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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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Bergen S, Maughan ED, Johnson KE, Cogan R, Secor M, Sommer M. The History of US Menstrual Health, School Nurses, and the Future of Menstrual Health Equity. Am J Public Health 2024; 114:903-908. [PMID: 39024527 PMCID: PMC11306616 DOI: 10.2105/ajph.2024.307705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 07/20/2024]
Abstract
In the United States, adolescents suffer from inadequate menstrual health, meaning that adolescents are unprepared for menarche, lack the practical resources they need to comfortably and confidently manage menstruation, and receive inadequate health education and care for menstrual pain and disorders. In this article, we provide a historical analysis of the role of school nurses in addressing menstruation from the early 20th century up to the present day. We contextualize the current realities of school nursing and menstrual health education and clinical support. We argue that the decentralized US school system, a cultural aversion to open discussion about menstruation, and the outsized influence of commercial menstrual product manufacturers have hampered the ability of school nurses to deliver menstrual health education along with menstrual health support. Finally, we discuss implications for today's schooling experiences as well as recommendations for how to support school nurses in aligning our national approach to menstrual health toward the public health perspective of menstrual equity. (Am J Public Health. 2024;114(9):903-908. https://doi.org/10.2105/AJPH.2024.307705).
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Affiliation(s)
- Sadie Bergen
- Sadie Bergen and Marni Sommer are with the Department of Sociomedical Sciences at Columbia University Mailman School of Public Health, New York, NY. Erin D. Maughan is with the George Mason University College of Public Health, Fairfax, VA. Karen E. Johnson is with the University of Texas at Austin School of Nursing. Robin Cogan is with Rutgers School of Nursing and is a school nurse in the Camden City School District, Camden, NJ. Molly Secor is with Montana State University Mark and Robyn Jones College of Nursing, Bozeman
| | - Erin D Maughan
- Sadie Bergen and Marni Sommer are with the Department of Sociomedical Sciences at Columbia University Mailman School of Public Health, New York, NY. Erin D. Maughan is with the George Mason University College of Public Health, Fairfax, VA. Karen E. Johnson is with the University of Texas at Austin School of Nursing. Robin Cogan is with Rutgers School of Nursing and is a school nurse in the Camden City School District, Camden, NJ. Molly Secor is with Montana State University Mark and Robyn Jones College of Nursing, Bozeman
| | - Karen E Johnson
- Sadie Bergen and Marni Sommer are with the Department of Sociomedical Sciences at Columbia University Mailman School of Public Health, New York, NY. Erin D. Maughan is with the George Mason University College of Public Health, Fairfax, VA. Karen E. Johnson is with the University of Texas at Austin School of Nursing. Robin Cogan is with Rutgers School of Nursing and is a school nurse in the Camden City School District, Camden, NJ. Molly Secor is with Montana State University Mark and Robyn Jones College of Nursing, Bozeman
| | - Robin Cogan
- Sadie Bergen and Marni Sommer are with the Department of Sociomedical Sciences at Columbia University Mailman School of Public Health, New York, NY. Erin D. Maughan is with the George Mason University College of Public Health, Fairfax, VA. Karen E. Johnson is with the University of Texas at Austin School of Nursing. Robin Cogan is with Rutgers School of Nursing and is a school nurse in the Camden City School District, Camden, NJ. Molly Secor is with Montana State University Mark and Robyn Jones College of Nursing, Bozeman
| | - Molly Secor
- Sadie Bergen and Marni Sommer are with the Department of Sociomedical Sciences at Columbia University Mailman School of Public Health, New York, NY. Erin D. Maughan is with the George Mason University College of Public Health, Fairfax, VA. Karen E. Johnson is with the University of Texas at Austin School of Nursing. Robin Cogan is with Rutgers School of Nursing and is a school nurse in the Camden City School District, Camden, NJ. Molly Secor is with Montana State University Mark and Robyn Jones College of Nursing, Bozeman
| | - Marni Sommer
- Sadie Bergen and Marni Sommer are with the Department of Sociomedical Sciences at Columbia University Mailman School of Public Health, New York, NY. Erin D. Maughan is with the George Mason University College of Public Health, Fairfax, VA. Karen E. Johnson is with the University of Texas at Austin School of Nursing. Robin Cogan is with Rutgers School of Nursing and is a school nurse in the Camden City School District, Camden, NJ. Molly Secor is with Montana State University Mark and Robyn Jones College of Nursing, Bozeman
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Kuhlmann AKS, Palovick KA, Allen C, Teni MT, Marshall C. Period Product Resources and Needs in Missouri Schools: Focus Group Discussions with School Nurses. J Sch Nurs 2024:10598405241247553. [PMID: 38646704 DOI: 10.1177/10598405241247553] [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: 04/23/2024] Open
Abstract
This study explored period product resources and needs in Missouri schools from the perspective of school nurses. We conducted eight focus groups with school nurses (n = 51) across Missouri using purposive sampling. Focus group data were analyzed in Dedoose via multiple coders and achieved strong inter-rater reliability (Cohen's Kappa = 0.92). Several interconnected themes with associated sub-themes were identified. First, school nurses do not have sufficient resources to help students manage menstruation and minimize menstruation-related absenteeism. Second, schools' heavy reliance on donations can lead to inconsistencies in supply and a mismatch between what is donated and what is most needed. Third, school nurses desire additional educational resources around menstruation management for students and caregivers. Nurse-identified themes can help inform recommendations for improving schools' response to students' menstrual hygiene needs by highlighting priorities for educational content, resources, and product acquisition with a goal of ensuring the suitability and sustainability of MHM in schools.
