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Napier-Raman S, Hossain SZ, Mpofu E, Lee MJ, Liamputtong P, Dune T. Sexual and reproductive health and rights decision-making among Australian migrant and refugee youth: a group concept mapping study. CULTURE, HEALTH & SEXUALITY 2024; 26:979-996. [PMID: 37975673 DOI: 10.1080/13691058.2023.2275303] [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: 04/13/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
Sexual and reproductive health (SRH) is a human right. Young people, particularly from marginalised groups such as migrant and refugees, are vulnerable to compromised sexual and reproductive health and rights. In this study, we aimed to identify socioecological factors influencing migrant and refugee youth SRH decision-making and compare perspectives of youth with key stakeholders. Data were collected using Group Concept Mapping (GCM), a mixed-methods participatory approach. Participants included migrant and refugee young people, aged 16-26 from Western Sydney (n = 55), and key stakeholders comprising clinicians, service providers and researchers (n = 13). GCM involved participants brainstorming statements about how migrant and refugee youth make SRH decisions. Participants then sorted statements into groups based on similarity, and rated statements on importance and impact. Multidimensional scaling and hierarchical cluster analysis were used to cluster statements into concept maps that represented participants' perspectives. The resulting maps comprised six clusters representing main concepts informing decision-making. The most important clusters were 'healthy relationships' and 'safe-sex practices'. Youth rated healthy relationships more important than stakeholders did. This study reveals factors informing migrant and refugee youth's decision-making. Future policy should go beyond biomedical constructions of SRH to incorporate emotional and relational factors, which young people consider to be equally important and beneficial to their agency.
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Affiliation(s)
- Sharanya Napier-Raman
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Syeda Zakia Hossain
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Elias Mpofu
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Rehabilitation and Health Services, University of North Texas, Denton, Texas, USA
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Mi-Joung Lee
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Tinashe Dune
- Translational Health Research Institute, Western Sydney University, Campbeltown, New South Wales, Australia
- Discipline of Psychological Science, Australian College of Applied Professions, Sydney, New South Wales, Australia
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Ghandour R, Hammoudeh W, Stigum H, Giacaman R, Fjeld H, Holmboe-Ottesen G. The hidden burden of dysmenorrhea among adolescent girls in Palestine refugee camps: a focus on well-being and academic performance. BMC Public Health 2024; 24:726. [PMID: 38448826 PMCID: PMC10918951 DOI: 10.1186/s12889-024-18219-0] [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] [Received: 08/22/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Dysmenorrhea (painful menstruation) is a condition that may have a profound effect on adolescent girls' health status and well-being. It can impede their engagement in daily activities and hamper their regular school attendance. This study aims to explore the relationship between dysmenorrhea, well-being, and academic performance among adolescent girls living in Palestine refugee camps in the West Bank and Jordan. METHODS We conducted a household survey between June and September 2019, with a total sample of 2737 adolescent girls 15 to 18 years old. Dysmenorrhea severity was assessed using the Working Ability, Location, Intensity, Duration of pain Dysmenorrhea scale (WaLIDD). The WHO-5 scale was used to evaluate the girls' overall well-being. Menstrual academic disruption (MAD) was measured using a self-reported scale. Multiple linear regression models were employed to evaluate the association between dysmenorrhea, well-being, and academic performance. Directed Acyclic Graphs (DAGs) were employed to identify variables for control in regression models. RESULTS The mean dysmenorrhea score was 6.6 ± 2.6, with 37.9% and 41.2% expressing moderate and severe symptoms, respectively. The mean WHO-5 score was 58.7 ± 25.1, and 34.9% reported a low well-being status. The mean MAD score was 3.1 ± 3.3. 26% reported missing school due to dysmenorrhea, 36% said dysmenorrhea impacted their ability to concentrate, and 39% were unable to study for tests, and complete homework. The first regression analysis showed a reduction of 1.45 units in WHO-5 score for each unit increase in dysmenorrhea. The second regression analysis showed a non-linear increase in MAD score for increasing dysmenorrhea. For each dysmenorrhea score less than 4 (mild) there was a modest increase in MAD scores (coefficient 0.08, p-value = 0.006), and for each dysmenorrhea score above 4 there was a stronger increase in MAD scores (coefficient 0.95, p < 0.001). CONCLUSION Dysmenorrhea poses significant challenges to the well-being and academic performance of adolescent girls living in Palestine refugee camps. Collaborative efforts and multifaceted approaches are crucial to address dysmenorrhea effectively. This involves research, targeted interventions, culturally sensitive strategies, and fostering a supportive environment that empowers girls to thrive academically and beyond.
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Affiliation(s)
- Rula Ghandour
- Institute of Community and Public Health, Birzeit University, Occupied Palestinian territory (oPt) Said Khoury Building for Development Studies, Birzeit, P.O. Box 14, Palestine.
- Department of Community Medicine and Global Health, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway.
| | - Weeam Hammoudeh
- Institute of Community and Public Health, Birzeit University, Occupied Palestinian territory (oPt) Said Khoury Building for Development Studies, Birzeit, P.O. Box 14, Palestine
| | - Hein Stigum
- Department of Community Medicine and Global Health, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway
| | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Occupied Palestinian territory (oPt) Said Khoury Building for Development Studies, Birzeit, P.O. Box 14, Palestine
| | - Heidi Fjeld
- Department of Community Medicine and Global Health, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway
| | - Gerd Holmboe-Ottesen
- Department of Community Medicine and Global Health, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway
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Rodríguez-Camacho MF, Sanchís-Ramón MJ, Ortiz-Barreda G, La Parra-Casado D, Gil-González D. Menarche and reproductive health in Spanish Roma women from a reproductive justice perspective: a qualitative study. Reprod Health 2024; 21:17. [PMID: 38308316 PMCID: PMC10837920 DOI: 10.1186/s12978-023-01726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 12/13/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES This study aimed to explore the perceptions of Roma women about their experience of menarche and reproductive health considering the principles of reproductive justice. DESIGN Qualitative study based on semi-structured interviews with Roma women ages 18 through 67 in different neighborhoods in the southeast of Spain. Using a thematic analysis, we analyzed experiences related to menarche and menstruation and their significance for reproductive health, the preparation for the phase of menarche and intergenerational support. RESULTS The Roma women interviewed shared their approach to the experiences of menarche and menstruation as children in their family environments with a focus on access to information provided by other women in the family and community for reproductive health management. In their discourses we observed that the onset of menstruation supposes a rupture in the public and private spaces of girls and women. CONCLUSIONS The results of this study suggest that women and girls do not gain access to information that contributes to their reproductive wellbeing through their experience of menarche. Access to resources and skills to manage biological changes in adolescents could contribute to reducing the impact of cultural myths, false ideas and taboos that prevent advocacy and empowerment on issues of reproductive justice.
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Affiliation(s)
- María Félix Rodríguez-Camacho
- Autonomous Federation of Roma Associations of Alicante, FAGA, Alicante, Spain.
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain.
| | | | - Gaby Ortiz-Barreda
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | | | - Diana Gil-González
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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Hirani SAA. Barriers to Women's Menstrual Hygiene Practices during Recurrent Disasters and Displacement: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:153. [PMID: 38397644 PMCID: PMC10888390 DOI: 10.3390/ijerph21020153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Disasters that involve displacement are particularly challenging for managing personal and menstrual hygiene, which can increase the risk of toxic shock syndrome, infections and other health conditions that can endanger women's lives. This study aimed to examine the menstrual hygiene challenges experienced by internally displaced women affected by recurrent natural disasters and subsequent displacement in the context of a low-middle-income country, i.e., Pakistan. A critical ethnographic study was undertaken in disaster-relief camps in the northern region of Pakistan. Data were collected using multiple methods, including field observations, review of media reports and in-depth interviews with 18 women. The findings suggested that the key barriers to the personal and menstrual hygiene of women during recurrent disasters and displacement in the mountainous rural region of Pakistan include inadequate housing, lack of infrastructure and humanitarian aid, no waste disposal system and lack of women-friendly spaces in disaster-relief camps. Community-based collaboration is necessary for the implementation of effective interventions. A comprehensive menstrual response to promote the health and well-being of women during disasters must include menstruation supplies, supportive facilities (mainly toilets and bathing facilities), supplementary supplies for storing, washing and drying, disposal/waste management facilities, education and culturally appropriate spaces and supplies.
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Affiliation(s)
- Shela Akbar Ali Hirani
- Faculty of Nursing, University of Regina, 516 RIC, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
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Thakur J, Goswami M, Roy S. Do contrasting socio-ecological conditions bring difference in premenstrual syndrome and its concomitants? A sedente-migrant comparative study from Eastern India. Am J Hum Biol 2023; 35:e23955. [PMID: 37403742 DOI: 10.1002/ajhb.23955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVES We asked in our research whether the premenstrual syndrome (PMS) and its concomitants, differ between "sedente" and "migrant" populations hailing from the same ethnic group, owing to their living in contrasting socio-ecological conditions. METHODS A total of 501 Oraon adolescents (sedente: 200, migrant: 301) were studied. Data on PMS was reported retrospectively using a list of 29 standard symptoms. Principal component analysis (PCA) was applied on PMS. PCA, which resulted in six principal components (PC1 to PC6) were loaded with "behavioral and cognitive," "negative mood," "pain and fluid retention," "vestibular and breast tenderness," and "fatigue," and/or "gastrointestinal" symptoms. Step-wise hierarchical regression was applied using migration status (step 1), socio-demographic (step 2), menstrual (step 3), and nutritional and lifestyle variables (step 4) as concomitants for each principal component. RESULTS Significantly, a greater number of migrants reported PMS but of milder intensity, unlike the sedentes. Significant sedente-migrant differences were found in the concomitants for PMS. Multivariate analyses showed differential socio-demographic (occupational, educational and wealth status, religion), nutritional (dietary carbohydrate protein and fat, tea intake, body mass index, percent body fat, waist hip ratio, fat mass index), menstrual (age at menarche, cycle length, dysmenorrhoea) and anemic status of the sedentes and the migrants were significantly associated with PMS. CONCLUSIONS Sedente and migrant participants, despite hailing from the same ethnic group, sharply differed in the prevalence of PMS and its concomitants owing to their living in contrasting socio-ecological conditions.
