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Global Research Update #27

Goddard & Sommer., 2020: Menstrual Health and Hygiene Management and WASH in Urban Menstrual Health and Hygiene Management and WASH in Urban Slums: Gaps in the Evidence and Recommendations. A review was done to highlight interlinkages between urbanisation, WASH, and MHM identified two important intersection influencing the experiences of menstruators in varying contexts: (1) The Intersection of Governance, Urban Slums and menstrual health and hygiene management (MHM), and (2) The Intersection of Urban Sanitation Systems, Gender, and Menstruation. Three recommendations emerged from this review on the intersection of menstruation and WASH systems in low-income urban contexts: (1) Building the evidence on menstruators’ lived experiences of MHM in urban contexts, including issues of privacy, dignity, and access to WASH systems; (2) Building the evidence on what works and what is acceptable in terms of addressing MHM products disposal in diverse cultural urban contexts with varying systems of governance; and (3) Inclusion of more specific targets and indicators related to MHM in global development frameworks.

Seydou et al., 2020: Menstrual Hygiene Management in School Setting in Two Secondary Schools in the Bamako District, Case of the School “La Chaine Grise” and the School Cheick Modibo Diarra. A cross-sectional, descriptive study was conducted in two schools among 100 girls ages 16-18 in the Bakamo District of Mali through January to June in 2019 to understand girls’ knowledge about menstruation, what product they use, and school attendance during their period. 50% of participants reported having poor knowledge on menstruation and not learning about menstruation until menarche. Mothers are the most common teachers on the subject (64%) and the source of finances to purchase menstruation products (90%). The most common product used during this time is cotton (90%), followed by both diapers and sanitary towels (6%), and pieces of cloth or fabric (4%). 1 out of 10 participants reported staying home during their period. Reasons for missing school include dysmenorrhea, fear of leaking on clothes, and inadequate sanitary facilities. Not only can the pain during menstruation be overwhelming or fear of leaking in clothes be all consuming during the school day, but the schools do not have proper facilities to change materials. This study in particular, found that 96% of girls find the toilets inadequate and 100% report lack of toilet paper, soap, and a container for water a difficulty. Additionally, 83% of the girls mentioned lack of privacy in the toilets.

Diamond-Smith et al., 2020: Knowledge of menstruation and fertility among adults in rural Western Kenya: Gaps and opportunities for support. In 2014, the Demographic and Health Survey of Kenya found only 26% of women knew the correct fertile window during their menstrual cycle, which displays no change from the survey sent out six years prior. Therefore, a qualitative study was done in Bondo, western Kenya among 45 parent participants (female age: 15-49, male age: >20) of a living preterm child under the age of 5 to inform the development of an intervention about the knowledge of menstruation, the link with fertility, and the support and approaches for tracking menstruation. Results: All 45 participants answered similarly about where they gained their knowledge of menstruation. Information comes mainly from friends and family, or wives in the case of the male participants, rather than health professionals. Participants reported being asked about their last menstrual period (LMP) at their antenatal care visits, but did not receive any information as to why they were being asked. Participants indicate low levels of knowledge about the relationship between women’s menstrual cycle and pregnancy. Many participants rely on calendars or even on their partners to help them keep track of their cycle. This also aids in avoiding “visits” for unmarried adolescents during the fertile window. However, there was a general misunderstanding of the timing of the fertile window by participants. When asked about methods of tracking periods, privacy was the most important aspect of tracking. There is a larger interest in a tool for tracking such as a calendar or journal on paper rather than a digital one.

Singer et al., 2020: Pediatricians’ knowledge, attitudes and practices surrounding menstruation and feminine products. The menstrual cycle was indicated as an important sign of overall health in females by the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists in 2006. Following this publication, recommendations were given for clinicians to guide patients and their caregivers on the pre-menarchal time including asking patients the date of their last menstrual period (LMP) as well as the pattern of their menses, and instructions on the safe usage of menstrual health products in 2015. Therefore, a 53 item online questionnaire was emailed to 2,500 AAP members across the United States to find if primary care pediatricians are knowledgeable about menstruation in general, routinely evaluating patients’ menstrual cycles, and educating patients about menstruation and menstrual health products. Of the pediatricians invited, 20.7% responded and a majority of them were female (78.8%). Results: 75.3% of pediatrics report that they provide guidance to pre-menarchal patients and 62.1% provide patients’ caregivers information about menstruation to “most” or “almost all” about what to expect of menarche. Despite 70.8% of pediatricians felt this guidance was “very” or “extremely” important, only 50.2% were familiar with the AAP guidelines on the subject. Similarly, 66.9% of pediatricians reported they discuss menstruation with post-menarchal patients “most” or “almost all” of the time and 78.6% believe it was “very” or “extremely” important to do so. Most pediatricians responded that they “very often” or “almost always” ask about the pattern of menses (94.4%) and the date of their LMP (71.6%). Pediatricians rated themselves as “very” or “extremely” knowledgeable about menstruation (60.4%). However, male pediatricians were less likely to talk to their patients, pre/post menarchal, and/or caregivers on all accounts and only 32% self-evaluated themselves “very” or “extremely” knowledgeable about menstruation. Many pediatricians indicated there was a “very low” or “low” likelihood of discussing menstrual health products, with male pediatricians being less likely to discuss than their female counterparts. Over half of pediatricians also noted that they “almost never” or “rarely” explain tampon insertion and closer to 30% marked the same for discussing how to change and the risks associated with tampons.

Belay et al., 2020: Girls’ attendance at school after a menstrual hygiene intervention in northern Ethiopia. A prospective study was conducted in 15 schools in northern Ethiopia among 8839 male and female students in grades 7–12 during the 2015–2016 academic year to evaluate the effect on school attendance of a menstrual hygiene intervention that distributes educational booklets to both male and female school children and menstrual hygiene kits to schoolgirls. Results: over 12 211 educational booklets were distributed to students and 5991 menstrual hygiene kits were distributed to schoolgirls. After the intervention, girls had 24% fewer school absences than boys.

Wea et al., 2020: The experiences of visually impaired teenage girls on menstrual hygiene management: a qualitative study. A qualitative study was done to collect the information from 6 visually impaired children related to their menstrual hygiene management. Results: The majority of the participants acquired the knowledge on menstruation and how to clean the menstrual pad from the teacher. The emotional responses stated such as dependence on feeling when doing menstrual self-hygiene. This study also indicates the negative thoughts such as fear as well as myth faced by the visually impaired children.

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