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Kubovski A, Cohen Shabot S. Experience of menstruation with the use of reusable menstrual products: a qualitative study among menstruators in Israel. CULTURE, HEALTH & SEXUALITY 2023:1-16. [PMID: 37782548 DOI: 10.1080/13691058.2023.2260465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
Menstruation is an embodied experience that influences menstruators' perceptions of the self and body. The stigma surrounding menstruation and its negative representation in popular culture has consequences for women's sexual and reproductive health. In this study, semi-structured interviews were conducted with forty 18-50 year old participants who used reusable menstrual products to examine their experience of menstruation and how their use of these products shaped their self-body image. Data were analysed using thematic analysis. Participants commonly reported physical, medical and emotional improvement in menstrual experience and improved acceptance of the menstrual body alongside changes in feeling towards menstrual products and related issues. The participants described menstruation, menstrual blood, and the menstrual body more positively than before, reported a high comfort level with and in their bodies, and rejected common representations of menstruation. Findings suggest that using reusable menstrual products can contribute to body appreciation. Given these benefits, further research is needed to assess how knowledge of alternative menstrual products can stimulate positive views about the menstruating body and contribute to menstrual health.
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Affiliation(s)
- Anna Kubovski
- Women's and Gender Studies, University of Haifa, Haifa, Israel
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Babbar K, Garikipati S. What socio-demographic factors support disposable vs. sustainable menstrual choices? Evidence from India's National Family Health Survey-5. PLoS One 2023; 18:e0290350. [PMID: 37590271 PMCID: PMC10434932 DOI: 10.1371/journal.pone.0290350] [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: 02/23/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
For over a decade, improving menstrual hygiene among poor girls and women in low-and-middle-income-countries has been a prominent global goal. Towards this, governments in the Global South have worked to promote the uptake of disposable sanitary pads. Despite this, we continue to see a high prevalence of period poverty mainly because disposable pads require monthly purchasing that may be burdensome for many women. Not only are pads financially unsustainable but also represent a heavy environmental burden which has kindled an interest in re-usable innovations like menstrual cups that present a sustainable solution. However, there is little understanding of factors that promote the take-up of disposable vs. sustainable products at population levels. In this paper, we draw on India's National Family Health Survey-5 to understand the socio-demographic determinants of period product usage among girls and women, differentiated by their sustainability quotient. Our findings suggest that awareness of sustainable products and cultural factors are the key driver to promote their use. Women with exposure to menstrual cups either via education or mass media were more likely to use them. Belonging to urban areas and to disadvantaged social categories are other driving factors, at least partly because taboos of vaginal insertion are less of a concern among these groups. These findings suggest that improving the uptake of menstrual cups requires a paradigm shift in menstrual health policies from the promotion of disposable pads alone to spreading awareness of sustainable period choices among women via innovative use of mass media and community networks. Some micro-level evidence of change supports our conclusions.
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Affiliation(s)
- Karan Babbar
- Jindal Global Business School, OP Jindal Global University, Sonipat, India
| | - Supriya Garikipati
- School of Politics and International Relations, University College Dublin, Dublin, Ireland
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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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Schevchenco B, Brandão S, Gomes Timbó P, Tonon da Luz SC, da Silva Honório GJ, Da Roza T. The influence of the menstrual cup on female pelvic floor muscles variables: a prospective case series. Women Health 2023; 63:35-43. [PMID: 36539689 DOI: 10.1080/03630242.2022.2155901] [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: 12/24/2022]
Abstract
The aim was to assess and report the effects of menstrual cup on pelvic floor muscles (PFM) function and tone, as well as check the acceptability after a period of three menstrual cycles in healthy young women. The data collected in assessments and reassessments included the International Consultation on Incontinence Questionnaire - Vaginal Symptoms (ICIQ-VS) questionnaire, evaluation of PFM function through PERFECT Scheme, PFM muscle tone, and PFM manometry (Peritron 9300®). A diary regarding the overall colletor acceptability and satisfaction was collected. Ten healthy young women completed the study. There was an improvement in the mean values of maximal voluntary contraction (MVC) (p = 0.032), a decrease in the vaginal resting pressure (VRP) (p = 0.05), and an increase in the number of repetitions of sustained muscle contractions (p = 0.042). Seven women reported some discomfort while using the vaginal cup only in the first cycle while three revealed discomfort during the whole experiment. This study provides preliminary case-based evidence that the use of the vaginal cup for a period of three menstrual cycles changes the VRP, MVC, and PFM tone, as well as improves the repetitions of PFM assessed by digital palpation. Moreover, the women reported the use of vaginal cup as a positive experience.