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Affiliation(s)
- Anne K Sebert Kuhlmann
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Kirstin A Palovick
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Casey Allen
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Mintesnot T Teni
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Cheleia Marshall
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
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Shah S, Shenkman J, Chicojay T, Kamiri-Ong J, DiPaolo M, DeClemente T, Fishman E, Phillips-Howard P, Neubauer LC. Building a Future for School-Based Menstruation Health and Hygiene (MHH): Evaluating Implementation of a Menstrual Hygiene Management (MHM) Policy in Chicago Public Schools. J Prev Interv Community 2024; 52:353-374. [PMID: 39037645 DOI: 10.1080/10852352.2024.2379082] [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: 07/23/2024]
Abstract
Menstrual health and hygiene (MHH) inequities disproportionately impact communities who are marginalized. In 2018, Illinois passed the Learn with Dignity Act (LWDA) requiring schools to provide menstrual products in bathrooms, yet little is known about its impacts. This evaluation examined LWDA implementation across Chicago Public Schools (CPS) and identified barriers, facilitators, and lessons to inform future MHH policy implementations. A qualitative study was conducted by thematically analyzing interviews with CPS staff (n = 36) from October 2020 - September 2021 in partnership with CPS Office of Student Health and Wellness (OSHW). Staff reported inadequate LWDA and MHH education and inconsistent menstrual product availability. Structural, systemic, and cultural implementation barriers hindered student access to products and created inequities based on age, gender, and income. Staff investment and student education were implementation facilitators. Staff awareness of policy implementation protocol, student MHH education, and addressing access inequities are key factors for consideration in future policy implementations. Through the WSCC model, these findings demonstrated the importance of strengthening MHH policies and policy implementation to promote student health, well-being, and educational opportunities.
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Affiliation(s)
- Serena Shah
- Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Julia Shenkman
- Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Thalia Chicojay
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, Illinois, USA
| | - Janet Kamiri-Ong
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, Illinois, USA
| | - Marisa DiPaolo
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, Illinois, USA
| | - Tarrah DeClemente
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, Illinois, USA
| | - Emily Fishman
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, Illinois, USA
| | | | - Leah C Neubauer
- Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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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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LeBlanc SS. School nurses and menstrual communication: Destigmatizing the stigma among adolescents. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241247793. [PMID: 38733209 PMCID: PMC11088806 DOI: 10.1177/17455057241247793] [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: 11/08/2023] [Revised: 03/01/2024] [Accepted: 03/29/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE The purpose of this study is to understand how school nurses, often the first line of defense for menstruating adolescents, use communication to assist adolescents in destigmatizing menstruation. DESIGN I conducted semi-structured narrative interviews with nine nurses employed in a large school district in Northeast Indiana. METHODS Interviews were coded, categorized, and used a phronetic iterative approach. RESULTS Analysis determines that nurses assist menstruating students using steps toward accepting menstruation and suggesting ways to avoid menstrual stigmatization. CONCLUSION This study suggests that school nurses use positive language to assist students in handling their menstruation problems, develop allyships with parents and other teachers, and stress menstrual education. This study highlights the need for more funding for menstrual products and additional school nurses.
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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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