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Global Research Update #38

Sang et al.,2021: Blood Work: Managing Menstruation, Menopause and Gynaecological Health Conditions in the Workplace. A qualitative survey was conducted among 627 female employees working in higher education settings in the UK to understand the experiences of those who experience menstruation, menopause, and gynaecological health conditions. Results: 69% reported experiencing a gynaecological health condition; the most frequently reported health conditions were heavy menstrual bleeding (59%) and menstrual irregularity (29%). Many respondents reported comorbid gynaecological health conditions. 4 main themes identified from this study: (1) Managing the leaky, messy, painful body: Respondents reported considerable time and effort being spent in managing their menstrual symptoms at work. They also reported that they continued to work through the pain, however it has a debilitating effect on their ability to function; (2) Managing access to facilities: Concerns were exacerbated by the lack of necessary facilities (particularly menstrual product disposal bins). The recurring themes emerged in this aspect included difficulty in accessing toilets to change menstrual products and to manage continence issues that are linked to gynaecological health conditions; (3) Managing stigma: 63% of participants explained that they opted not to discuss menstruation or gynaecological health at work. The reasons included menstruation or gynaecological health conditions were not something that ‘belongs in the workplace’ or were too personal to discuss at work. A culture of precarity and research performance management was reported as making any form of ill health or menstrual difficulty impossible to discuss for fear of being rejected for employment; and (4) Managing workload: Even though most of the respondents did not feel that menstruation had implications for their day-to-day working lives, 36% reported daily difficulties that are associated with menstruation such as managing menstrual pain and heavy bleeding that interfered with work or created problematic additional demands.

Schmitt et al., 2021. The intersection of menstruation, school and family: Experiences of girls growing up in urban areas in the U.S.A. a qualitative and participatory study was conducted in New York City, Los Angeles, and Chicago to explore girls’ experiences with menstruation and puberty within their families, school environments, communities and social networks. The methods used in this study included participatory sessions and in-depth interviews with 73 adolescent girls aged 15-19 as well as conduction of key informant interviews with adults involved in girls’ lives, such as teachers, counsellors, healthcare workers, etc. Results: This study revealed 3 major themes about how menstruation impacts the daily lives of adolescent girls growing up in urban areas of the USA today. This includes: (1) inadequate menstrual knowledge and practical preparation for managing periods; (2) challenges associated with menstrual pain; and (3) how menstruation hinders girls’ school-based physical and sport-related activities. The authors suggest the need for improved guidance on the practicalities of period management and strategies to support girls with menstrual pain and given the benefits of physical activity on girls’ health, new approaches are needed to improve their sport and physical activity experiences while menstruating.

Wilson et al., 2021: Seeking synergies: understanding the evidence that links menstrual health and sexual and reproductive health and rights. This paper describes evidence linking menstrual health (MH) and sexual and reproductive health and rights (SRHR) and offers recommendations for integration that could strengthen the impact of both fields. Results: Integrating MH and SRHR more intentionally could improve efforts to reduce STI and HIV rates, prevent unintended pregnancies, keep girls in school, reduce gender-based violence, and support women’s participation in the workforce. While studies have begun to collect MH data, there continues to be a need for further evaluation and integration of MH into SRHR programmes. In addition, supporting MH interventions among children and very young adolescents through comprehensive sexuality education (CSE) could help address the root causes of and potential contributing factors to negative SRHR outcomes. Lastly, providing resources for health care professionals to knowledgeably discuss menstruation, contraception-induced menstrual changes, and management options during provider-client counseling and health education sessions could offer an opportunity to address MH and SRHR common goals. Supporting individuals to manage their menstruation and MH provides them with dignity and is a human right. SRHR practitioners must embrace MH as an integral part of advocacy, policy, and programming.