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Affiliation(s)
- Joyeeta Thakur
- Department of Anthropology, University of Calcutta, Kolkata, India
| | - Monali Goswami
- Department of Anthropology & Tribal Studies, Maharaja Sriram Chandra Bhanja Deo University, Baripada, India
| | - Subho Roy
- Department of Anthropology, University of Calcutta, Kolkata, India
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Gammoh O, Durand H, Abu-Shaikh H, Alsous M. Post-traumatic stress disorder burden among female Syrian war refugees is associated with dysmenorrhea severity but not with the analgesics. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Dysmenorrhea association with post-traumatic stress disorder (PTSD) has not been studied in refugees. We aimed to examine the associations between dysmenorrhea severity, dysmenorrhea analgesics self-medications, and PTSD in a cohort of Syrian war refugees residing in Jordan.<br />
This is a cross-sectional study based on predetermined inclusion criteria held at Caritas primary care centers in Jordanian districts between September and October 2022. The participants’ demographics and analgesic self-medication type were recorded through a structured questionnaire. The dysmenorrhea severity was measured by (working ability, location, intensity, days of pain, and dysmenorrhea) WaLiDD scale, PTSD was measured by Davidson trauma scale (DTS)-DSM-IV.<br />
Data from 347 Syrian female war refugees were analyzed. The multivariate analysis showed that dysmenorrhea severity demonstrated significantly higher estimates for PTSD (10.48 [6.72-14.23], p=0.001), however, the analgesic type was not associated with PTSD burden.<br />
In conclusion, dysmenorrhea severity, but not self-medication, was associated with a higher PTSD burden.
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Affiliation(s)
- Omar Gammoh
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, JORDAN
| | - Hannah Durand
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, SCOTLAND
| | | | - Mervat Alsous
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, JORDAN
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Betsu BD, Medhanyie AA, Gebrehiwet TG, Wall LL. "Menstruation is a Fearful Thing": A Qualitative Exploration of Menstrual Experiences and Sources of Information About Menstruation Among Adolescent Schoolgirls. Int J Womens Health 2023; 15:881-892. [PMID: 37283993 PMCID: PMC10239630 DOI: 10.2147/ijwh.s407455] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Background Although menstruation is a biological phenomenon, it is still subjected to secrecy, shame, and negativity. Schoolgirls lack access to appropriate sources of information about menstruation. Little is known about the content of the information provided to schoolgirls concerning menstruation in northern Ethiopia. This study explored schoolgirls' experiences and the content of information they receive concerning menstrual hygiene management in Tigray. Methods A qualitative design was implemented. Focus group discussions and in-depth interviews were conducted using the local language among 79 schoolgirls who had experienced menarche. Data were audio-recorded, transcribed, translated, and imported into ATLAS.ti-7.5.18 computer software for analysis. Data were coded and analyzed using a thematic analysis. Results Five themes have emerged from the analysis: 1) there is an indistinct and haphazard source of menstrual information; 2) menstruation is perceived as "a natural gift"; 3) menstruation is also considered fearful and embarrassing; 4) negative community perceptions of menstruation lead to menstrual restrictions, and 5) lack of privacy for dealing with menstrual issues as well as the scarcity of menstrual hygiene management materials is an on going problem. Schoolgirls have indistinct and haphazard sources of information concerning menstrual hygiene management, obtaining it from teachers, mothers, sisters, and friends, but the information they receive is shrouded in secrecy and often is factually incorrect. Menstruation is commonly linked to notions of sexuality, shame, and the approach of marriageability. Conclusion The information that schoolgirls in rural Tigray receive about menstrual hygiene management is inaccurate, insufficient, and encumbered with social taboos. Thus, schoolgirls do not have an adequate understanding of the physiology of menstruation and do not receive adequate emotional support at menarche, leaving them with feelings of embarrassment and anxiety. There should be efforts to implement programs that change community perceptions about menstruation.
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Affiliation(s)
- Balem Demtsu Betsu
- Department of Midwifery, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Tesfay Gebregzabher Gebrehiwet
- Department of Anthropology, College of Arts and Sciences, Washington University in St. Louis, Campus, St. Louis, MO, USA
| | - L Lewis Wall
- Department of Anthropology, College of Arts and Sciences, Washington University in St. Louis, Campus, St. Louis, MO, USA
- Department of Obstetrics & Gynecology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Obstetrics & Gynecology, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Eyring JB, Crandall A, Magnusson BM. A Modified Menstrual Attitudes Scale: Heteronormative Attitudes, Sexism, and Attitudes Toward Menstruation in Male and Female Adults. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1535-1547. [PMID: 36856958 DOI: 10.1007/s10508-023-02565-y] [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: 03/26/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Social shame and stigma surround menstruation, which may compromise women's health and rights in various contexts. Men's attitudes are particularly important because men often hold positions of power that influence women's experience. This study examined factors associated with menstrual attitudes, including heteronormative attitudes, sexism, and family influences. A cross-sectional Qualtrics panel survey (n = 802; aged 18-44; 50.8% female) was performed. We tested a revised menstrual attitudes scale based on items drawn from previously validated measures. Data were analyzed using a structural equation modeling framework. Factor analysis identified and confirmed a 5-factor model for menstrual attitudes. Men endorsed more negative attitudes toward menstruation than women; however, this difference was largely explained by factors other than gender in the structural equation model. After controlling for family and demographic characteristics, attitudes toward openness and secrecy surrounding menstruation were most strongly associated with gender role expectations and hostile sexism. Benevolent sexism was associated with finding menstruation debilitating, denying menstrual symptoms, and endorsing avoidance of activities during menstruation. Heteronormative and sexist attitudes were associated with more negative menstrual attitudes, while increased menstrual knowledge was associated with more positive menstrual attitudes. The difference in menstrual attitudes between males and females was explained largely by heteronormative attitudes and sexism. This suggests that attitudes toward menstruation are closely linked to social ideals about men and women.
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Affiliation(s)
- J B Eyring
- Department of Public Health, College of Life Sciences, Brigham Young University, 4103 LSB, Provo, UT, 84003, USA.
| | - AliceAnn Crandall
- Department of Public Health, College of Life Sciences, Brigham Young University, 4103 LSB, Provo, UT, 84003, USA
| | - Brianna M Magnusson
- Department of Public Health, College of Life Sciences, Brigham Young University, 4103 LSB, Provo, UT, 84003, USA
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Ghandour R, Hammoudeh W, Stigum H, Giacaman R, Fjeld H, Holmboe-Ottesen G. Menstrual characteristics and dysmenorrhea among Palestinian adolescent refugee camp dwellers in the West Bank and Jordan: a cross-sectional study. Arch Public Health 2023; 81:47. [PMID: 36998019 PMCID: PMC10061948 DOI: 10.1186/s13690-023-01059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/10/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Women and girls experience menstruation throughout their reproductive years. Normal adolescent menstrual cycles gauge current and future reproductive health. Dysmenorrhea (painful menstruation) is the most prevalent menstrual disturbance in adolescents that can be debilitating. This study examines the menstrual characteristics of adolescent girls living in Palestinian refugee camps in the West Bank of the Israeli-occupied Palestinian territory and Jordan, including estimates of dysmenorrhea levels and associated factors. METHODS A household survey of 15 to 18-year-old adolescent girls was conducted. Trained field workers collected data on general menstrual characteristics and dysmenorrhea level using Working ability, Location, Intensity, Days of pain Dysmenorrhea scale (WaLIDD), in addition to demographic, socio-economic, and health characteristics. The link between dysmenorrhea and other participant characteristics was assessed using a multiple linear regression model. Additionally, data on how adolescent girls cope with their menstrual pain was collected. RESULTS 2737 girls participated in the study. Mean age was 16.8 ± 1.1 years. Mean age-at-menarche was 13.1 ± 1.2; mean bleeding duration was 5.3 ± 1.5 days, and mean cycle length was 28.1 ± 6.2 days. Around 6% of participating girls reported heavy menstrual bleeding. High dysmenorrhea levels were reported (96%), with 41% reporting severe symptoms. Higher dysmenorrhea levels were associated with older age, earlier age-at-menarche, longer bleeding durations, heavier menstrual flow, skipping breakfast regularly, and limited physical activity patterns. Eighty nine percent used non-pharmacological approaches to ease menstrual pain and 25% used medications. CONCLUSION The study indicates regular menstrual patterns in terms of length, duration, and intensity of bleeding and a slightly higher age-at-menarche than the global average. However, an alarmingly high prevalence of dysmenorrhea among participants was found that tends to vary with different population characteristics, some of which are modifiable and can be targeted for better menstrual health.This research emphasizes the need for integrated efforts to assist adolescents with menstrual challenges such as dysmenorrhea and irregular periods to achieve informed recommendations and effective actions.
