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Chidya R, Kachuma O, Thole T, Banda L, Loewenberger M, Nicholson J. Evaluation of knowledge, attitude, practices and effectiveness of menstrual hygiene interventions in rural schools from Lilongwe, Malawi. BMC Public Health 2024; 24:1435. [PMID: 38811971 PMCID: PMC11134943 DOI: 10.1186/s12889-024-18940-w] [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: 11/07/2023] [Accepted: 05/23/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Menstrual hygiene management (MHM) is associated with the menstrual process in women and adolescent girls who face cultural and financial challenges in rural areas of many developing countries. As part of the pilot study, we assessed the sustainability and effectiveness of the approaches and lessons learned from the MHM project intervention in rural areas of Lilongwe, Malawi. METHODS Rural primary schools (n = 4) were purposively selected where an MHM intervention was implemented in Lilongwe, Malawi. The study employed a mixed-method research design. Assessments and data collection were performed through surveys of learners, literature reviews, key informant interviews (KIIs) (n = 90), and 20 focus group discussions (FGDs). The study participants included boys and adolescent girls (n = 100, 11-19 years; grades 5-8), teachers, mother groups, and community leaders from the selected schools. RESULTS All the schools had water sanitation and hygiene facilities and latrines (45% improved, 54% ventilated improved pit latrines - VIPs) that promoted menstrual hygiene for adolescent girls. However, two of the schools studied (50%, n = 4) did not have separate washrooms for changing sanitary materials. There was a slight increase in latrine coverage in Kabuthu zone communities (90% at baseline versus 93.4% at midterm). However, the coverage dropped to 85.7% at the final evaluation, which was attributed to too much rain received in the area that damaged most of the latrines. There was a significant reduction (p < 0.05) in the number of girls failing to attend classes due to menstruation (70% at baseline versus 14% at final evaluation). Furthermore, the project resulted in the majority of girls (94.4%) having access to school. There was a strong uptake and adoption of sanitary products (reusable pads and menstrual cups) among adolescent girls of all age groups. The study has demonstrated that the inclusion of key stakeholders such as health workers, parents, mother groups and community leaders promoted the uptake and sustainability of reusable pads and menstrual cups and MHM interventions and programs. CONCLUSION The MHM project implementation improved adolescent girls' education in the area. The inclusion of boys and other key stakeholders in the health education talks addressed issues of stigma and discrimination. The study, therefore, calls for comprehensive training on MHM and hygiene education to remove discrimination and harmful cultural practices.
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Affiliation(s)
- Russel Chidya
- Department of Water and Sanitation, Mzuzu University, P/Bag 201. Luwinga, Mzuzu, Malawi.
- Innovation Research and Training Centre (INNORET), Head Office, P.O. Box 195, Mzuzu, Malawi.
| | - Olivia Kachuma
- Canadian Physicians for Aid & Relief (CPAR), P.O. Box 30998, Lilongwe, Malawi
| | - Tchaka Thole
- Canadian Physicians for Aid & Relief (CPAR), P.O. Box 30998, Lilongwe, Malawi
| | - Louis Banda
- Canadian Physicians for Aid & Relief (CPAR), P.O. Box 30998, Lilongwe, Malawi
| | - Mark Loewenberger
- Canadian Physicians for Aid & Relief (CPAR), P.O. Box 30998, Lilongwe, Malawi
| | - Jennifer Nicholson
- Canadian Physicians for Aid & Relief (CPAR), P.O. Box 30998, Lilongwe, Malawi
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Thorpe S, Vigil K, Iyiewuare P, Malone N, Peterson RL, Hargons CN. "Make Sure You Wash Your Monkey": Multigenerational Vaginal Hygiene Messages from Black Women. HEALTH COMMUNICATION 2024:1-13. [PMID: 38557391 DOI: 10.1080/10410236.2024.2335057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
In the United States, the messages Black women receive about vaginal hygiene are often rooted in misogynoir. As a result, Black women across multiple generations may engage in extensive vaginal hygiene practices that are harmful to their health as a means of decreasing the potential for dehumanization or confirming racist stereotypes. The purpose of the current qualitative study is to explore the messages four generations of Black women (n = 12) received about genital hygiene and grooming and the sociocultural factors that influence these messages. Reflexive thematic analysis was used to analyze the semi-structured interview data. The following themes were identified: (1) a culture of silence, (2) knowledge acquisition, (3) pressure to maintain Black cleanliness standards, and (4) gendered racist messaging. Subthemes emerged within the knowledge acquisition theme, including learning through word-of-mouth, observation, deduction, trial and error, and direct messaging. Overall, themes and subthemes were consistent across generations; however, some differences were discussed. Participants highlighted the importance of intergenerational conversations in promoting safe vaginal hygiene practices. Recommendations for sexuality educators and healthcare professionals are discussed.
