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Sommer M, Fan L, Hill SV, Efuribe C, Bell DL, Master S. Incorporating menstrual health into routine pediatric primary care. Lancet Reg Health Am 2024; 32:100716. [PMID: 38510787 PMCID: PMC10952032 DOI: 10.1016/j.lana.2024.100716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Linda Fan
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, Yale University, New Haven, CT, USA
| | - Samantha V. Hill
- Department of Pediatrics, Section on Adolescent Medicine, Emory University, Atlanta, GA, USA
| | | | - David L. Bell
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Samuel Master
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
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Kreuzer M, Sommer M, Deffner V, Bertke S, Demers PA, Kelly-Reif K, Laurier D, Rage E, Richardson DB, Samet JM, Schubauer-Berigan MK, Tomasek L, Wiggins C, Zablotska LB, Fenske N. Lifetime excess absolute risk for lung cancer due to exposure to radon: results of the pooled uranium miners cohort study PUMA. Radiat Environ Biophys 2024; 63:7-16. [PMID: 38172372 PMCID: PMC10920468 DOI: 10.1007/s00411-023-01049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024]
Abstract
The Pooled Uranium Miners Analysis (PUMA) study is the largest uranium miners cohort with 119,709 miners, 4.3 million person-years at risk and 7754 lung cancer deaths. Excess relative rate (ERR) estimates for lung cancer mortality per unit of cumulative exposure to radon progeny in working level months (WLM) based on the PUMA study have been reported. The ERR/WLM was modified by attained age, time since exposure or age at exposure, and exposure rate. This pattern was found for the full PUMA cohort and the 1960 + sub-cohort, i.e., miners hired in 1960 or later with chronic low radon exposures and exposure rates. The aim of the present paper is to calculate the lifetime excess absolute risk (LEAR) of lung cancer mortality per WLM using the PUMA risk models, as well as risk models derived in previously published smaller uranium miner studies, some of which are included in PUMA. The same methods were applied for all risk models, i.e., relative risk projection up to <95 years of age, an exposure scenario of 2 WLM per year from age 18-64 years, and baseline mortality rates representing a mixed Euro-American-Asian population. Depending upon the choice of model, the estimated LEAR per WLM are 5.38 × 10-4 or 5.57 × 10-4 in the full PUMA cohort and 7.50 × 10-4 or 7.66 × 10-4 in the PUMA 1960 + sub-cohort, respectively. The LEAR per WLM estimates derived from risk models reported for previously published uranium miners studies range from 2.5 × 10-4 to 9.2 × 10-4. PUMA strengthens knowledge on the radon-related lung cancer LEAR, a useful way to translate models for policy purposes.
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Affiliation(s)
- M Kreuzer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany.
| | - M Sommer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - V Deffner
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - S Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - P A Demers
- Occupational Cancer Research Centre, Toronto, Canada
| | - K Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - D Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - E Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | | | - J M Samet
- Colorado School of Public Health, Aurora, CO, USA
| | | | - L Tomasek
- National Radiation Protection Institute, Prague, Czech Republic
| | - C Wiggins
- University of New Mexico, Albuquerque, NM, USA
- New Mexico Tumor Registry, Albuquerque, NM, USA
| | | | - N Fenske
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
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Misunas C, Hindin MJ, Phillips-Howard PA, Sommer M. The Association Between Hormonal Contraceptive Use and Anemia Among Adolescent Girls and Young Women: An Analysis of Data From 51 Low- and Middle-Income Countries. J Adolesc Health 2024; 74:563-572. [PMID: 37978956 DOI: 10.1016/j.jadohealth.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE This study explores whether adolescent girls and young women aged 15-24 who use hormonal methods of contraception are more or less likely to be anemic than their peers. We further examine whether the association between anemia and hormonal contraception varies based on the severity of anemia or the duration of method use. METHODS We conducted secondary analysis of data available for 51 low- and middle-income countries from the Demographic and Health Surveys. For each country, we used logistic regression models to explore the odds of being anemic (mildly, moderately, or severely) for those using hormonal methods of contraception. We also explored the odds of being moderately or severely anemic based on hormonal method use. Drawing on country-level effect estimates, we conducted meta-regression analyses to produce overall estimates of the association between anemia and hormonal contraception. RESULTS Overall, adolescent girls and young women using hormonal methods had lower odds of being mildly, moderately, or severely anemic (adjusted odds ratio 0.68; p < .001) and lower odds of being moderately or severely anemic (adjusted odds ratio 0.57; p < .001) compared to those not using any contraception. Both short- and long-term users of hormonal methods had lower odds of being anemic and lower odds of being moderately or severely anemic compared to those not using hormonal methods. DISCUSSION This study furthers our understanding of the association between anemia and use of hormonal contraception among adolescent girls and young women. More research is needed to assess causality and whether hormonal methods mediate the effects of heavy menstrual bleeding or other risk factors of anemia.
