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Ndichu EG, Upadhyaya S. Exploring consumer vulnerability in the consumption of menstrual products: Insights from a developing country. Health Mark Q 2023; 40:396-414. [PMID: 37021624 DOI: 10.1080/07359683.2023.2193075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Consumer experiences in the consumption of menstrual products and the factors that underpin consumer vulnerability in the consumption process have largely been overlooked in marketing research. This research addresses this gap by examining consumer experiences of vulnerability in the consumption of menstrual products in a developing country context. Data from in-depth interviews and netnography reveals women's embodied experiences of vulnerability, with structural barriers, such as regulatory gaps and exclusionary marketing practices adversely affecting the women's physical and emotional well-being. Contributions to consumer vulnerability literature and implications for health marketing and policy are discussed.
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Affiliation(s)
- Edna G Ndichu
- School of Business, Whitworth University, Spokane, WA, USA
| | - Shikha Upadhyaya
- College of Business and Economics, California State University, Los Angeles, CA, USA
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Maulingin-Gumbaketi E, Larkins S, Whittaker M, Rembeck G, Gunnarsson R, Redman-MacLaren M. Socio-cultural implications for women's menstrual health in the Pacific Island Countries and Territories (PICTs): a scoping review. Reprod Health 2022; 19:128. [PMID: 35655221 PMCID: PMC9164467 DOI: 10.1186/s12978-022-01398-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, experiences of menarche and subsequent menstruation are embedded in social and cultural beliefs, norms and practices. Menarche is an important developmental milestone in sexual and reproductive health (SRH) for females. Menarche is intertwined with socio-cultural norms, beliefs and practices, which can impact on women's ability to manage menstruation with dignity. This paper reviews the social and cultural factors that affect women's ability to effectively manage their menstrual health and hygiene (MHH) in Pacific Island Countries and Territories (PICTs). METHODS A scoping review was conducted following PRISMA scoping review guidelines and inclusion/exclusion criteria. An online search was conducted for peer-reviewed publications in Medline/OVID; Medline/PubMED; PsycINFO; CINAHL; Scopus and JSTOR, and Google Scholar. A search for grey literature was conducted in Google Scholar and websites of international and local organizations. Experts in the field also contributed additional references. Extracted data were summarised in an Excel spreadsheet. Searches were conducted between May and June, 2019, and then repeated in July, 2020. RESULTS A total of 11 studies were included; 10 qualitative and one mixed methods study. Studies were conducted in Melanesian (n = 9), Polynesian (n = 1) and Micronesian (n = 1) PICTs. All 11 studies reported elements of societal and personal factors; ten studies reported evidence relating to interpersonal factors; nine studies reported elements relating to environmental factors; and two studies presented evidence linked to biological factors. Managing menstrual health with dignity is challenging for many women and girls because menstruation is associated with menstrual taboos and shame. CONCLUSION This review found that the MHH experiences of women in PICTs are affected by social and cultural beliefs, norms and practices. Beliefs, norms and practices about menarche need to be incorporated in SRH planning, programs and education in order to be relevant to diverse village and urban settings.
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Affiliation(s)
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Maxine Whittaker
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Gun Rembeck
- Research, Education, Development & Innovation, Primary Health Care, Alsvsborg Region, Västra Götaland, Sweden
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Regionhälsan Borås Youth Health Center, Vastra Gotaland, Sweden
| | - Ronny Gunnarsson
- Research, Education, Development & Innovation, Primary Health Care, Alsvsborg Region, Västra Götaland, Sweden
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Primary Health Care Clinic for Homeless People, Närhälsan, the Västra Götaland Region, Göteborg, Sweden
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Secor-Turner M, Huseth-Zosel A, Ostlund R. Menstruation Experiences of Middle and High School Students in the Midwest: A Pilot Study. J Sch Nurs 2020; 38:504-510. [PMID: 33207994 DOI: 10.1177/1059840520974234] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this pilot study was to expand understanding of the experience of menstruation for girls in the United States and its impact in the school setting. A qualitative approach was used to gather data from focus group interviews. Descriptive content analysis was used to categorize the range and types of menstruation experiences described by 12 participants aged 12-16 years. Findings revealed four main themes: (1) learning about menstruation, (2) experiencing menstruation, (3) managing menstruation, and (4) social norms and meaning of menstruation. Participants described multiple challenges faced learning about and experiencing menstruation, especially in the school setting. Participants described the limited understanding of menstruation experiences and confusion about the use of menstrual hygiene products. Challenges experienced at school included not having adequate access to menstrual hygiene products, limited time for changing products, fear of leaking menstrual blood, and impacts on school attendance. School nurses are well-positioned to contribute to creating school environments that are supportive of menstruation.
