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      A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools

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          Abstract

          Marni Sommer and colleagues reflect on priorities needed to guide global, national, and local action to address girls' menstrual hygiene management needs in schools.

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          A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management

          Colin Sumpter, Belen Torondel (2013)
          Background Differing approaches to menstrual hygiene management (MHM) have been associated with a wide range of health and psycho-social outcomes in lower income settings. This paper systematically collates, summarizes and critically appraises the available evidence. Methods Following the PRISMA guidelines a structured search strategy was used to identify articles investigating the effects of MHM on health and psycho-social outcomes. The search was conducted in May 2012 and had no date limit. Data was extracted and quality of methodology was independently assessed by two researchers. Where no measure of effect was provided, but sufficient data were available to calculate one, this was undertaken. Meta-analysis was conducted where sufficient data were available. Results 14 articles were identified which looked at health outcomes, primarily reproductive tract infections (RTI). 11 articles were identified investigating associations between MHM, social restrictions and school attendance. MHM was found to be associated with RTI in 7 papers. Methodologies however varied greatly and overall quality was low. Meta-analysis of a subset of studies found no association between confirmed bacterial vaginosis and MHM (OR: 1.07, 95% CI: 0.52–2.24). No other substantial associations with health outcomes were found. Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in management methods reduce school absenteeism. Conclusion The management of menstruation presents significant challenges for women in lower income settings; the effect of poor MHM however remains unclear. It is plausible that MHM can affect the reproductive tract but the specific infections, the strength of effect, and the route of transmission, remain unclear. There is a gap in the evidence for high quality randomised intervention studies which combine hardware and software interventions, in particular for better understanding the nuanced effect improving MHM may have on girls’ attendance at school.
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            Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls.

            Marni Sommer, Murat Sahin (2013)
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              ‘We Keep It Secret So No One Should Know’ – A Qualitative Study to Explore Young Schoolgirls Attitudes and Experiences with Menstruation in Rural Western Kenya

              Linda Mason, Elizabeth Nyothach, Kelly Alexander … (2013)
              Background Keeping girls in school offers them protection against early marriage, teen pregnancy, and sexual harms, and enhances social and economic equity. Studies report menstruation exacerbates school-drop out and poor attendance, although evidence is sparse. This study qualitatively examines the menstrual experiences of young adolescent schoolgirls. Methods and Findings The study was conducted in Siaya County in rural western Kenya. A sample of 120 girls aged 14–16 years took part in 11 focus group discussions, which were analysed thematically. The data gathered were supplemented by information from six FGDs with parents and community members. Emergent themes were: lack of preparation for menarche; maturation and sexual vulnerability; menstruation as an illness; secrecy, fear and shame of leaking; coping with inadequate alternatives; paying for pads with sex; and problems with menstrual hygiene. Girls were unprepared and demonstrated poor reproductive knowledge, but devised practical methods to cope with menstrual difficulties, often alone. Parental and school support of menstrual needs is limited, and information sparse or inaccurate. Girls’ physical changes prompt boys and adults to target and brand girls as ripe for sexual activity including coercion and marriage. Girls admitted ‘others’ rather than themselves were absent from school during menstruation, due to physical symptoms or inadequate sanitary protection. They described difficulties engaging in class, due to fear of smelling and leakage, and subsequent teasing. Sanitary pads were valued but resource and time constraints result in prolonged use causing chafing. Improvised alternatives, including rags and grass, were prone to leak, caused soreness, and were perceived as harmful. Girls reported ‘other girls’ but not themselves participated in transactional sex to buy pads, and received pads from boyfriends. Conclusions In the absence of parental and school support, girls cope, sometimes alone, with menarche in practical and sometimes hazardous ways. Emotional and physical support mechanisms need to be included within a package of measures to enable adolescent girls to reach their potential.
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                Author and article information

                Journal
                Journal ID (nlm-ta): PLoS Med
                Journal ID (iso-abbrev): PLoS Med
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosmed
                Title: PLoS Medicine
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Print): 1549-1277
                ISSN (Electronic): 1549-1676
                Publication date (Electronic): 23 February 2016
                Publication date Collection: February 2016
                Volume: 13
                Issue: 2
                Electronic Location Identifier: e1001962
                Affiliations
                [1 ]Mailman School of Public Health, Columbia University, New York, New York, United States of America
                [2 ]Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
                [3 ]UNICEF Headquarters, New York, New York, United States of America
                [4 ]UNICEF Bolivia, La Paz, Bolivia
                [5 ]WaterAid, London, United Kingdom
                [6 ]Liverpool School of Tropical Medicine, Liverpool, United Kingdom
                Author notes

                The authors have declared that no competing interests exist.

                Wrote the first draft of the manuscript: MSo PPH BAC. Contributed to the writing of the manuscript: MSo PAPH BAC SC MSa TM TC. Agree with the manuscript’s results and conclusions: MSo PAPH BAC SC MSa TM TC. Co-wrote the MHM at TEN proceedings document: MSo, SC, TM. Extensively edited the manuscript: MSo, SC, TM, MSa, TC. All authors have read, and confirm that they meet, ICMJE criteria for authorship.

                Article
                Publisher ID: PMEDICINE-D-15-01786
                DOI: 10.1371/journal.pmed.1001962
                PMC ID: 4764363
                PubMed ID: 26908274
                SO-VID: 8584f799-2bbd-4e73-97cf-d7d65ca71099
                Copyright © © 2016 Sommer et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Page count
                Figures: 0, Tables: 1, Pages: 9
                Funding
                The authors received no specific funding for this work.
                Categories
                Subject: Health in Action
                Subject: Social Sciences
                Subject: Sociology
                Subject: Education
                Subject: Schools
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Environmental Health
                Subject: Sanitation
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Subject: Environmental Health
                Subject: Sanitation
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Education and Awareness
                Subject: People and Places
                Subject: Population Groupings
                Subject: Professions
                Subject: Teachers
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Subject: Hygiene
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Children
                Subject: People and Places
                Subject: Population Groupings
                Subject: Families
                Subject: Children
                Subject: Science Policy
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Adolescents

                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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