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Roy N, Amin MB, Aktarujjaman M, Hossain E, Mugo C, Islam F, Mamun MA, Kumar M. 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. PLoS One 2024; 19:e0310451. [PMID: 39374244 PMCID: PMC11458041 DOI: 10.1371/journal.pone.0310451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 09/01/2024] [Indexed: 10/09/2024] Open
Abstract
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.
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Affiliation(s)
- Nitai Roy
- Department of Biochemistry and Food Analysis, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md. Bony Amin
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md. Aktarujjaman
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Ekhtear Hossain
- Department of Biological Sciences and Chemistry, Southern University and A&M College, Baton Rouge, LA, United States of America
| | - Cyrus Mugo
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Farhadul Islam
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
- Department of Public Health, University of South Asia, Dhaka, Bangladesh
| | - Manasi Kumar
- Institute for Excellence in Health Equity, New York University School of Medicine, New York, NY, United States of America
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Kelly AM. Public toilets and their potential impact on an individual's health. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:538-544. [PMID: 38900669 DOI: 10.12968/bjon.2023.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
In modern society, people engage in social interactions and activities outside their own home. When in public settings people may need to eliminate bodily waste, so public toilets are required. Accessibility, availability and adaptability are essential principles for safe, private, and purposeful visits to public toilets. A diverse range of individuals use public toilets: various age profiles, all gender groups, vulnerable individuals and people with additional needs. Public toilets essentially need to be a place of privacy, safety and cleanliness to facilitate elimination of urine, evacuation of faeces, management of menstruation, and changing/disposing of continence wear products in a secure environment.
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Affiliation(s)
- Anne Marie Kelly
- Clinical Nurse Specialist - Continence, Meath Primary Care Centre, Dublin, Ireland
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Sinharoy SS, Chery L, Patrick M, Conrad A, Ramaswamy A, Stephen A, Chipungu J, Reddy YM, Doma R, Pasricha SR, Ahmed T, Chiwala CB, Chakraborti N, Caruso BA. Prevalence of heavy menstrual bleeding and associations with physical health and wellbeing in low-income and middle-income countries: a multinational cross-sectional study. Lancet Glob Health 2023; 11:e1775-e1784. [PMID: 37802092 PMCID: PMC10581908 DOI: 10.1016/s2214-109x(23)00416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/14/2023] [Accepted: 08/24/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Data on the prevalence of heavy menstrual bleeding in low-income and middle-income countries (LMICs) are scarce. We aimed to assess the validity of a scale to measure heavy menstrual bleeding and calculate its prevalence in southern Asia and sub-Saharan Africa, and to examine associations between heavy menstrual bleeding and health outcomes. METHODS Between Aug 2, 2021 and June 14, 2022, we surveyed 6626 women across ten cities (Meherpur and Saidpur, Bangladesh; Warangal, Narsapur, and Tiruchirappalli, India; Kathmandu, Nepal; Dakar, Senegal; Nairobi, Kenya; Kampala, Uganda; and Lusaka, Zambia), including questions on demographics, health, and the SAMANTA scale, a six-item measure of heavy menstrual bleeding. We conducted confirmatory factor analysis to assess construct validity of the SAMANTA scale, calculated the prevalence of heavy menstrual bleeding, and used regression analyses to examine associations of heavy menstrual bleeding with health outcomes. FINDINGS 4828 women were included in the final analytic sample. Factor analysis indicated a one-factor model representing heavy menstrual bleeding. In the pooled analytic sample, 2344 (48·6%) of 4828 women were classified as experiencing heavy menstrual bleeding, and the prevalence was lowest in Dakar (126 [38·3%] of 329 women) and Kampala (158 [38·4%] of 411 women) and highest in Kathmandu (326 [77·6%] of 420 women). Experiencing heavy menstrual bleeding was significantly associated with feeling tired or short of breath during the menstrual period (risk ratio 4·12 (95% CI 3·45 to 4·94) and reporting worse self-rated physical health (adjusted odds ratio 1·27, 95% CI 1·08 to 1·51), but was not associated with subjective wellbeing (β -3·34, 95% CI -7·04 to 0·37). INTERPRETATION Heavy menstrual bleeding is highly prevalent and adversely impacts quality of life in women across LMIC settings. Further attention is urgently needed to understand determinants and identify and implement solutions to this problem. FUNDING Bill & Melinda Gates Foundation, United States Agency for International Development, National Institutes of Health.
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Affiliation(s)
- Sheela S Sinharoy
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Lyzberthe Chery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Madeleine Patrick
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amelia Conrad
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Jenala Chipungu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Rinchen Doma
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, The Walter and Eliza Hall Institute, Melbourne, VIC, Australia
| | - Tanvir Ahmed
- Department of Civil Engineering and International Training Network, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh
| | | | | | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Ramsay C, Hennegan J, Douglass CH, Eddy S, Head A, Lim MSC. Reusable period products: use and perceptions among young people in Victoria, Australia. BMC Womens Health 2023; 23:102. [PMID: 36906569 PMCID: PMC10006563 DOI: 10.1186/s12905-023-02197-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/30/2023] [Indexed: 03/13/2023] Open
Abstract
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.
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Affiliation(s)
- Caitlin Ramsay
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Caitlin H Douglass
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sarah Eddy
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Alexandra Head
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Megan S C Lim
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia.