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Affiliation(s)
- Shemeka Thorpe
- Department of Kinesiology & Health Promotion, University of Kentucky
| | - Kasey Vigil
- Department of Educational, School, and Counseling Psychology, University of Kentucky
| | | | - Natalie Malone
- Department of Educational, School, and Counseling Psychology, University of Kentucky
| | - Rayven L Peterson
- Department of Educational, School, and Counseling Psychology, University of Kentucky
| | - Candice N Hargons
- Department of Educational, School, and Counseling Psychology, University of Kentucky
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Jena SK, Dolui M, Ghoshal S, Sarkar S. Demographic and socio-economic correlates of knowledge of the ovulatory cycle among tribal women in India: Evidence from the nationally representative survey (NFHS-5). BMC Public Health 2024; 24:766. [PMID: 38475774 DOI: 10.1186/s12889-024-18296-1] [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: 10/13/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The knowledge of ovulatory cycle (KOC) is the basis for natural family planning methods. The absence of knowledge is a notable issue since the ovulatory cycle plays a crucial role in reproductive health and empowers women to make informed decisions that influence their lives. This study examines the knowledge of the ovulatory cycle among reproductive tribal women in India and its demographic and socio-economic determinants. METHODS The data were derived from the National Family Health Survey conducted in 2019-2021. The effective sample size for the present study was 1,01,914 tribal women aged 15-49 years in India. Descriptive statistics along with bivariate analysis were conducted to find the preliminary results. Additionally, multivariable binary logistic regressions were conducted to determine the likelihood of KOC among tribal women across different characteristics. We conducted statistical analysis in STATA 17.0 (StataCorp) and used ArcGIS 10.8.2 for spatial mapping. RESULTS Out of 1,01,914 tribal women, 78.8 per cent lack correct knowledge of the ovulatory cycle. Notably, Education level significantly influences KOC, with secondary education showing higher odds of KOC (AOR: 1.24, 95% CI:1.006-1.528) compared to no education. Christian women exhibit lower odds of having KOC (AOR: 0.749, 95% CI:0.564-0.996) compared to Hindu women. Husband/partner's education level shows a strong association, with higher-educated partners correlating with higher odds of KOC (AOR: 2.501, 95% CI: 1.807-3.461) for higher education. Knowledge of any contraceptive method and current contraceptive use type are strongly associated with KOC. Additionally, rural residence negatively influences KOC (AOR: 1.545, 95% CI: 1.236-1.932), while exposure to mass media has a positive effect (AOR: 1.152, 95% CI: 0.975-1.362) albeit modest. CONCLUSION The study highlights the need for targeted educational and awareness programs to improve KOC among tribal women in India. By addressing factors such as education, religious influences, and place of residence, we can empower these women to make informed decisions about their reproductive health, ultimately enhancing their overall well-being and quality of life. This knowledge is not only a foundation for natural family planning but also a key driver of women's agency and autonomy in shaping their lives.
