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Wichelt N, Montez K, Osorio R, Roberts R, Greene I, de la Vega G, Brown CL. Implementing a Clinical-Community Program to Address Menstrual Poverty: An Advocacy Case Study. Pediatrics 2025:e2024068710. [PMID: 40360178 DOI: 10.1542/peds.2024-068710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 03/21/2025] [Indexed: 05/15/2025] Open
Abstract
Menstrual poverty occurs when inadequate access to menstrual hygiene education or financial hardship creates difficulties in sufficiently accessing menstrual hygiene products, which results in adverse outcomes for emotional well-being, school attendance, and health autonomy. The American Academy of Pediatrics recently endorsed a position statement to eliminate menstrual poverty in adolescents and young adults (AYAs). However, few community-clinical collaborations exist in the literature that addresses menstrual poverty. We introduced a novel menstrual poverty screening tool in April 2022 at 1 academic pediatric clinic at all female AYA well visits. We partnered with a local advocacy organization, the Triad of North Carolina chapter of The Period Project, to create packets containing menstrual hygiene supplies. Those with positive screens were given the option of receiving a menstrual supply packet at the time of visit. Narrative feedback was obtained to evaluate for project feasibility and acceptability from AYA participants who screened positive for menstrual poverty and from clinic staff participating in screening or providing menstrual supply packets. Themes included (1) menstrual poverty as a problem in the community, (2) necessity of addressing and normalizing menstrual poverty at every AYA well visit, (3) medical and mental health consequences of menstrual poverty, and (4) suggestions to improve the clinical-community program. We found that a clinical program addressing menstrual poverty through partnership with a community-based advocacy organization was acceptable among patients and providers. Additional research is needed to determine effectiveness of a clinical-community program addressing menstrual poverty.
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Affiliation(s)
- Natalie Wichelt
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kimberly Montez
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Reyna Osorio
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Riley Roberts
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ivy Greene
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Gabriela de la Vega
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Callie L Brown
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Bedrick BS, Hamilton S, Sufrin C. Assessment of menstrual material needs as a measure of health and menstrual equity in the postpartum period. SEXUAL & REPRODUCTIVE HEALTHCARE 2025; 44:101108. [PMID: 40381545 DOI: 10.1016/j.srhc.2025.101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/16/2024] [Accepted: 05/09/2025] [Indexed: 05/20/2025]
Abstract
OBJECTIVE To evaluate lochia management needs in a diverse cohort of postpartum individuals admitted for delivery at two large urban hospitals in the United States and to assess the association between immigration and menstrual needs. METHODS English- or Spanish-speaking individuals delivering a live-born infant were recruited in this cross-sectional study via convenience sampling. We modified the Menstrual Practice Needs Scale to evaluate participant menstrual practices, menstrual poverty, preparedness for postpartum lochia, and experiences discussing menstrual material access with their healthcare team. RESULTS There were 123 participants, 60 of whom were immigrants. Twenty-seven women (22 %) experienced menstrual poverty, and 10 were unsure if they had adequate materials to manage lochia. Women with an annual household income at or below the poverty level (p = 0.0004) or who had moved (p = 0.009) or experienced food insecurity (p < 0.0001) in the last year were more likely to have experienced menstrual poverty than those who had not. Half of participants never received lochia counseling. Only 15 women (12 %) had been asked by a healthcare member whether they had enough menstrual materials, but over a third wanted to discuss how to obtain them. The majority of women wanted to receive lochia management materials from their prenatal clinic and from the hospital. CONCLUSIONS Despite a high rate of menstrual poverty, women were rarely asked about access to menstrual supplies. These women want to discuss how to acquire menstrual materials with their healthcare team. Standardized screening and discussions about postpartum lochia may help to reduce postpartum menstrual poverty.
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Affiliation(s)
- Bronwyn S Bedrick
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States.
| | - Sonia Hamilton
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carolyn Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Morley M, Cava I, Glass N, Salwitz E, Hughes-Wegner AT, DeMaria AL. Addressing Period Poverty: Evaluating a Free Period Product Program in a University Setting. Health Promot Pract 2025:15248399241311590. [PMID: 39882778 DOI: 10.1177/15248399241311590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2025]
Abstract
Period poverty, characterized by inadequate access to menstrual health resources and education, detrimentally affects school attendance, academic performance, and individual health. Recent studies have revealed nearly one-fifth of college-enrolled women experienced period poverty in the past year, highlighting the urgency of addressing this issue. Through our study at Purdue University, we evaluated the effectiveness of a free pad and tampon program aimed at reducing period poverty. Findings from our survey, which included responses from 766 university student participants, revealed many utilized the program due to not having products with them (43.2%). In contrast, others cited early or late periods (33.4%) and financial constraints (5.2%) as reasons for usage. In addition, 81.7% of respondents reported they were aware of the program's existence, indicating a need for more tailored promotional efforts to reach the entire student body. These insights contribute to a deeper understanding of the program's impact and provide actionable recommendations for improving accessibility and addressing the diverse needs of menstruating individuals within the university community. Leveraging these findings, university administrators can play a vital role in advancing menstrual equity initiatives and fostering supportive environments for all menstruators on campus.
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Affiliation(s)
- Megan Morley
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, US
| | - Isabel Cava
- Department of Global Studies, College of Liberal Arts, Purdue University, West Lafayette, IN, US
| | - Novalee Glass
- Department of Biochemistry, College of Agriculture, Purdue University, West Lafayette, IN, US
| | - Elizabeth Salwitz
- Department of Psychological Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, US
| | - Alexandra T Hughes-Wegner
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, US
| | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, US
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Noel J, Strong S, Miller S, Gately K, Rosenthal S. Period poverty and mental health among students attending a US university. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2025:1-8. [PMID: 39804781 DOI: 10.1080/07448481.2024.2449419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 12/04/2024] [Accepted: 12/29/2024] [Indexed: 01/16/2025]
Abstract
OBJECTIVE To determine the prevalence of period poverty in university students and if experiencing period poverty is associated with poor mental health outcomes. METHODS Participants were n = 311 females assigned at birth attending a university in the northeast US. Seven items assessed period poverty. Participants were also screened for depression, anxiety, and suicide ideation. Logistic regression models assessed main effects after adjusting for gender, sexual orientation, race, age, ethnicity, disability status, and income. RESULTS Overall, 18.3% experienced period poverty, with higher odds occurring in students identifying as trans-gender/nonconforming (OR[95%CI] = 3.34 [1.22,9.15]), LGB+ (OR[95%CI] = 1.94 [1.01,3.74]), and Black/African American (OR[95%CI] = 3.61 [1.30,10.0]). Period poverty was associated with higher odds of screening positive for depression (OR[95%CI] = 6.21 [2.45,15.7]), anxiety (OR[95%CI] = 4.01 [2.09,7.68]), and suicide ideation (OR[95%CI] = 2.85 [1.26,6.44]). CONCLUSIONS Period poverty is prevalent and is associated with adverse mental health outcomes in university students. Government agencies and universities should consider providing free period products to reduce health inequities.
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Affiliation(s)
- Jonathan Noel
- Department of Health Science, College of Health and Wellness, Johnson & Wales University, Providence, Rhode Island, USA
- Center for Student Research & Interdisciplinary Collaboration, Johnson & Wales University, Providence, Rhode Island, USA
| | - Samantha Strong
- Department of Health Science, College of Health and Wellness, Johnson & Wales University, Providence, Rhode Island, USA
- Center for Student Research & Interdisciplinary Collaboration, Johnson & Wales University, Providence, Rhode Island, USA
| | - Sarah Miller
- Department of Health Science, College of Health and Wellness, Johnson & Wales University, Providence, Rhode Island, USA
- Center for Student Research & Interdisciplinary Collaboration, Johnson & Wales University, Providence, Rhode Island, USA
| | - Kelsey Gately
- Department of Health Science, College of Health and Wellness, Johnson & Wales University, Providence, Rhode Island, USA
- Center for Student Research & Interdisciplinary Collaboration, Johnson & Wales University, Providence, Rhode Island, USA
| | - Samantha Rosenthal
- Department of Health Science, College of Health and Wellness, Johnson & Wales University, Providence, Rhode Island, USA
- Center for Student Research & Interdisciplinary Collaboration, Johnson & Wales University, Providence, Rhode Island, USA
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, Rhode Island, USA
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Bourne MP, Ahsan KZ. Parallel Plights in Advancing Menstrual Equity: A Scoping Review of Period Poverty in India and the United States. Health Promot Pract 2025:15248399241308901. [PMID: 39772910 DOI: 10.1177/15248399241308901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
As calls for improved menstrual health management have gained momentum in sociopolitical contexts, period poverty and menstrual equity have gradually been established and recognized in the discipline of public health. These conversations typically take place in the context of low- and middle-income countries (LMICs) where donor-sponsored projects are already underway. Nevertheless, research on period poverty in high-income countries (HICs) is seldom performed. In addition, current literature on the topic tends to generalize HICs and LMICs, thereby ignoring crucial cultural and socioeconomic distinctions that necessitate a more detailed comparison of individual countries facing period poverty. This case examines the current body of research on period poverty in the United States and India, and compares the causes, effects, and approaches toward ameliorating this phenomenon. Through performing a scoping review of the current literature on period poverty, this case illustrates that-as opposed to the breadth of research available on period poverty in LMICs-research on period poverty in HICs is underrepresented. In addition, the findings demonstrate a stunning parallel between the contributing factors of period poverty in India and the United States, suggesting that the current approach to isolate conversations on the topic based on regional economic incongruencies is inappropriate. Finally, this case identifies dismantling the stigmatization of periods, investing in water or hygiene infrastructure, promoting the economic mobilization of females, and reforming menstrual health curricula in schools as essential to ending period poverty.
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Affiliation(s)
- Mary Pope Bourne
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Casola AR, Luber K, Riley AH. Period Poverty: An Epidemiologic and Biopsychosocial Analysis. Health Promot Pract 2025; 26:65-74. [PMID: 37605547 DOI: 10.1177/15248399231192998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
In the United States, approximately one in five persons experience period poverty, defined as the inability to obtain resources needed for healthy, safe, and dignified menstrual management. Limited access to an inadequate number of menstrual supplies may lead to longer-than-recommended use, which can increase skin chafing, disruption of vaginal flora, and intravaginal toxin overgrowth. However, period poverty goes beyond simply having enough menstrual products and can encompass the embarrassment, stigma, shame, and barriers in conversation surrounding menstruation. Discussion and critical examination of the multilayered attributes surrounding period poverty have been intermittent in academic literature, particularly from a domestic lens. Thus, this narrative review and theoretical analysis aimed to describe the epidemiology of period poverty and analyze its biological, socio-emotional, and societal implications. We applied a descriptive epidemiology approach of person, place, and time, and employed a social-ecological lens to examine risk factors. Our findings describe the incidence, distribution, and possible ways to alleviate period poverty. Practitioners, medical providers, and public health professionals may have limited knowledge of period poverty, what it entails, and who it impacts, but they have great potential to address it and associated menstrual inequities in their work. With its widespread implications for psychosocial and community-level health, this phenomenon needs urgent attention to promote menstrual equity as an issue of human rights and social justice. We conclude with research and policy recommendations for alleviating period poverty.
