Exploring menstrual products: A systematic review and meta-analysis of reusable menstrual pads for public health internationally

Sustainable menstrual solutions: a scoping review of novel eco-friendly materials for reusable menstrual pads

BACKGROUND

Reusable menstrual pads (RMPs) offer a sustainable alternative, but the effectiveness and properties of novel eco-friendly materials for RMPs remain unclear. The objective of this scoping review is to identify novel eco-friendly materials used for RMPs.

METHODS

This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A comprehensive three-step search strategy was employed to locate both published and unpublished studies. Two reviewers independently screened titles and abstracts using the software Covidence. Data were extracted and charted using a standardized form. This search was conducted in February, 2024.

RESULTS

The search yielded 479 studies, 37 studies were assessed for full-text review, which led to inclusion of 16 studies. A diverse array of eco-friendly materials were identified for RMPs. The top layer includes bamboo, banana, organic cotton and other natural fibers. The core layer, focused on absorbency, features materials like cotton terry cloth, hemp, bamboo wadding and bamboo kun. The bottom layer uses water-repellent materials, such as polyester, polyurethane laminate, nylon and bio-plastic sheets.

CONCLUSION

This review highlights the potential of plant-based fibers as eco-friendly materials for RMPs.

Cycles of Neglect: A Statutory Review of State Policies Regarding Feminine Hygiene Product Provision During Incarceration

Historically, American correctional institutions were designed for men. An increase in incarcerated females has required states to grapple with issues related to menstrual hygiene, including menstrual cycles. While the federal government requires that women and persons who menstruate in federal prisons be supplied with minimal menstrual hygiene supplies, there is no such mandate for menstruators incarcerated in state prisons. We conducted a review and analysis of state legal statutes and Department of Corrections' (DoC) policies pertaining to menstrual product provision to incarcerated individuals in the United States. We assessed state statutes and policies for product type, amount and quality, requisition process, and cost. Forty-six jurisdictions had policy between state statute or a DoC manual or handbook. Results indicate policies regarding procurement processes and amount provided were vague.

Understanding autistic youths' menstrual product preferences and caregivers' product choices

LAY ABSTRACT

There is little research exploring the menstrual product preferences of autistic youth, especially those who recently started their period. Study authors surveyed caregivers' choice of menstrual products for their autistic children. They provided popular menstrual materials to autistic youth to try, then asked them which product(s) they preferred, did not try, and why they did not try it. Caregivers selected sensory impact as the most important feature they consider when choosing a menstrual product for their child, and youth participants preferred to use period underwear. Therefore, autistic youth may benefit from purchasing and using period underwear, and caregivers, clinicians, and companies should consider the impact of menstrual product features, like sensory sensitivities, on young autistic menstruators and how best to support them.

Sleep health epidemiology and associations with menstrual health, mental health, and educational performance among in-school female adolescents in Uganda: A longitudinal study

OBJECTIVES

Few studies have assessed sleep among African adolescents. We aim to understand factors associated with subjective sleep quality among female Ugandan adolescents and the association of poor sleep quality with subsequent menstrual- and mental health, and educational performance.

METHODS

We analyzed data from a cluster-randomized controlled trial that evaluated a menstrual health intervention in 60 Ugandan secondary schools. Data were collected through cross-sectional surveys at baseline (March-June 2022) and endline (July-August 2023), and prospective daily diaries (April-August 2023). We used logistic regression to analyze associations with poor sleep at baseline, and linear regression to analyze associations of poor sleep with subsequent menstrual and mental health, and education performance, adjusting for clustering.

RESULTS

Of 3841 female participants (mean age=15.6years), 580 (15.1%) reported poor sleep quality and 829 (21.6%) reported feeling tired at baseline. Poor sleep was associated with socio-economic factors including smaller household size, lower socioeconomic status, and fewer meals consumed the previous day. There was strong evidence that poor sleep at baseline was associated with multiple dimensions of poor menstrual health including menstrual pain (adjusted odds ratio=1.74, 95%CI 1.29-2.33), more unmet menstrual practice needs (adjusted odds ratio=2.68, 95%CI 1.99-3.60), and with mental health problems (adjusted odds ratio=2.40, 95%CI 1.80-3.19). Results were similar for baseline tiredness. Prospectively reported poor sleep quality was associated with subsequent poor menstrual and mental health, and subsequent poor educational performance.

CONCLUSIONS

Poor sleep is prevalent among in-school female Ugandan adolescents and is associated with subsequent poorer menstrual health, mental health, and educational performance. Improving sleep in this population could benefit menstrual health, mental health and education outcomes.

Suitability, acceptability, feasibility of modern menstrual methods: a qualitative study in Coimbatore district, Tamil Nadu, India

Objective

To examine women's perceptions of modern menstrual hygiene methods (MMHM), such as tampons and menstrual cups, focusing on socio-demographic variations and special groups in the Coimbatore district of Tamil Nadu.

Methods

A qualitative study among women of reproductive age (15-49 years) group was conducted using Focus Group Discussions (FGDs) among twelve women subgroups independently in 2023.