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Affiliation(s)
- Bruna Schevchenco
- Laboratory of Biomechanics, Center for Health and Sports Sciences (CEFID), Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Sofia Brandão
- Centro Hospitalar e Universitário de São João - EPE, Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), Porto, Portugal
| | - Paula Gomes Timbó
- Laboratory of Biomechanics, Center for Health and Sports Sciences (CEFID), Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Soraia Cristina Tonon da Luz
- Laboratory of Biomechanics, Center for Health and Sports Sciences (CEFID), Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Gesilani Júlia da Silva Honório
- Laboratory of Biomechanics, Center for Health and Sports Sciences (CEFID), Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Thuane Da Roza
- Laboratory of Biomechanics, Center for Health and Sports Sciences (CEFID), Santa Catarina State University (UDESC), Florianópolis, Brazil
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Patel K, Dwivedy S, Panda N, Swain S, Pati S, Palo SK. Is menstrual cup a sustainable and safe alternative in menstrual hygiene management? A qualitative exploratory study based on user's experience in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Singh R, Agarwal M, Sinha S, Chaudhary N, Sinha HH, Anant M. Study of Adaptability and Efficacy of Menstrual Cups in Managing Menstrual Health and Hygiene: A Descriptive Longitudinal Study. Cureus 2022; 14:e29690. [PMID: 36187174 PMCID: PMC9517956 DOI: 10.7759/cureus.29690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Menstrual cup is a device made up of silicon for menstrual hygiene. Despite its being safe, eco-friendly, cheap, and durable its non-acceptability may be due to higher adoption barriers. We conducted this study to assess the adaptability and efficacy of menstrual cups. Methods It was a descriptive longitudinal study, conducted in a tertiary care institute in eastern India. Women of 18-50 years of age, educated till secondary level were included in the study, to be conducted over three months. The quantitative response for the satisfaction with the menstrual cup was measured on a five-point Likert scale after each menstrual cycle. Side effects, the quantity of blood flow and frequency of cleaning the menstrual cup, and how many participants will continue to use it were also asked. Results After the third menstrual cycle, 68.9% of participants stated that they would continue the menstrual cup usage. The mean total satisfaction score improved from 5.4 (first cycle) to 12.6 (third cycle) (p<0.001). The majority (67%) had no side effects, 10% had irritation and leakage, and 13% had an unpleasant odor. Conclusions The study shows that menstrual cups are a better alternative. Adaptability increases gradually through proper counseling, peer support, and practice.
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Gharacheh M, Ranjbar F, Hajinasab N, Haghani S. Acceptability and safety of the menstrual cups among Iranian women: a cross-sectional study. BMC WOMENS HEALTH 2021; 21:105. [PMID: 33714263 PMCID: PMC7955610 DOI: 10.1186/s12905-021-01259-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022]
Abstract
Background Menstrual cup is one of the menstrual management products that is available throughout the world and can be effective in improving women's quality of life by empowering women in menstrual management. Although menstrual cups have recently entered the Iranian market, the use of this product is limited among women. The aim of this study was to determine the acceptability and safety of menstrual cups among Iranian women. Methods This is a cross-sectional study conducted in 2020. Iranian women between the ages of 18 and 50 with regular menstrual periods who used the menstrual cup at least for three months were included. Participants were selected through continuous sampling, and they completed a web-based questionnaire including a demographic characteristics form as well as checklists on acceptability and safety through a link sent electronically via social media. Results The mean score of the overall satisfaction with the cup was 6.54 ± 0.76, and the leakage had the lowest mean score among the satisfaction items (5.25 ± 1.63). About 83% of participants reported experiencing menstrual cup leakage. Among the reported health risks, the highest mean score was for vaginal pain during removal (23.9%). Most participants (83.9%) were familiar with the cup via social networks and 98.6% recommended this product to other women. Conclusions The high level of acceptability and safety of the menstrual cup showed that this product is a suitable alternative for menstrual management in Iranian women. The results of the study help healthcare providers to learn more about the potential advantages and disadvantages of using cup and create trust in the menstrual cup use based on the results of local evidence-based research.
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Affiliation(s)
- Maryam Gharacheh
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ranjbar
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Negar Hajinasab
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Haghani
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Pokhrel D, Bhattarai S, Emgård M, von Schickfus M, Forsberg BC, Biermann O. Acceptability and feasibility of using vaginal menstrual cups among schoolgirls in rural Nepal: a qualitative pilot study. Reprod Health 2021; 18:20. [PMID: 33487171 PMCID: PMC7831234 DOI: 10.1186/s12978-020-01036-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/02/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Menstrual hygiene management can be challenging in low-income settings and among school-aged girls due to traditional beliefs, lack of knowledge and information on best hygienic practices, and limited access to appropriate and affordable menstrual hygiene products. An alternative method for menstrual hygiene management, instead of sanitary pads or tampons, is the vaginal menstrual cup. As evidence on the use of menstrual cups is relatively limited, this study aimed to explore the acceptability and feasibility of using vaginal menstrual cups among school-aged girls in Thokarpa, Sindupalchowk, Nepal. METHODS This is an exploratory study based on four focus group discussions with a purposive sample of 28 schoolgirls between 13 and 19 years of age who were provided with vaginal menstrual cups in Thokarpa, Sindupalchowk, Nepal. The data were collected between February and March 2019, i.e. approximately three months after the distribution of the menstrual cup. Participants were included in the study if they had started their menstruation and never given birth. Conventional content analysis was applied. RESULTS Most participants perceived the menstrual cup positively. Not missing a single class in school due to problems related to menstrual hygiene management was described as a major benefit. The participants found using the menstrual cup easy and convenient, and described economic and environmental advantages of using it. Cleaning the menstrual cup did not cause any problems, according to the participants. Discomforts mentioned by the participants were: pain when inserting the menstrual cup, feeling the menstrual cup sticking out of the vagina, feeling a constant urge to urinate and leakage. Concerns were related to the size, shape and texture of the menstrual cup, and that it may "get stuck" in the vagina, while relatives were said to be concerned about the use of the menstrual cup leading to reduced fertility or losing virginity. CONCLUSION The use of vaginal menstrual cups for menstrual hygiene management among schoolgirls in Thokarpa, Sindupalchowk, Nepal, appears feasible and acceptable, as it involves practical, economic and environmental advantages. However, the scale-up of menstrual cups will require resolving described concerns and discomforts and fostering peer and family support.