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Buitrago-García T, Sawadogo NH, Souares A, Koulidiati JL, Sié A, Bärnighausen T, Langlotz S, McMahon SA. Female-friendly toilets in schools in Burkina Faso: A mixed-methods study using photo-elicitation. J Glob Health 2022; 12:04057. [PMID: 36073661 PMCID: PMC9454237 DOI: 10.7189/jogh.12.04057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background An absence of gender-sensitive sanitation facilities in schools and the negative effects this has on girls has been widely discussed among advocacy groups, though less examined in academic spheres. Drawing on triangulated data, we outline current challenges and respondent-driven solutions to enhance the female-friendly nature of toilets in a context of extreme poverty. Methods This mixed-methods study was informed by the tenets of human-centred design. We first quantitatively assessed facilities in 14 secondary schools in the Kossi Province of Burkina Faso. We then collected qualitative data, including 15 focus group discussions and 53 in-depth interviews among schoolgirls, mothers, teachers and key informants. We applied photo-elicitation, a novel method, to explore perceptions of facilities and the desirability and feasibility of interventions to improve gender-friendly sanitation facilities. Results No school met international water, sanitation and hygiene (WASH) standards for schools. Roughly one third of schools did not have water and, when present, there was no reliable way to use it within the toilet complex. Schoolgirls shared feelings of shame and stress when menstruating at school, and said that they would avoid using school toilets, if possible. Schoolgirls described water access as the most urgent need to address, followed by fostering privacy and facilitating cleanliness within facilities. Mothers and teachers mostly aligned with these priorities, while key informants additionally emphasised the need to raise awareness on both general and menstrual hygiene and to develop maintenance systems. Photo-elicitation engaged and empowered participants to pinpoint priorities and concrete solutions, namely a need for doors and locks, water containers and cleaning materials. Conclusions WASH needs in many schools remain unmet. Women and girls should be involved in decision-making across stages of intervention design and implementation. Young women's voices merit greater inclusion in academic literature. Future interventions should enhance access to water and privacy. Future research could explore maintenance and monitoring strategies to develop guidance on sustainable solutions.
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Affiliation(s)
- Teresa Buitrago-García
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- La Paz University Hospital, Madrid, Spain
| | | | - Aurélia Souares
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Jean-Louis Koulidiati
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Ali Sié
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Nouna Health Research Centre, Nouna, Burkina Faso
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Africa Health Research Institute, Nelson R. Mandela Medical School, Umbilo, Durban, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sarah Langlotz
- Chair of Development Economics (Prof. Fuchs), Georg-August-Universität Göttingen, Göttingen, Germany
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Hennegan J, Bukenya JN, Makumbi FE, Nakamya P, Exum NG, Schwab KJ, Kibira SPS. Menstrual health challenges in the workplace and consequences for women's work and wellbeing: A cross-sectional survey in Mukono, Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000589. [PMID: 36962362 PMCID: PMC10021399 DOI: 10.1371/journal.pgph.0000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/16/2022] [Indexed: 11/18/2022]
Abstract
This study describes women's menstrual health needs at work in Uganda and explores the associations between unmet needs and women's work and wellbeing. We undertook a cross-sectional survey of women working in marketplaces, public primary schools, and health care facilities in Mukono district, central Uganda. Survey questions were designed to capture women's experiences of managing menstrual bleeding, pain, social support, and the social environment. A total 435 women working in markets, 45 teachers and 45 health care facility workers participated. Of these, 15% missed work due to their last period, and 41% would prefer not to work during menstruation. Unmet menstrual health needs were associated with consequences for women's work and psychological wellbeing. Experiencing menstrual pain (aPR 3.65 95%CI 1.48-9.00), along with the use of improvised menstrual materials (aPR 1.41 95%CI 1.08-1.83), not feeling comfortable to discuss menstruation at work (aPR 1.54 95%CI 1.01-2.34) and the expectation that women should stay home when menstruating (aPR 2.44 95%CI 1.30-4.60) were associated with absenteeism due to menstruation. In contrast, not having menstrual management needs met (aPR 1.45 95%CI 1.17-1.79) and the attitude that menstruating women are dirty (aPR 1.94 95%CI 1.50-2.51), along with pain (aPR 1.59 95%CI 1.12-2.24) and norms around absenteeism were associated with wanting to miss work. After adjustment for age and poverty, unmet menstrual management needs (b = -5.97, 95%CI -8.89, -2.97), pain (b = -3.89, 95%CI -7.71, -0.08) and poor social support (b = -5.40, 95%CI -9.22, -1.57) were associated with lower wellbeing measured using the WHO-5. Attitudes that menstruation should be kept secret (b = 4.48, 95%CI 0.79, 8.17) and is dirty (b = 4.59, 95%CI 0.79, 8.40) were associated with higher wellbeing. Findings suggest that supporting care for menstrual pain, addressing secrecy surrounding menstruation and the perception of menstruation as dirty, and improving access to materials and facilities for managing menstrual bleeding are avenues for programs and policies to support working women.
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Affiliation(s)
- Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Environmental Health and Engineering, The Water Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Justine N. Bukenya
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fredrick E. Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Petranilla Nakamya
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Natalie G. Exum
- Department of Environmental Health and Engineering, The Water Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Kellogg J. Schwab
- Department of Environmental Health and Engineering, The Water Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Simon P. S. Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Domini M, Guidotti Pereira S, Win A, Win LY, Lantagne D. Qualitative and Quantitative Analysis of Latrine Management Approaches in Internally Displaced Persons Camps in Myanmar. Am J Trop Med Hyg 2022; 107:tpmd210526. [PMID: 35576948 PMCID: PMC9294669 DOI: 10.4269/ajtmh.21-0526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/20/2022] [Indexed: 11/07/2022] Open
Abstract
Water, sanitation, and hygiene (WASH) interventions provide dignity and prevent disease transmission. Sanitary facility provision (e.g., latrines) is a key WASH priority in all phases of humanitarian response. Currently, there are evidence gaps on field effectiveness of sanitation approaches, particularly in protracted crises. Thus, we conducted a qualitative and quantitative evaluation of sanitation approaches in internally displaced persons (IDP) camps in Myanmar. We conducted 36 focus group discussions, 65 household surveys, and 32 key informant interviews in Rakhine and Kachin states; results were analyzed qualitatively. We found family-shared, gender-segregated latrines were the preferred approach. Acceptance was a result of gender segregation, followed by lighting, state of repair, cleanliness, design, and distance from household. Contextual factors influencing sanitation approach development and acceptance were cultural and religious beliefs, community cohesion, camp size, livelihood access, land ownership and availability, and responding agency type. Overall, sanitation approaches generally met IDP needs; however, access was limited for children, the elderly, and people with special needs (including persons with disabilities). We recommend implementers of latrine programs in protracted contexts conduct community consultations, consider gender segregation, be flexible in considering context-specific solutions, prioritize access and dignity, and be inclusive of vulnerable groups.
