A systematic review of menstrual hygiene management (MHM) during humanitarian crises and/or emergencies in low- and middle-income countries

WASH services and menstrual hygiene management among reproductive age females in the IDPs camps of Shire town in Tigray region of Ethiopia: a cross- sectional study

Menstruation is a natural cyclic occurrence experienced by reproductive age females in a good health which deemed a proper management, otherwise, it ends with various health complications and impaired quality of life. The aim of this study was to investigate the menstrual hygiene management practice and its determinant factors among reproductive age females living in the IDPs camps of Shire town, Northern Ethiopia. A cross-sectional study was conducted among 633 reproductive age females in Shire town from May to June 2022. Data were entered, cleaned, and analyzed using SPSS version 23. Descriptive analysis and binary and multivariable logistic regression were conducted to obtain the descriptive findings and to investigate the strength of the association respectively. P-value < 0.05 was considered statistically significant. The prevalence of good menstrual hygiene management practice among the reproductive age females was 41.9% (95% CI, 38-45.8%). Menstrual hygiene management practice was significantly (p < 0.05) associated with access to sanitary materials, educational level, availability of continuous water supply and sex-separated latrines. The results of this study demonstrated that more than a half of the reproductive age females did not have good menstrual hygiene management practices. Consequently, it is recommended to work collaboratively to enhance the menstrual hygiene practice, especially in IDPs camps.

Menstrual health inequities and "period poverty" in Canada

Period poverty is the lack of access to menstrual products, sexual and reproductive health education, safe waste management, and adequate facilities. Despite its being a public health issue and a significant concern for numerous Canadians, there is a lack of peer-reviewed research on period poverty in Canada. Existing Canadian research has primarily been conducted by non-profit organizations/charities or industry leaders for menstrual products, resulting in incomplete data. More research is needed to explore the menstrual inequities in Canada and their impact on the well-being of Canadians. This is a critical step to ensure the menstrual needs of Canadians are appropriately addressed.

Breaking the Cycle: Addressing Period Poverty as a Critical Public Health Challenge and Its Relation to Sustainable Development Goals

This narrative review comprehensively examines the intricate relationship between period poverty and the Sustainable Development Goals (SDGs), positioning it as a critical public health challenge with far-reaching implications. Through an in-depth analysis of the multifaceted impact of period poverty on public health, including its effects on reproductive health, mental well-being, and economic participation, the paper underscores the urgent need to address this issue within the framework of the SDGs. An overview of existing literature on period poverty, its impact on health and well-being, and its relation to the SDGs was carried out. Different perspectives, interventions, and policy approaches to addressing period poverty were also explored. By illuminating the interplay between period poverty and various SDGs, particularly those related to gender equality, health, education, and economic empowerment, the study emphasizes the imperative of integrating menstrual health and hygiene into global development efforts. Advocating for targeted policies, funding, and advocacy, the manuscript calls for a holistic and inclusive approach to breaking the cycle of period poverty, ultimately contributing to advancing the SDGs and fostering a more equitable and healthier global society. Efforts to eradicate period poverty - providing affordable menstrual products, improving sanitation infrastructure, enhancing education, and implementing supportive policies - lead to significant progress in public health and gender equity. By prioritizing menstrual health management in public health policies, educational programs, and economic strategies, we can ensure that everyone who menstruates can do so with dignity and without limits on their potential.

Understanding associations between the COVID-19 pandemic and menstrual hygiene management among adolescent girls in Ethiopia: findings from a mixed-methods longitudinal study

OBJECTIVE

To understand the relationship between the COVID-19 pandemic and menstrual hygiene management (MHM) among adolescent girls in Ethiopia and to explore which girls were most affected by pandemic disruptions.

DESIGN

Two rounds of data from surveys and interviews were collected with adolescent girls immediately prior to and during the COVID-19 pandemic. The primary analysis is cross-sectional, controlling for pre-COVID-19 covariates.

SETTING

The setting was three zones in two regions of Ethiopia: East Hararghe and East Shewa Zones in Oromia and South Gondar Zone in Amhara. Data were collected in December 2019-March 2020 and September 2020-February 2021.

PARTICIPANTS

742 adolescent girls, ages 11-25 years.

OUTCOME MEASURES

Four primary outcomes were explored (1) the number of challenges girls experienced; (2) adolescent-identified challenges managing menstrual hygiene; (3) adolescent-identified difficulties accessing MHM products and (4) adolescent-identified difficulties accessing soap or water.