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Affiliation(s)
| | | | - Malin Emgård
- Linköping University Hospital, Linköping, Sweden.,Foundation Human Nature, Nidda, Germany
| | - Michael von Schickfus
- Linköping University Hospital, Linköping, Sweden.,Foundation Human Nature, Nidda, Germany
| | - Birger C Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Olivia Biermann
- Foundation Human Nature, Nidda, Germany. .,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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Manley H, Hunt JA, Santos L, Breedon P. Comparison between menstrual cups: first step to categorization and improved safety. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211058553. [PMID: 34798792 PMCID: PMC8606723 DOI: 10.1177/17455065211058553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Menstrual cups come in a range of shapes, sizes, and firmnesses, but unlike tampons are not categorized in any way. With these factors having an impact on product leaks and comfort, as well as being linked to illness and injury, women need the same level of transparency when purchasing a menstrual cup. The comparison of physical and mechanical properties of menstrual cups will be the first step to achieve this. METHODS In October 2020, 14 popular and highly rated menstrual cups underwent quantitative comparison in laboratory settings (the United Kingdom), and they were compared in terms of their dimensions, volume, and compressive strength (firmness) using the Instron Universal Testing System. The overall designs were compared including shape, material, and features. RESULTS Although all the products in this comparison were marketed to women below 30 years of age having never given birth, total volume varied from 18.88 mL to 38.14 mL, and compressive load to compress the menstrual cup 50% (±0.5%) maximum diameter varied from 3.39 N to 13.92 N. CONCLUSIONS Women are not sufficiently informed when choosing a menstrual cup. With no correlation between menstrual cup size, shape, and its volume, or material, shape, and its firmness, consumers cannot estimate which menstrual cup might be most suitable, and incorrect choice could cause injury. Transparency is needed across menstrual cup brands. With this and further regulation, women will make an informed decision to choose the correct menstrual cup and minimize injury. This work recommends firmness categories, ranging from 'very soft' to 'very firm' as a first step.
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Affiliation(s)
- Hannah Manley
- Medical Engineering Design Research Group, Nottingham Trent University, Nottingham, UK
| | - John A Hunt
- Medical Technologies Innovation Facility, Nottingham Trent University, Nottingham, UK
- College of Biomedical Engineering, China Medical University, Taichung, Taiwan
| | - Lívia Santos
- Sport, Health and Performance Enhancement (SHAPE) Research Centre, Nottingham Trent University, Nottingham, UK
| | - Philip Breedon
- Medical Engineering Design Research Group, Nottingham Trent University, Nottingham, UK
- Medical Technologies Innovation Facility, Nottingham Trent University, Nottingham, UK
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Beksinska M, Nkosi P, Zulu B, Smit J. Acceptability of the menstrual cup among students in further education institutions in KwaZulu-Natal, South Africa. EUR J CONTRACEP REPR 2020; 26:11-16. [PMID: 32938248 DOI: 10.1080/13625187.2020.1815005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The primary objective of this research was to evaluate long-term user acceptability of menstrual cups in a student population in South Africa. METHODS A cohort of female students aged 18-24 years attending 10 further education institutions including 22 campus sites in KwaZulu-Natal, South Africa, were offered menstrual cups after receiving education and training in their use. The students were followed for up to 12 months to assess menstrual cup acceptability, user experiences and continuation. RESULTS A total of 509 students were enrolled. Disposable pads were the primary menstrual hygiene product used in the 3 months prior to the baseline interview (95.5%, n = 486), and 8.1% (n = 41) of students reported that they had used toilet paper or newspapers. Of the 463 (91%) students interviewed at 1 month follow-up, 86% reported that they had tried to use the menstrual cup. There was mixed reporting on ease of insertion and removal on first use. Of those who attempted use, half (49.5%, n = 197) reported that inserting the menstrual cup on first use was very easy or quite easy. Of those who did not find it easy, 80% reported that two to three insertions were required to achieve comfort. A maximum of five insertions was mentioned to achieve comfort. The majority who had used the cup (>90%) reported they would continue to use it at each follow-up visit. CONCLUSION The menstrual cup was well accepted among this student population and should be considered as a cost-effective and environmentally sustainable option in menstrual health management initiatives in South Africa.
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Affiliation(s)
- Mags Beksinska
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Phumla Nkosi
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bongiwe Zulu
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer Smit
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Arenas-Gallo C, Ramírez-Rocha G, González-Hakspiel L, Merlano-Alcendra C, Palomino-Suárez D, Rueda-Espinel S. Acceptability and safety of the menstrual cup: A systematic review of the literature. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2020; 71:163-177. [PMID: 32770872 DOI: 10.18597/rcog.3425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/30/2020] [Indexed: 11/04/2022]
Abstract
Objectives To conduct a systematic review of the literature and assess the acceptability and safety of the menstrual cup as a feminine hygiene product. Materials and methods A search was conducted in the PubMed, Cochrane Library, Scopus, PopLine and Google Scholar databases for publications be- tween 1966 and July 2019. The terms ("Menstrual" AND "Cup") OR ("Copa" AND "Menstrual") were used. Quantitative, qualitative and mixed studies were included, as well as case series and case reports published in English and Spanish assessing the menstrual cup in women in childbearing age. The studies were selected and the data extracted by two reviewers working independently. Acceptability and safety were assessed as the primary result. The summary of the information is presented in narrative form. Results Overall, 737 titles were found for initial review and, in the end, 38 studies were included in this work. The acceptability of the menstrual cup ranges between 35 % and 90 %. Between 10 to 45 % of women found it difficult to use. It was described as more comfortable when compared to tampons and pads. Continued use of the cup ranges between 48 and 94 %. In terms of safety, there was one case of toxic shock syndrome, one case of mechanical entrapment, and another case of allergy; and a higher risk of expulsion was found among intrauterine device users. Conclusion The menstrual cup appears to be a comfortable, safe and efficient option for menstrual hygiene. Further randomized controlled studies and long-term prospective cohort studies are needed in order to determine the risk of complications due to excess bacterial colonization or retrograde menstruation.
