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Buitrago-García T, Sawadogo NH, Souares A, Koulidiati JL, Sié A, Bärnighausen T, Langlotz S, McMahon SA. Female-friendly toilets in schools in Burkina Faso: A mixed-methods study using photo-elicitation. J Glob Health 2022; 12:04057. [PMID: 36073661 PMCID: PMC9454237 DOI: 10.7189/jogh.12.04057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background An absence of gender-sensitive sanitation facilities in schools and the negative effects this has on girls has been widely discussed among advocacy groups, though less examined in academic spheres. Drawing on triangulated data, we outline current challenges and respondent-driven solutions to enhance the female-friendly nature of toilets in a context of extreme poverty. Methods This mixed-methods study was informed by the tenets of human-centred design. We first quantitatively assessed facilities in 14 secondary schools in the Kossi Province of Burkina Faso. We then collected qualitative data, including 15 focus group discussions and 53 in-depth interviews among schoolgirls, mothers, teachers and key informants. We applied photo-elicitation, a novel method, to explore perceptions of facilities and the desirability and feasibility of interventions to improve gender-friendly sanitation facilities. Results No school met international water, sanitation and hygiene (WASH) standards for schools. Roughly one third of schools did not have water and, when present, there was no reliable way to use it within the toilet complex. Schoolgirls shared feelings of shame and stress when menstruating at school, and said that they would avoid using school toilets, if possible. Schoolgirls described water access as the most urgent need to address, followed by fostering privacy and facilitating cleanliness within facilities. Mothers and teachers mostly aligned with these priorities, while key informants additionally emphasised the need to raise awareness on both general and menstrual hygiene and to develop maintenance systems. Photo-elicitation engaged and empowered participants to pinpoint priorities and concrete solutions, namely a need for doors and locks, water containers and cleaning materials. Conclusions WASH needs in many schools remain unmet. Women and girls should be involved in decision-making across stages of intervention design and implementation. Young women's voices merit greater inclusion in academic literature. Future interventions should enhance access to water and privacy. Future research could explore maintenance and monitoring strategies to develop guidance on sustainable solutions.
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Affiliation(s)
- Teresa Buitrago-García
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- La Paz University Hospital, Madrid, Spain
| | | | - Aurélia Souares
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Jean-Louis Koulidiati
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Ali Sié
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Nouna Health Research Centre, Nouna, Burkina Faso
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Africa Health Research Institute, Nelson R. Mandela Medical School, Umbilo, Durban, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sarah Langlotz
- Chair of Development Economics (Prof. Fuchs), Georg-August-Universität Göttingen, Göttingen, Germany
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Baird S, Hamory J, Gezahegne K, Pincock K, Woldehanna T, Yadete W, Jones N. Improving Menstrual Health Literacy Through Life-Skills Programming in Rural Ethiopia. Front Glob Womens Health 2022; 3:838961. [PMID: 35873135 PMCID: PMC9304804 DOI: 10.3389/fgwh.2022.838961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 06/09/2022] [Indexed: 11/14/2022] Open
Abstract
Despite its cultural and biological importance, limited knowledge about menstruation and cultural taboos in many contexts mean that menarche often brings fear and stigma. In Ethiopia, the context of this paper, lack of knowledge and the stigma around menstruation create challenges for adolescent girls related to menstrual hygiene management and their reproductive health more broadly. This paper uses a cluster-randomized controlled trial (cRCT), with 97 communities (kebeles) randomly assigned to treatment or control, to assess the impact of a gender-transformative life-skills intervention [Act With Her-Ethiopia (AWH-E)] on the menstrual health literacy of very young adolescent girls and boys (10–14) in two diverse regions of Ethiopia (South Gondar, Amhara and East Hararghe, Oromia). The evaluation employs a longitudinal mixed-methods design, with baseline data collected in late 2017/early 2018 and follow-up data collected in late 2019/early 2020. Quantitative surveys were undertaken with 2,492 very young adolescents and their primary caregivers, and complemented by qualitative interviews with 291 adolescents and their caregivers, as well as 96 key informants at community and district levels. Our quantitative findings highlight large and statistically significant improvements on norms around menstruation, knowledge about menstruation and biological function, and knowledge and behavior related to menstrual hygiene management, but with important differences by location and gender. Qualitative findings further unpack these gender and regional differences, highlighting the importance of adapting programming to the local context and, where possible, connecting to other health and gender initiatives. This analysis helps fill the evidence gap on “what works” to improve menstrual health literacy in rural low- and middle-income contexts.