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Affiliation(s)
- Rula Ghandour
- grid.22532.340000 0004 0575 2412Institute of Community and Public Health, Birzeit University, Said Khoury Building for Development Studies, Birzeit, P.O.Box 14, occupied Palestinian territory
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Weeam Hammoudeh
- grid.22532.340000 0004 0575 2412Institute of Community and Public Health, Birzeit University, Said Khoury Building for Development Studies, Birzeit, P.O.Box 14, occupied Palestinian territory
| | - Hein Stigum
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Rita Giacaman
- grid.22532.340000 0004 0575 2412Institute of Community and Public Health, Birzeit University, Said Khoury Building for Development Studies, Birzeit, P.O.Box 14, occupied Palestinian territory
| | - Heidi Fjeld
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Gerd Holmboe-Ottesen
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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Ghandour R, Hammoudeh W, Giacaman R, Holmboe-Ottesen G, Fjeld HE. Coming of age: a qualitative study of adolescent girls' menstrual preparedness in Palestinian refugee camps in the West Bank and Jordan. Sex Reprod Health Matters 2022; 30:2111793. [PMID: 36129456 PMCID: PMC9518256 DOI: 10.1080/26410397.2022.2111793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Menstrual health is important for adolescent girls and is particularly compromised in displaced communities due to restricted access to information and lack of private spaces to manage menstruation. Menarche is the biological and social milestone of girls' adolescence, marking the onset of puberty and confirming womanhood in many communities. It also marks a difficult transitional period influenced by socio-cultural beliefs and expectations. Menstrual preparedness is critical for this transition, and the lack of accurate, timely, age-appropriate information might impact current, and future reproductive health and well-being. This paper investigates the menstrual preparedness status of adolescents living in Palestinian refugee camps in the West Bank and Jordan. These are long-term refugee camps characterised by a variety of social, economic, and political constraints affecting the health of women and girls. We conducted 39 in-depth interviews and 23 focus-group discussions with adolescent girls. The study reveals inadequate menstrual preparedness among the participants, especially in pre-menarche. Among the barriers to adequate menstrual preparedness is a predominance of practical concerns, such as the use of sanitary pads and hygienic practices, socio-cultural norms that promote secrecy and taboo around menstruation, and divergent notions of timeliness of information among girls, their mothers, and teachers. The study contends that addressing the taboo around menstruation requires joint efforts by the family, school, and social services. Menstrual preparedness should begin early and encompass biological, practical, emotional, and psychological components. The paper advocates for Comprehensive, Contextually Relevant, Timely Menstrual Preparedness (CCTMP) policies and initiatives, empowering adolescent girls, their mothers, and educators.
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Affiliation(s)
- Rula Ghandour
- Academic Researcher, Institute of Community and Public Health, Birzeit University, Said Khoury Building for Development Studies, P.O.Box 14, Birzeit, occupied Palestinian territory (oPt)
- PhD candidate, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Blindern, PB 1130, 0318Oslo, Norway
| | - Weeam Hammoudeh
- Assistant Professor, Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory (oPt)
| | - Rita Giacaman
- Professor, Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory (oPt)
| | - Gerd Holmboe-Ottesen
- Professor, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Norway
| | - Heidi E. Fjeld
- Associate Professor, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Supporting young women with menstrual pain – Experiences of midwives working at youth clinics. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100795. [DOI: 10.1016/j.srhc.2022.100795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/14/2022]
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Hawkey AJ, Ussher JM, Perz J. What do women want? Migrant and refugee women's preferences for the delivery of sexual and reproductive healthcare and information. ETHNICITY & HEALTH 2022; 27:1787-1805. [PMID: 34569377 DOI: 10.1080/13557858.2021.1980772] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Migrant and refugee women experience inequities in sexual and reproductive health (SRH) care, reflected in the low uptake of SRH services. It is essential for healthcare providers and educators to be aware of women's preferences for SRH information and service delivery, to provide culturally responsive care. Identifying migrant and refugee women's preferences for SRH information and service delivery is the objective of this study. DESIGN This study investigated this issue, in communities of migrant and refugee women living in Australia and Canada. Eighty-four individual interviews and 16 focus groups comprising 85 participants were conducted (total n = 169), with migrant and refugee women aged 18 years and over from Afghanistan, India (Punjab), Iraq, Somalia, South Sudan, Sri-Lanka (Tamil), Sudan and various South American (Latina) backgrounds. Nine individual interviews were also undertaken with community interviewers, who were migrant or refugee women themselves. RESULTS Thematic analyses identified that migrant and refugee women are enthusiastic to learn about SRH across the lifespan, using a variety of modalities including group education delivered by community leaders; online and written material; and information provided by general practitioners. Participants emphasised the need for empathetic SRH care, which encompassed longer times for consultations, being seen as experts of their own bodies, privacy and healthcare provided by women practitioners. Greater engagement with migrant and refugee men was positioned as an additional solution to addressing SRH concerns of women. CONCLUSION Insights from this study can help facilitate the co-design and evaluation of acceptable and sustainable programs to address inequities in SRH experienced by migrant and refugee women.
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Affiliation(s)
- Alexandra J Hawkey
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
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13
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Meherali S, Louie-Poon S, Idrees S, Kauser S, Scott S, Salami B, Valliantos H, Meherali KM, Patel K, Suthar P, Akbarzada Z, Marcus I, Khangura M, Mangat A. Understanding the sexual and reproductive health needs of immigrant adolescents in Canada: A qualitative study. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:940979. [PMID: 36303669 PMCID: PMC9580723 DOI: 10.3389/frph.2022.940979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Literature suggests that immigrant adolescents receive limited sexual and reproductive health (SRH) education and rarely utilize SRH services in Canada. This study sought to explore the SRH information needs of immigrant adolescents in the province of Alberta. Methods A qualitative descriptive methodology was undertaken to conduct 21 individual interviews with immigrant adolescents in Alberta. Results A total of four themes emerged from the interviews: (1) Barriers to SRH; (2) needs of adolescents regarding SRH; (3) sources of knowledge; and (4) strategies to improve SRH. Our findings document the conflicting needs and preferences between adolescents and their parents regarding access to SRH resources and services. Discussion Adolescents often felt unprepared to deal with their SRH issues due to socio-cultural barriers and conflicts with their parents' conservative attitude toward SRH concerns. Structural barriers to accessing SRH resources and services were also reported, including the location and cost of services. As a result, the majority of adolescents relied on digital methods to receive SRH information. Conclusion This study highlights that future research and SRH service provider efforts need to remain cognizant of the positionality of immigrant adolescents and explore innovative ways to deliver SRH resources and services that meet their unique needs.
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14
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Hawkey A, Chalmers KJ, Micheal S, Diezel H, Armour M. “A day-to-day struggle”: A comparative qualitative study on experiences of women with endometriosis and chronic pelvic pain. FEMINISM & PSYCHOLOGY 2022. [DOI: 10.1177/09593535221083846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic pelvic pain (CPP) in women is a term that encompasses a range of conditions, including endometriosis, vulvodynia, painful bladder syndrome and adenomyosis. Given the impact on penetrative sex, fertility and potentially motherhood, CPP may also impact on women's identities as a wife or partner, a mother, and a woman. The aim of this study was to explore similarities and differences in experiences of women with endometriosis and non-endometriosis related CPP. A total of 17 participants aged between 21 and 48 years old participated in three focus groups. Using reflexive thematic analysis three main themes were found: the struggling woman, the unheard woman and the self-silenced woman. Women, regardless of the cause of their CPP, reported significant impacts on their intimate relationships, fertility, and parenting but those with non-endometriosis CPP often reported greater trouble communicating about pelvic pain in the workplace due to the “taboo” nature of discussing their vulval pain. Many participants described how a societal normalisation of pelvic pain resulted in women silencing their experiences, rendering their pain invisible. While women wanted to resist such silencing through information and support seeking, women with non-endometriosis CPP described fewer avenues to accessing credible informational resources or networks for support.
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15
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Pichon A, Jackman KB, Winkler IT, Bobel C, Elhadad N. The messiness of the menstruator: assessing personas and functionalities of menstrual tracking apps. J Am Med Inform Assoc 2022; 29:385-399. [PMID: 34613388 PMCID: PMC8757321 DOI: 10.1093/jamia/ocab212] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/08/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine trends in the intended users and functionalities advertised by menstrual tracking apps to identify gaps in personas and intended needs fulfilled by these technologies. MATERIALS AND METHODS Two types of materials were collected: a corpus of scientific articles related to the identities and needs of menstruators and a corpus of images and descriptions of menstrual tracking apps collected from the Google and Apple app stores. We conducted a scoping review of the literature to develop themes and then applied these as a framework to analyze the app corpus, looking for alignments and misalignments between the 2 corpora. RESULTS A review of the literature showed a wide range of disciplines publishing work relevant to menstruators. We identified 2 broad themes: "who are menstruators?" and "what are the needs of menstruators?" Descriptions of menstrual trackers exhibited misalignments with these themes, with narrow characterizations of menstruators and design for limited needs. DISCUSSION We synthesize gaps in the design of menstrual tracking apps and discuss implications for designing around: (1) an irregular menstrual cycle as the norm; (2) the embodied, leaky experience of menstruation; and (3) the varied biologies, identities, and goals of menstruators. An overarching gap suggests a need for a human-centered artificial intelligence approach for model and data provenance, transparency and explanations of uncertainties, and the prioritization of privacy in menstrual trackers. CONCLUSION Comparing and contrasting literature about menstruators and descriptions of menstrual tracking apps provide a valuable guide to assess menstrual technology and their responsiveness to users and their needs.