Results

The present study involved 23 focus group discussions (FGDs) across various groups of women, including those in formal and informal sectors, urban and rural areas, school and college students, healthcare workers, women in sports, tribal women, transgender women, and female sex workers (FSW), with a total of 188 participants. The age range varied across groups, from 15 to 45 years. Over half of the participants were married (51.1%), and 68.7% were literate, though illiteracy was higher in the informal sector, rural, tribal areas, transgender women, and FSW groups. Sanitary pads were the most used menstrual hygiene method (88.3%), followed by cloth (4.8%), and modern methods like menstrual cups or tampons (1.6%). Notably, 70% of FSW and 28.6% of tribal women still used cloths. Menstrual hygiene choices were often influenced by family recommendations, school-based menstrual hygiene sessions, institutional policies, and social media. Regarding satisfaction, 27.1% were content with their menstrual hygiene method, citing accessibility, affordability, and leakage prevention. However, issues with pads included heat, rashes, and discomfort. A significant number (31.4%) shifted from cloth to pads recently, mainly due to leakage and lack of adequate washing facilities. Only 6.1% had tried modern menstrual methods, with tampons and menstrual cups being considered more suitable but less feasible, especially among tribal women. Participant concerns ranged from the potential health risks of sanitary pads to waste disposal challenges. Recommendations included public menstrual hygiene management (MHM) dispensers, better waste collection practices, and increased awareness through advertisements. Some participants advocated for the concept of free menstruation, emphasizing informed choices and accessibility for all.

Conclusion

The findings suggest that increasing access to modern menstrual hygiene products, coupled with comprehensive education and support, could improve acceptance and feasibility, especially for marginalized and underrepresented women.

[Risks of urogenital infections and expulsion associated with the combination of an IUD and a menstrual cup]

OBJECTIVES

The increase in intrauterine devices (IUDs) contraception, and the growing use of reusables menstrual hygiene products such as the menstrual cup, necessitates an assessment of the implications of their co-use. The objectives are to assess whether women with IUDs who use menstrual cups have an increased risk of IUD expulsion and/or a change in the risk of upper and lower urogenital tract infections compared to women who use other menstrual hygiene products.

METHOD

An observational, prospective, multicenter study was conducted in France between 2020 and 2023. Participants were recruited by health professionals and data were collected by telephone questionnaire at the time of IUD insertion and at one year. The primary endpoints were the occurrence of IUD expulsion and the occurrence of urogenital tract infections in menstrual cup users compared to non-users.

RESULTS

One hundred and three women out of 119 included were analyzed, 25 of them were regular menstrual cup users and five experienced IUD expulsion. Among regular users, 12% experienced IUD expulsion compared to 2.6% among non-users, with no statistically significant difference (Chi2=3.65; P=0.056). Regarding urogenital tract infections, nine women (36%) of the regular menstrual cup users had urogenital infections, compared with 27 (34.6%) of the non-users or not regular users, with no statistically significant difference.

CONCLUSION

The tendency of menstrual cup users to expel their IUDs is a reason for caution, although it is not sufficient to contraindicate co-use. Physicians should therefore systematically screen such co-use and inform patients of the risks and monitoring instructions.

Experiences of menstrual health in the Nordic countries: a scoping review of qualitative research, applying an intersectional lens

Achieving menstrual health is fundamental to gender equality, human rights, and the well-being of all people who menstruate. We undertook a scoping review to map the extent and range of qualitative studies on menstrual health in the Nordic countries and applied an intersectional lens in reporting the findings. The specific research questions we aimed to answer were (1) what types of menstrual health experiences were researched, (2) whose experiences and voices were being researched, and (3) what gaps exist in understanding the experiences and challenges encountered by diverse groups. Four databases were searched for peer-reviewed articles published between 2011 and 2023. Searches yielded 2733, and 22 articles met our inclusion criteria. Included studies were undertaken in Denmark (n = 5), Iceland (n = 1), Norway (n = 3), and Sweden (n = 13). The samples included menstruating people, healthcare professionals, and/or other professionals. Most of the included studies reported on menstrual experiences related to menstrual pain and disorders such as endometriosis. Studies focusing on understanding menstrual health experiences among people in vulnerable situations in the Nordic countries are lacking. We found that menstrual health experiences of menstruating people with the following identities were under-researched: people with disabilities, non-Nordic ethnicities, refugees, gender-diverse people, people experiencing homelessness, and young adolescents. The findings suggest that we have little knowledge and understanding of the experiences and challenges that might be faced by these groups in the Nordic countries. Findings of this scoping review can be used to inform future research directions and policy programming.

The condition of women frequently changing sanitary pads in 28 cities of China: a cross-sectional study

OBJECTIVES

This study aims to fill the gap in understanding the frequency of changing sanitary pads and the key factors associated with this practice among women in China.

METHODS

Using a convenient sampling approach, a cross-sectional study was conducted with a quota sampling method to survey women from 28 cities in China between October 21 and 31, 2020. Basic demographic characteristics, personal hygiene habits, self-efficacy, health-related quality of life, and disease status were collected. Multiple logistic regression model was used to analyze the factors associated with the frequency of changing sanitary pads.

RESULTS

A total of 1682 respondents were included in this study. The condition of frequently changing sanitary pads was divided into three groups: "Not taken" (224 respondents, 13.32%), "Short-term taken" (330 respondents, 19.62%), and "Long-term taken" (1128 respondents, 67.06%). Multiple logistic analysis revealed that women who performed "long-term taken" cleaning up rubbish timely (OR = 22.89, P < 0.05), "long-term taken" regular breast self-examination (OR = 19.46, P < 0.05), "long-term taken" actively obtaining scientific contraception methods (OR = 7.40, P < 0.05), as well as those with higher health-related quality of life (OR = 33.72, P < 0.05), were more likely to perform "long-term taken" frequently changing sanitary pads. Conversely, women with chronic diseases (OR = 0.48, P < 0.05) and those aged 31-40 (OR = 0.44, P < 0.05) were less likely to perform the "long-term taken" frequently changing sanitary pads during menstruation.