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Affiliation(s)
| | - Kierstin Luber
- Thomas Jefferson University, Philadelphia, PA, USA
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
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Deniz AO, Acikgoz S. Menstrual poverty and genital hygiene behaviors among adolescents: A cross-sectional study. J Pediatr Nurs 2025; 80:e1-e6. [PMID: 39537433 DOI: 10.1016/j.pedn.2024.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 10/18/2024] [Accepted: 10/20/2024] [Indexed: 11/16/2024]
Abstract
PURPOSE Period poverty is an important public health problem that negatively affects genital hygiene behaviors. This study was conducted to examine period poverty and genital hygiene behaviors in adolescents. DESIGN AND METHODS This cross-sectional study was conducted with 397 adolescents between May 1, 2023 and November 30, 2023 by using a "Personal Information Form," a " Menstrual Cycle Characteristics Form," a "Period Poverty Characteristics Form," and the "Genital Hygiene Behavior Scale." The data were analyzed using SPSS 27.0 program and according to the results of descriptive statistical methods and normality analysis, t-test, Mann Whitney U test and Kruskal Wallis H test analysis were used in independent groups. RESULTS The total mean Adolescents' Genital Hygiene Behavior Scale score was 86.58 ± 10.03. The genital hygiene behavior scale score was low in adolescents who had financial difficulties purchasing hygiene products, whose frequency of changing hygiene products was negatively affected by economic reasons, who were worried about running out of hygiene products during the last period, and who thought that menstrual education was inadequate (p < 0.001). CONCLUSION Our results indicated that period poverty in adolescents negatively affected their genital hygiene behaviors. PRACTICAL IMPLICATIONS It is recommended that adolescents be addressed within the scope of social policies for better access to affordable menstrual products.
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Affiliation(s)
- Ayse Ozge Deniz
- Çankırı Karatekin University, Faculty of Health Sciences, Nursing Department, 18200 Çankırı, Turkey.
| | - Serap Acikgoz
- Çankırı Karatekin University, Faculty of Health Sciences, Nursing Department, 18200 Çankırı, Turkey.
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Aparnavi P, Ramanathan R, Shanmugam J, Narayanan S, Kumar M, Ramya V, Rathinamoorthy R, Vignesh S. Suitability, acceptability, feasibility of modern menstrual methods: a qualitative study in Coimbatore district, Tamil Nadu, India. Front Glob Womens Health 2024; 5:1497686. [PMID: 39776786 PMCID: PMC11703974 DOI: 10.3389/fgwh.2024.1497686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 12/09/2024] [Indexed: 01/11/2025] Open
Abstract
Objective To examine women's perceptions of modern menstrual hygiene methods (MMHM), such as tampons and menstrual cups, focusing on socio-demographic variations and special groups in the Coimbatore district of Tamil Nadu. Methods A qualitative study among women of reproductive age (15-49 years) group was conducted using Focus Group Discussions (FGDs) among twelve women subgroups independently in 2023. Results The present study involved 23 focus group discussions (FGDs) across various groups of women, including those in formal and informal sectors, urban and rural areas, school and college students, healthcare workers, women in sports, tribal women, transgender women, and female sex workers (FSW), with a total of 188 participants. The age range varied across groups, from 15 to 45 years. Over half of the participants were married (51.1%), and 68.7% were literate, though illiteracy was higher in the informal sector, rural, tribal areas, transgender women, and FSW groups. Sanitary pads were the most used menstrual hygiene method (88.3%), followed by cloth (4.8%), and modern methods like menstrual cups or tampons (1.6%). Notably, 70% of FSW and 28.6% of tribal women still used cloths. Menstrual hygiene choices were often influenced by family recommendations, school-based menstrual hygiene sessions, institutional policies, and social media. Regarding satisfaction, 27.1% were content with their menstrual hygiene method, citing accessibility, affordability, and leakage prevention. However, issues with pads included heat, rashes, and discomfort. A significant number (31.4%) shifted from cloth to pads recently, mainly due to leakage and lack of adequate washing facilities. Only 6.1% had tried modern menstrual methods, with tampons and menstrual cups being considered more suitable but less feasible, especially among tribal women. Participant concerns ranged from the potential health risks of sanitary pads to waste disposal challenges. Recommendations included public menstrual hygiene management (MHM) dispensers, better waste collection practices, and increased awareness through advertisements. Some participants advocated for the concept of free menstruation, emphasizing informed choices and accessibility for all. Conclusion The findings suggest that increasing access to modern menstrual hygiene products, coupled with comprehensive education and support, could improve acceptance and feasibility, especially for marginalized and underrepresented women.
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Affiliation(s)
- P. Aparnavi
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, India
| | - Rashmi Ramanathan
- Department of Physiology, KMCH Institute of Health Sciences and Research, Coimbatore, India
| | - Jeevithan Shanmugam
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, India
| | - Seetharaman Narayanan
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, India
| | - Mohan Kumar
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, India
| | - V. Ramya
- KMCH Institute of Health Sciences and Research, Coimbatore, India
| | - Ramesh Rathinamoorthy
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, India
| | - Sakthivel Vignesh
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, India
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Rome ES, Tyson N. Menstrual Equity. Obstet Gynecol Clin North Am 2024; 51:731-744. [PMID: 39510741 DOI: 10.1016/j.ogc.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
Menstrual equity refers to the access to safe environments in which to menstruate, including bathroom facilities and clean water, as well as access to menstrual products that allow for the ability to go to school, work, and engage in life with dignity. Menstruation is a physiologic process, not a reflection of maturity or self-worth. Providers within cultures should advocate that girls should be protected from abuse or shame related to menses.
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Affiliation(s)
- Ellen S Rome
- Center for Adolescent Medicine, Cleveland Clinic Children's Hospital, Cleveland Clinic Lerner College of Medicine at Case, 9500 Euclid Avenue, R3, Cleveland, OH 44195, USA.
| | - Nichole Tyson
- Pediatric and Adolescent Gynecology, Stanford University School of Medicine, Center for Academic Medicine, Obstetrics & Gynecology MC5317, 453 Quarry Road, Palo Alto, CA 94304, USA
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Pruneda Paz J, García-Egea A, Jacques-Aviñó C, Besoaín Cornejo AM, Medina-Perucha L. An intersectional approach on menstrual inequity as lived by women in circumstances of socioeconomic vulnerability in an urban and rural setting in Spain: a qualitative study. Sex Reprod Health Matters 2024; 32:2422155. [PMID: 39450492 PMCID: PMC11565678 DOI: 10.1080/26410397.2024.2422155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2024] Open
Abstract
Since menstrual health and menstrual inequity are determined by social power structures, this study proposes to analyse, from an intersectional perspective, the experiences of menstrual inequity of women and people who menstruate (PWM) (≥18 years) under circumstances of socioeconomic vulnerability in an urban and rural setting in Catalonia (Spain), focusing on menstrual poverty, menstrual management and access to health care for menstrual health. An exploratory and interpretative qualitative study was conducted. Venue-based convenience sampling was carried out, recruiting women from a non-governmental organisation and a primary health care centre. Eighteen individual semi-structured interviews were conducted between October 2022 and February 2023. Data were analysed through reflexive thematic analysis. Analysis revealed that menstrual care was generally a distant preoccupation that revolved around circumstances of socioeconomic vulnerability, housing, and productive/reproductive work. Menstrual poverty, menstrual management and menstrual self-care challenges, barriers to accessing health care for menstrual health, and menstrual taboo, stigma and discrimination were commonplace and deepened by socioeconomic vulnerability. In this way, women's menstrual experiences were rooted in intersecting axes of inequity, based on gender, race and class. Intersectional and critical participatory research, policy and practice are imperative to develop counter mechanisms that confront systems of privilege-oppression to modulate menstrual experience, health and equity.
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Affiliation(s)
- Josefina Pruneda Paz
- Master’s student, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Andrea García-Egea
- Research Assistant, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Research Assistant, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Constanza Jacques-Aviñó
- Senior Researcher, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Senior Researcher, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain; Senior Researcher, Network of Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Ana Maria Besoaín Cornejo
- Pre-doctoral researcher, Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Reserca Sant Joan de Deu, Esplugues de Llobregat, Spain
| | - Laura Medina-Perucha
- Post-doctoral researcher, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Post-doctoral researcher, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain; Post-doctoral researcher, Network of Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
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Bhoda K, Burgoa S, Zerrouki Y, Jhumkhawala V, Lobaina D, Knecht M, Kitsantas P, Sacca L. Examining Menstrual Health and Hygiene Educational Initiatives for American Middle and High School Menstruating Students: A Scoping Review. J Pediatr Adolesc Gynecol 2024; 37:465-476. [PMID: 38897447 DOI: 10.1016/j.jpag.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/26/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
According to the American Medical Women's Association, period poverty refers to "inadequate access to menstrual hygiene tools and education, including but not limited to sanitary products, washing facilities, and waste management." A component of period poverty in the US can be attributed to the neglect of menstrual education and lack of menstrual health and hygiene tools in schools. This scoping review aims to examine the educational methods employed to improve menstrual knowledge in middle and high school menstruating students in both school and clinical settings. It also highlights gaps and barriers in equitable access to menstrual hygiene products. The five-stage framework by Arksey and O'Malley (2005) and the updated Joanna Briggs Institute (JBI) guide were used to guide the review. Six studies were retained for analysis. Two-thirds of menstruating students reported using at least one of the school's resources to obtain period products, and one-third of the participants reported missing school due to a lack of period products. Nearly half of the students needed period products at least once in the past school year but lacked the financial resources to purchase such products. Menstruating students reported embarrassment and a need for secrecy when accessing school bathrooms since the social and physical environments of school bathrooms heightened their discomfort while menstruating. Although a majority of adolescent students had basic knowledge of menstrual periods prior to menarche, the depth of their understanding of menstruation was limited. Findings from this review can inform the future development of evidence-based educational interventions to improve the overall menstruation experience for US menstruating adolescents.
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Affiliation(s)
- Keerthi Bhoda
- Department of Biosciences, Rice University, Houston, Texas
| | - Sara Burgoa
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Yasmine Zerrouki
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Vama Jhumkhawala
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Diana Lobaina
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Michelle Knecht
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Panagiota Kitsantas
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Lea Sacca
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida.
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Öz Yildirim Ö, Hendekci A, Aydın Avci I. Menstrual poverty scale: reliability and validity study. Women Health 2024; 64:526-536. [PMID: 38955481 DOI: 10.1080/03630242.2024.2375382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 05/27/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024]
Abstract
The tendency toward poverty in the globalizing world significantly affects women. Unlike men, women have mandatory expenses every month. Especially poor women have difficulty in accessing to the hygienic products they need during the menstrual period. That is why, this study aims to develop a measurement tool that can effectively and widely assess women's menstrual poverty. This study is a methodological study that evaluates the psychometric properties of the scale. The study included 420 women living in a middle-income province in the north of Türkiye between April - July, 2023. The data were collected using the Menstrual Poverty Scale, and the items on the scale were developed based on a review of existing literature and expert opinions (CVI = 0.85-0.95). The sample was divided into two parts. It was made exploratory factor analysis and confirmatory factor analysis. Before conducting the study, an ethics committee decision and informed consent of the women were obtained. The collected data were analyzed using the SPSS 23 and AMOS 23 programs. The EFA revealed a structure consisting of 13 items and four factors. The four factors considered were as follows; access to hygiene products, quality of life, embarrassment, and receiving information, and education about menstruation. The item factor loadings varied from 0.46 to 0.91. The Cronbach's alpha coefficient was determined to be 0.69. The corrected item-total correlations for the scale items ranged from 0.62 to 0.84. According to the confirmatory factor analysis, the structural equation modeling results of the Menstrual Poverty Scale were found to be meaningful (p = .000; RMSEA 0.64; CMIN/Df 1.70). It is suggested to conduct validity and reliability studies in different cultures by applying the scale to women from different cultural backgrounds.