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Affiliation(s)
- Christina Misunas
- Department of Demography, University of California, Berkeley, Berkeley, California.
| | - Michelle J Hindin
- Global Health and Population Research Department, FHI 360, Durham, North Carolina
| | | | - Marni Sommer
- Department of Sociomedical Sciences, Columbia University, New York, New York
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Ibitoye M, Sandfort TGM, Bingenheimer JB, Sommer M. The sexual and reproductive health covariates of early menarche among adolescent girls. J Adolesc 2024. [PMID: 38297495 DOI: 10.1002/jad.12298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Research suggests that girls who reach menarche at an early age are at greater risk for negative sexual and reproductive health (SRH) outcomes than their later-maturing counterparts, but very little research has examined this issue in sub-Saharan Africa, especially in West Africa. The goal of the current study was to determine whether early menarche was associated with any SRH outcomes in a sample of Ghanaian girls. METHODS The study data were drawn from the baseline assessment of a longitudinal study involving two age cohorts (13-14 and 18-19 years) of 700 adolescent girls from Ghana. Logistic regressions were used to assess the association between early menarche (before age 13) and seven SRH outcomes (adolescent sexual activity, early sexual initiation, inconsistent condom use, transactional sex, sexual violence, multiple sexual partners, and adolescent pregnancy). RESULTS Early menarche was significantly associated with adolescent sexual activity (odds ratio [OR] = 6.4; 95% confidence interval [CI] 2.1-19.7), and sexual violence (OR = 3.2; 95% CI 1.6-6.2) in the younger cohort and early sexual initiation (OR = 3.2; 95% CI 1.19-8.61) and multiple sexual partners (OR = 3.7; 95% CI 1.39-9.87) in the older cohort. Early menarche was also associated with transactional sex and teen pregnancy in the full sample. CONCLUSIONS These findings suggest the need for special attention to the needs of early-maturing girls in SRH programming. Interventions are needed to delay adolescent sexual activity in girls with early menarche. Efforts to prevent sexual violence among adolescent girls in Ghana may benefit from targeting and addressing the specific needs of early-maturing girls.
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Affiliation(s)
- Mobolaji Ibitoye
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Theo G M Sandfort
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
- Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Jeffrey B Bingenheimer
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
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Plesons M, Torondel B, Caruso BA, Hennegan J, Sommer M, Haver J, Keiser D, van Eijk AM, Zulaika G, Mason L, Phillips-Howard PA. Research priorities for improving menstrual health across the life-course in low- and middle-income countries. Glob Health Action 2023; 16:2279396. [PMID: 38010372 PMCID: PMC10795652 DOI: 10.1080/16549716.2023.2279396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Research on menstrual health is required to understand menstrual needs and generate solutions to improve health, wellbeing, and productivity. The identification of research priorities will help inform where to invest efforts and resources. OBJECTIVES To identify research priorities for menstrual health across the life-course, in consultation with a range of stakeholder groups from a variety of geographic regions, and to identify if menstrual health research priorities varied by expertise. METHODS A modified version of the Child Health and Nutrition Research Initiative approach was utilized to reach consensus on a set of research priorities. Multisector stakeholders with menstrual health expertise, identified through networks and the literature, were invited to submit research questions through an online survey. Responses were consolidated, and individuals were invited to rank these questions based on novelty, potential for intervention, and importance/impact. Research priority scores were calculated and evaluated by participants' characteristics. RESULTS Eighty-two participants proposed 1135 research questions, which were consolidated into 94 unique research questions. The mean number of questions did not differ between low- and middle-income country (LMIC) and high-income country (HIC) participants, but significantly more questions were raised by participants with expertise in mental health and WASH. Sixty-six participants then ranked these questions. The top ten-ranked research questions included four on 'understanding the problem', four on 'designing and implementing interventions', one on 'integrating and scaling up', and one on 'measurement'. Indicators for the measurement of adequate menstrual health over time was ranked the highest priority by all stakeholders. Top ten-ranked research questions differed between academics and non-academics, and between participants from HICs and LMICs, reflecting differences in needs and knowledge gaps. CONCLUSIONS A list of ranked research priorities was generated through a consultative process with stakeholders across LMICs and HICs which can inform where to invest efforts and resources.