CONCLUSIONS

Most Chinese women practice good menstrual health management and frequently change their sanitary pads. However, there are still some women whose sanitary pad changing practices fall short of expectations. Multiple factors have been found to be associated with the frequency of changing sanitary pads. Based on the research results, healthcare institutions, schools, and the government can more effectively screen, assess, and support women who face menstrual health issues, thereby improving the overall level of menstrual hygiene management.

Menstrual cups to reduce bacterial vaginosis and STIs through reduced harmful sexual and menstrual practices among economically vulnerable women: protocol of a single arm trial in western Kenya

BACKGROUND

In western Kenya, menstrual hygiene management (MHM) is a pervasive problem. Challenges are compounded for economically constrained women who continue to engage in sex during menses and resort to practices such as vaginal insertion of tissue and cotton to maintain dryness during sex. These practices can be harmful to the vaginal microbiome (VMB) and can lead to high rates of sexually transmitted infections (STIs) and HIV. This study will evaluate whether menstrual cups that can be worn during intercourse may be beneficial to the VMB and help prevent Bacterial vaginosis (BV) and STI acquisition among these economically vulnerable women.

METHODS

In this single-arm trial among economically vulnerable women in semi-urban western Kenya, we will evaluate the preliminary efficacy of menstrual cups on non-optimal VMB, BV, and STIs, and investigate safety, acceptability, and implementation needs. Through peer referral we aim to recruit 402 menstruating women aged 15-35 who exchange sex for money or basic needs. Women who are pregnant, have delivered in the past six months, or use an intrauterine device (IUD) will not be eligible. Participants will be seen every six months for 24 months and be asked about their sexual and MHM practices, with samples collected to assess BV and VMB. At baseline, 12-, and 24-month visits, additional samples will be collected to measure HIV and STIs (C. trachomatis, N. gonorrhoeae, and T. vaginalis). HSV-2 status will be assessed at baseline. Intervention provision will consist of one reusable disc-shaped menstrual cup per participant and a group-based training within four weeks of the 12-month visit, followed by monthly telephone surveys for the first three months to assess cup use, adverse events, and provide any assistance. Primary analyses of preliminary efficacy will compare probabilities of optimal VMB, BV, and STIs in the pre-intervention period to the post-intervention period. Primary safety analyses will compare occurrence of menstrual toxic shock syndrome and cervicovaginal laceration.

DISCUSSION

If demonstrated safe and effective, this multipurpose reproductive health intervention will offer a dignified solution for the menstrual hygiene needs of women who engage in sex for livelihood and reduce their occurrence of non-optimal VMB, BV, and STIs.

TRIAL REGISTRATION

Clinicaltrials.gov NCT05666778 (28th December, 2022); Pan African Clinical Trials Registry 202,305,912,778,108 (25th May, 2023).

Cross-national variation in the prevalence and correlates of current use of reusable menstrual materials: Analysis of 42 cross-sectional surveys in low-income, lower-middle-income, and upper-middle-income countries

OBJECTIVES

This study investigates the prevalence of the use of reusable menstrual materials in LMICs, examines differences in prevalence between countries and areas, and identifies individual and country-level factors associated with their use.

METHODS

Data from Multiple Indicator Cluster surveys conducted between 2017 and 2020 in LMICs were used. Prevalence estimates and 95% CIs were calculated for overall, rural, and urban areas. Multivariable logistic regression was used to identify individual and country-level factors associated with the use of reusable menstrual materials.

RESULTS

The study included 42 surveys from LMICs, with 1653850 weighted women and girls aged 15-49 years. The overall prevalence of the use of reusable menstrual materials was 12.1% (95% CI 12.1-12.2), with significant variation between and within countries, ranging from 0.5% (0.3-0.8) in Serbia to 97.2% (96.5-97.9) in Sao Tome and Principe. The prevalence was higher in rural areas (23.9% [23.8-24.0]) than in urban areas (6.2% [6.2-6.2]), with significant differences between most countries. Use of reusable menstrual materials was associated with lower education levels, being married, low economic status, living in Asia and Africa, living in countries with lower GDP, living in rural areas, and limited availability of private places to wash menstrual materials. The prevalence of the use of reusable menstrual materials had an inverse linear relationship with the country's GDP.

CONCLUSIONS

The study found that the use of reusable menstrual materials is more prevalent among women and girls in rural areas, those with lower education levels, lower economic status, and those living in countries with lower GDP. Given these disparities, policies and initiatives targeted at improving menstrual health in LMICs should focus on socioeconomically disadvantaged groups to ensure they have access to safe and appropriate menstrual materials.