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Affiliation(s)
- Özge Öz Yildirim
- Health Science Faculty, Public Health Nursing Department, Ondokuz Mayıs University, Samsun, Turkey
| | - Ayla Hendekci
- Health Science Faculty, Public Health Nursing Department, Giresun University, Giresun, Turkey
| | - Ilknur Aydın Avci
- Health Science Faculty, Public Health Nursing Department, Ondokuz Mayıs University, Samsun, Turkey
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Kelly AM. Public toilets and their potential impact on an individual's health. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:538-544. [PMID: 38900669 DOI: 10.12968/bjon.2023.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
In modern society, people engage in social interactions and activities outside their own home. When in public settings people may need to eliminate bodily waste, so public toilets are required. Accessibility, availability and adaptability are essential principles for safe, private, and purposeful visits to public toilets. A diverse range of individuals use public toilets: various age profiles, all gender groups, vulnerable individuals and people with additional needs. Public toilets essentially need to be a place of privacy, safety and cleanliness to facilitate elimination of urine, evacuation of faeces, management of menstruation, and changing/disposing of continence wear products in a secure environment.
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Affiliation(s)
- Anne Marie Kelly
- Clinical Nurse Specialist - Continence, Meath Primary Care Centre, Dublin, Ireland
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14
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Sebert Kuhlmann A, Teni MT, Key R, Billingsley C. Period Product Insecurity, School Absenteeism, and use of School Resources to Obtain Period Products among High School Students in St. Louis, Missouri. J Sch Nurs 2024; 40:329-335. [PMID: 34962178 DOI: 10.1177/10598405211069601] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Menstrual hygiene management (MHM) among female students is a neglected public health issue in the U.S. This study documented period product insecurity, school absenteeism, and use of school resources to obtain period products among high-school students in St. Louis, MO. Female students completed an anonymous, self-administered survey in English (n = 119). Descriptive statistics were used to determine the prevalence of period product need, resources used to obtain period products, and period-related absenteeism. The mean age of participants was 15.78 ± 1.28. Nearly two-thirds (64.4% (95% CI 55.1%-73.0%)) reported period product insecurity. Two-thirds (66.9% (95% CI 57.7%-75.3%)) reported using at least one of the school's resources to obtain period products. One-third of the participants (33.6% (95% CI 25.0%-43.1%)) reported missing school due to a lack of period products. School nurses need to be cognizant of how MHM affects their students' attendance at school and what measures they can take to help reduce menstruation-related absenteeism.
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Affiliation(s)
- Anne Sebert Kuhlmann
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
| | - Mintesnot T Teni
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
| | - Rhonda Key
- Jennings School District, Jennings, Missouri, USA
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15
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Lee AC, Toory L, Harrison ME. Menstrual health inequities and "period poverty" in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:502-506. [PMID: 38381303 PMCID: PMC11151882 DOI: 10.17269/s41997-024-00853-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024]
Abstract
Period poverty is the lack of access to menstrual products, sexual and reproductive health education, safe waste management, and adequate facilities. Despite its being a public health issue and a significant concern for numerous Canadians, there is a lack of peer-reviewed research on period poverty in Canada. Existing Canadian research has primarily been conducted by non-profit organizations/charities or industry leaders for menstrual products, resulting in incomplete data. More research is needed to explore the menstrual inequities in Canada and their impact on the well-being of Canadians. This is a critical step to ensure the menstrual needs of Canadians are appropriately addressed.
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Affiliation(s)
- Ann C Lee
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Leisha Toory
- Faculty of Humanities and Social Sciences, Political Science, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Megan E Harrison
- Faculty of Medicine, Division of Adolescent Health, CHEO, University of Ottawa, Ottawa, ON, Canada.
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16
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Potter K, Beal-Stahl J. A pharmacist's role in increasing access to menstrual products: an education and advocacy approach. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1364698. [PMID: 38827820 PMCID: PMC11140102 DOI: 10.3389/frph.2024.1364698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/01/2024] [Indexed: 06/05/2024] Open
Abstract
Individuals who menstruate grapple with diverse challenges in menstrual and reproductive health. This includes financial burdens, societal stigmas, and negative mental and physical health implications. Period poverty, marked by insufficient access to menstrual products, education, and sanitation, remains a prevalent and poorly addressed issue. Alarming statistics highlight the extent of this problem and shed light on the staggering number of individuals lacking access to essential menstrual products. The discourse extends to the safety and accessibility of a diverse array of menstrual products. A comprehensive comparison of the cost of available period products was conducted using data obtained from various retail websites. The often-overlooked potential indirect expenses and profound impacts on quality of life were also discussed. Amidst other public health initiatives, pharmacists have emerged as pivotal advocates and educators. Pharmacists are poised to drive initiatives that increase access to menstrual products through public health education and advocacy. By providing education on different menstrual product options, pharmacists can empower individuals to make informed decisions based on their needs. This perspective illuminates the complex impacts of menstruation on individuals and proposes that pharmacists can play a role in overcoming barriers to access. The proposed strategies, rooted in education, research, and advocacy, pave the way for enhancing access, reducing stigma, and elevating the quality of life for those navigating the intricate complexities of menstruation.
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Affiliation(s)
- Kristal Potter
- Department of Clinical and Administrative Sciences, Larkin University College of Pharmacy, Miami, FL, United States
| | - Jessica Beal-Stahl
- Department of Clinical Research, Sports Pharmacy Network, Naples, FL, United States
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17
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Kelly AM. Incontinence and homelessness. Br J Community Nurs 2024; 29:S52-S58. [PMID: 38728160 DOI: 10.12968/bjcn.2024.29.sup5.s52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
The fundamental principles of why specific people become homeless, can be grounded in a simple rationale or founded within sophisticated reasoning. For instance, people who suffer from substance abuse, addiction, alcohol, gambling, have mental health concerns or financial difficulties may be susceptible to homelessness. It is also identified that persons who experienced violence in their childhood or abuse by a partner are at a higher risk of becoming homeless. Homelessness knows no ethnic, cultural, religious or gender boundaries, and can impact all individuals' health and well-being. A health problem and worldwide phenomenon that affects all cohorts of the population, including the homeless, is urinary incontinence. The aim of this article is to increase the awareness of incontinence and highlight the impact it has on the lives of people that experience homelessness.
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Affiliation(s)
- Anne Marie Kelly
- Clinical Nurse Specialist-Continence, Dublin South, Kildare and West Wicklow CHO, Elinor Lyons Building, Meath Campus, Heytesbury Street, Dublin 8
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18
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Dhumal T, Rai P, Shah D, Murray PW, Kelly KM. Menstrual Products: Attitudes About Taxation and Safety. J Womens Health (Larchmt) 2024; 33:491-498. [PMID: 38407820 DOI: 10.1089/jwh.2023.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Background: This study explored factors associated with the differences between women and men in attitudes, norms, and the support of taxation of menstrual products (MPs) and menstrual-adjacent products. It also investigated the use of these products in women. Methods: Young adults from 18 to 30 years of age were recruited via social media, listserve emails, and flyers placed throughout a university campus. Following cognitive interviewing, a survey investigated attitudes, beliefs, and behaviors associated with MPs. Results: Individuals self-identified as men or women. Women (n = 154) had more positive general attitudes, less positive safety attitudes, and less support for taxation of MPs than men (n = 43). Regression analyses indicated that factors, such as race, age, attitudes, norms, and taxation, were associated with product use. Conclusions: Attitudes about safety and taxation differ for men and women. Tax policies and attitude-shifting interventions need to be tailored to their audience, and our study can inform that effort.
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Affiliation(s)
- Trupti Dhumal
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Pragya Rai
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Drishti Shah
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Pamela W Murray
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kimberly M Kelly
- Center for Innovation in Health Equity Research, Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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19
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DeMaria AL, Martinez R, Otten E, Schnolis E, Hrubiak S, Frank J, Cromer R, Ruiz Y, Rodriguez NM. Menstruating while homeless: navigating access to products, spaces, and services. BMC Public Health 2024; 24:909. [PMID: 38539114 PMCID: PMC10976832 DOI: 10.1186/s12889-024-18379-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/18/2024] [Indexed: 11/12/2024] Open
Abstract
BACKGROUND People experiencing homelessness (PEH) in the United States face substantial challenges related to menstruation, exacerbated by the COVID-19 pandemic. Limited access to period products, heightened stigma, and gynecological challenges contribute to increased hardships for PEH, highlighting the need for improved services and policies to address period equity and overall well-being for this vulnerable population. METHODS We conducted semi-structured qualitative interviews with PEH (n = 12) and community healthcare and social service providers (e.g., case managers, shelter directors, community health workers, and nurses, n = 12) in Lafayette, Indiana, a city located between Indianapolis and Chicago in the United States. We used thematic analysis techniques for data analysis. RESULTS PEH's limited access to products, services, and safe spaces hindered effective menstruation management within restrictive community contexts. Although community healthcare and service providers offered some support, complex interactions with the healthcare system, stigma, and limited access to spaces exacerbated barriers. The COVID-19 pandemic further intensified these difficulties by closing public spaces, worsening economic conditions, and straining service provider resources. CONCLUSIONS Results highlight critical organizational and policy gaps in the United States for menstruation management resources and services, emphasizing the need for better integration into health and well-being programs for PEH. These insights will advance reproductive and public health research, shedding light on the disparities faced by PEH in managing menstruation in Indiana and contributing to the national discourse on addressing these barriers. Amid the complex landscape of public health, particularly during and after the pandemic, prioritizing menstrual health remains essential for all individuals' overall well-being, including those experiencing homelessness.
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Affiliation(s)
- Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
| | - Rebecca Martinez
- Department of Anthropology, Purdue University, West Lafayette, IN, USA
| | - Emily Otten
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | - Emma Schnolis
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | - Sofia Hrubiak
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - Jaclyn Frank
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | - Risa Cromer
- Department of Anthropology, Purdue University, West Lafayette, IN, USA
| | - Yumary Ruiz
- Department of Public Health, Purdue University, West Lafayette, IN, USA
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20
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Camas-Castillo MA, Gallardo-Alvarado N, Yánez-Sánchez P, Makuch MY, Osis MJD, Bahamondes L. Menstrual health: Inequities in a cohort of menstruating people in the Brazilian southeastern region. Int J Gynaecol Obstet 2024; 164:1160-1166. [PMID: 37922242 DOI: 10.1002/ijgo.15223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/08/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVE To assess menstrual hygiene management (MHM) and period poverty in a group of low- and medium-income menstruating people. METHODS A cross-sectional study was conducted at the University of Campinas, Brazil, from January to June 2022 with 535 participants aged 18-49. For data collection, we used the abbreviated version of the WHO Quality-of-Life questionnaire (WHOQOL-BREF) and a pre-tested questionnaire with items regarding MHM and period poverty. RESULTS We found an inverse relationship between the risk of no access to supplies to perform menstrual hygiene, which increased by 2.5% and each point less in the environmental domain of quality of life (QoL), and this risk increased by up to 3.1 times among participants who reported difficulty making ends meet. The risk of not having adequate conditions to perform menstrual hygiene at home increased by up to 2.6% for every one-point drop in the environmental domain of QoL. The risk of not having adequate conditions to perform menstrual hygiene outside the home increased by up to 1.3% for less points in the psychological domain of QoL, and 44.4% of those who indicated inadequate conditions for menstrual hygiene reported two or more childbirths. CONCLUSIONS Menstruating people who have an increased risk of lacking menstrual supplies and have an increased risk of inadequate conditions for MHM at home and outside the home, as well as those who have two or more deliveries and those having difficulties making ends meet, scored low on the QoL, especially in the environmental and psychological dimensions.
