A qualitative understanding of the effects of reusable sanitary pads and puberty education: implications for future research and practice (original) (raw)
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Plos One, 2016
Background The management of menstruation has been posited as a significant barrier to girls’ educational attainment in low income contexts. Interventions providing sanitary products and information about menstruation have been proposed as simple and efficient strategies for improving girls’ attendance and gender parity in education. Despite increasing implementation of such interventions, there have been limited high quality assessments of the effectiveness of proposed interventions to date. This trial aimed to assess the impact of providing sanitary pads and puberty education on school attendance and psychosocial outcomes for girls in rural Uganda. Methods A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. The trial included four conditions: the provision of puberty education alone; reusable sanitary pads alone; puberty education and reusable sanitary pads; and a control receiving no intervention. The primary outcome was school attendance measured at baseline and 18-month follow up. Change scores were compared across conditions. Secondary outcomes reflected psychosocial wellbeing including shame and insecurity during menstruation and were measured at the end of the follow-up period (24-months after intervention) through surveys administered verbally in the local language. Results After 18-months, school attendance worsened for girls across all conditions. Per-protocol analysis revealed that this decline was significantly greater for those in the control condition d = 0.52 (95% CI 0.26–0.77), with those in control schools having 17% greater drop in attendance than those in any intervention school. There was no difference between the intervention conditions. High rates of school-drop out, school-transfer, and girls moving away meant the trial suffered from substantial participant drop-out. However, intention-to-treat analyses using different imputation strategies revealed the same pattern of attendance retention in intervention conditions compared to the control. There were no differences between any of the conditions on girls’ self-reported feelings of shame and insecurity experienced during menstruation. Conclusion This trial is the largest to date demonstrating a positive impact of providing sanitary pads or puberty education for girls’ school attendance in a developing context. The study revealed no difference in the effectiveness of sanitary pad provision compared to education.
Reproductive Health, 2016
Background: Governments, multinational organisations, and charities have commenced the distribution of sanitary products to address current deficits in girls' menstrual management. The few effectiveness studies conducted have focused on health and education outcomes but have failed to provide quantitative assessment of girls' preferences, experiences of absorbents, and comfort. Objectives of the study were, first, to quantitatively describe girls' experiences with, and ratings of reliability and acceptability of different menstrual absorbents. Second, to compare ratings of freely-provided reusable pads (AFRIpads) to other existing methods of menstrual management. Finally, to assess differences in self-reported freedom of activity during menses according to menstrual absorbent. Methods: Cross-sectional, secondary analysis of data from the final survey of a controlled trial of reusable sanitary padand puberty education provision was undertaken. Participants were 205 menstruating schoolgirls from eight schools in rural Uganda. 72 girls who reported using the intervention-provided reusable pads were compared to those using existing improvised methods (predominately new or old cloth). Results: Schoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities, less difficulties changing absorbents, and less disgust with cleaning absorbents. There were no significant differences in reports of outside garment soiling (OR 1.00 95%CI 0.51-1.99), or odour (0.84 95%CI 0.40-1. 74) during the last menstrual period. When girls were asked if menstruation caused them to miss daily activities there were no differences between those using reusable pads and those using other existing methods. However, when asked about activities avoided during menstruation, those using reusable pads participated less in physical sports, working in the field, fetching water, and cooking. Conclusions: Reusable pads were rated favourably. This translated into some benefits for self-reported involvement in daily activities, although reports of actual soiling and missing activities due to menstruation did not differ. More research is needed comparing the impact of menstrual absorbents on girls' daily activities, and validating outcome measures for menstrual management research.
Waterlines, 2015
Poor menstrual hygiene management (MHM) among schoolgirls in low-income countries affects girls' dignity, self-esteem, and schooling. Hygienic, effective, and sustainable menstrual products are required. A randomized controlled feasibility study was conducted among 14-16-year-old girls, in 30 primary schools in rural western Kenya, to examine acceptability, use, and safety of menstrual cups or sanitary pads. Focus group discussions (FGDs) were conducted to evaluate girls' perceptions and experiences six months after product introduction. Narratives from 10 girls' and 6 parents' FGDs were analysed thematically. Comparison, fear, and confidence were emergent themes. Initial use of cups was slow. Once comfortable, girls using cups or pads reported being free of embarrassing leakage, odour, and dislodged items compared with girls using traditional materials. School absenteeism and impaired concentration were only reported by girls using traditional materials. Girls using cups preferred them to pads. Advantages of cups and pads over traditional items provide optimism for MHM programmes [Clinical Trials Registration: ISRCTN 17486946].
Sanitary Pad Interventions for Girls' Education in Ghana: A Pilot Study
PLoS ONE, 2012
Background: Increased education of girls in developing contexts is associated with a number of important positive health, social, and economic outcomes for a community. The event of menarche tends to coincide with girls' transitions from primary to secondary education and may constitute a barrier for continued school attendance and performance. Following the MRC Framework for Complex Interventions, a pilot controlled study was conducted in Ghana to assess the role of sanitary pads in girls' education. Methods: A sample of 120 schoolgirls between the ages of 12 and 18 from four villages in Ghana participated in a nonrandomized trial of sanitary pad provision with education. The trial had three levels of treatment: provision of pads with puberty education; puberty education alone; or control (no pads or education). The primary outcome was school attendance. Results: After 3 months, providing pads with education significantly improved attendance among participants, (lambda 0.824, F = 3.760, p,.001). After 5 months, puberty education alone improved attendance to a similar level (M = 91.26, SD = 7.82) as sites where pads were provided with puberty education (Rural M = 89.74, SD = 9.34; Periurban M = 90.54, SD = 17.37), all of which were higher than control (M = 84.48, SD = 12.39). The total improvement through pads with education intervention after 5 months was a 9% increase in attendance. After 3 months, providing pads with education significantly improved attendance among participants. The changes in attendance at the end of the trial, after 5 months, were found to be significant by site over time. With puberty education alone resulting in a similar attendance level. Conclusion: This pilot study demonstrated promising results of a low-cost, rapid-return intervention for girls' education in a developing context. Given the considerable development needs of poorer countries and the potential of young women there, these results suggest that a large-scale cluster randomized trial is warranted.