Choi et al., 2021:  Use of Menstrual Sanitary Products in Women of Reproductive Age: Korea Nurses’ Health Study. A cross-sectional study was conducted among 20,613 nurses between 20-45 years of age in Korea to identify the patterns of use of menstrual products and the rationale behind product choice. Results: Due to social, cultural, and age differences, the choice of menstrual products varies greatly. Tampons and the menstrual cup are rarely used in South Korea, but they are used by women under 30. The most common types of menstrual products across all age groups were disposable menstrual pads (89.0%), followed by cloth menstrual pads, tampons, and menstrual cups. Disposable menstrual pads were the most common across all age groups, but in those aged under 30 years, this was followed by tampon use. The most important criteria when choosing a menstrual product was a comfort for disposable menstrual pads (31.3%) and tampons (41.5%), natural ingredients or organic products for cloth menstrual pads (51.4%), and custom fit for the menstrual cup (50.7%). 

Mactaggart et al., 2021: Water, women and disability: Using mixed-methods to support inclusive wash programme design in Vanuatu. A mixed-methods study undertaken in two provinces of Vanuatu with one of the aims of exploring associations between WASH, disability and gender as well as the experiences of WASH users with additional requirements e.g. menstruators. Results:  People with disabilities were more likely to experience barriers e.g. WASH-related stigma, reliance on informal caregivers, and under-resourcing of WASH personnel were critical issues for people who menstruate.

Nabwera et al., 2021: Menstrual hygiene management practices and associated health outcomes among school-going adolescents in rural Gambia. A cross-sectional study was conducted among 358 adolescent schoolgirls in 13 schools in rural Gambia to describe menstrual hygiene management (MHM) practices among schoolgirls from rural Gambia and assess risk factors associated with urogenital infections and depressive symptoms. Results: Although, 63% of the girls attended schools providing free disposable pads, reusable cloths/ towels were the commonest absorbent materials used (53%); the mean number of packets of disposable pads provided to each girl last time they were to collect them was 1.3 (each packet had 10 disposable pads).  Less than 50% of the schools met the recommended latrine which is a student ratio of 20–50 students per latrine. Heavy menstrual bleeding was associated with depressive symptoms, while extreme menstrual pain, accessing sanitary pads in school and less access to functional water sources at school were associated with urinary tract infection (UTI) symptoms. Privacy in school toilets was protective for UTI symptoms. Heavy menstrual bleeding and taking less than 30 minutes to collect water at home were associated with reproductive tract infection (RTI) symptoms while availability of soap in school toilets was protective for RTI symptoms. Interventions to ensure that schoolgirls have access to private sanitation facilities with water and soap both at school and at home could reduce UTI and RTI symptoms.

Larson et al., 2021: Capturing menstrual health and hygiene in national surveys: insights from performance monitoring and accountability 2020 resident enumerators in Niamey, Niger. Performance Monitoring and Accountability 2020 Nigeria has completed five rounds of surveys, two of which included menstrual health and hygiene (MHH) questions (Round 2 in 2016 and Round 5 in 2018). Four focus group discussions (FGDs) were undertaken with resident enumerators and one with their female supervisors following the 2018 PMA2020 survey in Niamey, Niger to synthesise their insights on the performance of the MHH measures used. Results:  Enumerators reported that questions about menstruation were well tolerated and most were understood conceptually. Missing response options for the places used for MHH were raised during FGDs and it was suggested inclusion of common brands of menstrual products to ensure data quality. Moreover, questions in respect to cleanliness, privacy, and safety of menstrual management locations require modification or more intensive training efforts to consistently capture these concepts seeing that asking respondents to report the ‘privacy’ and ‘safety’ of their menstrual management location were the most challenging question to administer. They also highlighted that menstrual needs-related topics missing from MHH monitoring including access to pain relief, menstruation-related worry and stigma, access to supportive environments for menstrual management outside the home, and knowledge needs throughout the life-course. The authors suggest attention to question formulation and continued refinement for large-scale surveys and more explicit and detailed question wording that will ensure topics related to location privacy and MHH-related school and work absenteeism are more accurately measured are needed.

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