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Affiliation(s)
- Miriam A Camas-Castillo
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Negli Gallardo-Alvarado
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Paula Yánez-Sánchez
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
| | - María Y Makuch
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
- Campinas Center of Research in Reproductive Health (Cemicamp), Campinas, SP, Brazil
| | - María J D Osis
- Campinas Center of Research in Reproductive Health (Cemicamp), Campinas, SP, Brazil
- Department of Public Health, Faculty of Medicine of Jundiai, Jundiai, SP, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
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21
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VanderMeulen H, Tang GH, Sholzberg M. Tranexamic acid for management of heavy vaginal bleeding: barriers to access and myths surrounding its use. Res Pract Thromb Haemost 2024; 8:102389. [PMID: 38623473 PMCID: PMC11017359 DOI: 10.1016/j.rpth.2024.102389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 04/17/2024] Open
Abstract
Tranexamic acid is safe and effective for the treatment of heavy vaginal bleeding during menstruation and childbirth. It improves the quality of life, facilitates participation in school and work, and reduces the risk of death from postpartum hemorrhage. Despite its well-established benefits, individual- and structural-level barriers preclude its widespread utilization, hindering effective patient care and perpetuating health inequities in women's health. We first describe the evidence for the use of tranexamic acid in treating heavy menstrual bleeding and postpartum hemorrhage. Barriers to tranexamic acid use, including structural sexism, period poverty, misinformation in product monograph labeling, stigmatization of vaginal blood loss, and drug access, are then discussed. Finally, we summarize relevant data presented during the 2023 International Society on Thrombosis and Haemostasis Congress.
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Affiliation(s)
- Heather VanderMeulen
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Grace H. Tang
- Department of Hematology, Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Sholzberg
- Department of Medicine and Laboratory Medicine & Pathobiology, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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22
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Orsini GD, Tarabay J, Hardy-Johnson PL, Barker SL, Greenway FT. The homeless period: a qualitative evidence synthesis. Women Health 2024; 64:250-260. [PMID: 38343133 DOI: 10.1080/03630242.2024.2310716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/21/2023] [Accepted: 01/17/2024] [Indexed: 03/12/2024]
Abstract
Women experiencing homelessness are marginalized not only through their housing status but also through their access and ability to manage their menstrual health. Currently, there are no existing published reviews exploring this topic. This study aimed to begin closing that gap, by systematically reviewing the literature examining women's experiences of menstruation whilst being homeless. In June 2020 (and updated in December 2022), we conducted comprehensive and systematic searches of four electronic databases: Medline, Web of Science, CINAHL, and PsychINFO, from which nine studies were found. The findings were thematically analyzed, using the enhancing transparency in reporting the synthesis of qualitative research tools (ENTREQ) guidelines. Three themes related to menstrual experiences were found: (1) challenges in the logistics of managing menstruation while homeless, (2) feelings of embarrassment, shame, and dignity linked to maintaining menstrual health, and (3) making do: how people experiencing homelessness manage challenges related to menstruation. We discuss barriers women face in getting necessary products and in accessing private, safe, and clean facilities to manage menstrual health. The study found that women living with homelessness often abandon other basic needs in favor of managing menstruation (i.e. using unsuitable materials, stealing, etc.), which furthers their risk. The findings highlight the need for future research to investigate the experiences of women who are menstruating while being homeless and what support they would find helpful. Results show that it is high time for commissioners and policy-makers to address the provision of menstrual resources as a basic human right.
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Affiliation(s)
| | - Jennifer Tarabay
- Department of Psychology, University of Southampton, Southampton, UK
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23
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Durairaj T, Aparnavi P, Narayanan S, Mahantshetti S, Dhandapani S, Shanmugam J, Rathinamoorthy R, Kumar M. Utilization of modern menstrual methods and related unmet needs among college going women in Coimbatore district: a descriptive cross-sectional study. BMC Womens Health 2024; 24:78. [PMID: 38291382 PMCID: PMC10826201 DOI: 10.1186/s12905-024-02915-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVES The primary objectives were to determine the proportion of modern menstrual method (MMM) users among college going women in Coimbatore district, Tamil Nadu; and to estimate the unmet needs associated with use of MMMs in comparison with other menstrual hygiene methods (MHMs). We also assessed the factors that determine MMM use among college going women. METHODS This was a descriptive cross-sectional study conducted among college going women in Coimbatore district, Tamil Nadu, India between October 2022 and January 2023 using a purpose predesigned, pretested, semi-structured proforma that included validated Menstrual Practice Needs Scale (MPNS-36). RESULTS Only 1.4% of the study participants used MMMs - menstrual cups (1.3%) and tampons (0.1%). Sanitary pads were the most common MHM of choice (96.3%); of which majority (98.6%) used disposable pads and more than half (50.4%) used non-biodegradable pads. Importantly, one in six (16.5%) were not aware of nature of sanitary pads (biodegradable or nonbiodegradable) used. The unmet needs associated with MMMs (menstrual cups and tampons) were significantly lower than that for other MHMs (including sanitary pads), in particular, the unmet material and home environment needs, unmet material reliability concerns, unmet reuse needs and unmet reuse insecurity. However, we found no significant difference between MMMs, sanitary pads and other MHMs in terms of unmet transport, college environment, change and disposal insecurity needs. The significant predictors of use of MMMs were age (more than 21 years of age), residence (urban), type of stay (off campus including home), socioeconomic status (upper), fathers' and mothers' education (high school and above), and presence of personal income. Discussions with friends (or peers) both before and after menarche regarding menstruation resulted in higher adoption of modern menstrual methods. CONCLUSION MMMs provided comparative advantage with lesser unmet needs for material reliability and reuse insecurity concerns, particularly in home environment. However, none of the MHMs fulfilled the user expectations for transport and disposal insecurity concerns, particularly outdoors.
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Affiliation(s)
- Thavansree Durairaj
- KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Periasamy Aparnavi
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Seetharaman Narayanan
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Sushmitha Mahantshetti
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Srihari Dhandapani
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Jeevithan Shanmugam
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Ramesh Rathinamoorthy
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Mohan Kumar
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India.
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24
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Tyson N, Kciuk O, Blumenthal PD. Going with the flow: the emergence of menstrual science. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:1-3. [PMID: 37643875 DOI: 10.1136/bmjsrh-2023-201972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Nichole Tyson
- Obstetrics and Gynecology, Stanford University, Stanford, California, USA
| | - Olga Kciuk
- Obstetrics and Gynecology, Stanford University, Stanford, California, USA
| | - Paul D Blumenthal
- Obstetrics and Gynecology, Stanford University, Stanford, California, USA
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25
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Palovick KA, Hunter E, Teni MT, Sebert Kuhlmann A. Period Product Insecurity Is Increasing in the United States: Trends from 2018 to 2021. J Womens Health (Larchmt) 2024; 33:20-27. [PMID: 38016121 DOI: 10.1089/jwh.2023.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Background: Data documenting period product insecurity, or an inability to access products, in the United States have recently emerged. With multiple years of data now available, we assessed trends in period product insecurity among two nationally representative samples of U.S. adults. Materials and Methods: Data from nationally representative, cross-sectional online surveys conducted in January 2018 and April 2021 were used to run weighted logistic regressions. Those aged 18-49 years and who had menstruated in the past year (n = 922 in 2018; n = 1037 in 2021) were included. Results: In 2021, 59% experienced period product insecurity compared with 53% in 2018. In 2018 (adjusted odds ratio [aOR] 1.91, confidence interval [95% CI]: 1.29-2.83) and 2021 (aOR 1.53, 95% CI: 1.06-2.21), Hispanic respondents were more likely to find products unaffordable. Some college attainment was associated with finding products unaffordable in 2018 (aOR 1.53, 95% CI: 1.00-2.34) and 2021 (aOR 1.97, 95% CI: 1.35-2.88). Participants struggling to purchase products had higher odds of experiencing period product insecurity in 2018 (aOR 11.78, 95% CI: 8.07-17.20) and 2021 (aOR 7.71, 95% CI: 5.44-10.93). Conclusions: Hispanic ethnicity, lower educational attainment, and struggling to purchase period products were strong predictors of finding products unaffordable and experiencing product insecurity in both 2018 and 2021. Policies that improve access to or affordability of period products in the United States are needed to help those most vulnerable.
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Affiliation(s)
- Kirstin A Palovick
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
| | - Emily Hunter
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
| | - Mintesnot T Teni
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
| | - Anne Sebert Kuhlmann
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
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26
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Massengale KEC, Bowman KM, Comer LH, Van Ness S. Breaking the period product insecurity cycle: An observational study of outcomes experienced by recipients of free period products in the United States. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241267104. [PMID: 39051651 PMCID: PMC11273700 DOI: 10.1177/17455057241267104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 06/13/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The United States is increasingly recognizing period product insecurity, insufficient access to menstrual products and limited private spaces for managing menstruation due to financial constraints, as an issue impacting the well-being and dignity of Americans. One strategy to address period product insecurity has been distributing free period products via period supply banks. The outcomes of period product distribution outside the school setting are absent from the literature. OBJECTIVES This study, a formative evaluation of the free period product distribution efforts of the Alliance for Period Supplies, aims to identify (1) characteristics of individuals receiving products from period supply banks and their experiences of period product insecurity and (2) health and social outcomes experienced by recipients of free period products. DESIGN Survey data collection occurred at two points: baseline and one-year follow-up. All study participants provided verbal consent. METHODS Between Fall 2018 and Spring 2020, 1863 baseline and 80 follow-up surveys were administered. Participants received free period products for themselves and/or a household member from one of 20 participating Alliance for Period Supplies period supply banks directly or from one of their 64 partner agencies. RESULTS At baseline, 72.4% of participants had to choose between buying period products and another basic need. One year after accessing a period supply bank, 36.3% of participants reported this experience (p = 0.018). Participants reported at baseline, on average, 7.8 days in the past year of avoiding seeing others, canceling appointments, or skipping work or school because they did not have access to period products. At follow-up, this was reduced to 1.2 days, on average, t(68) = 2.214, p < 0.05. CONCLUSION Period supply banks play an essential role in facilitating access to period products and the resulting benefits. Our study highlights the need for sustainable, well-funded policies and interventions to address period product insecurity effectively in society.