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Affiliation(s)
- Sameer Kumar Jena
- Department of Population Studies, Fakir Mohan University, Balesore, Odisha, 756089, India
| | - Mriganka Dolui
- Department of Geography, Central University of Karnataka, Kalaburagi, Karnataka, 585311, India.
| | - Sucharita Ghoshal
- Department of Agriculture, Rural and Tribal Development, Ramakrishna Mission Vivekananda Educational and Research Institute, Morabadi, Ranchi, Jharkhand, 834008, India
| | - Sanjit Sarkar
- Department of Geography, Central University of Karnataka, Kalaburagi, Karnataka, 585311, India
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Gammoh O, Al Rob OA, Alqudah A, Al-Smadi A, Dobain MO, Zeghoul R, Aljabali AAA, Alsous M. Risk factors for severe dysmenorrhea in Arab women: A focus on war displacement and mental health outcomes. AIMS Public Health 2024; 11:209-222. [PMID: 38617411 PMCID: PMC11007414 DOI: 10.3934/publichealth.2024010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/26/2024] [Accepted: 02/19/2024] [Indexed: 04/16/2024] Open
Abstract
Background Dysmenorrhea is wide spread gynecological disorder among that affect the quality of life of women world wide. The current study aims to examine whether war displacement, mental health symptoms, and other clinical factors are associated with dysmenorrhea severity. Methods This is a cross-sectional case-control study recruiting two groups: displaced Syrian women and un-displaced local Jordanian women. Demographics and clinical details were recorded. The severity of dysmenorrhea was assessed using WaLIDD scale, the PHQ-9 scale was emplyed to assess depressive symptoms, anxiety was assessed using the GAD-7 scale, and insomnia was assessed using the ISI-A scale. Predictors of severe dysmenorrhea in females using multivariate binary logistic regression. Results Out of 808 of the total participants, 396 (49%) were Syrian displaced war refugees, 424 (42.5%) reported using paracetamol, 232 (23.2%) were using NSAIDs, and 257 (25.9%) using herbal remedies. Severe dysmenorrhea was associated with war displacement (OR = 2.14, 95% CI = 1.49-3.08, p < 0.001), not using NSAIDs (OR = 2.75, 95% CI = 1.91-3.95, p < 0.001), not using herbal remedies (OR = 2.01, 95% CI = 1.13-3.60, p = 0.01), depression (OR = 2.14, 95% CI = 1.40-3.29, p < 0.001), and insomnia (OR = 1.66, 95% CI = 1.14-2.42, p = 0.009). Conclusions War displacement, type of analgesic, depression, and insomnia are risk factors for severe dysmenorrhea.
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Affiliation(s)
- Omar Gammoh
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, 21163, Jordan
| | - Osama Abo Al Rob
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, 21163, Jordan
| | - Abdelrahim Alqudah
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa 13133, Jordan
| | - Ahmed Al-Smadi
- Adult Health Nursing, Prince Salma College, Al Al-Bayt University, Mafraq, Jordan
| | | | - Reham Zeghoul
- Adult Health Nursing, Prince Salma College, Al Al-Bayt University, Mafraq, Jordan
| | - Alaa A. A. Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, Irbid 21163, Jordan
| | - Mervat Alsous
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, 21163, Jordan
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Zota AR, Franklin ET, Weaver EB, Shamasunder B, Williams A, Siegel EL, Dodson RE. Examining differences in menstrual and intimate care product use by race/ethnicity and education among menstruating individuals. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1286920. [PMID: 38126001 PMCID: PMC10731462 DOI: 10.3389/frph.2023.1286920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction United States consumers spend over two billion dollars a year on intimate care products. These products, along with scented menstrual products, are marketed for odor control, perceived "freshness," and vaginal/vulvar cleanliness. However, these scent-altering products may increase exposure to carcinogenic and endocrine-disrupting chemicals. Prior research has not adequately characterized demographic differences in product use. The objective of our study is to examine racial/ethnic and educational differences in menstrual and intimate care product use among people who menstruate. Methods We pooled data from two US-based cross sectional studies to examine demographic characteristics and product use in 661 participants