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Affiliation(s)
- Adrienne Pichon
- Biomedical Informatics, Columbia University, New York, New York,
USA
| | - Kasey B Jackman
- School of Nursing, Columbia University, New York, New York,
USA
- New York-Presbyterian Hospital, New York, New York, USA
| | - Inga T Winkler
- Institute for the Study of Human Rights, Columbia University, New
York, New York, USA
- Legal Studies, Central European University, Vienna, Austria
| | - Chris Bobel
- Women’s, Gender, and Sexuality Studies, University of
Massachusetts, Boston, Massachusetts, USA
| | - Noémie Elhadad
- Biomedical Informatics, Columbia University, New York, New York,
USA
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16
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Munro AK, Keep M, Hunter EC, Hossain SZ. Confidence to manage menstruation among university students in Australia: Evidence from a cross-sectional survey. WOMEN'S HEALTH 2022; 18:17455065211070666. [PMID: 35001743 PMCID: PMC8744198 DOI: 10.1177/17455065211070666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: There has been increased attention to university students’ experiences of menstrual disorders, and access to menstrual products, in high-income countries. Less attention has been directed to other aspects of their menstrual experience, including confidence for menstrual management. This study aimed to understand the factors affecting university students’ confidence to manage menstruation at university. Methods: An online survey was completed by 410 participants (age range: 16–46 years, mean = 20.1 years) who menstruate and study at an Australian university. Participants reported demographic characteristics, confidence to manage menstruation at university, and personal, physical and environmental factors. A Mann–Whitney U-test analysed differences in confidence between groups of students. Pearson’s correlation coefficient and bivariate linear regressions determined associations between factors and confidence. Statistically significant associations were inputted into a multiple linear regression model. P-values less than 0.05 were considered significant. Results: A minority of students (16.2%) felt completely confident to manage their menstruation at university. Menstrual knowledge, positive perceptions of menstruation and comfort to discuss menstruation with others positively predicted confidence. Physical menstrual symptoms, negative perceptions of menstruation, perceived stigma and using a menstrual cup or period underwear predicted lower confidence. In multiple regression, private and clean and sanitary university bathroom facilities, changing menstrual products at university, perceived stigma and negative perceptions of menstruation remained significant predictors. Conclusion: Most students did not have complete confidence to manage their menstruation at university. Several personal, physical and environmental factors were related to students’ confidence to manage menstruation. Assessment of these factors in future research with university students is recommended to enable a comprehensive understanding of their menstrual needs, and inform interventions aimed at improving their menstrual management confidence at university.
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Affiliation(s)
- Alana K Munro
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Melanie Keep
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Erin C Hunter
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Syeda Z Hossain
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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17
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Chalmiers MA, Karaki F, Muriki M, Mody S, Chen A, de Bocanegra HT. Refugee women's experiences with contraceptive care after resettlement in high-income countries: A Critical Interpretive Synthesis. Contraception 2021; 108:7-18. [PMID: 34971601 DOI: 10.1016/j.contraception.2021.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
Refugee women often share histories of forced displacement, economic hardship, or gender-based violence and may face common barriers to reproductive healthcare access after resettlement in high-income countries. This Critical Interpretive Synthesis integrates the available data on contraceptive care for refugee women after resettlement. The review examined shared aspects of the refugee experience that impact women's access to high-quality contraceptive care and transcend the particularities of specific health systems or countries of origin. These include possible shifts in gendered norms and fertility preferences after resettlement, prior experiences with contraception in home countries, refugee camps, and other sites of first-asylum, and negative experiences with healthcare providers after resettlement (i.e. communication barriers or experiencing discrimination). Our findings demonstrate the need for further methodologically-rigorous research in the field of refugee reproductive health, specifically in relation to evidence-based approaches to training interpreters and providers in contraceptive care for refugees and on male partners and their influence on contraceptive use.
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Affiliation(s)
- Morgen A Chalmiers
- Department of Anthropology, Medical Scientist Training Program, University of California, San Diego.
| | - Fatima Karaki
- Department of Medicine, University of California San Francisco.
| | - Maneesha Muriki
- Public Health Sciences, School of Medicine, University of California Davis.
| | - Sheila Mody
- School of Medicine, Department of Gynecology, Obstetrics and Reproductive Sciences, University of California, San Diego.
| | - Andy Chen
- School of Medicine, Loyola University.
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18
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Munro AK, Hunter EC, Hossain SZ, Keep M. A systematic review of the menstrual experiences of university students and the impacts on their education: A global perspective. PLoS One 2021; 16:e0257333. [PMID: 34506544 PMCID: PMC8432759 DOI: 10.1371/journal.pone.0257333] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/29/2021] [Indexed: 12/05/2022] Open
Abstract
Background Higher education attainment is linked to improved health and employment outcomes but the impact of university students’ experiences of menstruation on their education is less clear. The objective of this review was to synthesise qualitative and quantitative research on university students’ menstrual experiences and educational impacts. Methods Eligible studies were identified through systematic searching across eight peer-reviewed databases, websites for menstrual health organisations, grey literature databases, and reference lists of included studies. Eligible studies must have reported on at least one of the antecedents or components of menstrual experience outlined in the integrated model of menstrual experience in relation to university students or reported on the impact of their menstrual experiences on their education. Study characteristics and findings were extracted, analysed and presented as a narrative synthesis. The quality of evidence was assessed with the Mixed Methods Appraisal Tool. This study is registered on PROSPERO, number CRD42020178470. Results Eighty-three studies were eligible for inclusion. Most studies (n = 74; 89%) were quantitative and the highest proportion of studies were conducted in lower-middle-income countries (n = 31; 37%). Self-reported dysmenorrhea, other physical and emotional menstrual-related symptoms, and menstrual stigma contributed to negative menstrual experiences among female students. Very few studies considered the menstrual experiences of non-binary and transgender menstruating students, and culturally diverse students. Dysmenorrhea contributed to university absenteeism, impaired participation and concentration, and declining academic performance. Inadequate sanitation facilities for menstrual management and challenges containing menstruation also negatively impacted education. Conclusions Female university students’ experiences of menstruation can negatively impact their education, highlighting the need for program and policy responses at university to improve students’ wellbeing and educational engagement. Further research on the menstrual experiences of gender diverse, migrant and international students is needed as there is insufficient evidence to date.
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Affiliation(s)
- Alana K. Munro
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
| | - Erin C. Hunter
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Syeda Z. Hossain
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Melanie Keep
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Barrington DJ, Robinson HJ, Wilson E, Hennegan J. Experiences of menstruation in high income countries: A systematic review, qualitative evidence synthesis and comparison to low- and middle-income countries. PLoS One 2021; 16:e0255001. [PMID: 34288971 PMCID: PMC8294489 DOI: 10.1371/journal.pone.0255001] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/07/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND There is growing recognition of the importance of menstruation in achieving health, education, and gender equality for all. New policies in high income countries (HICs) have responded to anecdotal evidence that many struggle to meet their menstrual health needs. Qualitative research has explored lived experiences of menstruating in HICs and can contribute to designing intervention approaches. To inform the growing policy attention to support people who menstruate, here we review and synthesise the existing research. METHODS AND FINDINGS Primary, qualitative studies capturing experiences of menstruation in HICs were eligible for inclusion. Systematic database and hand searching identified 11485 records. Following screening and quality appraisal using the EPPI-Centre checklist, 104 studies (120 publications) detailing the menstrual experiences of over 3800 individuals across sixteen countries were included. We used the integrated model of menstrual experiences developed from studies in low- and middle-income countries (LMICs) as a starting framework and deductively and inductively identified antecedents contributing to menstrual experiences; menstrual experiences themselves and impacts of menstrual experiences. Included studies described consistent themes and relationships that fit well with the LMIC integrated model, with modifications to themes and model pathways identified through our analysis. The socio-cultural context heavily shaped menstrual experiences, manifesting in strict behavioural expectations to conceal menstruation and limiting the provision of menstrual materials. Resource limitations contributed to negative experiences, where dissatisfaction with menstrual practices and management environments were expressed along with feelings of disgust if participants felt they failed to manage their menstruation in a discrete, hygienic way. Physical menstrual factors such as pain were commonly associated with negative experiences, with mixed experiences of healthcare reported. Across studies participants described negative impacts of their menstrual experience including increased mental burden and detrimental impacts on participation and personal relationships. Positive experiences were more rarely reported, although relationships between cis-women were sometimes strengthened by shared experiences of menstrual bleeding. Included studies reflected a broad range of disciplines and epistemologies. Many aimed to understand the constructed meanings of menstruation, but few were explicitly designed to inform policy or practice. Few studies focused on socioeconomically disadvantaged groups relevant to new policy efforts. CONCLUSIONS We developed an integrated model of menstrual experience in HICs which can be used to inform research, policy and practice decisions by emphasising the pathways through which positive and negative menstrual experiences manifest. REVIEW PROTOCOL REGISTRATION The review protocol registration is PROSPERO: CRD42019157618.