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Affiliation(s)
| | | | - Rachel Ostlund
- School of Nursing, North Dakota State University, Fargo, ND, USA
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Crankshaw TL, Strauss M, Gumede B. Menstrual health management and schooling experience amongst female learners in Gauteng, South Africa: a mixed method study. Reprod Health 2020; 17:48. [PMID: 32293481 PMCID: PMC7158143 DOI: 10.1186/s12978-020-0896-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
Background There has been increased attention to the menstrual health management (MHM) needs of girls and young women in Eastern and Southern Africa, relating to dignity, and to the potential link between the lack of access to sanitary products and school absenteeism. In the South Africa, there is inadequate evidence to guide appropriate national responses. This study explored the extent of access to modern sanitary products amongst female high school learners and the range of needs and challenges that they face in managing their menses in school settings in Gauteng, South Africa. Methods We collected mixed method data from 10 schools in Sedibeng district between June and August 2018. The qualitative component consisted of in-depth interviews with female learners (n = 30), educators (n = 8) and mothers of female learners (n = 9) and focus group discussions (FGDs) with male learners (n = 7) and female learners (n = 10). Five hundred and five female learners were recruited into the quantitative component consisting of a self-administered survey focussing on factors associated with access to sanitary products. Results The median age of survey participants was 17 years (interquartile range 16–18 years) and average age at menarche was 13.36 years. One in seven female learners reported not having enough sanitary products for every period in the last 3 months and this was reflected across the school quintiles. There was a complex interaction between menstrual-related challenges (physical discomfort, teasing, and feeling distracted in class) experienced by female learners, often amplified or compounded by factors in the school environment (unhygienic sanitation facilities and inadequate rest areas), and schooling participation and attendance. Girls who did not have enough products for every period in the last 3 months more likely reported missing school than those who reported sufficient products (46.27% vs 22.49% respectively, p < 0.001). However, there was no statistically significant difference between the groups in number of days missed. Conclusions Provision of sanitary products is important but only one component of a comprehensive MHM response. Ongoing attention over the link between product access and absenteeism risks overlooking complex systemic and structural factors which can negatively impact the sexual and reproductive health of learners in the school context, and more broadly.
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Affiliation(s)
- Tamaryn L Crankshaw
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa.
| | - Michael Strauss
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
| | - Bongiwe Gumede
- Legal Resources Centre, P.O. Box 9495, Johannesburg, 2000, South Africa
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Hennegan J, Shannon AK, Rubli J, Schwab KJ, Melendez-Torres GJ. Women's and girls' experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PLoS Med 2019; 16:e1002803. [PMID: 31095568 PMCID: PMC6521998 DOI: 10.1371/journal.pmed.1002803] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/12/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Attention to women's and girls' menstrual needs is critical for global health and gender equality. The importance of this neglected experience has been elucidated by a growing body of qualitative research, which we systematically reviewed and synthesised. METHODS AND FINDINGS We undertook systematic searching to identify qualitative studies of women's and girls' experiences of menstruation in low- and middle-income countries (LMICs). Of 6,892 citations screened, 76 studies reported in 87 citations were included. Studies captured the experiences of over 6,000 participants from 35 countries. This included 45 studies from sub-Saharan Africa (with the greatest number of studies from Kenya [n = 7], Uganda [n = 6], and Ethiopia [n = 5]), 21 from South Asia (including India [n = 12] and Nepal [n = 5]), 8 from East Asia and the Pacific, 5 from Latin America and the Caribbean, 5 from the Middle East and North Africa, and 1 study from Europe and Central Asia. Through synthesis, we identified overarching themes and their relationships to develop a directional model of menstrual experience. This model maps distal and proximal antecedents of menstrual experience through to the impacts of this experience on health and well-being. The sociocultural context, including menstrual stigma and gender norms, influenced experiences by limiting knowledge about menstruation, limiting social support, and shaping internalised and externally enforced behavioural expectations. Resource limitations underlay inadequate physical infrastructure to support menstruation, as well as an economic environment restricting access to affordable menstrual materials. Menstrual experience included multiple themes: menstrual practices, perceptions of practices and environments, confidence, shame and distress, and containment of bleeding and odour. These components of experience were interlinked and contributed to negative impacts on women's and girls' lives. Impacts included harms to physical and psychological health as well as education and social engagement. Our review is limited by the available studies. Study quality was varied, with 18 studies rated as high, 35 medium, and 23 low trustworthiness. Sampling and analysis tended to be untrustworthy in lower-quality studies. Studies focused on the experiences of adolescent girls were most strongly represented, and we achieved early saturation for this group. Reflecting the focus of menstrual health research globally, there was an absence of studies focused on adult women and those from certain geographical areas. CONCLUSIONS Through synthesis of extant qualitative studies of menstrual experience, we highlight consistent challenges and developed an integrated model of menstrual experience. This model hypothesises directional pathways that could be tested by future studies and may serve as a framework for program and policy development by highlighting critical antecedents and pathways through which interventions could improve women's and girls' health and well-being. REVIEW PROTOCOL REGISTRATION The review protocol registration is PROSPERO: CRD42018089581.