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Affiliation(s)
- Sarah Baird
- Department of Global Health, George Washington University, Washington, DC, United States
- *Correspondence: Sarah Baird
| | - Joan Hamory
- Department of Economics, University of Oklahoma, Norman, OK, United States
| | - Kiya Gezahegne
- Department of Social Anthropology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kate Pincock
- Gender and Adolescence: Global Evidence (GAGE), ODI, London, United Kingdom
| | - Tassew Woldehanna
- Department of Economics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workneh Yadete
- Gender and Adolescence: Global Evidence (GAGE), Quest Consulting, Addis Ababa, Ethiopia
| | - Nicola Jones
- Gender and Adolescence: Global Evidence (GAGE), ODI, London, United Kingdom
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Chai N, Mao C. Population management in an urban center using the dynamic integrated solution for an adequate atmospheric environmental quality. ENVIRONMENTAL RESEARCH 2022; 205:112482. [PMID: 34871597 DOI: 10.1016/j.envres.2021.112482] [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: 05/15/2021] [Revised: 10/26/2021] [Accepted: 11/30/2021] [Indexed: 06/13/2023]
Abstract
Accelerated growth in urban populations has become a powerful force for human development, particularly in developed countries. Metropolitan cities are centers for technical and economic advancement, but air pollution, overflowing of water, and other climate effects still pose significant problems related to nature, climate, and the environment. Cities are vulnerable to increasingly dense, diverse, and interdependent urban systems. A single extreme occurrence can contribute to a systemic break-up of a city's infrastructure, often like dominoes. In this paper, a dynamic integration-assisted population management solution (DI-PMS) has been proposed. DI-PMS recognizes that the latest facilities' optimal usage of knowledge and technologies is needed to increase urbanization. They are one of the critical priorities of the weather community. Such integrated urban weather, environmental, and climate services will help cities address dangers including storms, floods, heatwaves, and air pollution, especially in climate change. The goal is to create urban facilities that satisfy communities' unique needs by high-resolution forecasting and pollution reduction climate services, which allow the construction of durable, robust, and thriving cities that support the Sustainable Development Goals. Several recent international surveys to explore these topics have been undertaken. DI-PMS gives a brief description of urban hydrometeorological, climate and air pollution activities, outlines the new urban integrated weather and environmental services concept, and emphasizes the need for science to be implemented.
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Affiliation(s)
- Ning Chai
- School of Public Administration and Human Geography, Hunan University of Technology and Business, Changsha, 410205, China; School of Architecture and Art Design, Hunan University of Science and Technology, XiangTan, 411201, China.
| | - Chun Mao
- Cultural Centre, University of Malaya, Kuala Lumpur, 50603, Malaysia; School of Architecture and Art Design, Hunan University of Science and Technology, XiangTan, 411201, China.
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Hennegan J, Bukenya JN, Makumbi FE, Nakamya P, Exum NG, Schwab KJ, Kibira SPS. Menstrual health challenges in the workplace and consequences for women's work and wellbeing: A cross-sectional survey in Mukono, Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000589. [PMID: 36962362 PMCID: PMC10021399 DOI: 10.1371/journal.pgph.0000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/16/2022] [Indexed: 11/18/2022]
Abstract
This study describes women's menstrual health needs at work in Uganda and explores the associations between unmet needs and women's work and wellbeing. We undertook a cross-sectional survey of women working in marketplaces, public primary schools, and health care facilities in Mukono district, central Uganda. Survey questions were designed to capture women's experiences of managing menstrual bleeding, pain, social support, and the social environment. A total 435 women working in markets, 45 teachers and 45 health care facility workers participated. Of these, 15% missed work due to their last period, and 41% would prefer not to work during menstruation. Unmet menstrual health needs were associated with consequences for women's work and psychological wellbeing. Experiencing menstrual pain (aPR 3.65 95%CI 1.48-9.00), along with the use of improvised menstrual materials (aPR 1.41 95%CI 1.08-1.83), not feeling comfortable to discuss menstruation at work (aPR 1.54 95%CI 1.01-2.34) and the expectation that women should stay home when menstruating (aPR 2.44 95%CI 1.30-4.60) were associated with absenteeism due to menstruation. In contrast, not having menstrual management needs met (aPR 1.45 95%CI 1.17-1.79) and the attitude that menstruating women are dirty (aPR 1.94 95%CI 1.50-2.51), along with pain (aPR 1.59 95%CI 1.12-2.24) and norms around absenteeism were associated with wanting to miss work. After adjustment for age and poverty, unmet menstrual management needs (b = -5.97, 95%CI -8.89, -2.97), pain (b = -3.89, 95%CI -7.71, -0.08) and poor social support (b = -5.40, 95%CI -9.22, -1.57) were associated with lower wellbeing measured using the WHO-5. Attitudes that menstruation should be kept secret (b = 4.48, 95%CI 0.79, 8.17) and is dirty (b = 4.59, 95%CI 0.79, 8.40) were associated with higher wellbeing. Findings suggest that supporting care for menstrual pain, addressing secrecy surrounding menstruation and the perception of menstruation as dirty, and improving access to materials and facilities for managing menstrual bleeding are avenues for programs and policies to support working women.