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Affiliation(s)
- Dani Jennifer Barrington
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
- School of Civil Engineering, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Hannah Jayne Robinson
- School of Civil Engineering, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Emily Wilson
- Irise International, Sheffield, South Yorkshire, United Kingdom
| | - Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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20
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Maulingin-Gumbaketi E, Larkins S, Gunnarsson R, Rembeck G, Whittaker M, Redman-MacLaren M. 'Making of a Strong Woman': a constructivist grounded theory of the experiences of young women around menarche in Papua New Guinea. BMC Womens Health 2021; 21:144. [PMID: 33832465 PMCID: PMC8034129 DOI: 10.1186/s12905-021-01229-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/17/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Menarche, the first menstruation, is a significant developmental milestone for females. In Papua New Guinea (PNG), menarche is an important socio-cultural event marking transition from girlhood to womanhood. PNG is a culturally and linguistically diverse nation, with wide-ranging socio-cultural beliefs and practices around menarche. This study explored post-menarcheal women's understanding about body changes and menarche, preparation for menarche, and related cultural beliefs and practices at menarche. METHODS A constructivist grounded theory study was conducted with 98 female participants who originated from four PNG provinces: Eastern Highlands Province; East Sepik Province; Milne Bay Province; and National Capital District. The participants were purposively and theoretically sampled, with 10 focus group discussions and six individual interviews conducted using a semi-structured interview guide for data collection. Focus group discussions and interviews were voice recorded and transcribed. Data were inductively analyzed using initial, intermediate and advanced coding, memos and constant comparative methods to develop a theoretical model that explains women's experiences at menarche. Interview participants also identified actions required to improve future experiences of girls at menarche in PNG. RESULTS A grounded theory comprising the core category of 'Making of a Strong Woman' and four interconnecting categories ('Having Baby Sense'; 'Beginning of Learning'; 'Intensifying Learning'; and 'Achieving Womanhood') was constructed. 'Urban' and 'Rural' represented both geographical and socio-cultural intervening conditions that influence the experiences of girls at menarche. Experiences of young women at menarche were rooted in socio-cultural beliefs and practices. Women reported being physically and emotionally distressed and unprepared at onset of menarche. Mothers were considered important support, however, their ability to adequately prepare their daughters is limited by shame and secrecy. Despite these limitations, cultural practices at menarche provided an opportunity for intensive preparation of girls for womanhood. CONCLUSION Limited pre-menarcheal awareness of the meaning of body changes and menarche of girls was linked to culture of shame and secrecy about open discussion on sexuality. However, traditional cultural practices provide an opportunity for collective support and focused learning for girls. Findings from this study have implications for broader sexual and reproductive health education programs in addressing menstrual health and hygiene in PNG, and the Pacific.
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Affiliation(s)
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Ronny Gunnarsson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gun Rembeck
- Research and Development Primary Health Care, Research and Development Center Södra Älvsborg, Region Vastra Gotland, Sweden
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan, Borås Youth Health Center, Borås, Sweden
| | - Maxine Whittaker
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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21
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Armour M, Hyman MS, Al-Dabbas M, Parry K, Ferfolja T, Curry C, MacMillan F, Smith CA, Holmes K. Menstrual Health Literacy and Management Strategies in Young Women in Australia: A National Online Survey of Young Women Aged 13-25 Years. J Pediatr Adolesc Gynecol 2021; 34:135-143. [PMID: 33188935 DOI: 10.1016/j.jpag.2020.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/17/2020] [Accepted: 11/06/2020] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE To explore key aspects of menstrual health literacy and menstrual management in young women at school or in tertiary education. DESIGN Cross-sectional online survey. SETTING Australia-wide. PARTICIPANTS A total of 4202 adolescent and young women (13-25 years of age; median age 17 years), having reached menarche, living in Australia and currently attending school (n = 2421) or tertiary education (n = 1781). INTERVENTIONS Online survey hosted by Qualtrics between November 2017 and January 2018. Data were collected on contraceptive use, management strategies, sources of information, and knowledge of menstruation. MAIN OUTCOME MEASURES Information on prevalence and effectiveness of different management strategies, health-seeking behavior, knowledge about menstruation, and common menstrual disorders such as endometriosis. RESULTS The majority of young women did not seek medical advice for their menstrual symptoms, but used information from the Internet (50%) and engaged in self-management, most commonly with over-the-counter medications such as paracetamol (51%) or ibuprofen (52%). Oral contraceptive use was relatively common (35%), and mostly for reduction of menstrual pain (58%). Despite having significant dysmenorrhea, approximately one-half of the participants (51%) thought that their period was normal. Women with higher pain scores were more likely to rate their period as "abnormal" (P < .0001) but not more likely to consult a doctor (P = .13). Only 53% of those at school had heard of endometriosis. CONCLUSION Self-management of menstrual symptoms is common, but a significant minority of women are underdosing or choosing ineffective methods. Most women do not seek medical advice even when symptoms are severe, and cannot identify symptoms suggestive of secondary dysmenorrhea. Improved education on menstruation is vital.
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Affiliation(s)
- Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia; Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Mikayla S Hyman
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia; Department of Sociology/Anthropology, Middlebury College, Middlebury, Vermont
| | - Mahmoud Al-Dabbas
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kelly Parry
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Tania Ferfolja
- Centre for Educational Research, Western Sydney University, Penrith, NSW, Australia
| | - Christina Curry
- Centre for Educational Research, Western Sydney University, Penrith, NSW, Australia
| | - Freya MacMillan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia; School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Caroline A Smith
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia; Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kathryn Holmes
- Centre for Educational Research, Western Sydney University, Penrith, NSW, Australia
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22
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Zhao Y, Gjernes T, Hedlund M. Exploring Participation and Interaction in a Bottom-Up Health Promotion Program for Migrant Women in Norway. QUALITATIVE HEALTH RESEARCH 2021; 31:691-702. [PMID: 33349151 PMCID: PMC7882997 DOI: 10.1177/1049732320980397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In this article, we examine the participation and interactions of migrant women and experts who attended health parties. Based on data from participation observations and semi-structured interviews from participants of health parties, we examine how health parties may be considered an innovative bottom-up community program that could influence how migrant women focus, learn, and discuss health issues as well as interact with health care. Through a qualitative analysis, the article demonstrates two ways of organizing health parties and different approaches to the health expert role, and how this impacts the social setting and interactions of a health party. In the Norwegian setting, migrant women are considered by health authorities to be the most difficult group to reach due to cultural and language barriers. Health parties may represent an alternative for bridging these barriers and may create a useful context for active participation and learning about health for migrant women.
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Adolescent Menstrual Health Literacy in Low, Middle and High-Income Countries: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052260. [PMID: 33668788 PMCID: PMC7956698 DOI: 10.3390/ijerph18052260] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 11/27/2022]
Abstract
Background: Poor menstrual health literacy impacts adolescents’ quality of life and health outcomes across the world. The aim of this systematic review was to identify concerns about menstrual health literacy in low/middle-income countries (LMICs) and high-income countries (HICs). Methods: Relevant social science and medical databases were searched for peer-reviewed papers published from January 2008 to January 2020, leading to the identification of 61 relevant studies. Results: A thematic analysis of the data revealed that LMICs report detrimental impacts on adolescents in relation to menstrual hygiene and cultural issues, while in HICs, issues related to pain management and long-term health outcomes were reported more frequently. Conclusions: In order to improve overall menstrual health literacy in LMICs and HICs, appropriate policies need to be developed, drawing on input from multiple stakeholders to ensure evidence-based and cost-effective practical interventions.
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Schmitt ML, Hagstrom C, Nowara A, Gruer C, Adenu-Mensah NE, Keeley K, Sommer M. The intersection of menstruation, school and family: Experiences of girls growing up in urban cities in the U.S.A. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2021. [DOI: 10.1080/02673843.2020.1867207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Margaret L. Schmitt
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christine Hagstrom
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Azure Nowara
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Nana Ekua Adenu-Mensah
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Katie Keeley
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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25
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O'Mara B, Carey G, Weier M. Community-based health promotion about alcohol and other drugs in a multicultural Australia-what works? A review of evidence. HEALTH EDUCATION RESEARCH 2020; 35:437-449. [PMID: 33090214 DOI: 10.1093/her/cyaa027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
Refugee and migrant communities from culturally and linguistically diverse backgrounds in Australia experience dependency, stigma, isolation, mental health issues, family issues and other problems associated with alcohol and other drugs. Yet, refugee and migrant communities also face major linguistic, cultural and technological barriers to health promotion about drug-related problems. The aim of this review is to identify effective techniques and approaches for health promotion that reduces the risk of problems with drugs in culturally and linguistically inclusive ways. To identify what is effective, the Medline/PubMed database was systematically searched for health promotion literature published between 2008 and 2018. Grey literature from relevant agencies was also searched. The review considered both quantitative and qualitative outcome measures, and assessed studies using the Critical Appraisal Skills Programme quality assessment tool. Three studies met inclusion criteria, with weak evaluations. The studies demonstrated effective community engagement, but do not provide conclusive evidence of what is effective drug-related health promotion. The review's findings point to an important knowledge gap. More rigorous research and evaluation are required to identify effective health promotion for reducing drug-related issues with a larger, more diverse range of refugee and migrant communities.
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Affiliation(s)
- Ben O'Mara
- Department of Media and Communication, Faculty of Health, Arts and Design, Swinburne University, John Street, Hawthorn, Melbourne, Victoria, 3122, Australia
| | - Gemma Carey
- Centre for Social Impact, Business School, University of New South Wales, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Megan Weier
- Centre for Social Impact, Business School, University of New South Wales, High Street, Kensington, Sydney, NSW, 2052, Australia
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Riley AH, Slifer L, Hughes J, Ramaiya A. Results from a literature review of menstruation-related restrictions in the United States and Canada. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 25:100537. [PMID: 32610221 DOI: 10.1016/j.srhc.2020.100537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
Abstract
Initiation of menstruation is often associated with secrecy and silence, leading to menstruation-related restrictions enforced by various structural and social factors. Most of the research investigating menstruation-related restrictions has been conducted in low- and middle-income countries. It is unknown 1) which populations in the United States and Canada may face menstruation-related restrictions, and 2) what type of restrictions are practiced by these populations. A literature review found 21 articles published between 2000 and 2019 covering menstruation-related social and structural restrictions in the United States and Canada. In addition to more research, we encourage clinical providers to have culturally competent conversations with patients to understand potential menstruation-related restrictions.