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Affiliation(s)
- Marta Domini
- School of Engineering, Tufts University, Medford, Massachusetts
| | | | - Aye Win
- United Nations Children’s Fund, Kachin, Myanmar
| | - Lae Yee Win
- United Nations Children’s Fund, Rakhine, Myanmar
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Schmitt ML, Booth K, Sommer M. A Policy for Addressing Menstrual Equity in Schools: A Case Study From New York City, U.S.A. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 3:725805. [PMID: 36303999 PMCID: PMC9580679 DOI: 10.3389/frph.2021.725805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/22/2021] [Indexed: 12/03/2022] Open
Abstract
There has been a growth in menstrual equity policy advancements in the U.S.A. in recent years; with much of the new legislation prioritizing the needs of adolescent girls in schools. New York City, a predecessor of this movement, was the first U.S.A. locality to pass such legislation in 2016. The aim of this case study was to better understand the various factors which led to the development, passage and initial implementation of New York City's Menstrual Equity in Schools Policy. Data collection methods included a desk review and qualitative assessment with several actors involved across the policy and introduction phases. Key findings included (1) the utility of community narratives and a pilot project as a means for overcoming initial skepticisms, proving feasibility, and generating support; (2) the importance of policy champions for overcoming fiscal objections and navigating political discourse; and (3) lessons learned from early implementation efforts, including variance in awareness and distribution models. This case study yields valuable insights into the practical considerations when designing or implementing policies aimed at tackling issues of menstrual equity within school settings.
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Affiliation(s)
- Margaret L. Schmitt
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- *Correspondence: Margaret L. Schmitt
| | - Kathleen Booth
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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Pichon A, Jackman KB, Winkler IT, Bobel C, Elhadad N. The messiness of the menstruator: assessing personas and functionalities of menstrual tracking apps. J Am Med Inform Assoc 2022; 29:385-399. [PMID: 34613388 PMCID: PMC8757321 DOI: 10.1093/jamia/ocab212] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/08/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine trends in the intended users and functionalities advertised by menstrual tracking apps to identify gaps in personas and intended needs fulfilled by these technologies. MATERIALS AND METHODS Two types of materials were collected: a corpus of scientific articles related to the identities and needs of menstruators and a corpus of images and descriptions of menstrual tracking apps collected from the Google and Apple app stores. We conducted a scoping review of the literature to develop themes and then applied these as a framework to analyze the app corpus, looking for alignments and misalignments between the 2 corpora. RESULTS A review of the literature showed a wide range of disciplines publishing work relevant to menstruators. We identified 2 broad themes: "who are menstruators?" and "what are the needs of menstruators?" Descriptions of menstrual trackers exhibited misalignments with these themes, with narrow characterizations of menstruators and design for limited needs. DISCUSSION We synthesize gaps in the design of menstrual tracking apps and discuss implications for designing around: (1) an irregular menstrual cycle as the norm; (2) the embodied, leaky experience of menstruation; and (3) the varied biologies, identities, and goals of menstruators. An overarching gap suggests a need for a human-centered artificial intelligence approach for model and data provenance, transparency and explanations of uncertainties, and the prioritization of privacy in menstrual trackers. CONCLUSION Comparing and contrasting literature about menstruators and descriptions of menstrual tracking apps provide a valuable guide to assess menstrual technology and their responsiveness to users and their needs.
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Affiliation(s)
- Adrienne Pichon
- Biomedical Informatics, Columbia University, New York, New York,
USA
| | - Kasey B Jackman
- School of Nursing, Columbia University, New York, New York,
USA
- New York-Presbyterian Hospital, New York, New York, USA
| | - Inga T Winkler
- Institute for the Study of Human Rights, Columbia University, New
York, New York, USA
- Legal Studies, Central European University, Vienna, Austria
| | - Chris Bobel
- Women’s, Gender, and Sexuality Studies, University of
Massachusetts, Boston, Massachusetts, USA
| | - Noémie Elhadad
- Biomedical Informatics, Columbia University, New York, New York,
USA
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10
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The Stressor in Adolescence of Menstruation: Coping Strategies, Emotional Stress & Impacts on School Absences among Young Women in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178894. [PMID: 34501484 PMCID: PMC8431475 DOI: 10.3390/ijerph18178894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022]
Abstract
Throughout the developing world, girls face hardships surrounding menstruation, often resulting in poor emotional wellbeing and missing school. Providing ways to keep girls in school will increase their educational and earning potentials, which will ultimately trickle down to improving the economic standing of nations in the next generation. Informed by the Transactional Model of Stress and Coping, this work evaluates the roles that cultural and school environments play in appraisals of menstruation as a major life stressor for adolescent females and the impacts of emotional stress on missing school. Using primary survey data from schools in Nepal, robust results are found to support the theoretical framework based on conditional mixed-process (CMP) estimation with fixed effects, utilizing multiple index building techniques. Strong cultural norms during menstruation appear to increase the probability of girls self-reporting emotional stress, while the presence of hygiene supporting infrastructure at schools reduces this outcome. Furthermore, there is strong support for the finding that the presence of emotional stress during menstruation increases the likelihood of not only missing school but also for an extended period of time. Our findings motivate increasing government policies to provide stronger hygiene infrastructure in schools to improve successful coping skills and attendance rates.