Development and validation of a survey instrument for reusable sanitary products toward sustainable menstrual hygiene

The predominant use of disposable, non-organic menstrual products has significant environmental impacts due to waste and resource depletion. Concerns over the environmental, economic, and health implications of menstrual hygiene management (MHM) have highlighted the need to explore sustainable options like reusable sanitary pads (RSPs). Despite their benefits, the adoption of RSPs is limited by a lack of awareness, availability, cost, and research. This study emphasizes the need for the development of an instrument that can capture the effectiveness, safety, and user satisfaction of RSPs, addressing a significant gap in the literature. Using a convenient sampling method, data were collected through a structured offline survey and the sample comprised 446 South Asian women of reproductive age. The instrument included 15 items designed to measure factors such as comfort, hygiene, convenience, and environmental consciousness. The instrument's reliability and validity are thoroughly assessed using reliability and factor analysis to ensure its effectiveness in capturing the multifaceted dimensions of MHM product choices. The study revealed that the overwhelming majority of women would prefer the option of RSPs that are comfortable, accessible, and easy to use and dispose of. The findings aim to provide a validated tool for manufacturers, policymakers, and researchers to evaluate reusable pads, promoting their broader acceptance and adoption of a sustainable and equitable approach to menstrual hygiene.

Promoting menstrual health and hygiene-insights from the 2023 World Menstrual Hygiene Day celebration events in the Hohoe municipality in Ghana

The 2023 World Menstrual Hygiene Day (WMHD) celebration at the University of Health and Allied Sciences (UHAS) sought to create awareness about menstruation. Toward normalizing menstruation, the 3-day event brought together key stakeholders and engaged community members on various topics relating to menstruation. Among the stakeholders were basic school teachers (13), school children (155), in a 2:1 female vs. male ratio within the ages of 10-17 years, School Health and Education Program Coordinators (2), Health Officers (4), Academicians (15), University students (35), Media representatives (3), and Civil society representatives (130). Particular among these discussions were the biology of menstruation, nutrition related facts during menstruation, sociocultural, and mental health issues surrounding menstruation. These discussions were intended to incite more conversations about menstruation, and contribute toward the agenda 2030 goal of making menstruation a normal fact of life. The paper describes activities conducted to improve menstrual health, reduce period poverty, and involve men in breaking the stigma around menstruation. This contributes to creating supportive environments for menstruating individuals. Meanwhile, the lessons from the activities to celebrate WMHD in Ghana are relevant for other communities to consider replicating with consideration for contextual differences.

Prevalence and factors associated with unmet need for menstrual hygiene management in six countries in Sub-Saharan Africa: A multilevel analysis

BACKGROUND

Menstruation is a normal biological process experienced by more than 300 million women globally every day. Women require clean menstrual absorbents that can be changed as often as needed in a private and safe place with proper hygiene and disposal facilities. These needs must be met consistently throughout the duration of the menstrual cycle. Access to menstrual needs is crucial for women's health, wellbeing, and dignity. This study assessed the prevalence and factors associated with unmet need for menstrual hygiene management (MHM) in Ethiopia, Kenya, Uganda, Burkina Faso, Ghana, and Niger.

METHODS

We used data from the Performance Monitoring for Action (PMA) 2020 surveys. We defined the unmet need for MHM as the "lackof resources, facilities and supplies for MHM." Sample characteristics were summarised using frequencies and percentages, while prevalence was summarised using proportions and their respective confidence intervals (CI). Factors associated with unmet need for MHM were assessed using multilevel logistic regression models.

RESULTS

The study included 18,048 women of reproductive age from the six countries. The prevalence of unmet need for MHM was highest in Burkina Faso (74.8%), followed by Ethiopia (69.9%), Uganda (65.2%), Niger (57.8%), Kenya (53.5%), and lowest in Ghana (34.2%). Unmet need for MHM was consistently higher among uneducated and multiparous women, those who reused MHM materials, practiced open defecation, and lived in rural areas across all six countries. The odds of unmet need for MHM were higher among younger women under 35 years, unmarried women, those with lower education levels, and those from poorer households. Similarly, the reuse of MHM materials, use of shared or non-improved toilet facilities, and open defecation increased the odds of unmet need for MHM. In contrast, the presence of handwashing facilities reduced the odds of unmet need for MHM.

CONCLUSION

More than half of the women in five of the six countries have an unmet need for MHM, with significantly higher odds among younger women, those with low wealth status, the unmarried, and those with inadequate access to sanitary facilities. This study highlights the state of period poverty in Sub-Saharan Africa. Efforts to end period poverty should consider MHM needs as an integrated whole, as addressing each need in isolation is insufficient.

[Menstrual experiences and acceptability of a menstrual equity intervention among adolescents in Catalonia (Spain)]

OBJECTIVE

To explore menstrual knowledge, menstrual management, the use of menstrual products, the prevalence of menstrual poverty and to assess the acceptability of a menstrual equity intervention among students in the fourth grade of compulsory secondary education in Catalonia (Spain).

METHOD

Post-intervention mixed-methods study (cross-sectional study and qualitative study with focus groups) with a critical and gender perspective. It was conducted between July 2022 and March 2023. Descriptive and bivariate statistical analyses stratified by gender were carried out. Qualitative data were analysed using thematic analysis.

RESULTS

Women and people who menstruate rated the intervention favourably, while some men were reluctant. The intervention promoted the use of some reusable menstrual products, although some barriers to use menstrual cups were identified. Participants reported institutional barriers to menstrual management in the school setting and 19.4% stopped attending school during menstruation in the 6 months prior to the study. Between 10.9-16.4% reported menstrual poverty in the 6 months prior to the study, and 29,0% took actions to reduce the environmental impact of menstrual products.