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Affiliation(s)
- Marina Plesons
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Belen Torondel
- Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Bethany A. Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Julie Hennegan
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jacquelyn Haver
- School Health and Nutrition, Department of Education and Children Protection, Save the Children US, Washington, DC, USA
| | | | - Anna M. 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
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Ibitoye M, Sommer M, Davidson LL, Sandfort TGM. Exploring the effect of early menarche on sexual violence among adolescent girls and young women in southeastern Ghana: a longitudinal mediation analysis. Sex Reprod Health Matters 2023; 31:2244271. [PMID: 37656485 PMCID: PMC10478596 DOI: 10.1080/26410397.2023.2244271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Research from several high-income countries links early menarche with an increased risk for sexual violence. However, the role of early menarche in adolescent girls' and young women's sexual violence risk in sub-Saharan Africa, where sexual violence rates are high, is not well understood. The current study explores the association between early menarche and sexual violence in Ghana with secondary analysis of data collected from 700 adolescent girls and young women followed over three years. Logistic regressions were used to assess the cross-sectional association between early menarche and sexual violence. Generalised estimating equations were used to assess whether the association between early menarche and sexual violence persisted over time. Inverse odds weighting was used to test potential mediators of the association between early menarche and sexual violence. Sexual violence was fairly common in the study sample, with 27% reporting having experienced sexual violence at baseline, and approximately 50% at year three. Early menarche was associated with 72% greater odds of having experienced sexual violence at baseline (95% confidence interval: 1.01-2.93). However, the odds ratio attenuated and lost significance over the three-year study period, with a lower risk of sexual violence among girls with early menarche at year three. Neither child marriage nor early sexual initiation significantly mediated the association between early menarche and sexual violence. The findings suggest that early-maturing girls may be particularly vulnerable to sexual violence in early adolescence, thus necessitating prevention interventions around the time of menarche to reduce the risk for sexual violence.
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Affiliation(s)
- Mobolaji Ibitoye
- Postdoctoral Scholar, Institute for Population Research, Ohio State University, Columbus, OH, USA
| | - Marni Sommer
- Professor of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Leslie L. Davidson
- Professor Emerita of Epidemiology and of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Theo G. M. Sandfort
- Professor of Clinical Sociomedical Sciences (in Psychiatry), Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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Hennegan J, Caruso BA, Zulaika G, Torondel B, Haver J, Phillips-Howard PA, Valdez J, Gruer C, Okwaro N, Mahon T, Sommer M. Indicators for National and Global Monitoring of Girls' Menstrual Health and Hygiene: Development of a Priority Shortlist. J Adolesc Health 2023; 73:992-1001. [PMID: 37737755 PMCID: PMC10654045 DOI: 10.1016/j.jadohealth.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Despite the importance of menstrual health and hygiene (MHH) for adolescent girls' health, education, and gender equality, few countries monitor MHH. MHH needs remain underprioritized, and progress achieved through policies, programs, or investments go unmeasured. This article reports the systematic development of an indicator shortlist to monitor adolescent girls' MHH at the national and global levels across low- and middle-income countries. METHODS A core group of MHH researchers and practitioners collaborated with stakeholders from three countries with demonstrated commitment to monitoring MHH (Bangladesh, Kenya, and the Philippines), measures experts, and a global advisory group. The approach included the following: (1) define domains for monitoring MHH; (2) review and map existing indicators and measures; (3) iteratively shortlist indicators through appraising quality, feasibility, and stakeholder input; and (4) refine the shortlist and develop guidance for use. RESULTS The shortlist comprises 21 indicators across seven domains covering menstrual materials, water, sanitation, and hygiene facilities, knowledge, discomforts and disorders, supportive social environments, menstrual health impacts, and policies. Indicators are accompanied by measures that have been tested or are expected to provide reliable data, alongside justification for their selection and guidance for use. DISCUSSION The shortlisted indicators reflect the multisectoral collaboration necessary for ensuring girls' MHH. Uptake requires integration into monitoring systems at national and global levels. Future work remains to evaluate the performance of the indicators over time and to support their widespread use. Governments and stakeholders can use these indicators to track the progress of programs and policies, monitor unmet MHH needs, identify disparities, and set targets for improvement.