RESULTS

Girls who were more vulnerable to COVID-19 were more likely to have worse MHM outcomes. An SD increase in household vulnerability to COVID-19 was associated with an 8.7 percentage point increase in the likelihood that the respondent had difficulty getting MHM products (p<0.001), a 6 percentage point increase in the likelihood that she reported facing a challenge managing her menstruation (p=0.003) and a 5.2 percentage point increase in the likelihood she lacked soap or water (p=0.001). Qualitative themes, used to triangulate the quantitative findings, suggest that mobility restrictions, shutdowns of the local market, disruptions in supply chains, poverty, stigma and fear about contracting COVID-19 affected girls' access to MHM supplies.

CONCLUSIONS

The results of this study suggest that MHM was left behind in the COVID-19 response. New programming and policy interventions need to address financial hardship and disruptions to supplies to manage menstruation as well as tackle the inequitable gender norms that stigmatise menstruation during emergencies.

Factors Associated with Exclusive Use of Hygienic Methods during Menstruation among Adolescent Girls (15-19 Years) in Urban India: Evidence from NFHS-5

Background

Menstrual hygiene is a critical public health concern for adolescent girls in urban India. However, there is a paucity of research on this subject, particularly on a national scale. To the best of our knowledge, this study diverges from previous research, as the majority of prior investigations in India have centered on rural locales, married individuals, and those aged between 15 and 24 years. Thus, this study aims to fill this gap by investigating the factors associated with the exclusive use of hygienic methods during menstruation among urban adolescent girls (15-19 years) in India.

Method

A total of 25136 samples were included in this analysis from the National Family Health Survey 5 (NFHS-5). The Binary logistic regression model has been administered to determine the associated factors of the exclusive use of hygienic methods among adolescent girls.

Results

The results of the multivariate model revealed significant positive associations between higher education levels and usage of menstrual hygiene management products (AOR: 1.860; 95 % CI: 1.418-2.439), (AOR: 2.110; 95 % CI: 1.553-2.867). Additionally, individuals in higher wealth quintiles were more likely to use MHM products, with the richest quintile showing the highest likelihood (AOR: 5.310; 95 % CI: 4.494-6.275). Attendance at cultural events such as cinema or theater was positively associated with MHM product utilization (AOR: 1.338; 95 % CI: 1.181-1.517).Conversely, Lack of access to sanitation facilities was inversely associated with MHM product utilization (AOR: 0.742; 95 % CI: 0.628-0.877). Muslim girls had lower odds than Hindus (AOR: 0.576; 95 % CI: 0.520-0.637). Substantial regional variations were evident, with the Western (AOR: 0.879; 95 % CI: 0.759-1.019), Eastern (AOR: 0.747; 95 % CI: 0.654-0.854), Central (AOR: 0.349; 95 % CI: 0.313-0.388), and North-eastern regions (AOR: 0.597; 95 % CI: 0.490-0.727) displaying diminished odds of MHM product usage relative to the southern region. General caste had higher odds compared to scheduled caste (AOR: 1.255, 95 % CI: 1.103-1.429), while other backward caste had lower odds (AOR: 0.858, 95 % CI: 0.771-0.955).

Conclusion

These findings underscore the importance of addressing inequalities in access to menstrual hygiene products among urban adolescent girls in India. Targeted interventions and educational programs are essential to ensure equitable access and promote overall health and well-being.

A Qualitative Analysis of Urbanization and Menstrual Health Among Young Women

This qualitative study, grounded in theory, employed inductive coding for analysis, focusing on menstrual health among urban women aged 10-25. The research aims to explore the menstrual health status, practices, and beliefs of participants. The research delves into the impact of recent government initiatives on menstrual health and assesses the role of urbanization in shaping evolving menstrual health practices among young girls. Employing in-depth qualitative methods such as interviews and focus group discussions, the study seeks a comprehensive understanding of participants' experiences and perceptions related to menstrual health. The dynamics of women's menstrual experiences are significantly influenced by urbanization, heightened exposure to social media, evolving lifestyles, and government initiatives like the distribution of menstrual products in schools and the enhancement of water, sanitation, and hygiene (WASH) facilities in government institutions. Positive shifts have been observed, including reduced restrictions on menstruating individuals, enhanced access to affordable hygiene products, and improved disposal facilitated by municipal garbage collection services. However, notable gaps persist in basic knowledge about menstruation, hygienic practices, effective interpersonal communication with schoolteachers or community health care workers, and compliance with government programs promoting weekly iron-folic acid supplementation and biannual Albendazole intake, calling for substantial improvement.

Menstrual health: Inequities in a cohort of menstruating people in the Brazilian southeastern region

OBJECTIVE

To assess menstrual hygiene management (MHM) and period poverty in a group of low- and medium-income menstruating people.