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Affiliation(s)
- Kelley EC Massengale
- National Diaper Bank Network, New Haven, CT, USA
- Alliance for Period Supplies, New Haven, CT, USA
| | - Kelsey M Bowman
- Duke University Sanford School of Public Policy, Durham, NC, USA
| | - Lynn H Comer
- National Diaper Bank Network, New Haven, CT, USA
- Alliance for Period Supplies, New Haven, CT, USA
| | - Susan Van Ness
- National Diaper Bank Network, New Haven, CT, USA
- Alliance for Period Supplies, New Haven, CT, USA
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Darivemula SM, Massengale KEC, Montiel C, Stuebe AM, Tully KP. Postpartum menstrual equity: Video and audio analysis of vaginal bleeding counseling during postpartum inpatient care at a southeastern US tertiary hospital. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241274897. [PMID: 39245926 PMCID: PMC11382225 DOI: 10.1177/17455057241274897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 06/16/2024] [Accepted: 07/26/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Despite the universal nature of postpartum vaginal bleeding after childbirth and the importance of managing vaginal bleeding in the postpartum period to monitor health status, little is known about the information or products that birthing individuals are provided. Investigating current practices may offer insights to enacting more supportive and equitable postpartum care. OBJECTIVE To evaluate the patterns and content of vaginal bleeding counseling provided to birthing parents while on a postnatal inpatient unit. DESIGN Observational study of inpatient postpartum care. Birthing parents and their companions consented to video and audio recording of themselves, their infants, and healthcare team members during their postnatal unit stay. METHODS Following IRB approval and in coordination with clinicians at a tertiary hospital in the southeastern United States, data were collected with 15 families from August to December 2020. A multidisciplinary team coded video and audio data from each family from 12 h before hospital discharge. This analysis evaluates patterns of vaginal bleeding counseling timing, content, and language concordance and thematic content of this communication. RESULTS Birthing parent participants were self-identified Hispanic White (n = 6), non-Hispanic Black (n = 5), non-Hispanic White (n = 3), and non-Hispanic multi-race (n = 1). Six were Spanish-speaking and eight had cesarean section births. The timing, content, and language concordance of vaginal bleeding communication varied, with these topics mainly addressed in the hour preceding discharge. Twelve of the 15 birthing parents had communication on these topics between 2 and 5 times, 2 had one exchange, and 1 had no counseling on postpartum bleeding observed. Four of the six Spanish-speaking birthing parents had counseling on these topics that was not language concordant. Postpartum vaginal bleeding management involved the themes of access to products, patient safety, and meaningful counseling. There was a lack of adequate access, variation in accurate and respectful care, and a busy clinical environment with differences in information provided. CONCLUSION Findings suggest that there are opportunities to strengthen clinical practices for more consistent, proactive, and language concordant vaginal bleeding and subsequent menstrual care postpartum. Menstrual equity is an important part of dignified and safe care.
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Affiliation(s)
- Shilpa M Darivemula
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kelley EC Massengale
- Diaper Bank of North Carolina, Durham, NC, USA
- National Diaper Bank Network, New Haven, CT, USA
- Alliance for Period Supplies, New Haven, CT, USA
| | - Catalina Montiel
- Neonatal-Pediatric Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison M Stuebe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristin P Tully
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Miller TA, Farley M, Reji J, Obeidi Y, Kelley V, Herbert M. Understanding period poverty and stigma: Highlighting the need for improved public health initiatives and provider awareness. J Am Pharm Assoc (2003) 2024; 64:218-221. [PMID: 37863396 DOI: 10.1016/j.japh.2023.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/02/2023] [Accepted: 10/15/2023] [Indexed: 10/22/2023]
Abstract
Period poverty affects millions of people who menstruate, but there is limited research to fully understand the scope and impact. Societal stigmas and cultural taboos negatively affect menstruation, a natural, biologic process. When unable to afford or find appropriate menstrual products, individuals may resort to alternative, poorer quality items, which increase their risk of infections. In addition, lack of products may cause individuals to miss events and have negative emotions. Implicit sexism and gender inequality are notable through the high cost of essential period products. Uncomfortable environments prevent patients from openly discussing menstruation with health care providers, who may lack training to competently assess needs and address barriers. Period poverty is a public health issue that not only needs to be addressed by our health care providers but also through increased education in schools and changes in local and federal legislation. In this paper, we discuss the financial, physical, and mental health impacts of period poverty and describe our experience creating a period pantry at a free medical clinic.
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Glayzer EJ, Jennings CT, Schlaeger JM, Watkins B, Rieseler A, Ray M, Lee A, Glayzer JE. Fighting for menstrual equity through period product pantries. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241281459. [PMID: 39290126 PMCID: PMC11412208 DOI: 10.1177/17455057241281459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 07/16/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Menstruators facing period poverty often struggle with menstrual hygiene and waste management, which can result in harmful short- and long-term health outcomes such as urinary tract infections, yeast infections, and vulvar contact dermatitis. Research indicates that 42% of menstruators in the United States have difficulty affording period products. Traditional methods of distributing period products through social services may unintentionally undermine menstruators' agency, leading to disempowerment and inefficient resource allocation. Period product pantries are a novel approach aimed at addressing period poverty, inequity, and inadequate menstrual health education in the United States. OBJECTIVES This paper aims to examine the development, organization, and implementation of two distinct period product pantry networks in Ohio and New York. It seeks to compare the advantages and challenges of grassroots versus nonprofit-led models and to provide practical insights for future pantry operators. DESIGN The study examines two models of period product pantries: a grassroots effort led by three local residents in Ohio and an initiative spearheaded by a nonprofit organization in New York. The design includes a comparative analysis of both models' organization, funding methods, and operational structures. METHODS The authors gathered data on the construction, operation, and usage of two pantry networks, focusing on factors such as accessibility, community engagement, and sustainability. The study employed a combination of qualitative methods, including interviews with organizers, and a review of organizational documents to analyze the effectiveness and scalability of each model. RESULTS Both pantry networks increased accessibility to period products in low socioeconomic neighborhoods, which are disproportionately affected by period poverty. The grassroots model, while resource-limited, fostered strong community ties and local engagement. The nonprofit-led model benefited from dedicated staff and a more stable funding structure but faced bureaucratic challenges. Despite their differences, both models demonstrated the potential to empower menstruators by preserving their dignity and autonomy. CONCLUSIONS Period product pantries represent an innovative and equitable approach to addressing period poverty and inequity. The analysis of the two models offers valuable insights for organizations and individuals interested in establishing similar initiatives. While each model has its unique benefits and challenges, both are effective in empowering menstruators and providing accessible menstrual hygiene products to those in need. REGISTRATION Not applicable.
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Affiliation(s)
- Edward J Glayzer
- Department of Sociology, Anthropology, and Social Work, University of Dayton, College of Social Sciences, Dayton, OH, USA
| | - Claire T Jennings
- New York State Public Health Corps Fellowship Program, Cornell Cooperative Extension, Schenectady County, Schenectady, NY, USA
| | - Judith M Schlaeger
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, IL, USA
| | - Brynn Watkins
- New York State Public Health Corps Fellowship Program, Cornell Cooperative Extension, Schenectady County, Schenectady, NY, USA
| | - Annabelle Rieseler
- New York State Public Health Corps Fellowship Program, Cornell Cooperative Extension, Albany County, Albany, NY, USA
| | - Melissa Ray
- AmeriCorps VISTA Program, Schenectady Community Ministries, Loudonville, NY, USA
| | - Adrienne Lee
- Community Health Centers of Greater Dayton, Dayton, OH, USA
| | - Jennifer E Glayzer
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, IL, USA
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Raney EC. Menstrual health matters. Period. J Am Pharm Assoc (2003) 2024; 64:222-225. [PMID: 37940100 DOI: 10.1016/j.japh.2023.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
Menstrual health is composed of physical and psychosocial factors and fundamental to the well-being of menstruating individuals. Clinicians are urged to assess markers of menstruation as a vital sign, informing potential current and future health risks. Period poverty, or lack of access to menstrual hygiene products, sanitation, and clinical support, is a concern worldwide, particularly for vulnerable populations. As global health authorities and professional medical associations call for menstrual health as a priority, pharmacists are well-positioned to contribute solutions through access, education, advocacy, and research.
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Massengale KEC, Comer LH, Bowman KM, Van Ness S. Enhancing client engagement and alleviating period product insecurity: A cross-sectional study of community-based period supply banks' distribution of free period products through intermediary partner agencies in the United States. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241259731. [PMID: 38842090 PMCID: PMC11160112 DOI: 10.1177/17455057241259731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/20/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Period products like pads, tampons, and a variety of disposable and reusable hygiene supplies constitute just one facet essential for effectively managing menstruation in a way that allows an individual to feel comfortable carrying out their daily routine. Given the absence of comprehensive public policies ensuring access to period products for economically disadvantaged menstruating individuals, community-based basic needs banks, particularly period supply banks, were established to alleviate the challenges faced by those experiencing period product insecurity. These initiatives specifically aim to furnish essential menstrual products to individuals in need. OBJECTIVES This study aimed to assess any organizational benefits experienced by community-based organizations distributing period products on behalf of period supply banks. DESIGN This cross-sectional study is a formative evaluation of the distribution of free period products by period supply banks, which provide access to essential menstrual hygiene products for individuals in need through partnership with community-based partner agencies. METHODS Staff members at agencies distributing period products were invited to complete an anonymous web-based survey at two different time points about their agency's experiences distributing free period products. All participants provided informed consent via the web-based survey. RESULTS Agency staff reported that since they started providing period products, clients were more likely to: start a conversation about other needs (66.7%), extend the length of their relationship with the agency (60.0%), keep scheduled appointments (62.1%), ask for assistance with another need (75.0%), communicate between visits (42.4%), participate in other agency programming (55.9%), and seek other agency services (73.5%). Due to a shortage of period products, 41% of agencies have had to turn away clients needing period supplies. CONCLUSION Period supply banks, in collaboration with community-based partner agencies, enhance access to both menstrual products and the associated support, fostering engagement with diverse resources and opportunities among recipients. However, addressing unmet needs necessitates policies and additional funding to ensure universal access to essential hygiene supplies for everyone to thrive and actively participate in society.
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Affiliation(s)
- Kelley EC Massengale
- National Diaper Bank Network, New Haven, CT, USA
- Alliance for Period Supplies, New Haven, CT, USA
| | - Lynn H Comer
- National Diaper Bank Network, New Haven, CT, USA
- Alliance for Period Supplies, New Haven, CT, USA
| | - Kelsey M Bowman
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Susan Van Ness
- National Diaper Bank Network, New Haven, CT, USA
- Alliance for Period Supplies, New Haven, CT, USA
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Suleman A, Krishna S, Krishnakumar D, Nemoto K, Nguyễn MLT, Mehta SD. A pilot survey of students' menstrual attitudes, experiences, and needs on an urban university campus. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241254713. [PMID: 38819035 PMCID: PMC11143816 DOI: 10.1177/17455057241254713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/19/2024] [Accepted: 04/24/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND In the United States, many menstruators face barriers to period management, such as period poverty, or the lack of access to relevant knowledge and affordable menstrual products. Our current understanding of the social, emotional, and physical impacts of period poverty on students in post-secondary institutions is largely limited. OBJECTIVES The purpose of this pilot study is to assess period poverty, period-related class disruption, and avoidance of menstrual hygiene management on campus among students and to identify recommendations for action at the University of Illinois Chicago and other urban universities. DESIGN An online cross-sectional study from February to May 2023. METHODS Enrolled students who were at least 18 years old completed an anonymous, self-administered online survey. Through descriptive statistics and chi-square tests in SAS version 9.4, we analyzed the sociodemographic, academic, and menstrual characteristics of those who had a period in the past 12 months. We also performed a thematic analysis of students' open-ended responses regarding their menstrual experiences on campus. RESULTS Of our sample (N = 106), 17.1% of students have faced period poverty, 55.8% experienced period-related class disruption, and 47.5% avoided changing their menstrual products on campus. The relationships between the three menstrual experiences were statistically significant. In the open responses, students reported that their personal experiences with menstruation were largely painful and disruptive. We identified the following themes: (1) inadequate water, sanitation, and hygiene facilities; (2) understocked, empty, or non-existent menstrual product dispensers; (3) a desire for additional resources for menstruation; and (4) the unpredictability of menstruation. CONCLUSION Our findings indicate that students continue to face obstacles to menstruation management due to inadequate support related to menstrual infrastructure, products, and pain. We outline several recommendations for university/college institutions to prioritize a more inclusive and supportive educational environment for all students.