BMC International Health and Human Rights, 2011
Background The onset of menstruation is a landmark event in the life of a young woman. Yet the complications and challenges that can accompany such an event have been understudied, specifically in resource-poor settings. As interventions aim to improve female attendance in schools, it is important to explore how menstruation is perceived and navigated by girls in the school setting. This research conveys rural Kenyan schoolgirls' perceptions and practices related to menstruation Methods Data were collected at six rural schools in the Nyanza Province of Western Kenya. Using focus group discussions, in-depth interviews, and field notes from observations, researchers collected information from 48 primary schoolgirls and nine teachers. Systematic analysis began with a reading of transcripts and debriefing notes, followed by manual coding of the narratives. Results Focus group discussions became opportunities for girls to share thoughts on menstruation, instruct one another on management practices and advise one another on coping mechanisms. Girls expressed fear, shame, distraction and confusion as feelings associated with menstruation. These feelings are largely linked to a sense of embarrassment, concerns about being stigmatized by fellow students and, as teachers explained, a perception that the onset of menstruation signals the advent of a girl's sexual status. Among the many methods for managing their periods, girls most frequently said they folded, bunched up or sewed cloth, including cloth from shirts or dresses, scraps of old cloth, or strips of an old blanket. Cloth was reported to frequently leak and cause chafing, which made school attendance difficult particularly as the day progressed. Attitudes and practices of girls toward menstruation have been arranged into personal, environmental and behavioural factors. Conclusion Further research on menstrual management options that are practical, sustainable and culturally acceptable must be conducted to inform future programs and policies that aim to empower young girls as they transition into womanhood. Stakeholders working within this and similar contexts must consider systematic mechanisms to explain to young girls what menstruation is and how to manage it. Providing sanitary supplies or guiding girls on how to create supplies serve as critical components for future interventions.
Background: A lack of adequate guidance on menstrual management; water, disposal, and private changing facilities; and sanitary hygiene materials in low-and middle-income countries leaves schoolgirls with limited options for healthy personal hygiene during monthly menses. While a plethora of observational studies have described how menstrual hygiene management (MHM) barriers in school impact girls' dignity, well-being, and engagement in school activities, studies have yet to confirm if inadequate information and facilities for MHM significantly affects quantifiable school and health outcomes influencing girls' life chances. Evidence on these hard outcomes will take time to accrue; however, a current lack of standardized methods, tools, and research funding is hampering progress and must be addressed. Objectives: Compile research priorities for MHM and types of research methods that can be used. Results: In this article, we highlight the current knowledge gaps in school-aged girls' MHM research, and identify opportunities for addressing the dearth of hard evidence limiting the ability of governments, donors, and other agencies to appropriately target resources. We outline a series of research priorities and methodologies that were drawn from an expert panel to address global priorities for MHM in schools for the next 10 years. Conclusions: A strong evidence base for different settings, standardized definitions regarding MHM outcomes, improved study designs and methodologies, and the creation of an MHM research consortia to focus attention on this neglected global issue.
Background: Menstruation is a naturally occurring physiological phenomenon in adolescent girls and pre-menopausal women. menstrual hygiene management ( MHM) is the practice that involves women and adolescent girls using clean menstrual management materials to absorb or collect blood that can be changed in privacy as often as necessary for the duration of the menstruation period, using soap and water for washing the body as required and access to the facilities off used menstrual management materials. Method: The research study employed quantitative and simple random sampling techniques from various strata and was carried out for one week from 17th November 2020 to 24th November 2020. A total of 30 pupils were selected, Data was collected on a data collection tool and information was presented using descriptive statics in form of tables, pie charts, and graphs. Results: The overall results showed in the age group between 14-16 years which had 10(52.6%) the least which had 1(5.2%), of...
Waterlines, 2017
Is the menstrual cup a potential solution to address the challenges surrounding menstrual health and management (MHM) for girls and women in low-income contexts? This qualitative study assessed the drivers and challenges for acceptability of the menstrual cup (MC) among schoolgirls in rural Uganda. The study included 36 schoolgirls aged 13-17 recruited from a school-based controlled trial of MCs with 194 participants. After 4 months, 12 follow-up interviews and four focus group discussions were held with study participants After an initial learning curve the findings indicate that MCs are acceptable among schoolgirls in rural Uganda and suggest that the MC can be an acceptable, sustainable, and environmentally friendly MHM method for girls and women in similar contexts. Most (34 out of 36) participants overcame initial challenges mastering the techniques for insertion and removal and adapted to MC use. The main challenge for following the guidelines for hygienic use was finding equipment to boil the cup for disinfection. Major drivers for acceptability were creating trust in the MC and peer support as well as increased comfort, independence, and mobility due to reduced leakage compared with previous MHM methods, especially when in school.