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Global Research Update #37

Pokhrel et al., 2021: Acceptability and feasibility of using vaginal menstrual cups among schoolgirls in rural Nepal: a qualitative pilot study. An exploratory study based on four focus group discussions was conducted to explore the acceptability and feasibility of using menstrual cups (MCs) amongst a sample of 28 schoolgirls between 13-19 years of age in Thokarpa, Sindupalchowk, Nepal. Results: The study has identified two overarching themes: firstly, the practical, economic and environmental advantages of using the MC. Most participants perceived the MC positively because they did not miss any more a single class in school due to problems related to menstrual hygiene management, which was described as a major benefit; cleaning was not a problem, easy to use and convenient. The participants described the economic and environmental advantages of using the MC because buying sanitary pads used to be a financial burden. Secondly, discomfort and concerns related to the MC. They may experience pain when inserting the MC, feeling the MC sticking out of the vagina, feeling a constant urge to urinate and leakage. Some also report family members’ concern about fertility reduction and losing virginity. Participants of this study elaborated on the importance of gaining support from peers and family members, the nurse, and teacher who act as contact persons to help successfully adopt the MC.

Plesons et al., 2021:The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research. The WHO 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. The experts considered 9 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 five questions of (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?; and (5) what research is needed to achieve these goals?.  This commentary 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.

Alberda et al., 2021: Making the Case for Investing in Menstrual Health & Hygiene. The report is an investment case developed in collaboration with different partners. The aim is to provide a concise, comprehensive, and compelling case for both why and how to fund/invest in Menstrual Health & Hygiene (MHH) to improve women’s and girls’ health and well-being. Results: This report has identified key areas which may help trigger funding and investment in MHH (Outcome level-evidence, Global data consolidation, cost-effectiveness, user-centred insights & private sector). This should consider the principles of funding/investment: multi-sectoral, leave no one behind, rights-based approach, evidence-based and context-specific tailored interventions/program.  Three recommendations emerged from this report: (1) MHH is a critical component for the attainment of Human Rights, several SDGs, gender equality and women’s and girls’ health and well-being, and socioeconomic and educational opportunities. Funding MHH interventions can fulfil these goals and is an opportunity to increase the evidence base; (2) Multi-sectoral and multi-stakeholder programming in MHH is essential to achieve a positive and sustained impact on every person who menstruates and removes menstrual barriers; and (3) Strengthening collaboration as a community of implementers, funders, advocates, researchers are necessary to catalyse funding. Better coordination is needed to promote funding, track funding and progress and to be held accountable as a community is critical for success.

Holmes et al., 2021: Adolescent Menstrual Health Literacy in Low, Middle and High-Income Countries: A Narrative Review. A systematic review was conducted to synthesise the current literature dedicated to adolescent menstrual health literacy across low, middle, and high-income countries. A total of 61 peer-reviewed journals and reports form social science and medical databases were compiled regarding the educational delivery of menstrual health topics published from January 2008 through January 2020.  Results: Through a six-phase guide of analysing qualitative data including coding and finding and categorising similar themes, three underlying themes were identified: menstrual hygiene management, menstrual health issues (i.e. menstrual health disorders), or attitudes towards menstruation. In conclusion, this review demonstrates that menstrual health literacy in low, middle and high-income countries is still inadequate and fails to cater to the needs of adolescents. Low health literacy is associated with poor overall health, incorrect/inadequate medication usage and lower levels of preventative care. In particular, this review highlighted that menstrual health literacy issues transcend geographic, cultural, and socioeconomic status. Menstrual health is a cross-sectional issue that requires a coordinated effort by the government and stakeholders in the education and health sectors.

Kumbeni et al., 2020:Menstrual hygiene among adolescent girls in junior high schools in rural northern Ghana. A cross-sectional study was carried out to assess menstrual hygiene management (MHM) (e.g. self-care practices and barriers to menstrual hygiene) amongst 730 adolescent girls between 12-19 years of age in junior high schools in rural northern Ghana. Results: Above one-fourth of the respondents experienced school absenteeism due to menstruation, ranging from 1-7 days in a month.

Karrington, 2021: The Experiences of Transmasculine People with Contraception and Menstruation: A Literature Review of Qualitative and Mixed Method Studies. A literature review was done on 15 March 2020 to synthesise the existing qualitative and mixed methodology literature on how transmasculine people experience and navigate contraception and menstruation. Results: 3 main thematic categories derived from the result of this review including: (1) concerns with hormonal contraception use, including gender dysphoria and worries about interactions with testosterone; (2) discrimination and fears around seeking health care, especially concerning the assumptions made by practitioners; and (3) community as a positive influence, particularly for normalizing menstruation for transmasculine people. The author suggests the need of research in the interaction between hormonal contraception and testosterone. 

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