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Affiliation(s)
- Abigail Suleman
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Shruthi Krishna
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Divya Krishnakumar
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Kai Nemoto
- College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - My Lê Thảo Nguyễn
- College of Liberal Arts and Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Supriya D Mehta
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
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Ramaiyer M, Lulseged B, Michel R, Ali F, Liang J, Borahay MA. Menstruation in the USA. CURR EPIDEMIOL REP 2023; 10:186-195. [PMID: 38275000 PMCID: PMC10810236 DOI: 10.1007/s40471-023-00333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/27/2024]
Abstract
Purpose of review Menstruation touches all spheres of human society, including psychology, education, business, policy, race, and religion. This narrative review aims to describe the relationship menstruation holds with these spaces. Recent findings First, menstruation plays many roles in psychology - premenstrual syndrome affects psychological wellbeing and in turn, psychological stress impacts menstruation. Functional hypothalamic amenorrhea can result when stress hormones inhibit the Hypothalamus-Pituitary-Ovarian axis. Furthermore, menstruation has many implications for all aged individuals, especially adolescents and those who are menopausal. These implications underscore the importance of proper education surrounding menstruation, which can be achieved via social media, school systems, family, and clinicians. However, menstrual health education is highly variable depending on the state and family that someone is raised in. Additionally, menstruation can pose a financial burden as menstrual products can be expensive and access to these products is limited for those who are homeless, incarcerated, and low-income. Recent public policy measures in various states have aimed to achieve "menstrual equity," by requiring public schools to supply free menstrual products in bathrooms. Furthermore, racial disparities exist with menstrual disorders. Uterine fibroids occur more frequently in Black menstruators compared to White menstruators, and Black women experience worse outcomes overall with fibroids and endometriosis management. Finally, analysis of religion and its relationship to menstruation underscores the immense stigma and "impurity" associated with menstruation. Summary Overall, this review highlights the universality of menstruation in society. As a "fifth vital sign", there is significant room for improvement in terms of education, research, and cultural acceptance of menstruation. Future research should explore interventions to reduce these gaps.
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Affiliation(s)
| | | | | | - Fiza Ali
- Johns Hopkins University, Krieger School of Arts and Sciences, Baltimore, MD
| | - Jinxiao Liang
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore MD
| | - Mostafa A. Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
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Davies S, Darien K, Bazyar F, Biddle J, Brown B, Christman C, Saurman M, Wood S, Thomas D, Dowshen N. A Multimodal Qualitative Approach to Understanding Menstrual Health Equity among Adolescents and Young Adults. J Pediatr Adolesc Gynecol 2023; 36:511-517. [PMID: 37543239 DOI: 10.1016/j.jpag.2023.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023]
Abstract
STUDY OBJECTIVE Menstrual inequity-unequal access to menstrual health care or products-negatively affects well-being in relation to the menstrual cycle, a construct known as menstrual health. Few studies have explored menstrual inequities among adolescent and young adult populations in the United States. This multimodal qualitative research aimed to explore factors that influence the lived experience of menstruation among this population. METHODS This qualitative study consisted of individual interviews among menstruators ages 13-24, recruited from an urban academic medical center. Participants (N = 20) were a mean age of 19 years; 25% previously endorsed period poverty, and 90% were publicly insured. We conducted semi-structured interviews using participant video diaries in a video elicitation exercise. Data were coded by 2 investigators using thematic analysis driven by grounded theory. RESULTS Emergent themes included the need to normalize menstruation, the need for comprehensive menstrual health education, and the need for menstrual products to be more accessible. Twelve youth prepared video diaries, and all reported positive experiences with the video process. CONCLUSIONS This youth-centered, multimodal study is one of the first to qualitatively explore the lived experiences of menstruation among adolescents in the United States and identified key inequities in menstrual health from their own perspectives. Thematic findings were mapped onto a proposed framework for menstrual equity that can be applied to future research and efforts around policy change. More research is needed to assess the impacts of these policies.
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Affiliation(s)
- Shelby Davies
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Kaja Darien
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Farnaz Bazyar
- Menstrual Health Equity Youth Advisory Board, Adolescent Specialty Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Janaya Biddle
- Menstrual Health Equity Youth Advisory Board, Adolescent Specialty Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bernice Brown
- Menstrual Health Equity Youth Advisory Board, Adolescent Specialty Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Colton Christman
- Menstrual Health Equity Youth Advisory Board, Adolescent Specialty Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maxwell Saurman
- Menstrual Health Equity Youth Advisory Board, Adolescent Specialty Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sarah Wood
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Nadia Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania
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Sanders SL, Douglas LD, Sill TE, Stewart K, Pieniazek N, Li C, Walters E, Al-Hashimi M, Fang L, Davidson RD, Banerjee S. Tetrapodal textured Janus textiles for accessible menstrual health. iScience 2023; 26:108224. [PMID: 38107878 PMCID: PMC10725076 DOI: 10.1016/j.isci.2023.108224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/15/2023] [Accepted: 10/12/2023] [Indexed: 12/19/2023] Open
Abstract
Menstruating individuals without access to adequate hygiene products often improvise with alternatives that pose health risks and limit their participation in society. We describe here a menstrual hygiene product based on low-cost materials, which are integrated onto fabrics to imbue unidirectional permeability. A body-facing "Janus" fabric top layer comprising ZnO tetrapods spray-coated onto polyester mosquito netting imparts hierarchical texturation, augmenting the micron-scale texturation derived from the weave of the underlying fabric. The asymmetric coating establishes a gradient in wettability, which underpins flash spreading and unidirectional permeability. The hygiene product accommodates a variety of absorptive media, which are sandwiched between the Janus layer and a second outward-facing coated densely woven fabric. An assembled prototype demonstrates outstanding ability to wick saline solutions and a menstrual fluid simulant while outperforming a variety of commercially alternatives. The results demonstrate a versatile menstrual health product that provides a combination of dryness, discretion, washability, and safety.
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Affiliation(s)
- Sarah L. Sanders
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Lacey D. Douglas
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Tiffany E. Sill
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Kaylyn Stewart
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Noah Pieniazek
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Chenxuan Li
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
| | - Eve Walters
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | | | - Lei Fang
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
| | - Rachel D. Davidson
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Sarbajit Banerjee
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
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Darivemula S, Knittel A, Flowers L, Moore S, Hall B, Kelecha H, Li X, Ramaswamy M, Kelly PJ. Menstrual Equity in the Criminal Legal System. J Womens Health (Larchmt) 2023; 32:927-931. [PMID: 37535828 PMCID: PMC10510683 DOI: 10.1089/jwh.2023.0085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/06/2023] [Indexed: 08/05/2023] Open
Abstract
Background: Menstrual equity, that is, access to menstrual products and safe menstruating environments, is a basic human right not available to many vulnerable populations. Methods: We conducted a cross-sectional survey with a convenience sample of women involved in the criminal legal system to document experiences with access to hygiene and menstrual products while incarcerated. Results: Of the 156 respondents, 62.6% had to trade or barter to receive even basic hygiene products such as soap or shampoo; food and personal favors were used as the common currency. More than half (53.8%) received less than five menstrual products at intake/initial processing; 29.5% had to trade or barter menstrual hygiene products. Almost one-quarter (23.1%) suffered negative health consequences from prolonged use of products because of limited supply. Discussion: Findings document the lack of menstrual equity among women involved in the criminal legal system. Assuring the human right of menstrual equity in this population requires changes at the legal, the policy, the institutional, and the individual level.
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Affiliation(s)
- Shilpa Darivemula
- University of North Carolina School of Medicine, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina, USA
| | - Andrea Knittel
- University of North Carolina School of Medicine, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina, USA
| | - Lisa Flowers
- Emory University School of Medicine, Department of Obstetrics and Gynecology, Atlanta, Georgia, USA
| | - Shawana Moore
- Emory University School of Nursing, Doctor of Nursing Practice Program, Atlanta, Georgia, USA
| | - Bianca Hall
- Montefiore Medical Center and Albert Einstein College of Medicine, Department of Obstetrics and Gynecology and Women's Health, New York, New York, USA
| | - Hebron Kelecha
- Northwestern University School of Medicine, Department of Obstetrics and Gynecology, Evanston, Illinois, USA
| | - Xinyang Li
- University of Kansas Medical Center, Department of Sociology, Kansas City, Kansas, USA
| | - Megha Ramaswamy
- University of Kansas Medical Center, Department of Sociology, Kansas City, Kansas, USA
| | - Patricia J. Kelly
- Thomas Jefferson University School of Nursing, Department of Research Development, Philadelphia, Pennsylvania, USA
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Sebert Kuhlmann A, Palovick KA, Teni MT, Hunter E. Period Product Resources and Needs in Schools: A Statewide Survey of Missouri's School Nurses. THE JOURNAL OF SCHOOL HEALTH 2023; 93:557-564. [PMID: 36893763 DOI: 10.1111/josh.13326] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/13/2023] [Accepted: 02/26/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND School nurses play a vital role in ensuring the health and well-being of their students, but little is known about menstrual products and resources available in schools. This study assessed period product resources and needs in Missouri schools from the perspective of school nurses and analyzed differences by district enrollment characteristics. METHODS An electronic survey was emailed to public, charter, private, and parochial school nurses in Missouri who served fourth grade or older. From January through March 2022, 976 self-administered surveys were completed (40% response rate). Logistic regressions examined the associations between student needs and district characteristics. RESULTS Among the sample, 70.7% knew students who could not afford period products, and 68.0% knew students who had missed school because of their period. When controlling for district size, race/ethnicity, and urban/rural classification, as the percentage free- or reduced-lunch (FRL) eligibility increases in a school, awareness of students struggling to afford products increases (AOR = 1.008, 95% confidence interval 1.000, 1.015). IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY School nurses need the resources and educational materials to support students to help reduce menstruation-related absences. CONCLUSIONS Issues of period poverty cut across districts of differing enrollment characteristics, yet FRL percentage is an important predictor.
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Affiliation(s)
- Anne Sebert Kuhlmann
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
| | - Kirstin A Palovick
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
| | - Mintesnot T Teni
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
| | - Emily Hunter
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
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Nabiryo M, Ondia M, Izudi J. Behaviors and practices of incarcerated women towards menstrual hygiene in a large urban prison in Uganda: a phenomenological qualitative study. BMC Womens Health 2023; 23:339. [PMID: 37370083 DOI: 10.1186/s12905-023-02462-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Deplorable and unconducive conditions in prisons present serious challenges to menstrual hygiene management. However, little is known about menstrual hygiene among incarcerated women in Uganda. Our study explored the behaviors and practices of incarcerated women regarding menstrual hygiene management in a large government prison in Uganda. In addition, we explored the barriers to menstrual hygiene management in this population. METHODS In this phenomenological qualitative study, we conducted in-depth interviews with incarcerated women aged 20-49 years and key informant interviews with female prison officers (wardresses) at Luzira Prison in Kampala, Uganda. The data were analyzed using content analysis and the findings were presented using themes/sub-themes along with participant quotes. RESULTS We interviewed 15 incarcerated women aged 20-49 years (mean age, 29.5 ± 8.7 years) and five key informants aged 30-50 years (mean, 42.6 ± 4.9) about menstrual hygiene behaviors and practices, including barriers to menstrual hygiene. Five sub-themes emerged concerning behaviors and practices of menstrual hygiene among incarcerated women. Findings reveal the behaviors and practices of menstrual hygiene management were characterized by infrequent change of menstrual pads, lack of privacy during menstrual hygiene practices, use of poor-quality menstrual hygiene materials, and improper disposal of used sanitary products. However, bathing with soap and water during menstruation was frequent and non-restricted. Three sub-themes emerged as barriers to menstrual hygiene practices, largely at the institutional level, and they included unhygienic sanitary facilities, unreliable access to clean water, and insufficient sanitary products. CONCLUSIONS Behaviors and practices of incarcerated women fall short of desired standards and they face several barriers to practicing menstrual hygiene. The prison authorities should provide sufficient sanitary products like pads, and knickers including soap, construct more sanitary facilities, educate about the safe disposal of used sanitary products, and provide sufficient clean water to promote good menstrual hygiene management among incarcerated women.