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Affiliation(s)
- Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jacquelyn Haver
- Department of Education and Child Protection, School Health and Nutrition Program, Save the Children US, Washington, D.C
| | | | - Jonathan Valdez
- Department of Education and Child Protection, School Health and Nutrition Program, Save the Children US, Washington, D.C
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Therese Mahon
- International Programmes Department, WaterAid, London, United Kingdom
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York.
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Kreuzer M, Deffner V, Sommer M, Fenske N. Updated risk models for lung cancer due to radon exposure in the German Wismut cohort of uranium miners, 1946-2018. Radiat Environ Biophys 2023; 62:415-425. [PMID: 37695330 PMCID: PMC10628028 DOI: 10.1007/s00411-023-01043-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
UNSCEAR recently recommended that future research on the lung cancer risk at low radon exposures or exposure rates should focus on more contemporary uranium miners. For this purpose, risk models in the German Wismut cohort of uranium miners were updated extending the follow-up period by 5 years to 1946-2018. The full cohort (n = 58,972) and specifically the 1960 + sub-cohort of miners first hired in 1960 or later (n = 26,764) were analyzed. The 1960 + sub-cohort is characterized by low protracted radon exposure of high quality of measurements. Internal Poisson regression was used to estimate the excess relative risk (ERR) for lung cancer per cumulative radon exposure in Working Level Months (WLM). Applying the BEIR VI exposure-age-concentration model, the ERR/100 WLM was 2.50 (95% confidence interval (CI) 0.81; 4.18) and 6.92 (95% CI < 0; 16.59) among miners with attained age < 55 years, time since exposure 5-14 years, and annual exposure rates < 0.5 WL in the full (n = 4329 lung cancer deaths) and in the 1960 + sub-cohort (n = 663 lung cancer deaths), respectively. Both ERR/WLM decreased with older attained ages, increasing time since exposure, and higher exposure rates. Findings of the 1960 + sub-cohort are in line with those from large pooled studies, and ERR/WLM are about two times higher than in the full Wismut cohort. Notably, 20-30 years after closure of the Wismut mines in 1990, the estimated fraction of lung cancer deaths attributable to occupational radon exposure is still 26% in the full Wismut cohort and 19% in the 1960 + sub-cohort, respectively. This demonstrates the need for radiation protection against radon.
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Affiliation(s)
- M Kreuzer
- Federal Office for Radiation Protection, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.
| | - V Deffner
- Federal Office for Radiation Protection, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - M Sommer
- Federal Office for Radiation Protection, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - N Fenske
- Federal Office for Radiation Protection, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
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Hoppes E, Rademacher KH, Wilson L, Mahajan TD, Wilson K, Sommer M, Solomon M, Lathrop E. Strengthening Integrated Approaches for Family Planning and Menstrual Health. Glob Health Sci Pract 2023; 11:e2300080. [PMID: 37903573 PMCID: PMC10615238 DOI: 10.9745/ghsp-d-23-00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/29/2023] [Indexed: 11/01/2023]
Abstract
FP and menstrual health integration has the potential to improve individuals' health and well-being. The authors describe potential ways to integrate FP and menstrual health, outlining steps that stakeholders can take in designing integrated approaches.