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Affiliation(s)
- Camilo Arenas-Gallo
- Médico cirujano, Universidad Industrial de Santander, Bucaramanga (Colombia)
| | | | | | | | | | - Santiago Rueda-Espinel
- Residente Ginecología y Obstetricia, Universidad Autónoma de Bucaramanga, Bucaramanga (Colombia)
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Zulaika G, Kwaro D, Nyothach E, Wang D, Zielinski-Gutierrez E, Mason L, Eleveld A, Chen T, Kerubo E, van Eijk A, Pace C, Obor D, Juma J, Oyaro B, Niessen L, Bigogo G, Ngere I, Henry C, Majiwa M, Onyango CO, Ter Kuile FO, Phillips-Howard PA. Menstrual cups and cash transfer to reduce sexual and reproductive harm and school dropout in adolescent schoolgirls: study protocol of a cluster-randomised controlled trial in western Kenya. BMC Public Health 2019; 19:1317. [PMID: 31638946 PMCID: PMC6805471 DOI: 10.1186/s12889-019-7594-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Adolescent girls in sub-Saharan Africa are disproportionally vulnerable to sexual and reproductive health (SRH) harms. In western Kenya, where unprotected transactional sex is common, young females face higher rates of school dropout, often due to pregnancy, and sexually transmitted infections (STIs), including HIV. Staying in school has shown to protect girls against early marriage, teen pregnancy, and HIV infection. This study evaluates the impact of menstrual cups and cash transfer interventions on a composite of deleterious outcomes (HIV, HSV-2, and school dropout) when given to secondary schoolgirls in western Kenya, with the aim to inform evidence-based policy to improve girls’ health, school equity, and life-chances. Methods Single site, 4-arm, cluster randomised controlled superiority trial. Secondary schools are the unit of randomisation, with schoolgirls as the unit of measurement. Schools will be randomised into one of four intervention arms using a 1:1:1:1 ratio and block randomisation: (1) menstrual cup arm; (2) cash transfer arm, (3) cups and cash combined intervention arm, or (4) control arm. National and county agreement, and school level consent will be obtained prior to recruitment of schools, with parent consent and girls’ assent obtained for participant enrolment. Participants will be trained on safe use of interventions, with all arms receiving puberty and hygiene education. Annually, the state of latrines, water availability, water treatment, handwashing units and soap in schools will be measured. The primary endpoint is a composite of incident HIV, HSV-2, and all-cause school dropout, after 3 years follow-up. School dropout will be monitored each term via school registers and confirmed through home visits. HIV and HSV-2 incident infections and risk factors will be measured at baseline, mid-line and end-line. Intention to treat analysis will be conducted among all enrolled participants. Focus group discussions will provide contextual information on uptake of interventions. Monitoring for safety will occur throughout. Discussion If proved safe and effective, the interventions offer a potential contribution toward girls’ schooling, health, and equity in low- and middle-income countries. Trial registration ClinicalTrials.gov NCT03051789, 15th February 2017.
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Affiliation(s)
- Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Daniel Kwaro
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Elizabeth Nyothach
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Emily Zielinski-Gutierrez
- Center for Global Health, Division of Global Health HIV and TB, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Alie Eleveld
- Safe Water and AIDS Project (SWAP), Kisumu, Kenya
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Emily Kerubo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Annemieke van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Cheryl Pace
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - David Obor
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Jane Juma
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Boaz Oyaro
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Louis Niessen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Carl Henry
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Maxwell Majiwa
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Penelope A Phillips-Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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van Eijk AM, Zulaika G, Lenchner M, Mason L, Sivakami M, Nyothach E, Unger H, Laserson K, Phillips-Howard PA. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis. Lancet Public Health 2019; 4:e376-e393. [PMID: 31324419 PMCID: PMC6669309 DOI: 10.1016/s2468-2667(19)30111-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/15/2019] [Accepted: 06/17/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Girls and women need effective, safe, and affordable menstrual products. Single-use products are regularly selected by agencies for resource-poor settings; the menstrual cup is a less known alternative. We reviewed international studies on menstrual cup leakage, acceptability, and safety and explored menstrual cup availability to inform programmes. METHODS In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Web of Science, Popline, Cinahl, Global Health database, Emerald, Google Scholar, Science.gov, and WorldWideScience from database inception to May 14, 2019, for quantitative or qualitative studies published in English on experiences and leakage associated with menstrual cups, and adverse event reports. We also screened the Manufacturer and User Facility Device Experience database from the US Food and Drug Administration for events related to menstrual cups. To be eligible for inclusion, the material needed to have information on leakage, acceptability, or safety of menstrual cups. The main outcome of interest was menstrual blood leakage when using a menstrual cup. Safety outcomes of interest included serious adverse events; vaginal abrasions and effects on vaginal microflora; effects on the reproductive, digestive, or urinary tract; and safety in poor sanitary conditions. Findings were tabulated or combined by use of forest plots (random-effects meta-analysis). We also did preliminary estimates on costs and environmental savings potentially associated with cups. This systematic review is registered on PROSPERO, number CRD42016047845. FINDINGS Of 436 records identified, 43 studies were eligible for analysis (3319 participants). Most studies reported on vaginal cups (27 [63%] vaginal cups, five [12%] cervical cups, and 11 [25%] mixed types of cups or unknown) and 15 were from low-income and middle-income countries. 