METHODS

A cross-sectional study was conducted at the University of Campinas, Brazil, from January to June 2022 with 535 participants aged 18-49. For data collection, we used the abbreviated version of the WHO Quality-of-Life questionnaire (WHOQOL-BREF) and a pre-tested questionnaire with items regarding MHM and period poverty.

RESULTS

We found an inverse relationship between the risk of no access to supplies to perform menstrual hygiene, which increased by 2.5% and each point less in the environmental domain of quality of life (QoL), and this risk increased by up to 3.1 times among participants who reported difficulty making ends meet. The risk of not having adequate conditions to perform menstrual hygiene at home increased by up to 2.6% for every one-point drop in the environmental domain of QoL. The risk of not having adequate conditions to perform menstrual hygiene outside the home increased by up to 1.3% for less points in the psychological domain of QoL, and 44.4% of those who indicated inadequate conditions for menstrual hygiene reported two or more childbirths.

CONCLUSIONS

Menstruating people who have an increased risk of lacking menstrual supplies and have an increased risk of inadequate conditions for MHM at home and outside the home, as well as those who have two or more deliveries and those having difficulties making ends meet, scored low on the QoL, especially in the environmental and psychological dimensions.

Understanding challenges related to menstrual hygiene management: Knowledge and practices among the adolescent girls in urban slums of Jaipur, India

Objective

This study aimed to determine the factors associated with knowledge and practices related to menstrual hygiene management among adolescent girls in urban slums in Jaipur, India.

Material and Methods

A cross-sectional study among 417 adolescent girls was conducted. Descriptive statistics, Chi-square, and bivariate and multivariate logistic regression methods were used to analyze the data and determine the associated factors.

Findings

Only 48.7% of girls had a correct understanding of menstruation. In addition, 55.1% of the menstruating girls had faced health problems related to mensuration in the last 6 months; however, only 47.6% visited a health facility for treatment. Educational status of the girl (AOR = 1.89, 95% CI = 0.88-4.06), mother's education (AOR = 2.19, 95% CI = 1.30-3.67) and income (AOR = 1.89, 95% CI = 0.67-3.95), father's income (AOR = 1.42, 95% CI = 0.76-2.95), and counseling by field health workers (AOR = 2.08, 95% CI = 1.23-3.51) were found to be associated with knowledge about menstruation. Girl's education (AOR = 1.49, 95% CI = 0.74-2.95), mother's education (AOR = 1.46, 95% CI = 0.7-2.84) and income (AOR = 1.314, 95% CI = 0.44-2.02), father's education (AOR = 1.64, 95% CI = 0.55-3.08) and income (AOR = 2.0, 95% CI = 0.86-3.28), and counseling by field health workers (AOR = 1.48, 95% CI = 0.76-2.64) were found to be associated with the type of absorbents used.

Conclusion

The findings from the study show that the awareness about mensuration and utilization of health services among adolescent girls is low. There is a need to create an enabling environment for girls to access knowledge and health services related to menstruation by creating awareness at the community level, strengthening outreach by field health workers, and ensuring privacy in healthcare facilities.

Barriers to Women's Menstrual Hygiene Practices during Recurrent Disasters and Displacement: A Qualitative Study

Disasters that involve displacement are particularly challenging for managing personal and menstrual hygiene, which can increase the risk of toxic shock syndrome, infections and other health conditions that can endanger women's lives. This study aimed to examine the menstrual hygiene challenges experienced by internally displaced women affected by recurrent natural disasters and subsequent displacement in the context of a low-middle-income country, i.e., Pakistan. A critical ethnographic study was undertaken in disaster-relief camps in the northern region of Pakistan. Data were collected using multiple methods, including field observations, review of media reports and in-depth interviews with 18 women. The findings suggested that the key barriers to the personal and menstrual hygiene of women during recurrent disasters and displacement in the mountainous rural region of Pakistan include inadequate housing, lack of infrastructure and humanitarian aid, no waste disposal system and lack of women-friendly spaces in disaster-relief camps. Community-based collaboration is necessary for the implementation of effective interventions. A comprehensive menstrual response to promote the health and well-being of women during disasters must include menstruation supplies, supportive facilities (mainly toilets and bathing facilities), supplementary supplies for storing, washing and drying, disposal/waste management facilities, education and culturally appropriate spaces and supplies.

A comparative study of the knowledge and practices related to menstrual hygiene among adolescent girls in urban and rural areas of Sindh, Pakistan: A cross-sectional study

BACKGROUND

Menstrual hygiene management plays a significant role in the achievement of sustainable development goals, including good health and well-being, quality education, gender equality, women's empowerment, and sanitation. Even though the United Nations emphasizes menstrual hygiene management as a global public health and human rights issue, studies from different parts of the world have shown there is a lack of policies in this area that affects adolescent girls.

