC11140102 DOI: 10.3389/frph.2024.1364698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/01/2024] [Indexed: 06/05/2024] Open
Abstract
Individuals who menstruate grapple with diverse challenges in menstrual and reproductive health. This includes financial burdens, societal stigmas, and negative mental and physical health implications. Period poverty, marked by insufficient access to menstrual products, education, and sanitation, remains a prevalent and poorly addressed issue. Alarming statistics highlight the extent of this problem and shed light on the staggering number of individuals lacking access to essential menstrual products. The discourse extends to the safety and accessibility of a diverse array of menstrual products. A comprehensive comparison of the cost of available period products was conducted using data obtained from various retail websites. The often-overlooked potential indirect expenses and profound impacts on quality of life were also discussed. Amidst other public health initiatives, pharmacists have emerged as pivotal advocates and educators. Pharmacists are poised to drive initiatives that increase access to menstrual products through public health education and advocacy. By providing education on different menstrual product options, pharmacists can empower individuals to make informed decisions based on their needs. This perspective illuminates the complex impacts of menstruation on individuals and proposes that pharmacists can play a role in overcoming barriers to access. The proposed strategies, rooted in education, research, and advocacy, pave the way for enhancing access, reducing stigma, and elevating the quality of life for those navigating the intricate complexities of menstruation.
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Affiliation(s)
- Kristal Potter
- Department of Clinical and Administrative Sciences, Larkin University College of Pharmacy, Miami, FL, United States
| | - Jessica Beal-Stahl
- Department of Clinical Research, Sports Pharmacy Network, Naples, FL, United States
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Miller TA, Farley M, Reji J, Obeidi Y, Kelley V, Herbert M. Understanding period poverty and stigma: Highlighting the need for improved public health initiatives and provider awareness. J Am Pharm Assoc (2003) 2024; 64:218-221. [PMID: 37863396 DOI: 10.1016/j.japh.2023.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/02/2023] [Accepted: 10/15/2023] [Indexed: 10/22/2023]
Abstract
Period poverty affects millions of people who menstruate, but there is limited research to fully understand the scope and impact. Societal stigmas and cultural taboos negatively affect menstruation, a natural, biologic process. When unable to afford or find appropriate menstrual products, individuals may resort to alternative, poorer quality items, which increase their risk of infections. In addition, lack of products may cause individuals to miss events and have negative emotions. Implicit sexism and gender inequality are notable through the high cost of essential period products. Uncomfortable environments prevent patients from openly discussing menstruation with health care providers, who may lack training to competently assess needs and address barriers. Period poverty is a public health issue that not only needs to be addressed by our health care providers but also through increased education in schools and changes in local and federal legislation. In this paper, we discuss the financial, physical, and mental health impacts of period poverty and describe our experience creating a period pantry at a free medical clinic.
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Raney EC. Menstrual health matters. Period. J Am Pharm Assoc (2003) 2024; 64:222-225. [PMID: 37940100 DOI: 10.1016/j.japh.2023.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
Menstrual health is composed of physical and psychosocial factors and fundamental to the well-being of menstruating individuals. Clinicians are urged to assess markers of menstruation as a vital sign, informing potential current and future health risks. Period poverty, or lack of access to menstrual hygiene products, sanitation, and clinical support, is a concern worldwide, particularly for vulnerable populations. As global health authorities and professional medical associations call for menstrual health as a priority, pharmacists are well-positioned to contribute solutions through access, education, advocacy, and research.