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Affiliation(s)
- Amy Henderson Riley
- Thomas Jefferson University College of Population Health, 901 Walnut Street, 10(th) Floor, Philadelphia, PA 19107, United States.
| | - Laura Slifer
- Thomas Jefferson University College of Population Health, 901 Walnut Street, 10(th) Floor, Philadelphia, PA 19107, United States.
| | - Jessica Hughes
- Thomas Jefferson University College of Population Health, 901 Walnut Street, 10(th) Floor, Philadelphia, PA 19107, United States.
| | - Astha Ramaiya
- Johns Hopkins University Bloomberg School of Public Health, 110 Delaware Lane, Mount Hope, WV 25880, United States.
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Fahs B. There Will Be Blood: Women’s Positive and Negative Experiences with Menstruation. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/23293691.2019.1690309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Breanne Fahs
- Women and Gender Studies Program, Arizona State University, Glendale, Arizona, USA
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Royer PA, Olson LM, Jackson B, Weber LS, Gawron L, Sanders JN, Turok DK. "In Africa, There Was No Family Planning. Every Year You Just Give Birth": Family Planning Knowledge, Attitudes, and Practices Among Somali and Congolese Refugee Women After Resettlement to the United States. QUALITATIVE HEALTH RESEARCH 2020; 30:391-408. [PMID: 31347453 PMCID: PMC7219277 DOI: 10.1177/1049732319861381] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
It is crucial for refugee service providers to understand the family planning knowledge, attitudes, and practices of refugee women following third country resettlement. Using an ethnographic approach rooted in Reproductive Justice, we conducted six focus groups that included 66 resettled Somali and Congolese women in a western United States (US) metropolitan area. We analyzed data using modified grounded theory. Three themes emerged within the family planning domain: (a) concepts of family, (b) fertility management, and (c) unintended pregnancy. We contextualized these themes within existing frameworks for refugee cultural transition under the analytic paradigms of "pronatalism and stable versus evolving family structure" and "active versus passive engagement with family planning." Provision of just and equitable family planning care to resettled refugee women requires understanding cultural relativism, social determinants of health, and how lived experiences influence family planning conceptualization. We suggest a counseling approach and provider practice recommendations based on our study findings.
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Affiliation(s)
| | | | | | | | - Lori Gawron
- University of Utah, Salt Lake City, Utah, USA
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Duby Z, Katz AWK, Browne EN, Mutero P, Etima J, Zimba CC, Woeber K, Atujuna M, Reddy K, van der Straten A. Hygiene, Blood Flow, and Vaginal Overload: Why Women Removed an HIV Prevention Vaginal Ring During Menstruation in Malawi, South Africa, Uganda and Zimbabwe. AIDS Behav 2020; 24:617-628. [PMID: 31030301 DOI: 10.1007/s10461-019-02514-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We assessed the interference between vaginal ring use and menses among women who participated in the qualitative component of the MTN-020/ASPIRE vaginal ring trial in Malawi, South Africa, Uganda and Zimbabwe (N = 214). A common reason for imperfect ring adherence and premature removal of the vaginal ring cited by participants related to vaginal bleeding or menses. Whereas self-reporting via survey questions suggested that the majority (60%) of women did not mind wearing the ring while menstruating, and did not remove it (91%) during menses, in the qualitative interviews women frequently described removing the ring during menses. Their reasons included hygiene, beliefs that the ring blocked the flow of menstrual blood, fears that the ring would come out with blood or during tampon removal, and concerns around an 'overburdened' vagina. Examining women's narratives and subjective experiences related to menstruation helps build a better understanding of factors affecting ring use and adherence.
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Affiliation(s)
- Zoe Duby
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Ariana W K Katz
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| | - Erica N Browne
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| | | | - Juliane Etima
- Makerere University - Johns Hopkins University, Research Collaboration, Kampala, Uganda
| | | | - Kubashni Woeber
- South African Medical Research Council, Kwazulu Natal, South Africa
| | - Millicent Atujuna
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Ariane van der Straten
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA
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Krusz E, Hall N, Barrington DJ, Creamer S, Anders W, King M, Martin H, Hennegan J. Menstrual health and hygiene among Indigenous Australian girls and women: barriers and opportunities. BMC WOMENS HEALTH 2019; 19:146. [PMID: 31775735 PMCID: PMC6882156 DOI: 10.1186/s12905-019-0846-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 11/14/2019] [Indexed: 11/21/2022]
Abstract
Health inequities inhibit global development and achievement of the Sustainable Development Goals. One gendered health area, Menstrual Health & Hygiene (MHH), has received increasing attention in Low- and Middle-Income Countries as a barrier to health, wellbeing, and gender equity. Recent anecdotal evidence in Australia highlights that MHH also present challenges to High Income Countries, particularly among underrepresented populations, such as Indigenous Australian peoples, people from low socio-economic backgrounds, or communities that are remotely located. In this article, we chart the emergence of attention to MHH in the Australian context and highlight key considerations for the conduct of research with Aboriginal and Torres Strait Islander Peoples within the culturally- and gender-sensitive area of MHH. Further we draw on insights offered by a partnership between female Aboriginal and Torres Strait Islander leaders, NGO stakeholders, and non-Indigenous researchers. Through a convening (yarning circle) held in March 2018, the group identified multiple socioecological considerations for MHH research and practice, including: affordability and access to menstrual products, barriers to knowledge and culturally sensitive education, infrastructure and supply chain challenges, and the necessity of Indigenous-led research and community-driven data collection methods in addressing the sensitive topic. We draw together these insights to develop recommendations for future research, advocacy, and action in Australia.
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Premenstrual Syndrome Is Associated with Dietary and Lifestyle Behaviors among University Students: A Cross-Sectional Study from Sharjah, UAE. Nutrients 2019; 11:nu11081939. [PMID: 31426498 PMCID: PMC6723319 DOI: 10.3390/nu11081939] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 11/16/2022] Open
Abstract
Premenstrual syndrome (PMS) is a cyclical late luteal phase disorder of the menstrual cycle whereby the daily functioning of women is affected by emotional and physical symptoms substantially interfering with their quality of life. Little is known about PMS in the United Arab Emirates (UAE). This study aimed to determine the prevalence and severity of PMS among university students in Sharjah, UAE, and clarify its associations with dietary habits, lifestyle behaviors, and anthropometric factors. A cross-sectional study was conducted on female college students at the University of Sharjah, UAE. Data were collected using self-administered questionnaires and anthropometric assessments. Descriptive statistics and multiple logistic regression analyses were performed. Participants were 300 adult university students aged 18-24 years (mean age 20.07 ± 1.53 years). In total, 95% of participants reported at least one PMS symptom during their menstrual period. The prevalence of PMS was 35.3%, with mild symptoms being the most commonly reported. Multiple regression analysis showed that smoking was associated with increased risk of reporting psychological (OR 2.5, 95% CI 1.1-5.8; p < 0.05) and behavioral symptoms (OR 2.2, 95% CI 1.0-4.9; p < 0.05), while high calorie/fat/sugar/salt foods intake was associated with increased risk of reporting physical symptoms (OR 3.2, 95% CI 1.4-7.3; p < 0.05). However, fruit consumption (OR 0.34, 95% CI 0.125-0.92; p < 0.05) was associated with a decreased risk of reporting behavioral symptoms. A high prevalence of PMS was reported among university students, with smoking and high calorie/fat/sugar/salt food consumption identified as strong risk factors for PMS.
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Self-care strategies and sources of knowledge on menstruation in 12,526 young women with dysmenorrhea: A systematic review and meta-analysis. PLoS One 2019; 14:e0220103. [PMID: 31339951 PMCID: PMC6655766 DOI: 10.1371/journal.pone.0220103] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/08/2019] [Indexed: 01/05/2023] Open
Abstract
Introduction: Dysmenorrhea (period pain) is common and affects around three quarters of all young women under the age of 25. The majority of young women, for a variety of reasons, think of period pain as ‘normal’ and something to be managed or endured. This normalisation of pain often is reinforced by family and friends and results in young women using self-care strategies to manage their pain rather than seeking medical advice. This systematic review and meta-analysis examined observational studies reporting on the prevalence of different types of self-care, both pharmaceutical and non-pharmaceutical, self-rated effectiveness of self-care and the sources of information on menstruation in young women under 25 Methods: A search of Medline, PsychINFO, EMBASE and CINAHL in English was carried out from 1980 to December 2018. Studies that reported on menstrual self-care strategies in young women were included. Results: Nine hundred and forty-seven articles were screened. Twenty-four studies including 12,526 young women were eligible and included in the meta-analysis. Fifteen studies were from low, lower-middle or upper-middle-income countries (LMIC) and nine studies were from high income countries (HIC). Self-care was used by over half of all young women (55%, 95%CI 34.1–74.3) with both pharmaceutical (48%, 95%CI 40.0–57.0) and non-pharmaceutical (51.8%, 95%CI 31.3–71.7) options used. Paracetamol was the most common analgesic used (28.7%, 95%CI 19.6–39.9) but did not always provide sufficient pain relief in almost half of those using it. Contraceptive use was significantly higher (P<0.001) in HIC (22%) compared to LMIC (1%). Only 11% (95%CI 8.4–15.2) of young women reported seeing a medical doctor for their period pain. Conclusions: Self-care usage, both pharmaceutical and non-pharmaceutical, was common, but young women were not necessarily choosing the most effective options for pain management. High-quality information on self-care for period pain is urgently needed.