22 studies were included in qualitative or quantitative syntheses, of which only three were of moderate-to-high quality. Four studies made a direct comparison between menstrual cups and usual products for the main outcome of leakage and reported leakage was similar or lower for menstrual cups than for disposable pads or tampons (n=293). In all qualitative studies, the adoption of the menstrual cup required a familiarisation phase over several menstrual cycles and peer support improved uptake (two studies in developing countries). In 13 studies, 73% (pooled estimate: n=1144; 95% CI 59-84, I2=96%) of participants wished to continue use of the menstrual cup at study completion. Use of the menstrual cup showed no adverse effects on the vaginal flora (four studies, 507 women). We identified five women who reported severe pain or vaginal wounds, six reports of allergies or rashes, nine of urinary tract complaints (three with hydronephrosis), and five of toxic shock syndrome after use of the menstrual cup. Dislodgement of an intrauterine device was reported in 13 women who used the menstrual cup (eight in case reports, and five in one study) between 1 week and 13 months of insertion of the intrauterine device. Professional assistance to aid removal of menstrual cup was reported among 47 cervical cup users and two vaginal cup users. We identified 199 brands of menstrual cup, and availability in 99 countries with prices ranging US$0·72-46·72 (median $23·3, 145 brands). INTERPRETATION Our review indicates that menstrual cups are a safe option for menstruation management and are being used internationally. Good quality studies in this field are needed. Further studies are needed on cost-effectiveness and environmental effect comparing different menstrual products. FUNDING UK Medical Research Council, Department for International Development, and Wellcome Trust.
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Affiliation(s)
- Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Madeline Lenchner
- Population Health Sciences, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Muthusamy Sivakami
- Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - Elizabeth Nyothach
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Holger Unger
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK; Department of Obstetrics and Gynaecology, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Kayla Laserson
- Bill & Melinda Gates Foundation, India Country Office, New Delhi, India
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Magnay JL, O'Brien S, Gerlinger C, Seitz C. A systematic review of methods to measure menstrual blood loss. BMC WOMENS HEALTH 2018; 18:142. [PMID: 30134884 PMCID: PMC6106944 DOI: 10.1186/s12905-018-0627-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/27/2018] [Indexed: 11/10/2022]
Abstract
Background Since the publication over 50 years ago of the alkaline hematin method for quantifying menstrual blood loss (MBL) many new approaches have been developed to assess MBL. The aim of this systematic review is to determine for methods of measuring MBL: ability to distinguish between normal and heavy menstrual bleeding (HMB); practicalities and limitations in the research setting; and suitability for diagnosing HMB in routine clinical practice. Methods Embase®™, MEDLINE®, and ClinicalTrials.gov were screened for studies on the development/validation of MBL assessment methods in women with self-perceived HMB, actual HMB or uterine fibroids, or patients undergoing treatment for HMB. Studies using simulated menstrual fluid and those that included women with normal MBL as controls were also eligible for inclusion. Extracted data included study population, results of validation, and advantages/disadvantages of the technique. Results Seventy-one studies fulfilled the inclusion criteria. The sensitivity and/or specificity of diagnosing HMB were calculated in 16 studies of methods involving self-perception of MBL (11 pictorial), and in one analysis of the menstrual-fluid-loss (MFL) method; in 13 of these studies the comparator was the gold standard alkaline hematin technique. Sensitivity and specificity values by method were, respectively: MFL model, 89, 98%; pictorial blood loss assessment chart (PBAC), 58–99%, 7.5–89%; menstrual pictogram, 82–96%, 88–94%; models/questionnaires, 59–87%, 62–86%, and complaint of HMB, 74, 74%. The power of methods to identify HMB was also assessed using other analyses such as comparison of average measurements: statistical significance was reported for the PBAC, MFL, subjective complaint, and six questionnaires. In addition, PBAC scores, menstrual pictogram volumes, MFL, pad/tampon count, iron loss, and output from three questionnaires correlated significantly with values from a reference method in at least one study. In general, pictorial methods have been more comprehensively validated than questionnaires and models. Conclusions Every method to assess MBL has limitations. Pictorial methods strike a good balance between ease of use and validated accuracy of MBL determination, and could complement assessment of HMB using quality of life (QoL) in the clinical and research setting. Trial registration PRISMA registration number: CRD42016032956. Electronic supplementary material The online version of this article (10.1186/s12905-018-0627-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia L Magnay
- Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, UK
| | - Shaughn O'Brien
- Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, UK.,Department of Obstetrics & Gynaecology, Keele University School of Medicine, Stoke-on-Trent, UK
| | - Christoph Gerlinger
- Bayer AG, 13342, Berlin, Germany.,Gynecology, Obstetrics and Reproductive Medicine, University of Saarland Medical School, Homburg/Saar, Germany
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Use of menstrual cups among school girls: longitudinal observations nested in a randomised controlled feasibility study in rural western Kenya. Reprod Health 2018; 15:139. [PMID: 30119636 PMCID: PMC6098596 DOI: 10.1186/s12978-018-0582-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A menstrual cup can be a good solution for menstrual hygiene management in economically challenged settings. As part of a pilot study we assessed uptake and maintenance of cup use among young school girls in Kenya. METHODS A total of 192 girls between 14 to 16 years were enrolled in 10 schools in Nyanza Province, Western Kenya; these schools were assigned menstrual cups as part of the cluster-randomized pilot study. Girls were provided with menstrual cups in addition to training and guidance on use, puberty education, and instructions for menstrual hygiene. During repeated individual visits with nurses, girls reported use of the menstrual cup and nurses recorded colour change of the cup. RESULTS Girls were able to keep their cups in good condition, with only 12 cups (6.3%) lost (dropped in toilet, lost or destroyed). Verbally reported cup use increased from 84% in the first 3 months (n = 143) to 96% after 9 months (n = 74). Colour change of the cup, as 'uptake' indicator of use, was detected in 70.8% of 192 participants, with a median time of 5 months (range 1-14 months). Uptake differed by school and was significantly higher among girls who experienced menarche within the past year (adjusted risk ratio 1.29, 95% CI 1.04-1.60), and was faster among girls enrolled in the second study year (hazard ratio 3.93, 95% CI 2.09-7.38). The kappa score comparing self-report and cup colour observation was 0.044 (p = 0.028), indicating that agreement was only slightly higher than by random chance. CONCLUSIONS Objective evidence through cup colour change suggests school girls in rural Africa can use menstrual cups, with uptake improving with peer group education and over time. TRIAL REGISTRATION ISRCTN17486946 . Retrospectively registered 09 December 2014.