aged 18-54 years. Participants reported use of scented and unscented menstrual products (tampons, sanitary pads, and menstrual cups) and intimate care products (vaginal douches, sprays, wipes, and powders). We examined differences by race/ethnicity and education using log-binomial regression and latent class analysis (LCA), which can identify groups based on product use patterns. Results Our sample was 33.4% Black, 30.9% Latina, 18.2% White, and 16.2% another identity. Approximately half the population had a bachelor's degree or more; 1.4% identified as transgender and 1.8% as non-binary. In adjusted models, scent-altering products (i.e., scented menstrual and intimate care products) were more likely to be used by those with less formal education (p < 0.05). Unscented menstrual products were more likely to be used by those with more formal education. Compared to Black participants, White participants were more likely to use unscented tampons and menstrual cups and less likely to use douches and wipes (p < 0.05). Using LCA we identified two groups: one more likely to use scent-altering products, and a second more likely to use unscented menstrual products. Less education and older age, but not race/ethnicity, was significantly associated with membership in the group more likely to use scent-altering products. While sex/gender composition did not statistically vary across groups, all non-binary participants fell in the unscented menstrual product group. Discussion Lower educational attainment was consistently associated with greater use of scent-altering menstrual and intimate care products. Future research should examine associations between body odor stigma, product use, and health risks at intersections of race, class, and gender.
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Affiliation(s)
- Ami R. Zota
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | | | - Emily B. Weaver
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Bhavna Shamasunder
- Departments of Urban and Environmental Policy and Public Health, Occidental College, Los Angeles, CA, United States
| | | | - Eva L. Siegel
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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Yang Y, Kim Y. Integrating the Theory of Planned Behavior and Bonding Social Capital to Examine Chinese Women's Tampon Use Intentions. HEALTH COMMUNICATION 2023; 38:575-584. [PMID: 34353183 DOI: 10.1080/10410236.2021.1962586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study integrates the theory of planned behavior with a structural approach to examining social capital to investigate how bonding social capital affected Chinese women's tampon use intentions. Bonding social capital was operationalized as network closure, which included two main dimensions: density and hierarchy. Results from an online survey (N = 766) showed that network density was positively associated with attitudes toward, social norms about, and perceived behavior control around tampon usage, while network hierarchy negatively predicted attitudes only. Moreover, the indirect effects of network density on tampon use intentions were mediated by descriptive norms and perceived behavior control. Examining women's intentions to adopt a rarely used product in China, this study extended the theory of planned behavior into the realm of social capital in an understudied context. The findings provide practical implications for health communication practitioners in public education concerning feminine hygiene products and gynecological health.
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Affiliation(s)
- Yin Yang
- Bellisario College of Communications, The Pennsylvania State University
| | - Young Kim
- Department of Strategic Communication, J. William and Mary Diederich College of Communication, Marquette University
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Harrison ME, Tyson N. Menstruation: Environmental impact and need for global health equity. Int J Gynaecol Obstet 2023; 160:378-382. [PMID: 35781656 DOI: 10.1002/ijgo.14311] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/03/2022] [Accepted: 06/17/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Megan E Harrison
- Division of Adolescent Health, CHEO, University of Ottawa, Faculty of Medicine, CHEO Research Institute, Ottawa, Ontario, Canada
| | - Nichole Tyson