CONCLUSIONS

This study highlights the need for co-designing menstrual interventions that consider gender dynamics and sexist attitudes with students, as well as targeting it to teachers. The provision of reusable menstrual products can be helpful in promoting their use, although accompaniment should be provided. In parallel, it is crucial to strengthen menstrual education, as well as to reduce menstrual poverty and school absenteeism during menstruation.

Menstrual poverty scale: reliability and validity study

The tendency toward poverty in the globalizing world significantly affects women. Unlike men, women have mandatory expenses every month. Especially poor women have difficulty in accessing to the hygienic products they need during the menstrual period. That is why, this study aims to develop a measurement tool that can effectively and widely assess women's menstrual poverty. This study is a methodological study that evaluates the psychometric properties of the scale. The study included 420 women living in a middle-income province in the north of Türkiye between April - July, 2023. The data were collected using the Menstrual Poverty Scale, and the items on the scale were developed based on a review of existing literature and expert opinions (CVI = 0.85-0.95). The sample was divided into two parts. It was made exploratory factor analysis and confirmatory factor analysis. Before conducting the study, an ethics committee decision and informed consent of the women were obtained. The collected data were analyzed using the SPSS 23 and AMOS 23 programs. The EFA revealed a structure consisting of 13 items and four factors. The four factors considered were as follows; access to hygiene products, quality of life, embarrassment, and receiving information, and education about menstruation. The item factor loadings varied from 0.46 to 0.91. The Cronbach's alpha coefficient was determined to be 0.69. The corrected item-total correlations for the scale items ranged from 0.62 to 0.84. According to the confirmatory factor analysis, the structural equation modeling results of the Menstrual Poverty Scale were found to be meaningful (p = .000; RMSEA 0.64; CMIN/Df 1.70). It is suggested to conduct validity and reliability studies in different cultures by applying the scale to women from different cultural backgrounds.

Building a Future for School-Based Menstruation Health and Hygiene (MHH): Evaluating Implementation of a Menstrual Hygiene Management (MHM) Policy in Chicago Public Schools

Menstrual health and hygiene (MHH) inequities disproportionately impact communities who are marginalized. In 2018, Illinois passed the Learn with Dignity Act (LWDA) requiring schools to provide menstrual products in bathrooms, yet little is known about its impacts. This evaluation examined LWDA implementation across Chicago Public Schools (CPS) and identified barriers, facilitators, and lessons to inform future MHH policy implementations. A qualitative study was conducted by thematically analyzing interviews with CPS staff (n = 36) from October 2020 - September 2021 in partnership with CPS Office of Student Health and Wellness (OSHW). Staff reported inadequate LWDA and MHH education and inconsistent menstrual product availability. Structural, systemic, and cultural implementation barriers hindered student access to products and created inequities based on age, gender, and income. Staff investment and student education were implementation facilitators. Staff awareness of policy implementation protocol, student MHH education, and addressing access inequities are key factors for consideration in future policy implementations. Through the WSCC model, these findings demonstrated the importance of strengthening MHH policies and policy implementation to promote student health, well-being, and educational opportunities.

Environmental sustainability in obstetrics and gynaecology: A systematic review

BACKGROUND

The healthcare sector is responsible for 4%-10% of global greenhouse gas emissions. Considering the broad range of care that obstetricians and gynaecologists provide, mitigation strategies within this specialty could result in significant reductions of the environmental footprint across the whole healthcare industry.

OBJECTIVES

The aim of this review was to identify for what services, procedures and products within obstetric and gynaecological care the environmental impact has been studied, to assess the magnitude of such impact and to identify mitigation strategies to diminish it.

SEARCH STRATEGY

The search strategy combined terms related to environmental impact, sustainability, climate change or carbon footprint, with the field of obstetrics and gynaecology.

SELECTION CRITERIA

Articles reporting on the environmental impact of any service, procedure or product within the field of obstetrics and gynaecology were included. Included outcomes covered midpoint impact categories, CO2 emissions, waste generation and energy consumption.

DATA COLLECTION AND ANALYSIS

A systematic literature search was conducted in the databases of MEDLINE (Ovid), Embase (Ovid) and Scopus, and a grey literature search was performed on Google Scholar and two websites of gynaecological associations.

MAIN RESULTS

The scope of the investigated studies encompassed vaginal births, obstetric and gynaecological surgical procedures, menstrual products, vaginal specula and transportation to gynaecological oncologic consultations. Among the highest yielding mitigation strategies were displacing disposable with reusable materials and minimising content of surgical custom packs. The lowest yielding mitigation strategy was waste optimisation, including recycling.

CONCLUSIONS

This systematic review highlights opportunities for obstetricians and gynaecologists to decrease their environmental footprint in many ways. More high-quality studies are needed to investigate the environmental impact of other aspects of women's and reproductive health care.

Perceptions, Beliefs, and Experiences about the Menstrual Cycle and Menstruation among Young Women: A Qualitative Approach

The experience of menstruation is often associated with negative connotations and gender stereotypes, which results in making it invisible. This research aimed to explore the perceptions, beliefs, and knowledge of young Spanish women regarding the menstrual cycle and menstruation and their impact on their lives. The study delves into their understanding, menstrual management practices, the types of menstrual products employed, and their experiences related to menstrual health. Qualitative methodology was used with discussion groups as a data collection technique. The participants comprised 45 young Spanish women, aged between 18 and 23, hailing from both rural and urban areas. The majority were university students, with some engaged in part-time work, and one participant working full-time. While many experienced menstrual pain ranging from mild to debilitating, a normalization of this pain often led them to forego seeking specialist assistance. Disposable menstrual products (DMPs) are the most used by participants, despite limited awareness of their absorption capacity. Regarding reusable menstrual products (RMPs), menstrual cup users emphasized comfort but expressed a need for proper training. Negative menstruation experiences could evoke fear and difficulties, underscoring the importance of providing comprehensive menstrual health education encompassing both theoretical and practical components.