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Juma J, Nyothach E, Laserson KF, Oduor C, Arita L, Ouma C, Oruko K, Omoto J, Mason L, Alexander KT, Fields B, Onyango C, Phillips-Howard PA. Examining the safety of menstrual cups among rural primary school girls in western Kenya: observational studies nested in a randomised controlled feasibility study. BMJ Open 2017; 7:e015429. [PMID: 28473520 PMCID: PMC5566618 DOI: 10.1136/bmjopen-2016-015429] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Examine the safety of menstrual cups against sanitary pads and usual practice in Kenyan schoolgirls. DESIGN Observational studies nested in a cluster randomised controlled feasibility study. SETTING 30 primary schools in a health and demographic surveillance system in rural western Kenya. PARTICIPANTS Menstruating primary schoolgirls aged 14-16 years participating in a menstrual feasibility study. INTERVENTIONS Insertable menstrual cup, monthly sanitary pads or 'usual practice' (controls). OUTCOME MEASURES Staphylococcus aureus vaginal colonization, Escherichia coli growth on sampled used cups, toxic shock syndrome or other adverse health outcomes. RESULTS Among 604 eligible girls tested, no adverse event or TSS was detected over a median 10.9 months follow-up. S. aureusprevalence was 10.8%, with no significant difference over intervention time or between groups. Of 65 S.aureus positives at first test, 49 girls were retested and 10 (20.4%) remained positive. Of these, two (20%) sample isolates tested positive for toxic shock syndrome toxin-1; both girls were provided pads and were clinically healthy. Seven per cent of cups required replacements for loss, damage, dropping in a latrine or a poor fit. Of 30 used cups processed for E. coli growth, 13 (37.1%, 95% CI 21.1% to 53.1%) had growth. E. coli growth was greatest in newer compared with established users (53%vs22.2%, p=0.12). CONCLUSIONS Among this feasibility sample, no evidence emerged to indicate menstrual cups are hazardous or cause health harms among rural Kenyan schoolgirls, but large-scale trials and post-marketing surveillance should continue to evaluate cup safety.
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Affiliation(s)
- Jane Juma
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Elizabeth Nyothach
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kayla F Laserson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clifford Oduor
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lilian Arita
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Caroline Ouma
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kelvin Oruko
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jackton Omoto
- Siaya District Hospital, Ministry of Health, Siaya, Kenya
| | - Linda Mason
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Barry Fields
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clayton Onyango
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Schoolgirls' experience and appraisal of menstrual absorbents in rural Uganda: a cross-sectional evaluation of reusable sanitary pads. Reprod Health 2016; 13:143. [PMID: 27923379 PMCID: PMC5142137 DOI: 10.1186/s12978-016-0260-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Governments, multinational organisations, and charities have commenced the distribution of sanitary products to address current deficits in girls’ menstrual management. The few effectiveness studies conducted have focused on health and education outcomes but have failed to provide quantitative assessment of girls’ preferences, experiences of absorbents, and comfort. Objectives of the study were, first, to quantitatively describe girls’ experiences with, and ratings of reliability and acceptability of different menstrual absorbents. Second, to compare ratings of freely-provided reusable pads (AFRIpads) to other existing methods of menstrual management. Finally, to assess differences in self-reported freedom of activity during menses according to menstrual absorbent. Methods Cross-sectional, secondary analysis of data from the final survey of a controlled trial of reusable sanitary padand puberty education provision was undertaken. Participants were 205 menstruating schoolgirls from eight schools in rural Uganda. 72 girls who reported using the intervention-provided reusable pads were compared to those using existing improvised methods (predominately new or old cloth). Results Schoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities, less difficulties changing absorbents, and less disgust with cleaning absorbents. There were no significant differences in reports of outside garment soiling (OR 1.00 95%CI 0.51–1.99), or odour (0.84 95%CI 0.40–1.74) during the last menstrual period. When girls were asked if menstruation caused them to miss daily activities there were no differences between those using reusable pads and those using other existing methods. However, when asked about activities avoided during menstruation, those using reusable pads participated less in physical sports, working in the field, fetching water, and cooking. Conclusions Reusable pads were rated favourably. This translated into some benefits for self-reported involvement in daily activities, although reports of actual soiling and missing activities due to menstruation did not differ. More research is needed comparing the impact of menstrual absorbents on girls’ daily activities, and validating outcome measures for menstrual management research. Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0260-7) contains supplementary material, which is available to authorized users.