- Pediatric Adolescent Gynecology, Stanford Children's Health, Stanford University School of Medicine, Palo Alto, California, USA
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Maulingin-Gumbaketi E, Larkins S, Whittaker M, Rembeck G, Gunnarsson R, Redman-MacLaren M. Socio-cultural implications for women's menstrual health in the Pacific Island Countries and Territories (PICTs): a scoping review. Reprod Health 2022; 19:128. [PMID: 35655221 PMCID: PMC9164467 DOI: 10.1186/s12978-022-01398-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, experiences of menarche and subsequent menstruation are embedded in social and cultural beliefs, norms and practices. Menarche is an important developmental milestone in sexual and reproductive health (SRH) for females. Menarche is intertwined with socio-cultural norms, beliefs and practices, which can impact on women's ability to manage menstruation with dignity. This paper reviews the social and cultural factors that affect women's ability to effectively manage their menstrual health and hygiene (MHH) in Pacific Island Countries and Territories (PICTs). METHODS A scoping review was conducted following PRISMA scoping review guidelines and inclusion/exclusion criteria. An online search was conducted for peer-reviewed publications in Medline/OVID; Medline/PubMED; PsycINFO; CINAHL; Scopus and JSTOR, and Google Scholar. A search for grey literature was conducted in Google Scholar and websites of international and local organizations. Experts in the field also contributed additional references. Extracted data were summarised in an Excel spreadsheet. Searches were conducted between May and June, 2019, and then repeated in July, 2020. RESULTS A total of 11 studies were included; 10 qualitative and one mixed methods study. Studies were conducted in Melanesian (n = 9), Polynesian (n = 1) and Micronesian (n = 1) PICTs. All 11 studies reported elements of societal and personal factors; ten studies reported evidence relating to interpersonal factors; nine studies reported elements relating to environmental factors; and two studies presented evidence linked to biological factors. Managing menstrual health with dignity is challenging for many women and girls because menstruation is associated with menstrual taboos and shame. CONCLUSION This review found that the MHH experiences of women in PICTs are affected by social and cultural beliefs, norms and practices. Beliefs, norms and practices about menarche need to be incorporated in SRH planning, programs and education in order to be relevant to diverse village and urban settings.
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Affiliation(s)
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Maxine Whittaker
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Gun Rembeck
- Research, Education, Development & Innovation, Primary Health Care, Alsvsborg Region, Västra Götaland, Sweden
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Regionhälsan Borås Youth Health Center, Vastra Gotaland, Sweden
| | - Ronny Gunnarsson
- Research, Education, Development & Innovation, Primary Health Care, Alsvsborg Region, Västra Götaland, Sweden
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Primary Health Care Clinic for Homeless People, Närhälsan, the Västra Götaland Region, Göteborg, Sweden
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Sood S, Stevens S, Okumura M, Hauer M, Ramaiya A. A Systematic Review of Menstrual Health and Hygiene Management (MHHM) as a Human Right for Adolescents Girls. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:483-502. [PMID: 38596276 PMCID: PMC10903676 DOI: 10.1080/19317611.2022.2050874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 04/11/2024]
Abstract
Despite its relationship with several development issues and sexual health, menstrual health and hygiene management among adolescents have until recently been ignored by practitioners and researchers. This paper is a systematic review of existing literature and argues that menstrual health and hygiene management is a human rights issue. 28,745 articles were screened, with 84 articles included in the full-text review and quality assessment. The results indicate that using a cross-cutting, human rights framework to address inadequate menstrual health and hygiene management is fundamental to promoting menstrual health and hygiene management with dignity among girls and women across the globe.