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Affiliation(s)
- Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Environmental Health and Engineering, The Water Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Justine N Bukenya
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fredrick E Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Petranilla Nakamya
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Natalie G Exum
- Department of Environmental Health and Engineering, The Water Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Kellogg J Schwab
- Department of Environmental Health and Engineering, The Water Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Hennegan J, OlaOlorun FM, Oumarou S, Alzouma S, Guiella G, Omoluabi E, Schwab KJ. School and work absenteeism due to menstruation in three West African countries: findings from PMA2020 surveys. Sex Reprod Health Matters 2021; 29:1915940. [PMID: 33969811 PMCID: PMC8118433 DOI: 10.1080/26410397.2021.1915940] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Reports of school and work absences due to unmet menstrual needs have prompted increased attention to menstruation in policy and practice. However, there appear to be few quantitative studies reported in published literature capturing the prevalence of this hypothesised absenteeism. This study undertook secondary analysis of nationally representative Performance Monitoring and Accountability 2020 (PMA2020) data from Burkina Faso and Nigeria, and city-representative data from Niamey, Niger to determine the extent of women’s and girls’ self-reported absence from school and work due to menstruation. Among women and adolescent girls aged 15–49 years who had worked outside the household in the past month in Burkina Faso (n = 998), Niger (n = 212) and Nigeria (n = 3638), 19%, 11% and 17%, respectively, reported missing work due to menstruation. Among those aged 15–24 years who attended school in the past year in Burkina Faso (n = 461), Niger (n = 213) and Nigeria (n = 1574), 17%, 15% and 23% reported missing school in the past year due to menstruation. Findings support the assertion that menstruation is a source of absenteeism in West Africa and indicate that greater attention from research, practice, and policy is needed. In presenting this data we also reflect critically on the performance of questions regarding menstrual-related absenteeism in national monitoring surveys. Future monitoring efforts should consider the interpretability of similar survey data when many respondents did not attend any school or work and were ineligible to answer questions regarding absenteeism. Further, without additional research identifying the reasons for absenteeism, findings from similar survey questions may be difficult to interpret with relevance for policy decision making.