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Tapp K, Henson A. "For men, by men": Menstrual victimization and the weaponization of period products in carceral settings. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241240931. [PMID: 38554068 PMCID: PMC10981853 DOI: 10.1177/17455057241240931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/20/2024] [Accepted: 03/01/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND The literature on menstruation defines period poverty as the inability to access sufficient period products, education, and sanitary facilities needed to manage menstruation healthily and effectively. While research has identified shortcomings of healthcare in the carceral setting, period poverty behind bars has remained largely absent from criminal legal discourse. OBJECTIVES The current study examines the interplay of period poverty and carceral control to introduce the novel concept of menstrual victimization, defined as the physical, emotional, and financial victimization that results from period poverty perpetuated through carceral control. METHODS The study uses qualitative content analysis to systematically gather and code journalistic accounts pertaining to the menstrual experiences of incarcerated and previously incarcerated females, criminal justice practitioners, and journalists. The analysis uses literary pieces (n = 99), which were coded deductively and guided by concepts related to structural violence and radical feminist criminology. RESULTS The findings shed light on the unique structural harms incarcerated menstruators face and reveal the dearth of needed empirical research on period poverty in carceral spaces. The narratives in the sample revealed how manufactured scarcity of period products within carceral spaces is used as a means of oppression by institutional agents. The emergent themes highlight how the intersection of period poverty and carceral control led to menstrual victimization characterized through shame, humiliation, control, and coercion. CONCLUSION Potential outcomes associated with understanding menstrual victimization in the carceral setting are discussed, including reducing menstrual stigma, disseminating health education, minimizing health disparities, and ultimately, shifting modes of holding accountability away from oppressive, retributive, and controlling tactics.
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Affiliation(s)
- Kathryn Tapp
- School of Criminology and Criminal Justice, Arizona State University, Phoenix, AZ, USA
| | - Abigail Henson
- School of Criminology and Criminal Justice, Arizona State University, Phoenix, AZ, USA
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Suleman A, Krishna S, Krishnakumar D, Nemoto K, Nguyễn MLT, Mehta SD. A pilot survey of students' menstrual attitudes, experiences, and needs on an urban university campus. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241254713. [PMID: 38819035 PMCID: PMC11143816 DOI: 10.1177/17455057241254713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/19/2024] [Accepted: 04/24/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND In the United States, many menstruators face barriers to period management, such as period poverty, or the lack of access to relevant knowledge and affordable menstrual products. Our current understanding of the social, emotional, and physical impacts of period poverty on students in post-secondary institutions is largely limited. OBJECTIVES The purpose of this pilot study is to assess period poverty, period-related class disruption, and avoidance of menstrual hygiene management on campus among students and to identify recommendations for action at the University of Illinois Chicago and other urban universities. DESIGN An online cross-sectional study from February to May 2023. METHODS Enrolled students who were at least 18 years old completed an anonymous, self-administered online survey. Through descriptive statistics and chi-square tests in SAS version 9.4, we analyzed the sociodemographic, academic, and menstrual characteristics of those who had a period in the past 12 months. We also performed a thematic analysis of students' open-ended responses regarding their menstrual experiences on campus. RESULTS Of our sample (N = 106), 17.1% of students have faced period poverty, 55.8% experienced period-related class disruption, and 47.5% avoided changing their menstrual products on campus. The relationships between the three menstrual experiences were statistically significant. In the open responses, students reported that their personal experiences with menstruation were largely painful and disruptive. We identified the following themes: (1) inadequate water, sanitation, and hygiene facilities; (2) understocked, empty, or non-existent menstrual product dispensers; (3) a desire for additional resources for menstruation; and (4) the unpredictability of menstruation. CONCLUSION Our findings indicate that students continue to face obstacles to menstruation management due to inadequate support related to menstrual infrastructure, products, and pain. We outline several recommendations for university/college institutions to prioritize a more inclusive and supportive educational environment for all students.
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Affiliation(s)
- Abigail Suleman
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Shruthi Krishna
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Divya Krishnakumar
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Kai Nemoto
- College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - My Lê Thảo Nguyễn
- College of Liberal Arts and Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Supriya D Mehta
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
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Davies S, Darien K, Bazyar F, Biddle J, Brown B, Christman C, Saurman M, Wood S, Thomas D, Dowshen N. A Multimodal Qualitative Approach to Understanding Menstrual Health Equity among Adolescents and Young Adults. J Pediatr Adolesc Gynecol 2023; 36:511-517. [PMID: 37543239 DOI: 10.1016/j.jpag.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023]
Abstract
STUDY OBJECTIVE Menstrual inequity-unequal access to menstrual health care or products-negatively affects well-being in relation to the menstrual cycle, a construct known as menstrual health. Few studies have explored menstrual inequities among adolescent and young adult populations in the United States. This multimodal qualitative research aimed to explore factors that influence the lived experience of menstruation among this population. METHODS This qualitative study consisted of individual interviews among menstruators ages 13-24, recruited from an urban academic medical center. Participants (N = 20) were a mean age of 19 years; 25% previously endorsed period poverty, and 90% were publicly insured. We conducted semi-structured interviews using participant video diaries in a video elicitation exercise. Data were coded by 2 investigators using thematic analysis driven by grounded theory. RESULTS Emergent themes included the need to normalize menstruation, the need for comprehensive menstrual health education, and the need for menstrual products to be more accessible. Twelve youth prepared video diaries, and all reported positive experiences with the video process. CONCLUSIONS This youth-centered, multimodal study is one of the first to qualitatively explore the lived experiences of menstruation among adolescents in the United States and identified key inequities in menstrual health from their own perspectives. Thematic findings were mapped onto a proposed framework for menstrual equity that can be applied to future research and efforts around policy change. More research is needed to assess the impacts of these policies.