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Affiliation(s)
| | | | | | | | | | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, NY, USA
| | | | - Eva Lathrop
- Population Services International, Washington, DC, USA
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Werkl P, Sommer M, Singer C, Tomasic H, Seidel G, Woltsche N. [Central retinal vein thrombosis in a 21-year-old man-What is the cause?]. Ophthalmologie 2023; 120:838-840. [PMID: 35947155 PMCID: PMC9364846 DOI: 10.1007/s00347-022-01703-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 12/01/2022]
Affiliation(s)
- P Werkl
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich.
| | - M Sommer
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - C Singer
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - H Tomasic
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - G Seidel
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - N Woltsche
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
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Sommer M, Schmitt ML. Taking Stock: An Adaptable Research and Partnership Model for Developing Puberty Education in 10 Countries. Glob Health Sci Pract 2023; 11:e2200498. [PMID: 37348938 DOI: 10.9745/ghsp-d-22-00498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/04/2023] [Indexed: 06/24/2023]
Abstract
There is a growing global interest in puberty and early adolescence and the importance of ensuring young people have the information and support they need during this critical phase of transition in the life course. This article highlights an adaptable model being used to support the development of contextually appropriate puberty education, in the form of illustrated and often bilingual books, for early adolescent girls and boys in countries around the world. This youth-centered participatory research and design model, which relies on the generation of community and government partnerships, has been employed in 10 countries thus far. Valuable learning has been documented from various contexts, including the approach's flexibility in adapting to the inputs of government and community members, incorporating local buy-in as a key ingredient for sustainability, using in-country experts for social and cultural appropriateness of illustrations and translations, and ensuring that the authentic youth voices captured through the participatory data collection and field-testing shape the educational content. The continuous integration of insights and perceptions of adults who influence young people's lives into the development process is also essential to enabling the uptake of puberty content in each new country. Parents, educators, youth service providers, and government officials are often the gatekeepers to young adolescents receiving puberty content and are thus critical to the process. This review of more than a decade of experience using this model underscores the essentiality of 2 key components-local partnership and participatory data collection-and highlights the importance of flexible approaches that are adapted to the unique sociocultural and environmental conditions in each country context.
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Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University, New York, NY, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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13
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Bergen S, Murimi D, Gruer C, Munene G, Nyachieo A, Owiti M, Sommer M. Living with Endometriosis: A Narrative Analysis of the Experiences of Kenyan Women. Int J Environ Res Public Health 2023; 20:4125. [PMID: 36901136 PMCID: PMC10001793 DOI: 10.3390/ijerph20054125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Despite the high global prevalence of endometriosis, little is known about the experiences of women living with the disease in low- and middle-income contexts, including in Kenya and other countries across sub-Saharan Africa. This study captures the perspectives and recommendations of Kenyan women living with endometriosis through written narratives about the impact of the disease on their daily lives and their journeys through diagnosis and treatment. Thirty-seven women between the ages of 22 and 48 were recruited from an endometriosis support group in Nairobi and Kiambu, Kenya (February-March of 2022) in partnership with the Endo Sisters East Africa Foundation. Narrative data (written anonymous stories submitted through Qualtrics) were analyzed using a deductive thematic analysis methodology. Their stories revealed three themes related to their shared experiences with endometriosis: (1) stigma and disruption to quality of life, (2) barriers to acceptable healthcare, and (3) reliance on self-efficacy and social support to cope with the disease. These findings demonstrate a clear need for improved social awareness of endometriosis in Kenya and the establishment of clear, effective, and supportive pathways, with trained, geographically and financially accessible health care providers, for endometriosis diagnosis and treatment.