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Affiliation(s)
- Julie Hennegan
- The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Alexandra K. Shannon
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Kellogg J. Schwab
- The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - G. J. Melendez-Torres
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
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Chinyama J, Chipungu J, Rudd C, Mwale M, Verstraete L, Sikamo C, Mutale W, Chilengi R, Sharma A. Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls. BMC Public Health 2019; 19:16. [PMID: 30611223 PMCID: PMC6321718 DOI: 10.1186/s12889-018-6360-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 12/21/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction While in school, girls require an environment that is supportive of menstrual hygiene management (MHM) in order to ensure regular school attendance and participation. Little is known about schoolgirls access to and practice of MHM in rural Zambia. This study explores girls’ experiences of MHM in rural schools of Zambia from the perspectives of schoolgirls, schoolboys and community and school-based adults key to MHM for schoolgirls. Methods In July and August 2015, we conducted this qualitative exploratory study in six rural schools of Mumbwa and Rufunsa districts of Zambia. Twelve in-depth interviews (IDIs) and six focus group discussions (FGDs) were conducted among girls ages 14–18 who had begun menstruating. Two FGDs with boys ages 14–18 and 25 key informant interviews were also conducted with teachers, female guardians and traditional leaders to provide the context within which schoolgirls practice MHM. Results Most girls reported learning about menstruation only at menarche and did not know the physiological basis of menstruation. They reported MHM-related challenges, including: use of non-absorbent and uncomfortable menstrual cloth and inadequate provision of sanitary materials, water, hygiene and sanitation facilities (WASH) in schools. In particular, toilets did not have soap and water or doors and locks for privacy and had a bad odor. Girls’ school attendance and participation in physical activities was compromised when menstruating due to fear of teasing (especially by boys) and embarrassment from menstrual leakage. Boys said they could tell when girls were menstruating by the smell and their behaviour, for instance, moving less and isolating themselves from their peers. Girls complained of friction burns on their inner thighs during their long journey to school due to chaffing of wet non-absorbent material used to make menstrual cloth. Girls preferred to dispose used menstrual materials in pit latrines and not waste bins for fear that they could be retrieved for witchcraft against them. Though traditional leaders and female guardians played a pivotal role in teaching girls MHM, they have not resolved challenges to MHM among schoolgirls. Conclusion When menstruating, schoolgirls in rural Zambia would rather stay home than be uncomfortable, inactive and embarrassed due to inadequate MHM facilities at school. A friendly and supportive MHM environment that provides education, absorbent sanitary materials and adequate WASH facilities is essential to providing equal opportunity for all girls. Electronic supplementary material The online version of this article (10.1186/s12889-018-6360-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joyce Chinyama
- Centre for Infectious Disease Research in Zambia, P.O Box 34681, Lusaka, Zambia.
| | - Jenala Chipungu
- Centre for Infectious Disease Research in Zambia, P.O Box 34681, Lusaka, Zambia
| | - Cheryl Rudd
- Centre for Infectious Disease Research in Zambia, P.O Box 34681, Lusaka, Zambia
| | - Mercy Mwale
- Centre for Infectious Disease Research in Zambia, P.O Box 34681, Lusaka, Zambia
| | | | - Charity Sikamo
- United Nations Children's Fund, P.O Box 33610, Lusaka, Zambia
| | - Wilbroad Mutale
- Department of Public Health, Section of Health promotion, School of Medicine, University of Zambia, P.O Box 50110, Lusaka, Zambia
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia, P.O Box 34681, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, P.O Box 34681, Lusaka, Zambia
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Mazokopakis EE, Samonis G. Is Vaginal Sexual Intercourse Permitted during Menstruation? A Biblical (Christian) and Medical Approach. MÆDICA 2018; 13:183-188. [PMID: 30568737 DOI: 10.26574/maedica.2018.13.3.183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
According to the Old Testament (Provisions for clean and unclean of the Mosaic Law), a woman during menstruation or a man who has sexual relations with a menstruating woman are perceived as "unclean". When seven days pass after the first day of menstruation, the woman is regarded as "clean" and sexual contact is permitted. The character of these Provisions, according to the New Testament and Fathers of the Christian Church, was mainly pedagogical and aimed at helping the Israelites to transcend from physical purity to purification of the soul and from the worship of stereotypes to spiritual worship. Moreover, sexual contact that occurred during menstruation was considered as prostitution. From a modern medical point of view, sexual intercourse during menstruation is normal and not perversion, but is associated, although remote, with undesirable pregnancy, the development of sexually transmitted diseases (STDs) and possible endometriosis, which affects, inter alia, the health of the reproductive tract. These Provisions were essentially hygiene rules imposed by the social and cultural circumstances of that time and were invested with religious authority. The main aims of the Lawmaker were to promote the Israelites' health, prevent them from contracting STDs, and increase their fertility and birth of healthy offspring. The term "unclean" for each menstruating woman served this aim.