OBJECTIVE

The study aimed to assess the menstrual-related knowledge and practices of adolescent girls (10-18 years) attending urban and rural public schools of district Khairpur of province Sindh of Pakistan.

DESIGN

This research is an analytical cross-sectional study design.

METHODS

Adolescent girls (n = 310), 159 girls from urban and 159 girls from rural schools, were enrolled. Data were collected through self-administered questionnaires. Knowledge was considered satisfactory if the participant scored ⩾12/20, and <12/20 was considered unsatisfactory knowledge. Practice scores were considered good for >10 and poor for <10. Statistical Package for the Social Science (SPSS) version 20.0 was used for data analysis. Descriptive statistics such as mean and standard deviation were calculated. The chi-square test was used to assess and compare the differences between practices and knowledge of menstrual hygiene management between urban and rural adolescent school girls.

RESULTS

We found significant differences in menstrual hygiene management among adolescent girls between urban and rural areas. Approximately two-thirds of the total school girls thought that school management had inadequate resources and toilet facilities (rural: 76% versus urban: 62%). The major source of knowledge in adolescent rural and urban girls for menstrual-related matters was mothers. More girls from the urban school (81%) were aware of using sanitary pads during menstruation. The majority of the girls from urban areas showed satisfactory knowledge whereas only 38% of rural girls were shown to have satisfactory results. Nearly 71% of urban girls were found to have good practices when compared with rural girls (12%).

CONCLUSION

With further importance by the United Nations on female education in less developed regions, where the health of women is usually given less importance, policies are required on the inclusion of reproductive health of female adolescents in the curriculum.

The menstrual cup knowledge, attitudes, and behaviors of Turkish women in reproductive age

OBJECTIVE

To evaluate the knowledge, attitudes, and behaviors of Turkish women of reproductive age toward menstrual cup.

METHODS

This descriptive study was conducted via online platforms with 301 Turkish women between March-June 2023. The Participant Information Form was used to collect the data. A p value of <0.05 was considered.

RESULTS

The mean age of the participants was 26.42 ± 7.81 years. The most common used menstrual hygiene product was sanitary pad. Of the women, 72.1 % have heard of the menstrual cup before, however, only 6.6 % of the women used menstrual cups. The 42.9 % of the women who use the menstrual cup had difficulty in using it. The most common concern of women who did not use menstrual cups was that they thought they were uncomfortable and did not know how to use them. Factors such as age, marital status, place of residence, occupation, previous pregnancy and finding the menstrual hygiene product used comfortable was found statistically significantly correlated with the menstrual cup usage.

CONCLUSION

In our study, very few of the women use menstrual cups, and nearly half of them stated that they had difficulty in using it. The participants who did not use the menstrual cup most frequently did not know how to use the cup and did not use it because they thought the cup was uncomfortable. It is essential to increase the awareness of reproductive age women about the menstrual cups.

Assessment of knowledge, attitudes, and practices regarding menstruation and menstrual hygiene among early-reproductive aged women in Bangladesh: a cross-sectional survey

Background

Poor menstrual hygiene practices during menstruation increases the risk of reproductive tract infections, absenteeism, and negative impact on school performance. Despite being a global problem, there is a lack of knowledge and misconceptions about menstrual hygiene among women of all ages, especially in developing countries like Bangladesh. The study aims to assess the knowledge, attitudes, and practices toward menstrual hygiene among early reproductive-aged women in Bangladesh to help policymakers and planners take effective initiatives.

Methodology

A cross-sectional survey was conducted between July and December 2022 in Dhaka, Rajshahi, Chittagong, Sylhet, and Barisal regions of Bangladesh. A convenience sampling technique was utilized to recruit a total of 1,214 participants (100% female; mean age: 22.87 ± 2.64 years). A semi-structured questionnaire including informed consent, socio-demographic information, as well as questions regarding knowledge (6-item), attitudes (7-item), and practices (6-item) toward menstruation and menstrual hygiene practices, was used to conduct the survey. All analyses were performed using the STATA (Version 15.0) and Statistical Package for the Social Sciences (SPSS version 25.0).

Result

The mean scores of the knowledge, attitudes, and practices were 4.9 ± 1.51 (out of 6), 12.58 ± 1.58 (out of 14), and 8.80 ± 1.87 (out of 12), respectively. The higher scores of knowledge, attitudes, and practices were significantly associated with several socio-demographic and menstruation-related factors (education, family type, type of menstruation, duration of menstruation, etc.).