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Affiliation(s)
- Suruchi Sood
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Sarah Stevens
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Maho Okumura
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Michael Hauer
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Astha Ramaiya
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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MAMUK R, PARLAN H, ASİF E, DEVECİ M, AKDENİZ E. An Assessment of Menstrual and Genital Hygiene Behaviours among Adolescent Females at Gazimağusa, Northern Cyprus. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.909836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Casola AR, Kunes B, Jefferson K, Riley AH. Menstrual Health Stigma in the United States: Communication Complexities and Implications for Theory and Practice. J Midwifery Womens Health 2021; 66:725-728. [PMID: 33619886 DOI: 10.1111/jmwh.13216] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/29/2020] [Accepted: 01/11/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Allison R Casola
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Brianna Kunes
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karen Jefferson
- Midwifery and Women's Health Programs, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amy Henderson Riley
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
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Kambala C, Chinangwa A, Chipeta E, Torondel B, Morse T. Acceptability of menstrual products interventions for menstrual hygiene management among women and girls in Malawi. Reprod Health 2020; 17:185. [PMID: 33228723 PMCID: PMC7686682 DOI: 10.1186/s12978-020-01045-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background A key challenge for menstruating girls and women in low-resource countries is the inadequate and unreliable supply of menstrual products. Although development partners are implementing menstrual product interventions to address this challenge in Malawi, there is a paucity of information on the distribution of menstrual products and the acceptability of these interventions among users. Methods We conducted in-depth interviews with girls (n = 20) and women (n = 26) and 4 focus group discussions (FGDs) with women (n = 35) and 7 FGDs with girls (n = 60) to explore the acceptability of menstrual products interventions in 8 districts. Teachers (n = 12), community leaders (n = 6), community health workers (n = 8) and service providers (n = 9) were also interviewed to explore implementation issues and their views regarding the effect of menstrual products interventions on girls and women. Data were analyzed using content analysis. Results Common menstrual products being promoted include locally made reusable pads, commercially made disposable pads and menstrual cups. Overall, adult women preferred reusable pads and young girls preferred disposable pads. Reported benefits of using any type of material distributed included enhanced cleanliness and reduced school absenteeism for girls. While community leaders and teachers applauded the use of disposable menstrual products they expressed concern that they are not affordable for an average Malawian and bemoaned the indiscriminate disposal of used disposable pads. Women and girls highlighted their lack of facilities to effectively wash and dry reusable pads. Service providers bemoaned poor coordination and the lack of national standards to regulate the quality of menstrual products distributed at national level. Improved inclusion of males and health workers could enhance the sustainability of programmes. Conclusion While the available menstrual products interventions are acceptable among participants, we note several challenges including affordability, poor disposal methods, lack of attention on sanitation facilities and the lack of standard protocols to regulate the quality of menstrual products. Recommendations to address these issues are reported.
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Affiliation(s)
- Christabel Kambala
- The Polytechnic, Environmental Health Department, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi.
| | - Angela Chinangwa
- The Polytechnic, Environmental Health Department, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi
| | - Effie Chipeta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Chimutu Building, Private Bag 360, Chichiri, Blantyre 3, Malawi.,The Center of Excellence in Public Health and Herbal Medicine, University of Malawi, Blantyre, Malawi
| | - Belen Torondel
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Tracy Morse
- The Polytechnic, Environmental Health Department, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi.,Centre for Water, Environment, Sustainability and Public Health, Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, UK
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13
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Wall LL. Period Poverty in Public Schools: A Neglected Issue in Adolescent Health. J Adolesc Health 2020; 67:315-316. [PMID: 32829755 DOI: 10.1016/j.jadohealth.2020.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
- L Lewis Wall
- Departments of Obstetrics & Gynecology and Anthropology, Washington University in St. Louis, St. Louis, Missouri
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Smith AD, Muli A, Schwab KJ, Hennegan J. National Monitoring for Menstrual Health and Hygiene: Is the Type of Menstrual Material Used Indicative of Needs Across 10 Countries? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2633. [PMID: 32290529 PMCID: PMC7215803 DOI: 10.3390/ijerph17082633] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/18/2022]
Abstract
Surveys monitoring population health and sanitation are increasingly seeking to monitor menstrual health. In the absence of established indicators, these surveys have most often collected data on the type of menstrual material used. This study investigated whether such data provides a useful indication of women's menstrual material needs being met. Using data from 12 national or state representative surveys from the Performance Monitoring and Accountability 2020 program, we compared self-reported menstrual material use against respondents' reported menstrual material needs (including needing clean materials, money, or access to a vendor). The use of menstrual pads did not indicate that menstrual material needs were met for many respondents. Of those exclusively using pads, a pooled 26.4% (95% Confidence Interval 17.1-38.5) of respondents reported that they had unmet material needs. More disadvantaged groups were particularly misrepresented; of rural women exclusively using pads, a pooled 38.5% (95%CI 27.3-51.1) reported unmet material needs, compared to 17.1% (95%CI 12.4-23.0) of urban women. Similar disparities were observed for levels of education and wealth, with a pooled 45.9% (95%CI 29.2-63.6) of women in the lowest wealth quintile reporting unmet material needs. Findings suggest that caution is needed when using menstrual material use as an indicator for menstrual health.