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Affiliation(s)
- Julie Hennegan
- Research Associate, The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Correspondence:
| | - Funmilola M OlaOlorun
- Senior Lecturer, Department of Community Medicine, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Sani Oumarou
- Statisticien Démographe, Conseiller du Directeur Général, l'Institut National de la Statistique du Niger, Niamey, Niger
| | - Souleymane Alzouma
- Ingénieur Statisticien Economiste, Directeur des Enquêtes et des Recensements, l'Institut National de la Statistique du Niger, Niamey, Niger
| | - Georges Guiella
- Lecturer, Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Elizabeth Omoluabi
- Senior Lecturer, Department of Statistics, University of the Western Cape, Cape Town, South Africa
| | - Kellogg J Schwab
- Professor, The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ratcliffe HL, Bell G, Awoonor-Williams K, Bitton A, Kim JH, Lipstiz S, Macarayan E, Ofosu A, Otupiri E, Schwarz D, Hirschhorn LR. Towards patient-centred care in Ghana: health system responsiveness, self-rated health and experiential quality in a nationally representative survey. BMJ Open Qual 2021; 9:bmjoq-2019-000886. [PMID: 32404309 PMCID: PMC7228562 DOI: 10.1136/bmjoq-2019-000886] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/07/2020] [Accepted: 04/18/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Person-centredness, including patient experience and satisfaction, is a foundational element of quality of care. Evidence indicates that poor experience and satisfaction are drivers of underutilisation of healthcare services, which in turn is a major driver of avoidable mortality. However, there is limited information about patient experience of care at the population level, particularly in low-income and middle-income countries. Methods A multistage cluster sample design was used to obtain a nationally representative sample of women of reproductive age in Ghana. Women were interviewed in their homes regarding their demographic characteristics, recent care-seeking characteristics, satisfaction with care, patient-reported outcomes, and—using questions from the World Health Survey Responsiveness Module—the seven domains of responsiveness of outpatient care to assess patient experience. Using Poisson regression with log link, we assessed the relationship between responsiveness and satisfaction, as well as patient-reported outcomes. Results Women who reported more responsive care were more likely to be more educated, have good access to care and have received care at a private facility. Controlling for respondent and visit characteristics, women who reported the highest responsiveness levels were significantly more likely to report that care was excellent at meeting their needs (prevalence ratio (PR)=13.0), excellent quality of care (PR=20.8), being very likely to recommend the facility to others (PR=1.4), excellent self-rated health (PR=4.0) and excellent self-rated mental health (PR=5.1) as women who reported the lowest responsiveness levels. Discussion These findings support the emerging global consensus that responsiveness and patient experience of care are not luxuries but essential components of high-performing health systems, and highlight the need for more nuanced and systematic measurement of these areas to inform priority setting and improvement efforts.
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Affiliation(s)
- Hannah L Ratcliffe
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Griffith Bell
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Koku Awoonor-Williams
- Division of Policy, Planning, Monitoring and Evaluation, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.,Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - June-Ho Kim
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.,Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stuart Lipstiz
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.,Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Erlyn Macarayan
- Harvard Global Health Institute, Harvard University T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
| | | | - Easmon Otupiri
- Department of Population, Family and Reproductive Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Dan Schwarz
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.,Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lisa R Hirschhorn
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.,Department of Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low- and Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052571. [PMID: 33806590 PMCID: PMC7967348 DOI: 10.3390/ijerph18052571] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 02/05/2023]
Abstract
Menstrual hygiene management and health is increasingly gaining policy importance in a bid to promote dignity, gender equality and reproductive health. Effective and adequate menstrual hygiene management requires women and girls to have access to their menstrual health materials and products of choice, but also extends into having private, clean and safe spaces for using these materials. The paper provides empirical evidence of the inequality in menstrual hygiene management in Kinshasa (DRC), Ethiopia, Ghana, Kenya, Rajasthan (India), Indonesia, Nigeria and Uganda using concentration indices and decomposition methods. There is consistent evidence of wealth-related inequality in the conditions of menstrual hygiene management spaces as well as access to sanitary pads across all countries. Wealth, education, the rural-urban divide and infrastructural limitations of the household are major contributors to these inequalities. While wealth is identified as one of the key drivers of unequal access to menstrual hygiene management, other socio-economic, environmental and household factors require urgent policy attention. This specifically includes the lack of safe MHM spaces which threaten the health and dignity of women and girls.
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Smith AD, Muli A, Schwab KJ, Hennegan J. National Monitoring for Menstrual Health and Hygiene: Is the Type of Menstrual Material Used Indicative of Needs Across 10 Countries? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2633. [PMID: 32290529 PMCID: PMC7215803 DOI: 10.3390/ijerph17082633] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/18/2022]
Abstract
Surveys monitoring population health and sanitation are increasingly seeking to monitor menstrual health. In the absence of established indicators, these surveys have most often collected data on the type of menstrual material used. This study investigated whether such data provides a useful indication of women's menstrual material needs being met. Using data from 12 national or state representative surveys from the Performance Monitoring and Accountability 2020 program, we compared self-reported menstrual material use against respondents' reported menstrual material needs (including needing clean materials, money, or access to a vendor). The use of menstrual pads did not indicate that menstrual material needs were met for many respondents. Of those exclusively using pads, a pooled 26.4% (95% Confidence Interval 17.1-38.5) of respondents reported that they had unmet material needs. More disadvantaged groups were particularly misrepresented; of rural women exclusively using pads, a pooled 38.5% (95%CI 27.3-51.1) reported unmet material needs, compared to 17.1% (95%CI 12.4-23.0) of urban women. Similar disparities were observed for levels of education and wealth, with a pooled 45.9% (95%CI 29.2-63.6) of women in the lowest wealth quintile reporting unmet material needs. Findings suggest that caution is needed when using menstrual material use as an indicator for menstrual health.