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Maroko AR, Hopper K, Gruer C, Jaffe M, Zhen E, Sommer M. Public restrooms, periods, and people experiencing homelessness: An assessment of public toilets in high needs areas of Manhattan, New York. PLoS One 2021; 16:e0252946. [PMID: 34161351 PMCID: PMC8221515 DOI: 10.1371/journal.pone.0252946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
Access to safe, clean water and sanitation is globally recognized as essential for public health. Public toilets should be accessible to all members of a society, without social or physical barriers preventing usage. A public toilet facility's design and upkeep should offer privacy and safety, ensure cleanliness, provide required sanitation-related resources, and be gender equitable, including enabling comfortable and safe management of menstruation. Menstrual hygiene management (MHM) refers to the need to ensure that girls, women and all people who menstruate have access to clean menstrual products, privacy to change the materials as often as needed, soap and water for washing the body as required, and access to facilities to dispose of used materials. Challenges around menstruation faced by people experiencing homelessness, which tend to be greater than those facing the general population, include inadequate toilet and bathing facilities, affordability issues around menstrual products, and menstrual stigma. Public toilets are a vital resource for managing menstruation, particularly for vulnerable populations without reliable access to private, safe, and clean spaces and menstrual products. This mixed-methods study sought to: 1) understand the lived experiences of MHM among people experiencing homelessness in New York City with respect to public toilets; 2) describe general and MHM-related characteristics of public toilets in high need areas of Manhattan and analyze their interrelationships; and 3) examine the associations among neighborhood-level demographics and the public toilet characteristics in those areas. Qualitative methods included key informant interviews (n = 15) and in-depth interviews (n = 22) with people with experience living on the street or in shelters, which were analyzed using Malterud's 'systematic text condensation' for thematic cross-case analysis. Quantitative methods included audits and analyses of public toilet facilities (n = 25) using traditional statistics (e.g., Spearman's correlations) and spatial analyses (e.g., proximity buffers). Qualitative findings suggest cleanliness, access to restrooms, and availability of resources are critical issues for the participants or prospective users. Quantitative analyses revealed insufficiently provided, maintained, and resourced public toilets for managing menstruation in high-needs areas. Findings also suggest that toilets with more MHM-related resource availability, such as menstrual products and toilet stall disposal bins, were more difficult to access. Neighborhood-level characteristics showed a potential environmental injustice, as areas characterized by higher socioeconomic status are associated with more access to MHM-specific resources in public restrooms, as well as better overall quality.
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Affiliation(s)
- Andrew R. Maroko
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States of America
| | - Kim Hopper
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Maayan Jaffe
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Erica Zhen
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States of America
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Macura B, Del Duca L, Soto A, Carrard N, Gosling L, Hannes K, Thomas J, Sara L, Sommer M, Waddington HS, Dickin S. PROTOCOL: What is the impact of complex WASH interventions on gender and social equality outcomes in low- and middle-income countries? A mixed-method systematic review protocol. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1164. [PMID: 37051177 PMCID: PMC8356345 DOI: 10.1002/cl2.1164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
| | - Laura Del Duca
- Stockholm Environment InstituteStockholmSweden
- Institute of Development StudiesUniversity of SussexBrightonUK
| | | | - Naomi Carrard
- Institute for Sustainable FuturesUniversity of TechnologySydneyAustralia
| | | | - Karin Hannes
- Research group SoMeTHin'K (Social, Methodological and Theoretical Innovation Kreative), CESO, Faculty of Social SciencesKU LeuvenLeuvenBelgium
| | - James Thomas
- Department of Social Science, EPPI‐CentreUCL Institute of EducationLondonUK
| | | | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public HealthColumbia UniversityNew York CityNew YorkUSA
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Women's Cognition and Attitude with Eco-Friendly Menstrual Products by Consumer Lifestyle. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115534. [PMID: 34064156 PMCID: PMC8196694 DOI: 10.3390/ijerph18115534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022]
Abstract
With rapid technology developments and the convenient and fast pace of life in recent years, many people are using disposable products, which cause environmental and ecological damages. A variety of eco-friendly menstrual products have been launched on the market, and "menstrual pads" now have a large market share in Taiwan's menstrual product industry. This study interviewed experts and collected questionnaires for qualitative and quantitative investigation and analysis. The results show that women have positive and open concepts regarding sustainability, as well as a good understanding of their body and are very interested in the performance and usage efficiency of products. The results also indicate that consumers purchase based on their lifestyles; most women collected enough product information before purchasing while overcoming the difficulties in dealing with the environment and learning to adapt them, and the majority of consumers attach importance to comfort, volume, and duration of blood absorption. The results suggest that the government and private enterprises should increase and improve sanitation education and sanitary facilities and guide the approach and serve as an important reference index for the promotion of eco-friendly menstrual products for environmental benefits.
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Shannon AK, Melendez-Torres GJ, Hennegan J. How do women and girls experience menstrual health interventions in low- and middle-income countries? Insights from a systematic review and qualitative metasynthesis. CULTURE, HEALTH & SEXUALITY 2021; 23:624-643. [PMID: 32116149 DOI: 10.1080/13691058.2020.1718758] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/16/2020] [Indexed: 06/10/2023]
Abstract
Increasing recognition of the difficulties women and adolescent girls face during menstruation has the prompted rapid implementation of menstrual health programmes and policies. Yet, there remains limited understanding of the influence of these interventions on individuals' menstrual experiences. We systematically reviewed and synthesised qualitative studies of participant experiences of menstrual health interventions. Included studies were undertaken in 6 countries (India, Uganda, Kenya, Ethiopia, Zimbabwe, South Africa) and involved over 900 participants. Interventions focused on menstrual product or education provision. Only 6 of the 12 included studies were rated as high or medium trustworthiness. Exposure to new menstrual products led to changes in women's and girls' expectations of what a menstrual material should offer, with recipients highly valuing reduced fears of leakage and improved freedom of movement. After learning how to use new products or receiving educational materials, women and girls reported feeling more empowered and aware of the physiological process of menstruation, and in some cases wanted to share this knowledge with others in their communities. For each intervention, the process of introduction, trial and error, and acceptance of the new technologies or information was influenced by the sociocultural environment including parents, peers and teachers.