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Phillips-Howard PA, Nyothach E, Ter Kuile FO, Omoto J, Wang D, Zeh C, Onyango C, Mason L, Alexander KT, Odhiambo FO, Eleveld A, Mohammed A, van Eijk AM, Edwards RT, Vulule J, Faragher B, Laserson KF. Menstrual cups and sanitary pads to reduce school attrition, and sexually transmitted and reproductive tract infections: a cluster randomised controlled feasibility study in rural Western Kenya. BMJ Open 2016; 6:e013229. [PMID: 27881530 PMCID: PMC5168542 DOI: 10.1136/bmjopen-2016-013229] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Conduct a feasibility study on the effect of menstrual hygiene on schoolgirls' school and health (reproductive/sexual) outcomes. DESIGN 3-arm single-site open cluster randomised controlled pilot study. SETTING 30 primary schools in rural western Kenya, within a Health and Demographic Surveillance System. PARTICIPANTS Primary schoolgirls 14-16 years, experienced 3 menses, no precluding disability, and resident in the study area. INTERVENTIONS 1 insertable menstrual cup, or monthly sanitary pads, against 'usual practice' control. All participants received puberty education preintervention, and hand wash soap during intervention. Schools received hand wash soap. PRIMARY AND SECONDARY OUTCOME MEASURES Primary: school attrition (drop-out, absence); secondary: sexually transmitted infection (STI) (Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoea), reproductive tract infection (RTI) (bacterial vaginosis, Candida albicans); safety: toxic shock syndrome, vaginal Staphylococcus aureus. RESULTS Of 751 girls enrolled 644 were followed-up for a median of 10.9 months. Cups or pads did not reduce school dropout risk (control=8.0%, cups=11.2%, pads=10.2%). Self-reported absence was rarely reported and not assessable. Prevalence of STIs in the end-of-study survey among controls was 7.7% versus 4.2% in the cups arm (adjusted prevalence ratio (aPR) 0.48, 0.24 to 0.96, p=0.039), 4.5% with pads (aPR=0.62; 0.37 to 1.03, p=0.063), and 4.3% with cups and pads pooled (aPR=0.54, 0.34 to 0.87, p=0.012). RTI prevalence was 21.5%, 28.5% and 26.9% among cup, pad and control arms, 71% of which were bacterial vaginosis, with a prevalence of 14.6%, 19.8% and 20.5%, per arm, respectively. Bacterial vaginosis was less prevalent in the cups (12.9%) compared with pads (20.3%, aPR=0.65, 0.44 to 0.97, p=0.034) and control (19.2%, aPR=0.67, 0.43 to 1.04, p=0.075) arm girls enrolled for 9 months or longer. No adverse events were identified. CONCLUSIONS Provision of menstrual cups and sanitary pads for ∼1 school-year was associated with a lower STI risk, and cups with a lower bacterial vaginosis risk, but there was no association with school dropout. A large-scale trial on menstrual cups is warranted. TRIAL REGISTRATION ISRCTN17486946; Results.
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Affiliation(s)
- Penelope A Phillips-Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Elizabeth Nyothach
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Jackton Omoto
- Siaya District Hospital, Ministry of Health, Siaya, Kenya
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
| | - Clement Zeh
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
- Centers for Disease Control and Prevention (CDC)-Kenya, Kisumu, Kenya
| | - Clayton Onyango
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
- Centers for Disease Control and Prevention (CDC)-Kenya, Kisumu, Kenya
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
| | - Kelly T Alexander
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
| | - Frank O Odhiambo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Alie Eleveld
- Safe Water and AIDS Project (SWAP), Kisumu, Kenya
| | - Aisha Mohammed
- Division of Reproductive Health, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Anna M van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
| | | | - John Vulule
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Brian Faragher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
| | - Kayla F Laserson
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Phillips-Howard PA, Otieno G, Burmen B, Otieno F, Odongo F, Odour C, Nyothach E, Amek N, Zielinski-Gutierrez E, Odhiambo F, Zeh C, Kwaro D, Mills LA, Laserson KF. Menstrual Needs and Associations with Sexual and Reproductive Risks in Rural Kenyan Females: A Cross-Sectional Behavioral Survey Linked with HIV Prevalence. J Womens Health (Larchmt) 2015; 24:801-11. [PMID: 26296186 PMCID: PMC4624246 DOI: 10.1089/jwh.2014.5031] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Females in low and middle income countries (LMICs) have difficulty coping with menstrual needs, but few studies have examined the social or health implications of these needs. Methods: Responses from 3418 menstruating females aged 13–29 years were extracted from an HIV and behavioral risks cross-sectional survey conducted in rural western Kenya. We examined sanitary products used, provision of products from sexual partners or from transactional sex, and demographic and sexual exposures. Results: Overall, 75% of females reported using commercial pads and 25% used traditional materials such as cloth or items like paper or tissue, with 10% of girls <15 years old depending on makeshift items. Two-thirds of females with no education relied on traditional items. Having attended secondary school increased the odds of using commercial pads among married (adjusted odds ratios [AOR] 4.8, 95% confidence interval [CI] 3.25–7.12) and single females (AOR 2.17, 95% CI 1.04–4.55). Married females had lower odds of pad use if they reported early (<12 years of age) compared with later (≥18 years) sexual debut (64% vs. 78%, AOR 0.45, 95% CI 0.21–0.97). Two-thirds of pad users received them from sexual partners. Receipt was lower among married females if partners were violent (AOR 0.67, 95% CI 0.53–0.85). Receipt among single females was higher if they had two or more sexual partners in the past year (AOR 2.11, 95% CI 1.04–4.29). Prevalence of engaging in sex for money to buy pads was low (1.3%); however, 10% of 15-year-olds reported this, with girls ≤15 having significantly higher odds compared with females over 15 (AOR 2.84, 95% CI 0.89–9.11). The odds of having transactional sex for pads was higher among females having two or more partners in the past 12 months (AOR 4.86, 95% CI 2.06–11.43). Conclusions: Menstrual needs of impoverished females in rural LMICs settings likely leads to increased physical and sexual harms. Studies are required to strengthen knowledge and to evaluate interventions to reduce these harms.