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Affiliation(s)
- Margaret Nabiryo
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda.
| | - Miriam Ondia
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda.
| | - Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda.
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Delanerolle G, Yang XJ, Cavalini H, Kurmi OP, Røstvik CM, Shetty A, Saraswat L, Taylor J, Sajid S, Rathod S, Shi JQ, Phiri P. Exploratory systematic review and meta-analysis on period poverty. World J Meta-Anal 2023; 11:196-217. [DOI: 10.13105/wjma.v11.i5.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/18/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Period poverty is a global health and social issue that needs to be addressed. It has been reported that many females compromise their education, employment, and social commitments during their menstruation days due to a number of reasons, including lack of access to toilets or menstrual products.
AIM To provide a comprehensive understanding on period poverty, including outcomes associated with menstruation.
METHODS All observational and randomised clinical trials reporting menstruation challenges, menstrual poverty and menstrual products were included. Our search strategy included multiple electronic databases of PubMed, Web of Science, ScienceDirect, ProQuest and EMBASE. Studies published in a peer review journal in English between the 30th of April 1980 and the 30th of April 2022 were included. The Newcastle-Ottawa Scale was used to assess the risk of bias of the systematic included studies. Pooled odds ratios (ORs) together with 95% confidence intervals (CIs) are reported overall and for sub-groups.
RESULTS A total of 80 studies were systematically selected, where 38 were included in the meta-analysis. Of the 38 studies, 28 focused on children and young girls (i.e., 10-24 years old) and 10 included participants with a wider age range of 15-49 years. The prevalence of using disposable sanitary pads was 45% (95%CI: 0.35-0.58). The prevalence of menstrual education pre-menarche was 68% (95%CI: 0.56-0.82). The prevalence of good menstrual hygiene management (MHM) was 39% (95%CI: 0.25-0.61). Women in rural areas (OR = 0.30, 95%CI: 0.13-0.69) were 0.70 times less likely to have good MHM practices than those living in urban areas.
CONCLUSION There was a lack of evidence, especially from low- and middle- income countries. Further research to better understand the scope and prevalence of period poverty should be considered. This will enable the development of improved policies to increase access to menstrual products and medical support where necessary.
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Affiliation(s)
- Gayathri Delanerolle
- Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Xiao-Jie Yang
- School of Statistics and Mathematics, Yunnan University of Finance and Economics, Kunming 650221, Yunnan Province, China
- University College London, London WC1E 6BT, United Kingdom
| | - Heitor Cavalini
- Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Om P Kurmi
- Centre for Intelligent Healthcare, Institute of Health and Wellbeing, Coventry University, Coventry CV1 5LB, United Kingdom
| | - Camilla Mørk Røstvik
- Centre for Contemporary Art, University of St Andrews, Scotland KY16 9AJ, United Kingdom
| | - Ashish Shetty
- University College London, London WC1E 6BT, United Kingdom
- Pain Management Centre, University College London Hospitals NHS Foundation Trust, London W1T 4AJ, United Kingdom
| | - Lucky Saraswat
- Aberdeen Centre for Women’s Health, University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
| | - Julie Taylor
- School of Nursing, University of Birmingham, Birmingham B152TT, United Kingdom
| | - Sana Sajid
- Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Shanaya Rathod
- Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Jian-Qing Shi
- Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Peter Phiri
- Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
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Avelar Portillo LJ, Kayser GL, Ko C, Vasquez A, Gonzalez J, Avelar DJ, Alvarenga N, Franklin M, Chiang YY. Water, Sanitation, and Hygiene (WaSH) insecurity in unhoused communities of Los Angeles, California. Int J Equity Health 2023; 22:108. [PMID: 37264411 PMCID: PMC10233557 DOI: 10.1186/s12939-023-01920-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/20/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Access to water and sanitation is a basic human right; however, in many parts of the world, communities experience water, sanitation, and hygiene (WaSH) insecurity. While WaSH insecurity is prevalent in many low and middle-income countries, it is also a problem in high-income countries, like the United States, as is evident in vulnerable populations, including people experiencing homelessness. Limited knowledge exists about the coping strategies unhoused people use to access WaSH services. This study, therefore, examines WaSH access among unhoused communities in Los Angeles, California, a city with the second-highest count of unhoused people across the nation. METHODS We conducted a cross-sectional study using a snowball sampling technique with 263 unhoused people living in Skid Row, Los Angeles. We calculated frequencies and used multivariable models to describe (1) how unhoused communities cope and gain access to WaSH services in different places, and (2) what individual-level factors contribute to unhoused people's ability to access WaSH services. RESULTS Our findings reveal that access to WaSH services for unhoused communities in Los Angeles is most difficult at night. Reduced access to overnight sanitation resulted in 19% of the sample population using buckets inside their tents and 28% openly defecating in public spaces. Bottled water and public taps are the primary drinking water source, but 6% of the sample reported obtaining water from fire hydrants, and 50% of the population stores water for night use. Unhoused people also had limited access to water and soap for hand hygiene throughout the day, with 17% of the sample relying on hand sanitizer to clean their hands. Shower and laundry access were among the most limited services available, and reduced people's ability to maintain body hygiene practices and limited employment opportunities. Our regression models suggest that WaSH access is not homogenous among the unhoused. Community differences exist; the odds of having difficulty accessing sanitation services is two times greater for those living outside of Skid Row (Adj OR: 2.52; 95% CI: 1.08-6.37) and three times greater for people who have been unhoused for more than six years compared to people who have been unhoused for less than a year (Adj OR: 3.26; 95% CI: 1.36-8.07). CONCLUSION Overall, this study suggests a need for more permanent, 24-h access to WaSH services for unhoused communities living in Skid Row, including toilets, drinking water, water and soap for hand hygiene, showers, and laundry services.
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Affiliation(s)
- Lourdes Johanna Avelar Portillo
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California (UCSD), 9500 Gilman Drive, La Jolla, CA, 92093, USA.
- Benioff Homelessness and Housing Initiative, School of Medicine, University of California San Francisco, 2789 25th Street, San Francisco, CA, 94110, USA.
| | - Georgia L Kayser
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California (UCSD), 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Charlene Ko
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Angelica Vasquez
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Jimena Gonzalez
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Diego Jose Avelar
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Nayib Alvarenga
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Meredith Franklin
- Department of Statistical Sciences, University of Toronto, 700 University Ave., Toronto, ON, Canada
| | - Yao-Yi Chiang
- Department of Computer Science and Engineering, University of Minnesota, 200 Union St. SE, Minneapolis, MN, 55455, USA
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Medina-Perucha L, López-Jiménez T, Jacques-Aviñó C, Holst AS, Valls-Llobet C, Munrós-Feliu J, Martínez-Bueno C, Pinzón-Sanabria D, Vicente-Hernández MM, Berenguera A. Menstruation and social inequities in Spain: a cross-sectional online survey-based study. Int J Equity Health 2023; 22:92. [PMID: 37198680 DOI: 10.1186/s12939-023-01904-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/30/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Available research suggests that menstrual inequity has an impact on (menstrual) health outcomes and emotional wellbeing. It is also a significant barrier to achieve social and gender equity and compromises human rights and social justice. The aim of this study was to describe menstrual inequities and their associations with sociodemographic factors, among women and people who menstruate (PWM) aged 18-55 in Spain. METHODS A cross-sectional survey-based study was conducted in Spain between March and July 2021. Descriptive statistical analyses and multivariate logistic regression models were performed. RESULTS A total of 22,823 women and PWM were included in the analyses (Mean age = 33.2, SD = 8.7). Over half of the participants had accessed healthcare services for menstruation (61.9%). The odds for accessing menstrual-related services were significantly higher among participants with university education (aOR: 1.48, 95% CI, 1.13-1.95). Also, 57.8% reported having had partial or no menstrual education pre-menarche, with odds being higher among participants born in non-European or Latin American countries (aOR: 0.58, 95% CI, 0.36-0.93). Lifetime self-reported menstrual poverty was between 22.2-39.9%. Main risk factors for menstrual poverty were identifying as non-binary (aOR: 1.67, 95% CI, 1.32-2.11), being born in non-European or Latin American countries (aOR: 2.74, 95% CI, 1.77-4.24), and not having a permit to reside in Spain (aOR: 4.27, 95% CI, 1.94-9.38). Completed university education (aOR: 0.61, 95% CI, 0.44-0.84) and no financial hardship < 12 months (aOR: 0.06, 95% CI, 0.06-0.07) were protective factors for menstrual poverty. Besides, 75.2% reported having overused menstrual products due to lack of access to adequate menstrual management facilities. Menstrual-related discrimination was reported by 44.5% of the participants. Non-binary participants (aOR: 1.88, 95% CI, 1.52-2.33) and those who did not have a permit to reside in Spain (aOR: 2.11, 95% CI, 1.10-4.03) had higher odds of reporting menstrual-related discrimination. Work and education absenteeism were reported by 20.3% and 62.7% of the participants, respectively. CONCLUSIONS Our study suggests that menstrual inequities affect a high number of women and PWM in Spain, especially those more socioeconomically deprived, vulnerabilised migrant populations and non-binary and trans menstruators. Findings from this study can be valuable to inform future research and menstrual inequity policies.
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Affiliation(s)
- Laura Medina-Perucha
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Gran Via de Les Corts Catalanes 587 Attic, 08007, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.
| | - Tomàs López-Jiménez
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Gran Via de Les Corts Catalanes 587 Attic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Gran Via de Les Corts Catalanes 587 Attic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Anna Sofie Holst
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Gran Via de Les Corts Catalanes 587 Attic, 08007, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Jordina Munrós-Feliu
- Atenció a La Salut Sexual I Reproductiva (ASSIR) Muntanya/La Mina, Institut Català de La Salut, Barcelona, Spain
- Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain
| | - Cristina Martínez-Bueno
- Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain
- Servei d'Atenció a La Salut Sexual I Reproductiva (ASSIR). Direcció Assistencial d'Atenció Primària. Institut Català de La Salut, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | | | | | - Anna Berenguera
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Gran Via de Les Corts Catalanes 587 Attic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Departament d'Infermeria, Universitat de Girona, Girona, Spain
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Schmitt ML, Dimond K, Maroko AR, Phillips-Howard PA, Gruer C, Berry A, Nash D, Kochhar S, Sommer M. "I stretch them out as long as possible:" U.S. women's experiences of menstrual product insecurity during the COVID-19 pandemic. BMC Womens Health 2023; 23:179. [PMID: 37060006 PMCID: PMC10104689 DOI: 10.1186/s12905-023-02333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 04/05/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND A growing body of evidence highlights how the COVID-19 pandemic has exacerbated gender inequalities in the US. This resulted in women being more vulnerable to economic insecurity and decreases in their overall well-being. One relevant issue that has been less explored is that of women's menstrual health experiences, including how inconsistent access to menstrual products may negatively impact their daily lives. METHODS This qualitative study, conducted from March through May 2021, utilized in-depth interviews that were nested within a national prospective cohort study. The interviews (n = 25) were conducted with a sub-sample of cis-gender women living across the US who had reported challenges accessing products during the first year of the pandemic. The interviews sought to understand the barriers that contributed to experiencing menstrual product insecurity, and related coping mechanisms. Malterud's 'systematic text condensation', an inductive thematic analysis method, was utilized to analyze the qualitative transcripts. RESULTS Respondents came from 17 different states across the U.S. Three key themes were identified: financial and physical barriers existed to consistent menstrual product access; a range of coping strategies in response to menstrual product insecurity, including dependence on makeshift and poorer quality materials; and heightened experiences of menstrual-related anxiety and shame, especially regarding the disclosure of their menstruating status to others as a result of inadequate menstrual leak protection. CONCLUSIONS Addressing menstrual product insecurity is a critical step for ensuring that all people who menstruate can attain their most basic menstrual health needs. Key recommendations for mitigating the impact of menstrual product insecurity require national and state-level policy reform, such as the inclusion of menstrual products in existing safety net basic needs programs, and the reframing of menstrual products as essential items. Improved education and advocacy are needed to combat menstrual stigma.