Research priorities for improving menstrual health across the life-course in low- and middle-income countries

BACKGROUND

Research on menstrual health is required to understand menstrual needs and generate solutions to improve health, wellbeing, and productivity. The identification of research priorities will help inform where to invest efforts and resources.

OBJECTIVES

To identify research priorities for menstrual health across the life-course, in consultation with a range of stakeholder groups from a variety of geographic regions, and to identify if menstrual health research priorities varied by expertise.

METHODS

A modified version of the Child Health and Nutrition Research Initiative approach was utilized to reach consensus on a set of research priorities. Multisector stakeholders with menstrual health expertise, identified through networks and the literature, were invited to submit research questions through an online survey. Responses were consolidated, and individuals were invited to rank these questions based on novelty, potential for intervention, and importance/impact. Research priority scores were calculated and evaluated by participants' characteristics.

RESULTS

Eighty-two participants proposed 1135 research questions, which were consolidated into 94 unique research questions. The mean number of questions did not differ between low- and middle-income country (LMIC) and high-income country (HIC) participants, but significantly more questions were raised by participants with expertise in mental health and WASH. Sixty-six participants then ranked these questions. The top ten-ranked research questions included four on 'understanding the problem', four on 'designing and implementing interventions', one on 'integrating and scaling up', and one on 'measurement'. Indicators for the measurement of adequate menstrual health over time was ranked the highest priority by all stakeholders. Top ten-ranked research questions differed between academics and non-academics, and between participants from HICs and LMICs, reflecting differences in needs and knowledge gaps.

CONCLUSIONS

A list of ranked research priorities was generated through a consultative process with stakeholders across LMICs and HICs which can inform where to invest efforts and resources.

Experiences, awareness, perceptions and attitudes of women and girls towards menstrual hygiene management and safe menstrual products in Pakistan

Background

The taboo of menstruation, lack of discussion on puberty, misinformation and poor awareness on menstrual hygiene management and limited access to safe menstrual products can negatively impact the physical and mental health of women and girls residing in low middle income countries.

Aim

The aim of the study was to explore the experiences, awareness, perceptions and attitudes of women and girls towards menstrual hygiene management in Pakistan. Moreover, the study also assessed consumer satisfaction towards locally manufactured organic menstrual products.

Methods

A descriptive cross-sectional study design was used with a sample of 400 women and girls selected through convenience sampling from high schools, universities, outpatient department and gynaecological clinics located in 2 cities, i.e., Islamabad and Rawalpindi, Pakistan. A pre-structured questionnaire was used to explore experiences, awareness, perceptions and attitudes of women and girls towards menstrual hygiene management. Moreover, each respondent was provided with sample of locally designed and manufactured organic menstrual hygiene & wellness kit by a group of women researchers named "FemPure" including organic sanitary pads, feminine wellness mist and feminine wellness wash. The respondents were asked to use the products and a telephonic follow-up was conducted to assess consumer satisfaction for the products after a period of 1 month. Data was analyzed statistically using SPSS 21.

Results

The results of the study reported that 86.2% (n = 345) of the respondents had normal periods. Out of 400 respondents, 58.5% (n = 234) knew about any health conditions related to abnormal menstrual cycle while 88.3% (n = 353) were aware of female menstrual hygiene. Majority of the respondents 78.7% (n = 315) felt ashamed while buying sanitary pads. Out of 400 respondents, 5.4% (n = 22) were interested in getting awareness regarding menstrual hygiene. The results of the study showed that all the respondents (100%, n = 400) were satisfied with FemPure organic menstrual products.

Conclusion

The study concluded that majority of women and girls faced menstrual hygiene issues during and after the cycle and were eager to receive information on MHM and use organic rash free menstrual wellness products which could be ordered via mobile app. The respondents were satisfied after the use of FemPure organic menstrual products.

Menstrual Hygiene Practices in Indian Tribal Females: A Systematic Review and Meta-Analysis

India is native to many tribal communities: Bharia (Madhya Pradesh), Bihl (Rajasthan), Santhal (Bihar, Jharkhand), Bodo (Assam, West Bengal), and many more. They reside in isolated geographical regions, which poses challenges in reaching out to them. In addition, they still have firm beliefs and taboos regarding menstruation. Knowledge about menstrual health and hygiene is one of the most important aspects of tribal health. Therefore, it is important to synthesize the results of menstrual hygiene data from the Indian tribal population. We have calculated the pooled prevalence of sanitary pad use, dustbin disposal, and hygienic reuse of menstrual materials. Online databases, namely PubMed, Cochrane Central, CINAHL, Pan African Journals, EBSCO, and Google Scholar, were searched. After the removal of duplicates, a quality check, and screening of cross-references, 19 articles were selected for final review. Statistical analysis was done by Revman 5.4 and STATA 17.0. A p-value of <0.05 was considered statistically significant. PRISMA guidelines were followed. The protocol registration number was CRD42022331376. This is a non-funded article. The pooled prevalence of sanitary pad use in Indian tribal females was 2% (95% CI 1 to 3). The pooled prevalence of dustbin disposal of menstrual material was 1% (95% CI: 0.00 to 0.02). The pooled prevalence of hygienic reuse of menstrual materials was 1%. Sanitary menstrual hygiene practices are very less prevalent in Indian tribal females. Awareness programs and tribal health policies need to be accelerated for the promotion of menstrual hygiene. Also, literature on the use, disposal, and storage of menstrual adsorbents is scarce in Indian tribes. Health research in this area needs to be emphasized.