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Affiliation(s)
- Alexandra K Shannon
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Julie Hennegan
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Gruer C, Hopper K, Smith RC, Kelly E, Maroko A, Sommer M. Seeking menstrual products: a qualitative exploration of the unmet menstrual needs of individuals experiencing homelessness in New York City. Reprod Health 2021; 18:77. [PMID: 33849575 PMCID: PMC8042836 DOI: 10.1186/s12978-021-01133-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been increasing recognition that certain vulnerable populations in the United States of America struggle to meet their menstruation-related needs, including people experiencing homelessness. Media and policy attention on this subject has focused on the provision of free menstrual products to vulnerable populations, including a New York City legislative bill, which guarantees access to menstrual products for Department of Homeless Services shelter residents (Intros 1123-A). METHODS This qualitative study explored the challenges people experiencing homelessness in New York City face in accessing menstrual products. Data collection was conducted from June to August 2019 and included: Semi-structured key informant interviews with staff from relevant government agencies and homeless service providers (n = 15), and semi-structured in-depth interviews with individuals with experience living on the street and in shelters (n = 22). Data were analysed using thematic analysis. RESULTS Key themes that emerged included: (1) insufficient and inconsistent access to menstrual products; (2) systemic challenges to providing menstrual products; and (3) creative solutions to promote access to menstrual products. Both shelter- and street-living individuals reported significant barriers to accessing menstrual products. While both populations struggle, those in shelters were more likely to be able to purchase menstrual products or access free products at their shelter, while those living on the streets were more likely to have to resort to panhandling, theft, or using makeshift materials in place of menstrual products. Across both populations, individuals described barriers to accessing free products at shelters and service providers, primarily due to distribution systems that rely on gatekeepers to provide a few pads or tampons at a time, sometimes of inadequate quality and only upon request. Shelters and service providers also described challenges providing these products, including inconsistent supply. CONCLUSION These findings highlight the critical importance of expanding and improving initiatives seeking to provide access to menstrual products for vulnerable populations. Despite policy level efforts to support menstrual product access, individuals experiencing homelessness in New York City, whether living in shelters or on the street, are often not able to access the menstrual products that they need to manage their monthly menstrual flow.
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Affiliation(s)
- Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA.
| | - Kim Hopper
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA
| | - Rachel Clark Smith
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA
| | - Erin Kelly
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA
| | - Andrew Maroko
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY School of Public Health, 55 W. 125th Street, Room 508, New York, NY, 10027, USA
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA
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Schmitt ML, Wood OR, Clatworthy D, Rashid SF, Sommer M. Innovative strategies for providing menstruation-supportive water, sanitation and hygiene (WASH) facilities: learning from refugee camps in Cox's bazar, Bangladesh. Confl Health 2021; 15:10. [PMID: 33637096 PMCID: PMC7912835 DOI: 10.1186/s13031-021-00346-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background There is growing attention to addressing the menstrual hygiene management (MHM) needs of the over 21 million displaced adolescent girls and women globally. Current approaches to MHM-related humanitarian programming often prioritize the provision of menstrual materials and information. However, a critical component of an MHM response includes the construction and maintenance of water, sanitation and hygiene (WASH) facilities, including more female-friendly toilets. This enables spaces for menstruating girls and women to change, dispose, wash and dry menstrual materials; all of which are integral tasks required for MHM. A global assessment identified a number of innovations focused on designing and implementing menstruation-supportive WASH facilities in the Rohingya refugee camps located in Cox’s Bazar (CXB), Bangladesh. These pilot efforts strove to include the use of more participatory methodologies in the process of developing the new MHM-supportive WASH approaches. This study aimed to capture new approaches and practical insights on innovating menstrual disposal, waste management and laundering in emergency contexts through the conduct of a qualitative assessment in CXB. Methods The qualitative assessment was conducted in the Rohingya refugee camps in CXB in September of 2019 to capture new approaches and practical insights on innovating for menstrual disposal, waste management and laundering. This included Key Informant Interviews with 19 humanitarian response staff from the WASH and Protection sectors of a range of non-governmental organizations and UN agencies; Focus Group Discussions with 47 Rohingya adolescent girls and women; and direct observations of 8 WASH facilities (toilets, bathing, and laundering spaces). Results Key findings included: one, the identification of new female-driven consultation methods aimed at improving female beneficiary involvement and buy-in during the design and construction phases; two, the design of new multi-purpose WASH facilities to increase female beneficiary usage; three, new menstrual waste disposal innovations being piloted in communal and institutional settings, with female users indicating at least initial acceptability; and four, novel strategies for engaging male beneficiaries in the design of female WASH facilities, including promoting dialogue to generate buy-in regarding the importance of these facilities and debate about their placement. Conclusions Although the identified innovative participatory methodologies and design approaches are promising, the long term viability of the facilities, including plans to expand them, may be dependent on the continued engagement of girls and women, and the availability of resources.
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Affiliation(s)
- Margaret L Schmitt
- Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA.
| | - Olivia R Wood
- Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA
| | - David Clatworthy
- International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA
| | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, Bangladesh
| | - Marni Sommer
- Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA.