Conclusion

This study identified several key factors associated with improved knowledge, attitudes, and practices related to menstrual hygiene, including higher education levels, student status, younger age, non-alcohol consumption, and regular menstrual cycles. To enhance menstrual hygiene practices among women, it is crucial to implement targeted interventions that address knowledge disparities and tackle social and environmental influences.

Perceived difficulties in maintaining menstrual hygiene practices among indigenous adolescents during seasonal water scarcity periods in Bandarban hill district of Bangladesh: A cross-sectional study

BACKGROUND

Access to clean water is important for menstrual hygiene practices, an important aspect of health for adolescent girls. In Bangladesh, adolescent girls represent poor menstrual hygiene practices, whereas the practice is worse among vulnerable population groups living in areas experiencing seasonal water scarcity. This study portrays perceived difficulties in menstrual hygiene practices among indigenous adolescent girls during the period of seasonal water scarcity in Bandarban Hill District, Bangladesh.

METHOD

Data was collected from 242 indigenous adolescent girls through interviews during the period of water scarcity. Backward stepwise regression model was used to identify factors associated with perceived difficulty in maintaining menstrual hygiene (PD) practices.

RESULT

The study participants, mainly living in hard-to-reach areas, reported difficulty in getting adequate water during the water scarcity period, and the quality of water was reported to be poor. PD due to water scarcity was found to be significantly associated with water source degradation (β = 0.247, < 0.001), the need for boiling/purifying water before use for menstrual hygiene (β = 0.203, p = 0.005), and experience of water availability when it was necessary to maintain their optimal menstrual hygiene practice (β = 0.449, p < 0.001), time required to collect water (β = 0.209, p < 0.001), taking a bath every day (β = -0.228, p < 0.001), and frequency of washing genitals per day (β = - 0.094, p = 0.040).

CONCLUSION

Indigenous adolescents perceive difficulty in menstrual hygiene practices during the period of water scarcity. Further research could be carried out to observe to what extent the seasonal water scarcity could be attributable to worsen the menstrual hygiene practices and to identify the need for addressing the problems.

Menstrual hygiene management in flood-affected Pakistan: Addressing challenges and ensuring women's health and dignity

Pakistan's recent floods have worsened women's and girls' menstrual hygiene problems, compromising their health, dignity, and well-being. Supply chain issues, poor facilities, and cultural stigma limit menstrual products and hygiene management. Gender-sensitive disaster management and menstrual health education programmes can help. The Minimum Initial Service Package (MISP) can provide emergency reproductive health services. Involving men, working with religious leaders, and pre-disaster planning for menstrual hygiene management can help break the taboo and increase access to resources. Meeting ongoing needs requires timely menstrual hygiene product distribution, restocking, and renewal. By addressing these issues, Pakistan can empower post-flood women and girls through economic opportunities and legal protection.

Menstrual health and hygiene among young Palestinian female university students in the West Bank: a cross-sectional study

OBJECTIVE

We investigated some aspects of menstrual health and hygiene among young female students at Birzeit University in the West Bank of the occupied Palestinian territory.

DESIGN

Cross-sectional study in a large central university.

PARTICIPANTS

Out of a total of 8473 eligible female students, a calculated sample size of 400 students aged between 16 and 27 years was obtained.SettingLarge central university, West Bank, occupied Palestinian territory (oPt).

MEASURES

An anonymous structured international research instrument consisting of 39 questions based on the Menstrual Health Questionnaire, in addition to few questions relevant to the context, was administered.

RESULTS

30.5% of participants were not informed about menstruation before menarche, and 65.3% reported that they were not ready when they got their first period. The highest reported source of information regarding menstruation was family (74.1%), followed by school (69.3%). About 66% of respondents reported that they need more information on various topics of menstruation. The most common type of menstrual hygiene products used were single-use pads (86%), followed by toilet paper (13%), nappies (10%) and reusable cloths (6%). Of the total 400 students, 14.5% reported that menstrual hygiene products are expensive, and 15.3% reported that they always/sometimes had to use menstrual products that they do not like because they are cheaper. Most (71.9%) of the respondents reported that they used menstrual products for longer time than recommended due to inadequate washing facilities at the university campus.

CONCLUSIONS

The findings provide useful evidence on the lack and the need for menstrual-related information for female university students, inadequate infrastructure to help them manage their menstruation with dignity and pointed to some menstrual poverty in accessing menstrual products. A national intervention programme is needed to increase awareness regarding menstrual health and hygiene among women in local communities and female teachers in schools and universities to enable them to disseminate information to and meet the practical needs of girls at home, at school and at the university.