The Menstrual Cup: Menstrual Hygiene With Less Environmental Impact

This JAMA Insights Women’s Health aims to expand clinician knowledge about the safety and best practices of menstrual cup use to support patients who choose this product by discussing the advantages, insertion and removal process, and potential risks of menstrual cup use.

Reusable period products: use and perceptions among young people in Victoria, Australia

BACKGROUND

Reusable menstrual products have expanded the choices available for menstrual care and can offer long-term cost and environmental benefits. Yet, in high-income settings, efforts to support period product access focus on disposable products. There is limited research to understand young people's product use and preferences in Australia.

METHODS

Quantitative and open-text qualitative data were collected through an annual cross-sectional survey of young people (aged 15-29) in Victoria, Australia. The convenience sample was recruited through targeted social media advertisements. Young people who reported menstruating in the past 6 months (n = 596) were asked questions about their menstrual product use, use of reusable materials, product priorities and preferences.

RESULTS

Among participants, 37% had used a reusable product during their last menstrual period (24% period underwear, 17% menstrual cup, 5% reusable pads), and a further 11% had tried using a reusable product in the past. Reusable product use was associated with older age (age 25-29 PR = 3.35 95%CI = 2.09-5.37), being born in Australia (PR = 1.74 95%CI = 1.05-2.87), and having greater discretionary income (PR = 1.53 95%CI = 1.01-2.32). Participants nominated comfort, protection from leakage and environmental sustainability as the most important features of menstrual products, followed by cost. Overall, 37% of participants reported not having enough information about reusable products. Having enough information was less common among younger participants (age 25-29 PR = 1.42 95%CI = 1.20-1.68) and high school students (PR = 0.68 95%CI = 0.52-0.88). Respondents highlighted the need for earlier and better information, challenges navigating the upfront cost and availability of reusables, positive experiences with reusables, and challenges for use, including cleaning reusables and changing them outside the home.

CONCLUSIONS

Many young people are using reusable products, with environmental impacts an important motivator. Educators should incorporate better menstrual care information in puberty education and advocates should raise awareness of how bathroom facilities may support product choice.

Assessing menstrual equity amongst BAMER women fleeing gender-based abuse in Sheffield (UK): A cross-sectional study

OBJECTIVES

Menstruation is not openly discussed in numerous Black, Asian, minority ethnic and refugee (BAMER) communities. Consequently, it is unclear if transitioning between cultures impacts BAMER women's menstrual health. This study aimed to evaluate menstrual equity and sanitary protection preference amongst BAMER abuse survivors displaced to Sheffield (UK).

METHODS

Fifty participants were recruited from women's support services between December 2018 and May 2019. Selection criteria required participants to menstruate, identify as BAMER, be displaced, and have experienced gender-based abuse. Descriptive and inferential statistical analyses were performed using SPSS (IBM, USA) to assess menstrual equity.

RESULTS

Many struggled to afford products (86 %), changed them infrequently (68 %) or improvised sanitary wear (40 %). Financially restricted women often changed products irregularly (p = 0.02) or used proxy items (p = 0.02). Participants disliked reusable pads (48 %) and vaginally inserted products (tampons 46 %, cups 78 %) without having tried them. Negativity surrounding reusable pads (p = 0.01) and cups (p = 0.04) was linked to menstrual taboo. Few women knew of menstruation prior to menarche (28 %). These participants were more likely to accept male doctors (p = 0.04), unlike those that regarded menstruation as taboo (p = 0.02), unclean (p = 0.02) or shameful (p = 0.001).

CONCLUSION

We provide key information regarding the menstrual health status of marginalised women. Our findings suggest limited menstrual-health education at menarche and negative belief-systems may compromise access to products and healthcare in adulthood. This study advises policymakers to unify distribution of hygienic absorbents and menstrual-health education to normalise menstruation, thereby reducing menstrual shame and empowering women to make informed sanitary protective choices.

Menstrual Hygiene Management Inequalities among School Girls in Badagry, Nigeria

OBJECTIVES

The study assessed menstrual hygiene management (MHM) inequalities among public and private in-school adolescents in Badagry, southwest Nigeria. Also assessed was the impact of available water, sanitation, and hygiene (WASH) facilities on MHM within the school premises.

METHODS

For this descriptive, cross-sectional study 420 students were selected via multi-stage sampling and data were obtained via a validated semi-structured questionnaire and observational checklist. Data were analysed at 95% confidence limit.

RESULTS

The students had a mean age of 15.3±1.6 years. All the private schools had functioning WASH facilities whereas only 50% of public schools did. The toilet to student ratios for the private and public schools were 1:155 and 1:296, respectively. Over two-thirds (67.1%) of the students reportedly use sanitary napkins for MHM, followed by tissue (17.1%), and clothes (15.5%). Additionally, the private school students were two times less likely to use alternatives to sanitary napkins and 9.8 times more likely to obtain sanitary materials at school if required (p<0.001). A significantly higher proportion of public-school menstruating in-school adolescents changed their sanitary towels in the bush (p=0.003) due to lack of privacy and took their used sanitary materials home (p<0.001) for management due to reduced access to sanitary bins.