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Affiliation(s)
- Shelby Davies
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Kaja Darien
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Farnaz Bazyar
- Menstrual Health Equity Youth Advisory Board, Adolescent Specialty Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Janaya Biddle
- Menstrual Health Equity Youth Advisory Board, Adolescent Specialty Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bernice Brown
- Menstrual Health Equity Youth Advisory Board, Adolescent Specialty Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Colton Christman
- Menstrual Health Equity Youth Advisory Board, Adolescent Specialty Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maxwell Saurman
- Menstrual Health Equity Youth Advisory Board, Adolescent Specialty Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sarah Wood
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Nadia Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania
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Hassan S, Ghandour R, Bakri L, Shwiki S, Safi S, Abuzaid R, Zeidan H. Menstrual health and hygiene among young Palestinian female university students in the West Bank: a cross-sectional study. BMJ Open 2023; 13:e069222. [PMID: 36997246 PMCID: PMC10069603 DOI: 10.1136/bmjopen-2022-069222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE We investigated some aspects of menstrual health and hygiene among young female students at Birzeit University in the West Bank of the occupied Palestinian territory. DESIGN Cross-sectional study in a large central university. PARTICIPANTS Out of a total of 8473 eligible female students, a calculated sample size of 400 students aged between 16 and 27 years was obtained.SettingLarge central university, West Bank, occupied Palestinian territory (oPt). MEASURES An anonymous structured international research instrument consisting of 39 questions based on the Menstrual Health Questionnaire, in addition to few questions relevant to the context, was administered. RESULTS 30.5% of participants were not informed about menstruation before menarche, and 65.3% reported that they were not ready when they got their first period. The highest reported source of information regarding menstruation was family (74.1%), followed by school (69.3%). About 66% of respondents reported that they need more information on various topics of menstruation. The most common type of menstrual hygiene products used were single-use pads (86%), followed by toilet paper (13%), nappies (10%) and reusable cloths (6%). Of the total 400 students, 14.5% reported that menstrual hygiene products are expensive, and 15.3% reported that they always/sometimes had to use menstrual products that they do not like because they are cheaper. Most (71.9%) of the respondents reported that they used menstrual products for longer time than recommended due to inadequate washing facilities at the university campus. CONCLUSIONS The findings provide useful evidence on the lack and the need for menstrual-related information for female university students, inadequate infrastructure to help them manage their menstruation with dignity and pointed to some menstrual poverty in accessing menstrual products. A national intervention programme is needed to increase awareness regarding menstrual health and hygiene among women in local communities and female teachers in schools and universities to enable them to disseminate information to and meet the practical needs of girls at home, at school and at the university.
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Affiliation(s)
- Sahar Hassan
- Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine, State of
| | - Rula Ghandour
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine, State of
| | - Lamia Bakri
- Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine, State of
| | - Siham Shwiki
- Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine, State of
| | - Sara Safi
- Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine, State of
| | - Reem Abuzaid
- Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine, State of
| | - Hiba Zeidan
- Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine, State of
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Hillard PJA. NASPAG ACRM Inspires Us Again, and Please Note Updated JPAG Author Instructions. J Pediatr Adolesc Gynecol 2022; 35:245-246. [PMID: 35623744 DOI: 10.1016/j.jpag.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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