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Affiliation(s)
- Annie D Smith
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - Kellogg J Schwab
- The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Julie Hennegan
- The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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15
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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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MacRae ER, Clasen T, Dasmohapatra M, Caruso BA. 'It's like a burden on the head': Redefining adequate menstrual hygiene management throughout women's varied life stages in Odisha, India. PLoS One 2019; 14:e0220114. [PMID: 31369595 PMCID: PMC6675075 DOI: 10.1371/journal.pone.0220114] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/21/2019] [Indexed: 11/29/2022] Open
Abstract
There has been growing recognition of menstrual hygiene management (MHM) as a significant public health issue. However, research has predominately focused on the experiences of adolescent girls in school settings. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India at various life stages with a view toward improving international monitoring of MHM. Focus group discussions and in-depth interviews were conducted to understand women’s experiences of menstruation across four life stages (unmarried women, recently married women, married women, and older women). Thematic analysis was used to identify menstruation-related challenges and needs. We found women voiced needs that aligned with those captured by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) definition for MHM: access to clean materials, privacy for changing materials, soap and water for bathing, and disposal facilities for materials. However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible. Additionally, we identified needs that extend beyond the existing definition: pain management, social support, and an enabling sociocultural environment. Overall, women representing all life stages discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials. Cloth management challenges were most acute for unmarried and recently married women, who were concerned that practices could reveal their menstrual status and harm their reputations, thus informing their preference for disposable materials, if attainable. We propose a revised definition of adequate MHM for this population that more comprehensively captures their needs. This definition may also prove useful for other populations, future research, creating measures of assessment, and guiding interventions and program priorities.
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Affiliation(s)
- Elizabeth R. MacRae
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Bethany A. Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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17
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"It's not perfect but it's mine": Genital self-image among women living in Italy. Body Image 2019; 29:140-148. [PMID: 30959326 DOI: 10.1016/j.bodyim.2019.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 03/30/2019] [Accepted: 03/30/2019] [Indexed: 01/25/2023]
Abstract
The purpose of this article is to describe Italian women's attitudes toward their genitals, and the intersection of genital self-image (GSI) and reproductive and sexual health behaviors. Individual interviews were conducted with 46 reproductive-aged women. All interviews were transcribed verbatim with observer comments to identify emerging data patterns. Researchers completed coding between and within interviews for a constant comparative approach to data analysis to identify emergent themes. Participants expressed embarrassment discussing genitals and equated this with societal taboos; however, friends provided one opportunity to speak more openly. Odor discussions and hygiene practices were frequently occurring themes, especially during menstruation. GSI limited some daily activities and sexual experiences due to feelings of self-consciousness. Concerns stemmed from limited knowledge about how women's genitals should look, smell, and feel. In contrast, some women detailed positive GSI in terms of autonomy and self-care. Results illustrate practical recommendations for healthcare providers to address women's genital concerns and improve women's GSI and overall reproductive and sexual health experiences.