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Plesons M, Patkar A, Babb J, Balapitiya A, Carson F, Caruso BA, Franco M, Hansen MM, Haver J, Jahangir A, Kabiru CW, Kisangala E, Phillips-Howard P, Sharma A, Sommer M, Chandra-Mouli V. The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research. Reprod Health 2021; 18:31. [PMID: 33557877 PMCID: PMC7869499 DOI: 10.1186/s12978-021-01082-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/18/2021] [Indexed: 11/29/2022] Open
Abstract
In recognition of the opportunity created by the increasing attention to menstrual health at global, regional, and national levels, the World Health Organization’s Department of Sexual and Reproductive Health and Research and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction convened a global research collaborative meeting on menstrual health in adolescents in August 2018. Experts considered nine domains of menstrual health (awareness and understanding; stigma, norms, and socio-cultural practices; menstrual products; water and sanitation; disposal; empathy and support; clinical care; integration with other programmes; and financing) and answered the following five questions: (1) What is the current situation? (2) What are the factors contributing to this situation? (3) What should the status of this domain of adolescent menstrual health be in 10 years? (4) What actions are needed to achieve these goals? (5) What research is needed to achieve these goals? This commentary summarizes the consensus reached in relation to these questions during the expert consultation. In doing so, it describes the state of adolescent menstrual health in low- and middle-income countries and sets out suggestions for action and research that could contribute to meeting the holistic menstrual health needs of adolescent girls and others who menstruate worldwide.
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Affiliation(s)
- Marina Plesons
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Archana Patkar
- Gender, Human Rights and Community Engagement Department, UNAIDS, Geneva, Switzerland
| | - Jenelle Babb
- Regional Bureau for Education for the Asia-Pacific, UNESCO, Bangkok, Thailand
| | | | - Flo Carson
- Foreign, Commonwealth and Development Office, London, UK
| | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | | | | | | | - Andisheh Jahangir
- WoMena Knowledge Management Team, WoMena Denmark, Copenhagen, Denmark
| | | | - Ephraim Kisangala
- African Centre for Systematic Review and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Aditi Sharma
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, State College, USA
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, New York, USA
| | - Venkatraman Chandra-Mouli
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Hennegan J, Nansubuga A, Akullo A, Smith C, Schwab KJ. The Menstrual Practices Questionnaire (MPQ): development, elaboration, and implications for future research. Glob Health Action 2020; 13:1829402. [PMID: 33052077 PMCID: PMC7594862 DOI: 10.1080/16549716.2020.1829402] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
High-quality evidence is needed to inform policies and programmes aiming to improve menstrual health. Quantitative studies must address the many evidence gaps in this field, and practitioners have increased monitoring and evaluation efforts to track their progress. A significant barrier to improving the rigor of this work is the lack of comprehensive and comparable measures to capture core concepts. The Menstrual Practices Questionnaire (MPQ) is a new tool to support comprehensive and standardised assessment of the activities undertaken in order to collect, contain, and remove menstrual blood from the body in self-report surveys. The questionnaire is freely available online for download and can be adapted for use across contexts and age groups. In this article, we describe the purpose of the MPQ as a best-practice tool to align the description of menstrual practices and provide a foundation for further question refinement. We outline the development of the tool using systematic review of qualitative studies of menstrual experiences, audit of measures used in the study of menstrual health and hygiene, survey of experts, insights from past research, and examples from piloted questions in a survey of adolescent girls in Soroti, Uganda. We describe the identification of menstrual practices as a priority for measurement, coverage of practices included in the MPQ, and justify the inclusion of location-specific questions. For each section of the questionnaire, we outline key reasons for the inclusion of practice items alongside elaboration for users to help inform item selection. Finally, we outline priorities for future research to refine the assessment and reporting of menstrual practices, including the identification of minimum reporting requirements for population characteristics to facilitate comparison across studies, testing the extent to which experiences during the most recent menstrual period reflect those over longer time periods, and further exploration of biases in self-report.
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Affiliation(s)
- Julie Hennegan
- The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | | | | | | | - Kellogg J Schwab
- The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
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Sommer M, Gruer C, Smith RC, Maroko A, Kim Hopper. Menstruation and homelessness: Challenges faced living in shelters and on the street in New York City. Health Place 2020; 66:102431. [PMID: 32987242 DOI: 10.1016/j.healthplace.2020.102431] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/06/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022]
Abstract
A growing literature attests to menstrual management difficulties of girls, women and other people who menstruate. Largely ignored are the menstruation-management needs of people experiencing homelessness. We explored these realities in New York City through in-depth interviews with individuals living on the street and in shelters (n = 22), key informant interviews with staff at government agencies, shelters and service provider organizations (n = 15), and field audits of public toilets. This paper explores both pragmatic difficulties presented by inadequate access to toilets, bathing spaces, and laundering services, and pervasive menstrual stigma. Amplifying the difficulties was near-constant pressure "to pass," as someone who was not homeless in order to enable increased access to toilets, and as someone who was not menstruating, in order to engage in the activities of daily living. Our findings highlight the need for improved quality and accessibility of bathrooms for sheltered and street-dwelling homeless, and expedited access to bathing and laundering. Such actions are essential given the steady increase in homelessness in NYC and - under the long shadow of COVID - especially timely.