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Affiliation(s)
- Sadie Bergen
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Doris Murimi
- Endo Sisters East Africa Foundation, Laiboni Center, Off Lenana Rd., Nairobi P.O. Box 100798-00101, Kenya
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Gibson Munene
- Endo Sisters East Africa Foundation, Laiboni Center, Off Lenana Rd., Nairobi P.O. Box 100798-00101, Kenya
| | - Atunga Nyachieo
- Institute of Primate Research, Karen, Nairobi P.O. Box 24481-00502, Kenya
| | - Maureen Owiti
- The Department of Obstetrics and Gynaecology, Kenyatta National Hospital, Nairobi P.O. Box 20723-00202, Kenya
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
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14
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Teizazu H, Gruer C, Mandara E, Sommer M. Exploring a faith-based approach to puberty education in Tanzania. Front Reprod Health 2023; 5:1024550. [PMID: 36844258 PMCID: PMC9950263 DOI: 10.3389/frph.2023.1024550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023] Open
Abstract
Background Many adolescents in Tanzania do not receive timely and comprehensive puberty education. This study explored faith-based organizations a site for puberty education. Two puberty books, each developed through participatory research with Tanzanian adolescents and stakeholders, were promoted to 177 Christian denomination churches in Dar es Salaam, Tanzania to understand the factors that faith leaders considered in their decision to purchase puberty books, or share information about the intervention to their peers and congregants. Methods Data collection included routine monitoring via weekly reports and ethnographic observation. Data were analyzed using the Ecological Framework for Health Promotion to capture how individual, interpersonal, and institutional factors influenced leaders' decisions to purchase or promote puberty books. Results At the individual level, leaders cited their personal experiences in their support for the intervention, but leaders' time and confidence in their ability to effectively promote books to others were barriers to participation. Interpersonally, the diffusion of information between church leaders, particularly when information came from well-known or respected leaders, emerged as an important factor in leaders' willingness to promote books. At the institutional level, leaders' decisions were impacted by resources, institutional culture, and institutional hierarchy. Importantly, twelve churches in the sample purchased books. Limited financial resources and the need to receive approval from denominational leaders were discussed by leaders as barriers to purchasing books. Conclusions Despite research showing high religiosity in Tanzania, the role of religious institutions in providing puberty education has remained unexplored. Our results inform future research and practice by providing an articulation of the socioecological factors that played a role in faith leaders' decisions related to puberty education interventions in Tanzania.
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Affiliation(s)
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Elisia Mandara
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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15
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Macura B, Foggitt E, Liera C, Soto A, Orlando A, Del Duca L, Carrard N, Hannes K, Sommer M, Dickin S. Systematic mapping of gender equality and social inclusion in WASH interventions: knowledge clusters and gaps. BMJ Glob Health 2023; 8:bmjgh-2022-010850. [PMID: 36693669 PMCID: PMC9884933 DOI: 10.1136/bmjgh-2022-010850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/29/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Poor access to water, sanitation and hygiene (WASH) services threatens population health and contributes to gender and social inequalities, especially in low-resource settings. Despite awareness in the WASH sector of the importance of promoting gender equality and social inclusion (GESI) to address these inequalities, evaluations of interventions focus largely on health outcomes, while gender equality and other social outcomes are rarely included. This review aimed to collate and describe available research evidence of GESI outcomes evaluated in WASH intervention studies. METHODS We applied a systematic mapping methodology and searched for both academic and grey literature published between 2010 and 2020 in 16 bibliographic databases and 53 specialist websites. Eligibility screening (with consistency checking) was conducted according to predetermined criteria, followed by metadata coding and narrative synthesis. RESULTS Our evidence base comprises 463 intervention studies. Only 42% of studies measured transformative GESI outcomes of WASH interventions, referring to those that seek to transform gender relations and power imbalances to promote equality. A majority of studies disaggregated outcome data by sex, but other forms of data disaggregation were limited. Most included studies (78%) lacked a specific GESI mainstreaming component in their intervention design. Of the interventions with GESI mainstreaming, the majority targeted women and girls, with very few focused on other social groups or intersectional considerations. CONCLUSION The review points to various areas for future primary and secondary research. Given the potential contribution of WASH to GESI, GESI considerations should be incorporated into the evaluation of WASH interventions. Regular collection of data and monitoring of GESI outcomes is needed as well as developing new and testing existing methods for monitoring and evaluation of such data.