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Wall LL, Teklay K, Desta A, Belay S. Tending the 'monthly flower:' a qualitative study of menstrual beliefs in Tigray, Ethiopia. BMC WOMENS HEALTH 2018; 18:183. [PMID: 30424763 PMCID: PMC6234636 DOI: 10.1186/s12905-018-0676-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 10/28/2018] [Indexed: 11/23/2022]
Abstract
Background Menstruation is a universal aspect of human female reproductive life. Management of menstrual flow presents hygiene challenges to girls and women in low-income countries, especially when they first start their periods. As part of a project to improve menstrual hygiene management in the Tigray Region of Ethiopia, we explored the local understanding of menstruation through focus-group discussions and individual interviews. Methods A detailed ethnographic survey of menstrual beliefs was carried out through 40 focus group discussions, 64 in-depth key informant interviews, and 16 individual case histories in the Tigray Region of northern Ethiopia. A total of 240 individuals participated in six types of focus groups (pre-menarchal girls, menstruating adolescents, married women of reproductive age, post-menopausal women, adolescent males, and married men). In-depth interviews were also carried out with 80 individuals, including Orthodox Christian priests, imams from the Muslim community, principals of primary and secondary schools, teachers and nurses, as well as menstruating schoolgirls and women. Audio data were transcribed and translated, then broken down into discrete codes using Atlas Ti software (version 7.5.4, Atlas.ti Scientific Software Development Mnbh, Berlin) and further grouped into related families and sub-families based on their content. The results were then synthesized to produce a cohesive narrative concerning menstruation in Tigray. Results Recurrent themes identified by participants included descriptions of the biology of menstruation (which were sometimes fanciful); the general unpreparedness of girls for menarche; cultural restrictions imposed by menstruation on females (particularly the stigma of ritual uncleanliness in both Christian and Muslim religious traditions); the prevalence and challenges of unmet menstrual hygiene needs at schools (including lack of access to sanitary pads and the absence of acceptable toilet/washing facilities); and the stigma and shame associated with menstrual hygiene accidents in public. Conclusions Changes in the educational system in northern Ethiopia are required to improve student understanding of the biology of menstruation, to foster gender equity, to overcome the barriers to school attendance presented by poor menstrual hygiene management, and to create a society that is more understanding and more accepting of menstruation.
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Affiliation(s)
- L Lewis Wall
- Department of Anthropology, College of Arts and Sciences, Washington University in St. Louis, Campus Box 1114, One Brookings Drive, St. Louis, MO, 63130, USA. .,Department of Obstetrics & Gynecology, Ayder Comprehensive Specialist Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. .,Department of Obstetrics & Gynecology, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Alem Desta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Shewaye Belay
- Department of Microbiology and Parasitology, Institute of Biomedical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Wall LL, Belay S, Bayray A, Salih S, Gabrehiwot M. A community-based study of menstrual beliefs in Tigray, Ethiopia. Int J Gynaecol Obstet 2016; 135:310-313. [PMID: 27599601 DOI: 10.1016/j.ijgo.2016.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/24/2016] [Accepted: 08/10/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate knowledge and beliefs about menstruation in the Tigray Region of Ethiopia. METHODS Between May 5 and May 25, 2015, a cross-sectional survey using semi-structured questionnaires was undertaken in 10 subdistricts (5 urban, 5 rural) in the Tigray Region of northern Ethiopia by trained data collectors (native speakers of the local languages). Individuals in randomly selected households who were aged 10years or older and who were willing to participate were asked various questions regarding the nature and management of menstruation. Interviews were recorded, and handwritten field notes were taken during the interview process. Data were compiled, transcribed, translated into English, categorized, and analyzed thematically. RESULTS Overall, 428 household members (349 female, 79 male) were interviewed. Reproductive anatomy and biology of menstrual regulation were poorly understood by the respondents. The belief that menstruating girls should not attend school was voiced by 17 (21.5%) male and 37 (10.6%) female respondents. Satisfactory management of menstrual hygiene was acknowledged to be a problem, and many respondents complained about the high cost of commercially produced, disposable menstrual pads. CONCLUSION Improved education on menstruation and better access to low-cost, reusable menstrual hygiene supplies would be worthwhile in the Tigray Region of Ethiopia.
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Affiliation(s)
- L Lewis Wall
- Department of Anthropology, Washington University, St. Louis, MO, USA; Department of Obstetrics and Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; Department of Obstetrics and Gynecology, Washington University, St. Louis, MO, USA.
| | - Shewaye Belay
- Department of Medical Parasitology and Immunology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Alemayehu Bayray
- Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Seidi Salih
- Tigray Regional Health Bureau, Mekelle, Ethiopia
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