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Ussher JM, Hawkey AJ, Perz J. 'Age of despair', or 'when life starts': migrant and refugee women negotiate constructions of menopause. CULTURE, HEALTH & SEXUALITY 2019; 21:741-756. [PMID: 30280959 DOI: 10.1080/13691058.2018.1514069] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
There has been a call for research on migrant and refugee women's negotiation of diverse discourses and cultural constraints associated with sexual embodiment, including menopause, in order to facilitate sexual and reproductive health and understand gendered subjectivity. This study examined the construction and experience of menopause among migrant and refugee women who had settled in Australia or Canada in the last 10 years. Eighty-four individual interviews and 16 focus groups comprising 85 participants were conducted (total n = 169), with women aged 18 years and over from Afghanistan, India (Punjab), Iraq, Somalia, South Sudan, Sri-Lanka (Tamil), Sudan and various South American (Latina) backgrounds. Thematic decomposition identified three discursive themes: Menopause as the Age of Despair; a Discourse of Silence and Secrecy; and Menopause as a Life Stage - or when Life Starts. Negative constructions of menopause, associated with silence and secrecy, were evident across different cultural groups, with implications for women's positioning and experience of menopausal change and embodiment. However, resistance to negative discourse was also evident. This was primarily associated with having received menopause education and more open communication about menopausal change, suggesting that education and health information can facilitate affirming aspects of menopause.
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Affiliation(s)
- Jane M Ussher
- a Translational Health Research Institute, School of Medicine , Western Sydney University , Sydney , New South Wales , Australia
| | - Alexandra J Hawkey
- a Translational Health Research Institute, School of Medicine , Western Sydney University , Sydney , New South Wales , Australia
| | - Janette Perz
- a Translational Health Research Institute, School of Medicine , Western Sydney University , Sydney , New South Wales , Australia
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Rizkia M, Setyowati, Ungsianik T. Female Adolescents' Preparations, Knowledge, and Emotional Response toward Menarche: A Preliminary Study. Compr Child Adolesc Nurs 2019; 42:108-114. [PMID: 31192723 DOI: 10.1080/24694193.2019.1578431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Emotional response toward menarche is a psychological problem for female adolescents. In addition menarche is considered taboo and embarrassing by female adolescents. Many female adolescents have a negative feeling and do not prepare for menarche. The purpose of this paper is to identify female adolescents' preparation and emotional response toward menarche. This study used a qualitative method including focus group discussion (FGD) and in-depth interview. FGD was carried out with five female adolescents in a school setting about female adolescents' preparations and emotional response toward menarche. The participants were female adolescent students who had not entered menarche yet. Some teachers were also interviewed as key persons. The results of this study indicate that female adolesents do not prepare for menarche. The participants did not have adequate knowledge and felt ashamed and worried about menarche. This study recommended the use of reproductive health education related to menarcheal preparations in school and community settings to prepare female adolescents to confidently face menarche.
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Affiliation(s)
- Mira Rizkia
- a Faculty of Nursing , Universitas Indonesia , Depok , Indonesia
| | - Setyowati
- a Faculty of Nursing , Universitas Indonesia , Depok , Indonesia
| | - Titin Ungsianik
- a Faculty of Nursing , Universitas Indonesia , Depok , Indonesia
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35
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Setyowati, Rizkia M, Ungsianik T. Improving Female Adolescents' Knowledge, Emotional Response, and Attitude toward Menarche following Implementation of Menarcheal Preparation Reproductive Health Education. Asian Pac Isl Nurs J 2019; 4:84-91. [PMID: 31259234 PMCID: PMC6571916 DOI: 10.31372/20190402.1041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Menarche and menstruation are considered taboos and disconcerting by communities, including female adolescents. The Menarcheal Preparation Reproductive Health Education program was designed to prepare female adolescents for menarche. The aim of this study was to identify the influence of reproductive health education on female adolescents’ preparation, knowledge, emotional response, and attitude toward menarche. The research design was a quasi-experimental, pre–post test with control group design. We selected 174 female adolescents by a stratified random sampling technique. The respondents were divided into two groups: control and intervention. The intervention group was provided Menarcheal Preparations Reproductive Health Education program in the form of a booklet, whereas the control group experienced no intervention. Data analyses involved the use of a chi-square test, McNemar test, and logistic regression. The results showed that there were significant differences in terms of knowledge (p = .001), emotional responses (p = .001), and attitude (p = .001) between the groups, as well as before and after intervention in the intervention group. Logistic regression revealed that reproductive education was the most influencing factor among female adolescents’ knowledge (OR = 45.1; 95% CI: 13.8–148.1), emotional responses (OR = 12.7; 95% CI: 5.6–28.5), and attitude (OR = 12.4; 95% CI: 5.8–26.6) toward menarche. Therefore, this study supports a recommendation of using Reproductive Health Education Related to Menarcheal Preparation in schools and community settings to prepare female adolescents for menarche.
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Affiliation(s)
- Setyowati
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Mira Rizkia
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Titin Ungsianik
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
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Duby Z, Katz A, Musara P, Nabukeera J, Zimba CC, Woeber K, Palanee-Phillips T, van der Straten A. "The state of mind tells me it's dirty": menstrual shame amongst women using a vaginal ring in Sub Saharan Africa. Women Health 2019; 60:72-86. [PMID: 31043134 DOI: 10.1080/03630242.2019.1607803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Socio-cultural beliefs and practices surrounding menses influence women's sexual and reproductive health behaviors and decision-making. We analyzed menstrual experiences within the context of the MTN-020/ASPIRE clinical trial during which women were asked to use a monthly vaginal ring for HIV prevention. The qualitative component of the trial was conducted during February 2013-June 2015, included interviews and focus group discussions with 214 women aged 18-42, in Malawi, Zimbabwe, Uganda, and South Africa. Emotions of shame, embarrassment and disgust relating to menses emerged. Menstruation was referred to using euphemistic terms or language about dirtiness. Women were uncomfortable touching their own menstrual blood when removing vaginal rings and felt embarrassed about study staff seeing blood on returned rings. Despite reassurances, women felt ashamed performing study procedures while menstruating, leading to missed study visits. Women's aversion to menstrual blood was linked to narratives about avoiding sex during menses and beliefs about its potential harms. Women associated men's disgust pertaining to menstrual blood with men's willingness to use condoms for sex only during menses, highlighting another way through which socio-cultural beliefs and practices around menstruation affect HIV protective behaviours. These findings provide novel insight into menstrual shame among women in these four countries.
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Affiliation(s)
- Zoe Duby
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Rondebosch South Africa
| | - Ariana Katz
- Women's Global Health Imperative, RTI International, San Francisco, California, USA
| | - Petina Musara
- University of Zimbabwe College of Health Sciences-Clinical Trials Unit (UZCHS-CTRC), Harare, Zimbabwe
| | - Josephine Nabukeera
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Kubashni Woeber
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
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DeMaria AL, Delay C, Sundstrom B, Wakefield AL, Naoum Z, Ramos-Ortiz J, Meier S, Brig K. "My mama told me it would happen": menarche and menstruation experiences across generations. Women Health 2019; 60:87-98. [PMID: 31023171 DOI: 10.1080/03630242.2019.1610827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to understand women's menarche and menstruation-related knowledge, attitudes, and behaviors across generations. Women ages 18 years and older (Mean = 49.13 ± 14.76 years; Range = 19-78 years) living in South Carolina were recruited to participate in semi-structured interviews during May-November 2016. A total of 70 interviews were conducted, which were audio-recorded and transcribed verbatim. Thematic analysis using open and axial coding techniques from grounded theory provided the framework for data interpretation. Women described vivid menarche memories; however, most women had not received proper education or preparation for what to expect prior to onset. Participants discussed their experiences with menstrual products, oral contraceptives, and medical procedures to suppress, manipulate, or manage menstruation. Findings provide practical recommendations for health professionals to develop further effective and timely messaging related to menarche and menstruation across the lifespan. Messaging should inform women about what to expect with menarche, menstruation management, and health-related impacts, as well as methods to reduce menses-related myths and stigmas.
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Affiliation(s)
- Andrea L DeMaria
- College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Cara Delay
- Department of History, College of Charleston, Charleston, South Carolina, USA
| | - Beth Sundstrom
- Department of Communication, College of Charleston, Charleston, South Carolina, USA
| | - Audrey L Wakefield
- College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Zeina Naoum
- College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Jaziel Ramos-Ortiz
- Department of Consumer Science, Purdue University, West Lafayette, Indiana, USA
| | - Stephanie Meier
- College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Kristin Brig
- Department of The History of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Hawkey AJ, Ussher JM, Perz J. Regulation and Resistance: Negotiation of Premarital Sexuality in the Context of Migrant and Refugee Women. JOURNAL OF SEX RESEARCH 2018; 55:1116-1133. [PMID: 28682121 DOI: 10.1080/00224499.2017.1336745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Constructions of normative sexuality shape the sexual scripts that women are permitted to adopt and the manner in which such sexuality can be expressed. We explored experiences and constructions of premarital sexuality among migrant and refugee women recently resettled in Sydney, Australia, and Vancouver, Canada. A total of 78 semistructured individual interviews and 15 focus groups composed of 82 participants were undertaken with women who had migrated from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, and South America. We analyzed the data using thematic decomposition. Across all cultural groups, women's premarital sexuality was regulated through cultural and religious discourse and material practice. Such regulation occurred across three main facets of women's lives, shaping the themes presented in this article: (1) regulating premarital sex-the virginity imperative; (2) regulation of relationships with men; and (3) regulation of the sexual body. These themes capture women's reproduction of dominant discourses of premarital sexuality, as well as women's resistance and negotiation of such discourses, both prior to and following migration. Identifying migrant and refugee women's experiences and constructions of premarital sexuality is essential for culturally safe sexual health practice, health promotion, and health education.