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Affiliation(s)
| | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
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Wall LL, Teklay K, Desta A, Belay S. Tending the 'monthly flower:' a qualitative study of menstrual beliefs in Tigray, Ethiopia. BMC WOMENS HEALTH 2018; 18:183. [PMID: 30424763 PMCID: PMC6234636 DOI: 10.1186/s12905-018-0676-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 10/28/2018] [Indexed: 11/23/2022]
Abstract
Background Menstruation is a universal aspect of human female reproductive life. Management of menstrual flow presents hygiene challenges to girls and women in low-income countries, especially when they first start their periods. As part of a project to improve menstrual hygiene management in the Tigray Region of Ethiopia, we explored the local understanding of menstruation through focus-group discussions and individual interviews. Methods A detailed ethnographic survey of menstrual beliefs was carried out through 40 focus group discussions, 64 in-depth key informant interviews, and 16 individual case histories in the Tigray Region of northern Ethiopia. A total of 240 individuals participated in six types of focus groups (pre-menarchal girls, menstruating adolescents, married women of reproductive age, post-menopausal women, adolescent males, and married men). In-depth interviews were also carried out with 80 individuals, including Orthodox Christian priests, imams from the Muslim community, principals of primary and secondary schools, teachers and nurses, as well as menstruating schoolgirls and women. Audio data were transcribed and translated, then broken down into discrete codes using Atlas Ti software (version 7.5.4, Atlas.ti Scientific Software Development Mnbh, Berlin) and further grouped into related families and sub-families based on their content. The results were then synthesized to produce a cohesive narrative concerning menstruation in Tigray. Results Recurrent themes identified by participants included descriptions of the biology of menstruation (which were sometimes fanciful); the general unpreparedness of girls for menarche; cultural restrictions imposed by menstruation on females (particularly the stigma of ritual uncleanliness in both Christian and Muslim religious traditions); the prevalence and challenges of unmet menstrual hygiene needs at schools (including lack of access to sanitary pads and the absence of acceptable toilet/washing facilities); and the stigma and shame associated with menstrual hygiene accidents in public. Conclusions Changes in the educational system in northern Ethiopia are required to improve student understanding of the biology of menstruation, to foster gender equity, to overcome the barriers to school attendance presented by poor menstrual hygiene management, and to create a society that is more understanding and more accepting of menstruation.
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Affiliation(s)
- L Lewis Wall
- Department of Anthropology, College of Arts and Sciences, Washington University in St. Louis, Campus Box 1114, One Brookings Drive, St. Louis, MO, 63130, USA. .,Department of Obstetrics & Gynecology, Ayder Comprehensive Specialist Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. .,Department of Obstetrics & Gynecology, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Alem Desta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Shewaye Belay
- Department of Microbiology and Parasitology, Institute of Biomedical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Shin H, Park YJ, Cho I. Development and psychometric validation of the Menstrual Health Instrument (MHI) for adolescents in Korea. Health Care Women Int 2018; 39:1090-1109. [PMID: 29313762 DOI: 10.1080/07399332.2017.1423487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aims of the researchers were to develop and test initial psychometric properties of the Menstrual Health Instrument, a measure of menstrual health in adolescents that comprehensively evaluates menstrual health. Data were collected with a convenience sample of 230 Korean adolescent girls. As a result of exploratory factor analysis with the 29-item instrument, five factors were extracted: affective symptoms, somatic symptoms and school life, daily habits for menstrual health, menstrual cycle characteristics, and attitudes and perceptions on menstruation. The reliability and validity estimates indicate the Menstrual Health Instrument could be used for screening in school or community settings.
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Affiliation(s)
| | | | - Inhae Cho
- a College of Nursing, Korea University
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