CONCLUSION

Even though the situation in the public schools was worse, both public and private schools lack the enabling environment for MHM. School health promotion interventions, such as provision of subsidized/affordable menstrual pads and basic WASH facilities and campaigns to break the culture of silence are required for the wellbeing of girls. This article is protected by copyright. All rights reserved.

The burdens of incontinence: Quantifying incontinence product usage and costs in women

INTRODUCTION

Urinary incontinence is a common condition in women, who often use incontinence containment products to self-manage. Few studies have sought to quantify use and costs of incontinence products associated with subtypes of incontinence and severity, therefore this study aimed to quantify incontinence product use and personal costs to women.

METHODS

This is a secondary analysis from a sample of adult women recruited electronically via ResearchMatch for a study on urinary symptoms and social determinants of health. Participants completed validated questionnaires on urinary symptoms, and were asked about daily numbers and types of incontinence products used and weekly costs, along with demographic and baseline clinical information, and information about unmet social needs. Descriptive statistics were performed, in addition to Wilcoxon rank sum and Kruskal-Wallis tests to compare incontinence product usage and cost based on type of incontinence, symptom severity, and other demographics, in addition to multivariable linear regression.

RESULTS

A total of 702 women who reported using weekly incontinence products were included in the final analytic sample. Overall, women reported using a mean of 1.8 ± 2.1 incontinence products in 24 h (median: 1, interquartile range [IQR]: 1), with a maximum of 32. Mean weekly cost of was $5.42 ± $8.59 (median: $3, IQR: $4), with cost up to $100. Nonwhite women trended towards having higher product usage and cost, with significant cost increase seen among non-Hispanic Black women and Hispanic women. Usage and cost were higher in women who had less education, had household income below the poverty line, were on disability, were using Medicaid or were uninsured, had more unmet social needs, and in those with mixed incontinence. Additionally, daily product use and weekly costs increased with incontinence symptom severity, with the biggest increase between those with severe and very severe symptoms.

CONCLUSIONS

In this study, we were able to quantify the number of incontinence products used daily and the weekly costs in incontinent women across types and severity of incontinence. Costs were even greater and may be prohibitive, in women with more unmet social needs, Medicaid or no insurance, less than a college education, lower income, or on disability.

Period poverty: The perceptions and experiences of impoverished women living in an inner-city area of Northwest England

BACKGROUND

The menstrual needs of girls and women are important to health, education, and well-being. Unmet need and harm from poor menstrual health in low-and- middle-income countries have been documented, but with little empirical research undertaken in high income countries. Continuing austerity in the UK suggests menstruators are likely more vulnerable to 'period poverty' than previously, with the COVID-19 pandemic assumed to exacerbate the situation.

AIM

To explore the menstrual experiences and perceptions of women in the UK who are living under circumstances of deprivation, alongside views of staff working in organisations supporting these women, to understand whether women's menstrual needs are met.

METHODS

A qualitative study was conducted in an inner-city in NW England. Three focus group discussions and 14 in-depth interviews were conducted across three study sites supporting impoverished women. Data was analysed thematically.

RESULTS

Themes were: reflections on menstruation; affordability of products; access to public facilities; organisational support; potential solutions. Many women perceived menstruation as a burden in three aspects: physical discomfort and pain; psychological anxiety; and shame and stigma. Managing menstruation was difficult due to cost relative to low incomes, with food, heating and lighting prioritised, leaving women improvising with materials or wearing products for longer than desired. Most suggested that products should be free, often remarking if men required similar items this would happen. Most women were unaware supporting organisations provided free products. Staff felt the small range of products offered did not meet client needs and were ill-prepared to have conversations on products and clients' menstrual needs.

CONCLUSION

Impoverished women lack the necessary resources to manage their menses well which negatively impacts their health and brings stress, embarrassment, and shame. Support, including access to free products, is needed at both local and national level to help impoverished women manage their menstrual hygiene.

Use and perceptions on reusable and non-reusable menstrual products in Spain: A mixed-methods study

BACKGROUND

Menstrual products are necessary goods for women and people who menstruate to manage menstruation. Understanding the use and perceptions of menstrual products is key to promote menstrual equity and menstrual health. This study aimed at assessing the use and perceptions on menstrual products among women and people who menstruate aged 18-55 in Spain.

METHODS

A mixed-methods study was conducted, including a cross-sectional study (N = 22,823), and a qualitative study (N = 34).

RESULTS

Participants used a combination of products. Non-reusable products were the most used, while over half used reusable products. Usage changed when data were stratified by age, gender identification, completed education, country of birth and experiencing financial issues. It also varied between trans and cis participants. Menstrual products' use also shifted based on experiences of menstrual poverty and access to information and products. Overall, reusable products were perceived to be more acceptable than non-reusable. Barriers to use the menstrual cup were also identified, including experiences of menstrual inequity (e.g., menstrual poverty, lack of access to information or menstrual management facilities).

CONCLUSION

Perceptions and choices of menstrual products need to be acknowledged, especially when designing and implementing menstrual policies to address menstrual inequity and menstrual health.