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Affiliation(s)
- Annie D Smith
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - Kellogg J Schwab
- The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Julie Hennegan
- The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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9
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MacRae ER, Clasen T, Dasmohapatra M, Caruso BA. 'It's like a burden on the head': Redefining adequate menstrual hygiene management throughout women's varied life stages in Odisha, India. PLoS One 2019; 14:e0220114. [PMID: 31369595 PMCID: PMC6675075 DOI: 10.1371/journal.pone.0220114] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/21/2019] [Indexed: 11/29/2022] Open
Abstract
There has been growing recognition of menstrual hygiene management (MHM) as a significant public health issue. However, research has predominately focused on the experiences of adolescent girls in school settings. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India at various life stages with a view toward improving international monitoring of MHM. Focus group discussions and in-depth interviews were conducted to understand women’s experiences of menstruation across four life stages (unmarried women, recently married women, married women, and older women). Thematic analysis was used to identify menstruation-related challenges and needs. We found women voiced needs that aligned with those captured by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) definition for MHM: access to clean materials, privacy for changing materials, soap and water for bathing, and disposal facilities for materials. However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible. Additionally, we identified needs that extend beyond the existing definition: pain management, social support, and an enabling sociocultural environment. Overall, women representing all life stages discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials. Cloth management challenges were most acute for unmarried and recently married women, who were concerned that practices could reveal their menstrual status and harm their reputations, thus informing their preference for disposable materials, if attainable. We propose a revised definition of adequate MHM for this population that more comprehensively captures their needs. This definition may also prove useful for other populations, future research, creating measures of assessment, and guiding interventions and program priorities.
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Affiliation(s)
- Elizabeth R. MacRae
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Bethany A. Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Thapa S, Bhattarai S, Aro AR. 'Menstrual blood is bad and should be cleaned': A qualitative case study on traditional menstrual practices and contextual factors in the rural communities of far-western Nepal. SAGE Open Med 2019; 7:2050312119850400. [PMID: 31205696 PMCID: PMC6537045 DOI: 10.1177/2050312119850400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 04/23/2019] [Indexed: 12/14/2022] Open
Abstract
Objective: Unhealthy menstrual practices and the contexts surrounding them should be
explored and clearly understood; this information could be useful while
developing and implementing interventions to increase hygienic practices
during menstruation and consequently increase health and well-being of
women. Therefore, this study was conducted to explore traditional menstrual
practices and the contextual factors surrounding the practices in the rural
communities of far-western Nepal. Methods: This was a qualitative case study conducted in the Achham district of Nepal.
Semi-structured interviews were conducted among four women, three men and
two female community health volunteers to collect data and thematic analysis
was performed to analyze the data. Results: We found two commonly reported menstrual practices: seclusion practice
(Chhaupadi) and separation practice. In the Chhaupadi practice, women are
secluded to stay in a small shed away from the house and restricted to wash
or take a bath in public water sources for 5–7 days of the periods, whereas
in the separation practice, women can stay in the house, but they still have
several restrictions. The contextual factors that were reported to influence
the cultural practices are as follows: cultural beliefs that symbolize
menstruation as impure, menstrual stigma, poverty, illiteracy, the influence
of traditional healers and family members, and limited effect of Chhaupadi
elimination interventions. We also found that some development in the
reduction of cultural myths and practices is happening, but the rate of
change is rather slow. Conclusion: Most of the Nepalese women, especially in the rural areas of far-western
Nepal, are forced to follow the harmful menstrual practices because of the
socio-cultural context surrounding their lives. We believe the findings of
this study would be relevant in terms of developing and implementing further
menstrual health-related, community-based interventions that will be
responsive to the local cultural context, beliefs, and practices.
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Affiliation(s)
- Subash Thapa
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Shivani Bhattarai
- Department of Public Health, Nobel College, Pokhara University, Kathmandu, Nepal
| | - Arja R Aro
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
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