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Global Research Update #29

WoMena, 2020: Menstrual Cup Market Accessibility Report (MCMAP). An evaluation was conducted by WoMena Uganda in collaboration with several partners (Marie Stopes (MS) Uganda, Welthungerhilfe (WHH), private pharmacies, Ruby Life, and HUE Experiential) in Uganda from Nov 2016 to Oct 2017 to integrate menstrual cup (MC) distribution and 6 payment models into service delivery and evaluate the models in terms of effectiveness and feasibility, targeting adolescent girls and young women aged 15-30 who were the existing members or clients of the sales models. Results: A total of 1227 MCs were sold across the different models given that the project initially aimed to sell 285 MCs. The two sales models of WHH “Goat and Cup for work scheme” with 73% and MS Ladies with 26% were best performing models.  The most MC sales were made at the price point of approximately 7 USD. Around 73% of all MC sales reached the target group of girls and women between the ages of 15 and 30. 42% of sales were made to women aged 25-30. The evaluation suggests the possibility of scaling up MC supply to achieve greater accessibility in Uganda at subsidised or below current market prices.

WoMena FAQ, 2020: How does inadequate Menstrual Health Management pose challenges to achieving the SDGs?. Menstruation is connected to many of the Sustainable Development Goals (SDGs). This is not unique – many other fields also find this connectedness. However, we find it particularly striking in view of the fact that menstruation has only become a high profile issue in the last 5-10 years, and the SDGs still make only a few references to menstrual health management (MHM) and those references are indirect. Those indirect mentions are SDG4 (Quality Education) and SDG6 (Clean Water and Sanitation). However, strong connections can be demonstrated between inadequate MHM and many of the 17 SDGs.

Hennegan et al., 2020: Measurement in the study of menstrual health and hygiene: A systematic review and audit. Two linked systematic reviews were conducted to describe the current concepts assessed in studies of menstrual health and hygiene interventions in low- and middle-income countries and identify measures developed across all countries to assess menstrual experiences. Results: Most measure validation studies focused on assessing attitudes towards menstruation, while a group of studies assessed the accuracy of women’s recall of their menstrual characteristics such as timing and cycle length. Measures of menstrual knowledge, attitudes, beliefs, and restrictions were inconsistent and frequently overlapped. Interdisciplinary efforts to better define core constructs such as menstrual and hygiene practices, menstrual knowledge, attitudes, norms and restrictions are needed. The authors also recommend including full surveys in published supplementary materials where feasible, conducting research to develop and test reliable and valid measures for core concepts, and using mid-level theory of menstrual experiences and intervention effects to inform priority measures and identify concepts against which such measures can be tested for validity.

Amaya et al., 2020: Advancing Gender Equity by Improving Menstrual Health-Opportunities in Menstrual Health and Hygiene. FSG is a consulting firm aiming to support leaders to create social change and is committed to advancing gender equity. In this study, FSG, partnered with the Bill & Melinda Gates Foundation, began researching changes in the menstrual health and hygiene (MHH) landscape since 2016 and how to address menstruation in a more integrated and effective way. As a field, MHH lacks a unified, cohesive set of metrics and is rarely included in public health surveys. As a result, there are challenges to compare, track and monitor progress on MHH outcomes. Studies have found that MHH is linked to a range of life outcomes beyond school absenteeism such as health, well-being, gender, education, equity, empowerment, and human rights. Puberty and menarche are pivotal moments in a girl’s life. Educating them about this and its relation to sexual and reproductive health can lead to more knowledge about their cycle as well as a greater body literacy and understanding of contraceptive outcomes. Previously, MHH programmes focused on menstrual products as a specific solution. Recently, they have become a part of a broader solution. Without the proper waste management systems, product based MHH programme models create a new problem. Similarly, water, sanitation, and hygiene (WASH) programmes normally do not account for menstrual waste, nor do they consider menstrual taboos. Leading organisations call for a holistic approach, including education and social/gender norms, rather than infrastructure and product components. Lastly, taboos and stigmas are ingrained in many cultures globally while being highly contextualised. If the bias around menstruation is not addressed, many MHH programmes will struggle to create change.

WoMena, 2020: MENSTRUAL CUP PILOT INTERVENTION IN ADJUMANI DISTRICT UGANDA- Final Implementation Report. A pilot intervention was carried out amongst adolescent girls through integration into the school’s programme in two secondary schools of Alere and Dzaipi in Dzaipi and Alere Refugee Settlements in Adjumani District, Uganda over a period of 14 months to assess the acceptability and possible potential impacts of Bfree menstrual cups (MCs) as a menstrual health management (MHM) method for girls in the refugee context. The primary target group was girls and boys in schools, male and female teachers and health workers within the humanitarian context. Results: Despite initial concerns about the MC, a product uptake of 91% (N=58) in comparison to 57% (N=49) captured at midline, there was a 34% increase in MC usage and acceptability within the two months following the initial follow-up and refresher training. After getting over the initial fear of using the MC, users reported the MC being comfortable to use. Adherence to safe care and user guidelines appeared high amongst participants, reporting they maintained correct handwashing and storage procedures. Access to clean water for rinsing the MCs was the biggest barrier, although girls found ways around it by carrying a bottle of water with them to the school latrine/washrooms. The male teachers and boys were involved from the initial stages of the project with a necessity to understand what their views and perceptions are on menstruation. At end line, there was a reported change in school attendance as out of ten interviewed girls from both schools, 60% of them reported not missing any school days after receiving the MC. 76% (44 out of 58) stated that they did not feel embarrassed in their last menstrual period and 95% (55 out of 58) said they felt comfortable during their last period compared to 72% at baseline. 

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