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Affiliation(s)
| | - Ella Foggitt
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - Carla Liera
- Stockholm Environment Institute, Stockholm, Sweden
| | - Adriana Soto
- Stockholm Environment Institute, Stockholm, Sweden
| | - Arianna Orlando
- Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | | | - Naomi Carrard
- Institute for Sustainable Futures, University of Technology Sydney, Broadway, Sydney, Australia
| | - Karin Hannes
- Research Group SoMeTHin’K, Faculty of Social Sciences, KU Leuven, Leuven, Belgium
| | - Marni Sommer
- Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Sarah Dickin
- Stockholm Environment Institute, Stockholm, Sweden,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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16
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Schmitt ML, Hagstrom C, Gruer C, Nowara A, Keeley K, Adenu-Mensah NE, Sommer M. “Girls May Bleed Through Pads Because of Demerits”: Adolescent Girls’ Experiences With Menstruation and School Bathrooms in the U.S.A. Journal of Adolescent Research 2022. [DOI: 10.1177/07435584221139342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The aim of this study was to better understand the role of school bathrooms in shaping the menstrual experiences of adolescents in the U.S.A. The participants were Black and Latina, low-income adolescent girls (15–19) and adults interacting closely with youth in three U.S.A. cities (Chicago, Los Angeles, New York City). Data collection methods included: (1) Participatory Methodologies (PM) sessions with adolescent girls ( n = 73); (2) In-depth interviews (IDI) with adolescent girls ( n = 12); and (3) Key Informant Interviews (KII) with adults ( n = 23). Malterud’s “systematic text condensation,” an inductive thematic analysis method, was utilized to analyze the various data types (field notes, in-depth interviews, drawings). Key findings include, one, that menstruating girls experience embarrassment and a need for secrecy when accessing school bathrooms; two, the social and physical environments of school bathrooms, including poor design and maintenance, heighten girls’ discomfort, especially while menstruating; and three, school policies restricting students’ bathroom access are problematic for many menstruating students, especially those experiencing heavy and/or unpredictable bleeding. Schools and policymakers need to consider holistic approaches when addressing the menstrual needs of adolescents in U.S.A. schools, including better prioritizing issues related to menstrual stigma, school bathroom design and bathroom access policies.
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Affiliation(s)
| | | | | | | | - Katie Keeley
- Ann & Robert H. Lurie Children’s Hospital of Chicago, IL, USA
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17
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Öttl LK, Wilken F, Hupfer A, Sommer M, Fiener P. Non-inversion conservation tillage as an underestimated driver of tillage erosion. Sci Rep 2022; 12:20704. [PMID: 36456592 PMCID: PMC9715560 DOI: 10.1038/s41598-022-24749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022] Open
Abstract
Tillage erosion is a widely underestimated process initiating soil degradation especially in case of large agricultural fields located in rolling topography. It is often assumed that, conservation, non-inversion tillage causes less tillage erosion than conventional inversion tillage. In this study, tillage erosion was determined on three paired plots comparing non-inversion chisel versus inversion mouldboard tillage. The experiments were performed at three sites in Northeast Germany with gentle, moderate, and steep slope, while tillage depth (0.25 m) and speed (≈ 6 km h-1) were kept constant during all experiments. The results indicate that non-inversion tillage produces significantly more soil movement compared to inversion tillage. The soil translocation distance was by a factor of 1.3-2.1 larger in case of chisel tillage. The largest difference in translocation distance and tillage transport coefficient (ktil) was found on the gentle slope exhibiting the lowest soil cohesion. Our results together with an evaluation of ktil values derived from literature and standardised for 0.25 m tillage depth contradict the general assumption that non-inversion tillage reduces tillage erosion. In tillage erosion dominated areas, non-inversion tillage applied with high tillage speed and depth potentially increases tillage erosion and fails its purpose to serve as soil conservation measure.
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Affiliation(s)
- L. K. Öttl
- grid.7307.30000 0001 2108 9006Institute of Geography, University of Augsburg, Alter Postweg 118, 86159 Augsburg, Germany
| | - F. Wilken
- grid.7307.30000 0001 2108 9006Institute of Geography, University of Augsburg, Alter Postweg 118, 86159 Augsburg, Germany
| | - A. Hupfer
- grid.7307.30000 0001 2108 9006Institute of Geography, University of Augsburg, Alter Postweg 118, 86159 Augsburg, Germany
| | - M. Sommer
- grid.433014.1Landscape Pedology Working Group, Leibniz Center for Agricultural Landscape Research ZALF e.V., Eberswalder Str. 84, 15374 Müncheberg, Germany ,grid.11348.3f0000 0001 0942 1117Institute of Environmental Science and Geography, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany
| | - P. Fiener
- grid.7307.30000 0001 2108 9006Institute of Geography, University of Augsburg, Alter Postweg 118, 86159 Augsburg, Germany
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18
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Carney A, Mulei T, Kurao D, Hagstrom C, Sommer M. “When I woke up I was so worried and ashamed, I thought it was a disease”: Adolescent boys’ transitions through puberty in Kenya. Front Reprod Health 2022; 4:956060. [PMID: 36419962 PMCID: PMC9677552 DOI: 10.3389/frph.2022.956060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
Growing evidence suggests a need for more focused attention on boys’ experiences of puberty in sub-Saharan Africa to assure healthy transitions into young adulthood. Existing research remains limited on the masculinity norms shaping boys’ maturation experiences in Kenya. To help fill this gap, we conducted a comparative case study using qualitative methodologies with 16–19-year-old male youth in rural and urban Kenya, and with adults interacting in boys’ daily lives. Findings suggest that Kenyan boys experience shame, confusion and silence around changes happening in their bodies; face pressures from new societal expectations as they become young men; and have adolescent lives shaped by minimal supervision, increased peer pressures and engagement in more risky health behaviors. Additional research and targeted interventions on boys transitioning through puberty and early adolescence are needed to better understand their vulnerabilities and prevent or reduce their engagement in unsafe behaviors.