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Affiliation(s)
- Marni Sommer
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 W. 168th Street, Room 537, New York, NY 10032, USA.
| | - Caitlin Gruer
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 W. 168th Street, Room 537, New York, NY 10032, USA
| | - Rachel Clark Smith
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 W. 168th Street, Room 537, New York, NY 10032, USA
| | - Andrew Maroko
- Lehman College, CUNY School of Public Health, Department of Environmental, Occupational, and Geospatial Health Sciences, 55 W. 125th Street, Room 508, New York, NY 10027, USA.
| | - Kim Hopper
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 W. 168th Street, Room 537, New York, NY 10032, USA
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20
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Jahan F, Nuruzzaman M, Sultana F, Mahfuz MT, Rahman M, Akhand F, Luby SP, Unicomb L, Winch PJ. Piloting an acceptable and feasible menstrual hygiene products disposal system in urban and rural schools in Bangladesh. BMC Public Health 2020; 20:1366. [PMID: 32894120 PMCID: PMC7487504 DOI: 10.1186/s12889-020-09413-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Access to washroom facilities and a place to dispose of menstrual waste are prerequisites for optimal menstrual hygiene management in schools. Like other low- and middle-income countries, Bangladeshi schools lack facilities for girls to change and dispose of their menstrual absorbents. We explored existing systems for disposing of menstrual absorbent wastes in urban and rural schools of Bangladesh and assessed the feasibility and acceptability of alternative disposal options. METHODS We explored how girls dispose of their menstrual products, identified girls' preferences and choices for a disposal system and piloted four disposal options in four different schools. We then implemented one preferred option in four additional schools. We explored girls', teachers', and janitors' perspectives and evaluated the acceptability, feasibility, and potential for sustainability of the piloted disposal system. RESULTS Barriers to optimal menstrual hygiene management included lack of functional toilets and private locations for changing menstrual products, and limited options for disposal. Girls, teachers, and janitors preferred and ranked the chute disposal system as their first choice, because it has large capacity (765 L), is relatively durable, requires less maintenance, and will take longer time to fill. During implementation of the chute disposal system in four schools, girls, teachers, and janitors reported positive changes in toilet cleanliness and menstrual products disposal resulting from the intervention. CONCLUSIONS The chute disposal system for menstrual products is a durable option that does not require frequent emptying or regular maintenance, and is accepted by schoolgirls and janitors alike, and can improve conditions for menstrual hygiene management in schools. However, regular supervision, motivation of girls to correctly dispose of their products, and a long-term maintenance and management plan for the system are necessary.
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Affiliation(s)
- Farjana Jahan
- Infectious Diseases Division, Environmental Interventions Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Ave, Dhaka, 1212, Bangladesh
| | - Md Nuruzzaman
- Infectious Diseases Division, Environmental Interventions Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Ave, Dhaka, 1212, Bangladesh
| | - Farhana Sultana
- Infectious Diseases Division, Environmental Interventions Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Ave, Dhaka, 1212, Bangladesh
| | - Mehjabin Tishan Mahfuz
- Infectious Diseases Division, Environmental Interventions Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Ave, Dhaka, 1212, Bangladesh
| | - Mahbubur Rahman
- Infectious Diseases Division, Environmental Interventions Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Ave, Dhaka, 1212, Bangladesh
| | - Farhana Akhand
- Infectious Diseases Division, Environmental Interventions Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Ave, Dhaka, 1212, Bangladesh
| | - Stephen P Luby
- Department of Medicine, Division of Infectious Diseases & Geographic Medicine, Stanford University, 300 Pasteur Dr., L-134, Stanford, CA, 94305, USA
| | - Leanne Unicomb
- Infectious Diseases Division, Environmental Interventions Unit, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Ave, Dhaka, 1212, Bangladesh
| | - Peter J Winch
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
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21
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Sommer M, Lee C, Liu D, Gruer C. The Extent to Which Menstruation-Related Issues Are Included in Graduate-Level Public Health Curricula. Front Public Health 2020; 8:442. [PMID: 32984243 PMCID: PMC7491256 DOI: 10.3389/fpubh.2020.00442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/17/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives: Menstruation is increasingly recognized as an issue in domestic and global public health. Public health graduates of U.S. schools of public health must have adequate competencies to address menstruation and its implications for health and well-being in their future endeavors in research, practice and policy. This study sought to understand the extent to which U.S. schools currently integrate menstruation-related content (menstrual health, menstrual hygiene, etc.) and related competencies into their curricula. Methods: We reviewed the course directories of the top 20 US schools of public health as ranked in 2018. Courses were selected based on inclusion of menstruation and adolescent health-related search terms. Syllabi were subsequently obtained and analyzed for inclusion of specific menstruation-related terms. Syllabi including these terms were further analyzed to determine the level of inclusion of menstruation-related topics in relation to public health competencies, and the area of specialization. Results: Of an estimated 5,000 courses assessed, 28 included menstruation-related topics. Most frequently, this inclusion was minimal (e.g., a single reading or assignment), and was limited in scope. Content was typically found within global health, environmental health, and maternal and child health. Conclusions: Given growing attention to menstruation domestically and globally, and the limited current inclusion of this issue in US schools of public health curricula, graduates may not be receiving adequate training on a critically important topic of relevance within population health. Schools should consider reviewing their curricula to assess whether there are opportunities to integrate menstruation-related content in relation to the relevant public health competencies.
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Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christina Lee
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Danting Liu
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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Caruso BA, Portela G, McManus S, Clasen T. Assessing Women's Menstruation Concerns and Experiences in Rural India: Development and Validation of a Menstrual Insecurity Measure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3468. [PMID: 32429238 PMCID: PMC7277189 DOI: 10.3390/ijerph17103468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022]
Abstract
Qualitative research has documented menstruator's challenges, particularly in water and sanitation poor environments, but quantitative assessment is limited. We created and validated a culturally-grounded measure of Menstrual Insecurity to assess women's menstruation-related concerns and negative experiences. With cross-sectional data from 878 menstruating women in rural Odisha, India, we carried out Exploratory (EFA) and Confirmatory (CFA) Factor Analyses to reduce a 40-item pool and identify and confirm the scale factor structure. A 19-item, five factor model best fit the data (EFA: root mean square error of approximation (RMSEA) = 0.027; comparative fit index (CFI) = 0.994; Tucker-Lewis index (TLI) = 0.989; CFA: RMSEA = 0.058; CFI = 0.937; TLI = 0.925). Sub-scales included: Management, Menstrual Cycle Concerns, Symptoms, Restrictions, and Menstruation-Related Bodily Concerns. Those without access to a functional latrine, enclosed bathing space, water source within their compound, or who used reusable cloth had significantly higher overall Menstrual Insecurity scores (greater insecurity) than those with these facilities or using disposable pads. Post-hoc exploratory analysis found that women reporting experiencing tension at menstrual onset or difficulty doing work had significantly higher Menstrual Insecurity scores. This validated tool is useful for measuring Menstrual Insecurity, assessing health inequities and correlates of Menstrual Insecurity, and informing program design.