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Affiliation(s)
- Margaret L Schmitt
- Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA.
| | - Katie Dimond
- Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA
| | - Andrew R Maroko
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, USA
| | | | - Caitlin Gruer
- Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, USA
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, USA
| | - Marni Sommer
- Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA
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Liberty A, Samuelson Bannow B, Matteson K, Edelman A, Colwill A. Menstrual Technology Innovations and the Implications for Heavy Menstrual Bleeding. Obstet Gynecol 2023; 141:666-673. [PMID: 36791417 PMCID: PMC10026971 DOI: 10.1097/aog.0000000000005126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/20/2022] [Accepted: 01/05/2023] [Indexed: 02/17/2023]
Abstract
Menstruation is a personal and cultural experience with financial and health implications. Menstruation historically has been managed with disposable commodities, including tampons and pads. New technologies, including underwear and menstrual cups and discs, have emerged to address diverse menstrual needs such as prioritization of sustainability, discretion, and inclusivity. New technologies are not routinely integrated into history taking or validated questionnaires, which currently rely on traditional tampon and pad use for identifying individuals with heavy menstrual bleeding. Review of menstrual technologies and accessories provides insight to empower gynecologists and other clinicians to take comprehensive menstrual histories, including strategies for identification of heavy menstrual bleeding and troubleshooting menstrual disturbances, within the context of new menstrual technologies.
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Affiliation(s)
- Abigail Liberty
- Division of Family Planning, Department of Obstetrics and Gynecology, and the Division of Hematology/Medical Oncology, Department of Medicine, Oregon Health and Science University, Portland, Oregon; and the Department of Obstetrics and Gynecology, UMass Memorial Medical Center, Worcester, Massachusetts
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Trant AA, Espinal M, Kisanga EP, Vash-Margita A, Lundsberg L, Sheth SS, Fan L. Optimizing menstrual health and hygiene management in the U.S.: A mixed-methods study of the barriers and the role of healthcare professionals. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100808. [PMID: 36563412 DOI: 10.1016/j.srhc.2022.100808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 11/26/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Menstrual health (MH) practices have been understudied in the U.S. This study aimed to assess patient and medical staff views of MH. METHODS The mixed-methods approach included medical staff and patient surveys, and patient interviews on MH experiences. Quantitative survey data generated descriptive statistics. Thematic content analysis (TCA) evaluated qualitative interviews. Convergent Parallel Triangulation Analysis (CPTA) evaluated both datasets in tandem. RESULTS The medical staff survey's response rate was 72% (54 participants/75 invited staff). Only 7% (4/54) of staff consistently asked patients about menstrual products (MP), while 54% (29/54) were concerned about patients affording MP. The patient survey's response rate was 90% (186/207); 22% (40/186) of respondents showed MH insecurity, which was associated with annual income <$30,000 (p < 0.01); 45% (85/186) missed commitments during menses; 53% (98/186) never discussed MP with healthcare providers. To reach thematic saturation 10/17 invited patients were interviewed. Five themes were identified through TCA: menstruation as a social barrier; menstrual education comes from a variety of sources; MP choice is a balance of comfort, cost, and convenience; patients value relationships with their providers; adolescence is the window for establishing MH. Three threads were identified through CPTA: MH insecurity is common; MH screening and education are limited; menstruation impacts patients' ability to engage in daily activities. CONCLUSION A holistic approach toward MH is needed; education and screening are inconsistent. Comprehensive MH can enhance a patient's understanding of and capacity to advocate for their health. These findings are specific to this population and may not be generalizable.
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Affiliation(s)
| | - Mariana Espinal
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States
| | | | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States
| | - Lisbet Lundsberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States
| | - Sangini S Sheth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States
| | - Linda Fan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States.
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Smoyer AB, Pittman A, Borzillo P. Humans peeing: Justice-involved women's access to toilets in public spaces. PLoS One 2023; 18:e0282917. [PMID: 36897925 PMCID: PMC10004595 DOI: 10.1371/journal.pone.0282917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Justice-involved women face myriad challenges as they negotiate the terms of community supervision and manage the long-term implications and stigma of living with a criminal record. Major tasks that women juggle include securing safe, affordable housing, finding and retaining employment, accessing physical and mental health care (including substance use treatment), and handling relationships with family, friends, children, and intimate partners. In addition to these responsibilities, women must meet their basic physiological needs to eat, sleep, and use the toilet. Women's ability to safely meet their personal care needs may impact their capacity to manage their criminal-legal challenges. This study uses qualitative methods to understand justice-involved women's lived experiences related to urination. Specifically, the study reports on a thematic analysis of 8 focus groups conducted with justice-involved women (n = 58) and the results of a toilet audit conducted in the downtown areas of the small city in the United States where the focus group participants were living. Findings suggest that women had limited access to restrooms and reported urinating outside. Lack of restroom access impacted their engagement with social services support and employment and their ability to travel through public spaces. Women perceived their public toilet options as unsafe, increasing their sense of vulnerability and reinforcing the idea that they did not have full access to citizenship in the community because of their criminal-legal involvement. The exclusion and denial of women's humanity that is perpetuated by a lack of public toilet access impacts women's psychosocial outcomes. City governments, social service agencies, and employers are encouraged to consider how lack of toilet access may impact their public safety and criminal-legal objectives and expand opportunities for people to access safe restroom facilities.
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Affiliation(s)
- Amy B. Smoyer
- Department of Social Work, College of Health and Human Services, Southern Connecticut State University, New Haven, Connecticut, United States of America
- * E-mail:
| | - Adam Pittman
- Department of Sociology, College of Arts and Sciences, Southern Connecticut State University, New Haven, Connecticut, United States of America
| | - Peter Borzillo
- Department of Curriculum and Learning, College of Education, Southern Connecticut State University, New Haven, Connecticut, United States of America
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Bedrick BS, Sufrin C, Polk S. Adolescent and Young Adult Menstrual Poverty: a Barrier to Contraceptive Choice. Pediatrics 2023; 151:190253. [PMID: 36478062 DOI: 10.1542/peds.2022-058172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Carolyn Sufrin
- Departments of Gynecology and Obstetrics.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Polk
- Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.,Johns Hopkins Centro SOL, Baltimore, Maryland
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47
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Harrison ME, Davies S, Tyson N, Swartzendruber A, Grubb LK, Alderman EM. NASPAG Position Statement: Eliminating Period Poverty in Adolescents and Young Adults Living in North America. J Pediatr Adolesc Gynecol 2022; 35:609-611. [PMID: 35933081 DOI: 10.1016/j.jpag.2022.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Megan E Harrison
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, Canada K1H8L1.
| | - Shelby Davies
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, Canada K1H8L1
| | - Nichole Tyson
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, Canada K1H8L1
| | - Andrea Swartzendruber
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, Canada K1H8L1
| | - Laura K Grubb
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, Canada K1H8L1
| | - Elizabeth M Alderman
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, Canada K1H8L1
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Hunter E, Palovick K, Teni MT, Sebert Kuhlmann A. COVID-19 made it harder to access period products: The effects of a pandemic on period poverty. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:1003040. [PMID: 36438906 PMCID: PMC9685992 DOI: 10.3389/frph.2022.1003040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2023] Open
Abstract
Background Prior to the COVID-19 pandemic, a few studies started to highlight the extent of period poverty in the U.S., especially among low-income women and girls. Preliminary data documenting the effects of the pandemic, subsequent economic downturn, and closure of schools and businesses on menstrual hygiene management are now emerging. Objective This study explores the relationship between the effects of the COVID-19 pandemic and period poverty among a nationally representative sample of U.S. adults. Methods Cross-sectional, secondary analyses of a 2021 nationwide, self-administered, online panel survey used weighted logistic regressions to assess the relationship between the COVID-19 pandemic making it more difficult to access products and missing work due to a lack of products. Responses from 1,037 menstruating individuals age 18-49 were included. Results Overall, 30% of the sample indicated the COVID-19 pandemic made it more difficult to access period products, 29% struggled to purchase period products in the past year, and 18% missed work due to a lack of period products. Those who identified as Hispanic (aOR 2.06 95% CI 1.29-3.29) and had children under 18 (aOR 15.3 95% CI 1.03-2.26) were more likely to indicate that the pandemic made it harder to access period products. Subsequently, those who indicated that the pandemic made it more difficult to access period supplies were more likely to report missing work due to a lack of period products in the past 12 months (aOR 4.32 95% CI 4.69-6.94). Discussion The COVID-19 pandemic exacerbated period poverty, especially among those in the U.S. who struggle with accessibility and affordability of products. Future pandemic response planning should consider period products as a basic need for vulnerable households. In addition, policies that increase the affordability and accessibility of period products for all should help reduce menstruation-related absenteeism from work.
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Affiliation(s)
| | | | | | - Anne Sebert Kuhlmann
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
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Knighton SC. Ideal or real: A call to harness infection prevention education and resources through the lens of equity, inclusion and hygiene poverty. Am J Infect Control 2022; 50:1077-1078. [PMID: 36150793 DOI: 10.1016/j.ajic.2022.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Shanina C Knighton
- Association for Professions in Infection Control and Epidemiology, Center for Research, Practice and Innovation, Arlington, VA; Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH.
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Period poverty: The perceptions and experiences of impoverished women living in an inner-city area of Northwest England. PLoS One 2022; 17:e0269341. [PMID: 35834506 PMCID: PMC9282460 DOI: 10.1371/journal.pone.0269341] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The menstrual needs of girls and women are important to health, education, and well-being. Unmet need and harm from poor menstrual health in low-and- middle-income countries have been documented, but with little empirical research undertaken in high income countries. Continuing austerity in the UK suggests menstruators are likely more vulnerable to 'period poverty' than previously, with the COVID-19 pandemic assumed to exacerbate the situation. AIM To explore the menstrual experiences and perceptions of women in the UK who are living under circumstances of deprivation, alongside views of staff working in organisations supporting these women, to understand whether women's menstrual needs are met. METHODS A qualitative study was conducted in an inner-city in NW England. Three focus group discussions and 14 in-depth interviews were conducted across three study sites supporting impoverished women. Data was analysed thematically. RESULTS Themes were: reflections on menstruation; affordability of products; access to public facilities; organisational support; potential solutions. Many women perceived menstruation as a burden in three aspects: physical discomfort and pain; psychological anxiety; and shame and stigma. Managing menstruation was difficult due to cost relative to low incomes, with food, heating and lighting prioritised, leaving women improvising with materials or wearing products for longer than desired. Most suggested that products should be free, often remarking if men required similar items this would happen. Most women were unaware supporting organisations provided free products. Staff felt the small range of products offered did not meet client needs and were ill-prepared to have conversations on products and clients' menstrual needs. CONCLUSION Impoverished women lack the necessary resources to manage their menses well which negatively impacts their health and brings stress, embarrassment, and shame. Support, including access to free products, is needed at both local and national level to help impoverished women manage their menstrual hygiene.
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