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Affiliation(s)
- Penelope A Phillips-Howard
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine , Liverpool, United Kingdom .,2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - George Otieno
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Barbara Burmen
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Frederick Otieno
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya .,3 Nyanza Reproductive Health Society , Kisumu, Kenya
| | - Frederick Odongo
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Clifford Odour
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Elizabeth Nyothach
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Nyanguara Amek
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | | | - Frank Odhiambo
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Clement Zeh
- 5 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Kisumu, Kenya
| | - Daniel Kwaro
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Lisa A Mills
- 5 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Kisumu, Kenya
| | - Kayla F Laserson
- 6 Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention , Atlanta, Georgia
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Beksinska ME, Smit J, Greener R, Todd CS, Lee MLT, Maphumulo V, Hoffmann V. Acceptability and performance of the menstrual cup in South Africa: a randomized crossover trial comparing the menstrual cup to tampons or sanitary pads. J Womens Health (Larchmt) 2015; 24:151-8. [PMID: 25682816 DOI: 10.1089/jwh.2014.5021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In low-income settings, many women and girls face activity restrictions during menses, owing to lack of affordable menstrual products. The menstrual cup (MC) is a nonabsorbent reusable cup that collects menstrual blood. We assessed the acceptability and performance of the MPower® MC compared to pads or tampons among women in a low-resource setting. METHODS We conducted a randomized two-period crossover trial at one site in Durban, South Africa, between January and November 2013. Participants aged 18-45 years with regular menstrual cycles were eligible for inclusion if they had no intention of becoming pregnant, were using an effective contraceptive method, had water from the municipal system as their primary water source, and had no sexually transmitted infections. We used a computer-generated randomization sequence to assign participants to one of two sequences of menstrual product use, with allocation concealed only from the study investigators. Participants used each method over three menstrual cycles (total 6 months) and were interviewed at baseline and monthly follow-up visits. The product acceptability outcome compared product satisfaction question scores using an ordinal logistic regression model with individual random effects. This study is registered on the South African Clinical Trials database: number DOH-27-01134273. RESULTS Of 124 women assessed, 110 were eligible and randomly assigned to selected menstrual products. One hundred and five women completed all follow-up visits. By comparison to pads/tampons (usual product used), the MC was rated significantly better for comfort, quality, menstrual blood collection, appearance, and preference. Both of these comparative outcome measures, along with likelihood of continued use, recommending the product, and future purchase, increased for the MC over time. CONCLUSION MC acceptance in a population of novice users, many with limited experience with tampons, indicates that there is a pool of potential users in low-resource settings.
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Affiliation(s)
- Mags E Beksinska
- 1 Department of Obstetrics and Gynaecology, Maternal, Adolescent and Child Health Research, University of the Witwatersrand , Durban, South Africa
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Grose RG, Grabe S. Sociocultural attitudes surrounding menstruation and alternative menstrual products: the explanatory role of self-objectification. Health Care Women Int 2014; 35:677-94. [PMID: 24527840 DOI: 10.1080/07399332.2014.888721] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We extend objectification theory research to consider the relationship between self-objectification and attitudes toward an alternative menstrual product in a diverse sample of female undergraduates from the United States (N = 151). We use a survey design to investigate attitudes toward one's menstruation as a potential mechanism that may explain this relationship. Reactions to an alternative menstrual product were predominantly negative, supporting prior research on stigma and shame surrounding menstruation. Exploratory structural equation modeling revealed attitudes toward one's menstruation mediated the relationship between self-objectification and participants' reactions to an alternative menstrual product. Implications for women's health are discussed.
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Affiliation(s)
- Rose Grace Grose
- a Department of Psychology, University of California, Santa Cruz , Santa Cruz , California , USA
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Abstract
The environmental and social costs of consumer societies have increasingly been recognized. Achieving sustainable household consumption requires an understanding of the underlying roots of current consumption levels. Using the case study of menstrual care practices, different theoretical frameworks—or narratives—for understanding household consumption are evaluated. The author argues that theories of consumption that focus on individual choice based on assessments of convenience or cleanliness, or only on cultural imperatives need to be expanded to take account of the wider political–economic context. Using commoditization theory helps explain not only why mass-produced, disposable menstrual products are dominant in free market societies but also why certain theories of consumption are more prevalent.
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Affiliation(s)
- Anna Davidson
- State University of New York College of Environmental Science and Forestry, Syracuse, NY, USA
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