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Affiliation(s)
- Bethany A. Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Gerard Portela
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Shauna McManus
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
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23
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Krusz E, Hall N, Barrington DJ, Creamer S, Anders W, King M, Martin H, Hennegan J. Menstrual health and hygiene among Indigenous Australian girls and women: barriers and opportunities. BMC WOMENS HEALTH 2019; 19:146. [PMID: 31775735 PMCID: PMC6882156 DOI: 10.1186/s12905-019-0846-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 11/14/2019] [Indexed: 11/21/2022]
Abstract
Health inequities inhibit global development and achievement of the Sustainable Development Goals. One gendered health area, Menstrual Health & Hygiene (MHH), has received increasing attention in Low- and Middle-Income Countries as a barrier to health, wellbeing, and gender equity. Recent anecdotal evidence in Australia highlights that MHH also present challenges to High Income Countries, particularly among underrepresented populations, such as Indigenous Australian peoples, people from low socio-economic backgrounds, or communities that are remotely located. In this article, we chart the emergence of attention to MHH in the Australian context and highlight key considerations for the conduct of research with Aboriginal and Torres Strait Islander Peoples within the culturally- and gender-sensitive area of MHH. Further we draw on insights offered by a partnership between female Aboriginal and Torres Strait Islander leaders, NGO stakeholders, and non-Indigenous researchers. Through a convening (yarning circle) held in March 2018, the group identified multiple socioecological considerations for MHH research and practice, including: affordability and access to menstrual products, barriers to knowledge and culturally sensitive education, infrastructure and supply chain challenges, and the necessity of Indigenous-led research and community-driven data collection methods in addressing the sensitive topic. We draw together these insights to develop recommendations for future research, advocacy, and action in Australia.
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24
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Hyun C, Burt Z, Crider Y, Nelson KL, Sharada Prasad CS, Rayasam SDG, Tarpeh W, Ray I. Sanitation for Low-Income Regions: A Cross-Disciplinary Review. ANNUAL REVIEW OF ENVIRONMENT AND RESOURCES 2019; 44:287-318. [PMID: 32587484 PMCID: PMC7316187 DOI: 10.1146/annurev-environ-101718-033327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Sanitation research focuses primarily on containing human waste and preventing disease; thus, it has traditionally been dominated by the fields of environmental engineering and public health. Over the past 20 years, however, the field has grown broader in scope and deeper in complexity, spanning diverse disciplinary perspectives. In this article, we review the current literature in the range of disciplines engaged with sanitation research in low- and middle-income countries (LMICs). We find that perspectives on what sanitation is, and what sanitation policy should prioritize, vary widely. We show how these diverse perspectives augment the conventional sanitation service chain, a framework describing the flow of waste from capture to disposal. We review how these perspectives can inform progress toward equitable sanitation for all [i.e., Sustainable Development Goal (SDG) 6]. Our key message is that both material and nonmaterial flows-and both technological and social functions-make up a sanitation "system." The components of the sanitation service chain are embedded within the flows of finance, decision making, and labor that make material flows of waste possible. The functions of capture, storage, transport, treatment, reuse, and disposal are interlinked with those of ensuring equity and affordability. We find that a multilayered understanding of sanitation, with contributions from multiple disciplines, is necessary to facilitate inclusive and robust research toward the goal of sanitation for all.
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Affiliation(s)
- Christopher Hyun
- Energy and Resources Group, University of California, Berkeley, California 94720, USA
| | - Zachary Burt
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Yoshika Crider
- Energy and Resources Group, University of California, Berkeley, California 94720, USA
| | - Kara L Nelson
- Department of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, California 94720, USA
| | - C S Sharada Prasad
- School of Development, Azim Premji University, Bengaluru, Karnataka 560100, India
| | | | - William Tarpeh
- Chemical Engineering, Stanford University, Stanford, California 94305, USA
| | - Isha Ray
- Energy and Resources Group, University of California, Berkeley, California 94720, USA
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25
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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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26
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Legitimization of the Inclusion of Cultural Practices in the Planning of Water and Sanitation Services for Displaced Persons. WATER 2019. [DOI: 10.3390/w11020359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During large and rapid influxes of displaced persons, hosting communities may face challenges in accommodating incoming populations. This study seeks to assess the institutional response to international displacement in developed urban contexts through exploring how stakeholders (de)legitimized (i.e., either withheld or attributed legitimacy to) the inclusion of cultural practices in the planning of water and sanitation for displaced persons. This study is enabled by 28 semi-structured interviews of individuals involved in the accommodation of displaced persons in Germany conducted in 2016. The interview content was qualitatively analyzed to identify the types of decisions made, legitimacy types used to (de)legitimize those decisions, and information used to assess cultural practices. Results indicate that the institutional response to international displacement was most commonly reactive rather than proactive. However, the interviewees demonstrated a willingness to adapt, primarily using their experiences (comprehensibility legitimacy) and moral considerations (procedural legitimacy). Recommendations to stakeholders arising from this study include: (1) improve access to information about displaced persons’ practices and needs in water and sanitation, (2) collect more information by communicating with displaced persons, (3) promote collaborations between involved organizations, (4) monitor organizational changes during the response, and (5) enhance discussions about integration through the built environment.
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