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Affiliation(s)
- Alexandra J Hawkey
- a Translational Research Institute (THRI), School of Medicine, Western Sydney University
| | - Jane M Ussher
- a Translational Research Institute (THRI), School of Medicine, Western Sydney University
| | - Janette Perz
- a Translational Research Institute (THRI), School of Medicine, Western Sydney University
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Hawkey AJ, Ussher JM, Perz J. “If You Don’t Have a Baby, You Can’t Be in Our Culture”: Migrant and Refugee Women’s Experiences and Constructions of Fertility and Fertility Control. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23293691.2018.1463728] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Alexandra J. Hawkey
- Translational Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Jane M. Ussher
- Translational Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Janette Perz
- Translational Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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VanLeeuwen C, Torondel B. Exploring menstrual practices and potential acceptability of reusable menstrual underwear among a Middle Eastern population living in a refugee setting. Int J Womens Health 2018; 10:349-360. [PMID: 30034256 PMCID: PMC6047600 DOI: 10.2147/ijwh.s152483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Menstruation is a biological process that approximately half of the world's population experiences over a significant period of their lifetime. As a displaced female, managing menstruation can be challenging as limited resources and changes in context confront the cultural norms of communities. This study explores the hypothetical acceptability and potential utility of a reusable menstrual underwear product through examining the beliefs, behaviors, and practices toward menstrual hygiene in a Middle Eastern population living in a refugee setting. Participants and methods A qualitative study employing a questionnaire, semi-structured interviews, and focus group discussions was conducted with 30 refugee women and 5 humanitarian staff in Ritsona, Greece. All 30 refugee women completed a questionnaire, six refugee women and five humanitarian staff participated in individual semi-structured interviews, and four focus group discussions were held containing five to six refugee women per group. Inductive analysis led to the development of key themes. Results Primary data analysis of narratives around the beliefs, behaviors, and practices of menstrual hygiene in this population revealed key themes related to the physical environment, the social environment, cleanliness, comfort, and health, and adaptation and coping. Themes related to the potential use of menstrual underwear included comfort, appearance, and concept, absorbent capacity and selected use, hygiene, and knowledge and implementation. Conclusion Menstrual hygiene beliefs, behaviors, and practices are mostly consistent with existing literature. An acceptance of the concept of reusable menstrual underwear was expressed, although the perceived benefits of this product did not outweigh customary practices. The use of menstrual underwear as a complimentary product to traditional absorbents was expressed as helpful for promoting dignity.
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Affiliation(s)
- Crystal VanLeeuwen
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK,
| | - Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK,
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"In My Culture, We Don't Know Anything About That": Sexual and Reproductive Health of Migrant and Refugee Women. Int J Behav Med 2018. [PMID: 28620774 DOI: 10.1007/s12529-017-9662-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Migrant and refugee women are at risk of negative sexual and reproductive health (SRH) outcomes due to low utilisation of SRH services. SRH is shaped by socio-cultural factors which can act as barriers to knowledge and influence access to healthcare. Research is needed to examine constructions and experiences of SRH in non-English-speaking migrant and refugee women, across a range of cultural groups. METHOD This qualitative study examined the constructions and experiences of SRH among recent migrant and refugee women living in Sydney, Australia, and Vancouver, Canada. A total of 169 women from Afghanistan, Iraq, Somalia, South Sudan, Sudan, India, Sri Lanka and South America participated in the study, through 84 individual interviews, and 16 focus groups comprised of 85 participants. Thematic analysis was used to analyse the data. RESULTS Three themes were identified: "women's assessments of inadequate knowledge of sexual and reproductive health and preventative screening practices", "barriers to sexual and reproductive health" and "negative sexual and reproductive health outcomes". Across all cultural groups, many women had inadequate knowledge of SRH, due to taboos associated with constructions and experiences of menstruation and sexuality. This has implications for migrant and refugee women's ability to access SRH education and information, including contraception, and sexual health screening, making them vulnerable to SRH difficulties, such as sexually transmissible infections and unplanned pregnancies. CONCLUSION It is essential for researchers and health service providers to understand socio-cultural constraints which may impede SRH knowledge and behaviour of recent migrant and refugee women, in order to provide culturally safe SRH education and services that are accessible to all women at resettlement irrespective of ethnicity or migration category.
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Womanhood, reproduction, and pollution: Greek Cypriot women's accounts of menstruation. WOMENS STUDIES INTERNATIONAL FORUM 2018. [DOI: 10.1016/j.wsif.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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VanLeeuwen C, Torondel B. Improving menstrual hygiene management in emergency contexts: literature review of current perspectives. Int J Womens Health 2018; 10:169-186. [PMID: 29692636 PMCID: PMC5901152 DOI: 10.2147/ijwh.s135587] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Management of menstruation in contexts of humanitarian emergencies can be challenging. A lack of empirical research about effective interventions which improve menstrual hygiene management (MHM) among female populations in humanitarian emergencies and a lack of clarity about which sectors within a humanitarian response should deliver MHM interventions can both be attributable to the lack of clear guidance on design and delivery of culturally appropriate MHM intervention in settings of humanitarian emergencies. The objective of this review was to collate, summarize, and appraise existing peer-reviewed and gray literature that describes the current scenario of MHM in emergency contexts in order to describe the breadth and depth of current policies, guidelines, empirical research, and humanitarian aid activities addressing populations’ menstrual needs. A structured-search strategy was conducted for peer-reviewed and gray literature to identify studies, published reports, guidelines, and policy papers related to menstrual response in emergency humanitarian contexts. Of the 51 articles included in the review, 16 were peer-reviewed papers and 35 were gray literature. Most of the literature agreed that hardware interventions should focus on the supply of adequate material (not only absorbent material but also other supportive material) and adequate sanitation facilities, with access to water and private space for washing, changing, drying, and disposing menstrual materials. Software interventions should focus on education in the usage of materials to manage menstruation hygienically and education about the female body’s biological processes. There was clear agreement that the needs of the target population should be assessed before designing any intervention. Although there is insight about which factors should be included in an effective menstrual hygiene intervention, there is insufficient empirical evidence to establish which interventions are most effective in humanitarian emergencies and which sectors should be responsible for the coordination and implementation of such. Increased monitoring and evaluation studies of interventions should be completed and publicly shared, in order to feed evidence-based guidelines in the humanitarian sector.
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Affiliation(s)
- Crystal VanLeeuwen
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Ussher JM, Perz J, Metusela C, Hawkey AJ, Morrow M, Narchal R, Estoesta J. Negotiating Discourses of Shame, Secrecy, and Silence: Migrant and Refugee Women's Experiences of Sexual Embodiment. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1901-1921. [PMID: 28083724 PMCID: PMC5547186 DOI: 10.1007/s10508-016-0898-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 05/12/2023]
Abstract
In Australia and Canada, the sexual health needs of migrant and refugee women have been of increasing concern, because of their underutilization of sexual health services and higher rate of sexual health problems. Previous research on migrant women's sexual health has focused on their higher risk of difficulties, or barriers to service use, rather than their construction or understanding of sexuality and sexual health, which may influence service use and outcomes. Further, few studies of migrant and refugee women pay attention to the overlapping role of culture, gender, class, and ethnicity in women's understanding of sexual health. This qualitative study used an intersectional framework to explore experiences and constructions of sexual embodiment among 169 migrant and refugee women recently resettled in Sydney, Australia and Vancouver, Canada, from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, India, and South America, utilizing a combination of individual interviews and focus groups. Across all of the cultural groups, participants described a discourse of shame, associated with silence and secrecy, as the dominant cultural and religious construction of women's sexual embodiment. This was evident in constructions of menarche and menstruation, the embodied experience that signifies the transformation of a girl into a sexual woman; constructions of sexuality, including sexual knowledge and communication, premarital virginity, sexual pain, desire, and consent; and absence of agency in fertility control and sexual health. Women were not passive in relation to a discourse of sexual shame; a number demonstrated active resistance and negotiation in order to achieve a degree of sexual agency, yet also maintain cultural and religious identity. Identifying migrant and refugee women's experiences and constructions of sexual embodiment are essential for understanding sexual subjectivity, and provision of culturally safe sexual health information in order to improve well-being and facilitate sexual agency.
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Affiliation(s)
- Jane M Ussher
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia.
| | - Janette Perz
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia
| | - Christine Metusela
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia
| | - Alexandra J Hawkey
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia
| | - Marina Morrow
- Centre for the Study of Gender, Social Inequities and Mental Health, Simon Fraser University, Vancouver, BC, Canada
| | - Renu Narchal
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia
| | - Jane Estoesta
- , Family Planning New South Wales, Sydney, NSW, Australia
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