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Affiliation(s)
| | | | | | - Christine Hagstrom
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
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19
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Winter SC, Sommer M, Obara LM, Nair D. “There is no place to dispose them. What would you have me do?’’: A qualitative study of menstruation in the unique physical and social environment in informal settlements in Nairobi, Kenya. Health Place 2022; 78:102932. [DOI: 10.1016/j.healthplace.2022.102932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 10/02/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
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20
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Schmitt ML, Gruer C, Hagstrom C, Ekua Adenu-Mensah N, Nowara A, Keeley K, Sommer M. “It always gets pushed aside:” Qualitative perspectives on puberty and menstruation education in U.S.A. schools. Front Reprod Health 2022; 4:1018217. [PMID: 36339773 PMCID: PMC9635341 DOI: 10.3389/frph.2022.1018217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Adolescent girls in the U.S.A. often lack sufficient education on pubertal and menstrual health topics. This educational gap may be growing given the current decline in American elementary and middle schools' delivery of sexual health education. Furthermore, little is known about the actual scope and quality of existing menstruation and puberty education in U.S.A. schools. This paper provides insights into some of the challenges with the delivery of menstruation and puberty education in schools. Qualitative and participatory research methodologies were utilized with Black and Latina girls ages 15–19 and adults working with youth in three U.S.A. cities (Chicago, Los Angeles, and New York City), exploring experiences of menstruation within school and family contexts. Findings revealed tension between school responsibility and family authority in providing menstruation and puberty education in schools, school- and teacher-related delivery challenges, and inadequate and disengaging menstruation and puberty content. Further research is needed on the effectiveness and best practices for providing this education in schools, including improved understanding on student and parent preferences, delivery mediums and the scope of content.
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Affiliation(s)
- Margaret L. Schmitt
- Mailman School of Public Health, Columbia University, New York City, NY, United States
- Correspondence: Margaret L. Schmitt
| | - Caitlin Gruer
- Mailman School of Public Health, Columbia University, New York City, NY, United States
| | - Christine Hagstrom
- Mailman School of Public Health, Columbia University, New York City, NY, United States
| | | | - Azure Nowara
- Mailman School of Public Health, Columbia University, New York City, NY, United States
| | - Katie Keeley
- Office of Clinical and Community Trials, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Marni Sommer
- Mailman School of Public Health, Columbia University, New York City, NY, United States
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21
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Marsh AD, Moller AB, Saewyc E, Adebayo E, Akwara E, Azzopardi P, Ba MG, Baltag V, Bose K, Burrows S, Carvajal L, Dastgiri S, Fagan L, Ferguson J, Friedman HS, Giyava C, Hagell A, Inchley J, Jackson D, Kågesten AE, Mangombe A, Morgan A, Newby H, Schultz L, Sommer M, Speizer I, Tang K, Guthold R. Priority Indicators for Adolescent Health Measurement - Recommendations From the Global Action for Measurement of Adolescent Health (GAMA) Advisory Group. J Adolesc Health 2022; 71:455-465. [PMID: 35779998 PMCID: PMC9477504 DOI: 10.1016/j.jadohealth.2022.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/25/2022] [Accepted: 04/23/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This article describes the selection of priority indicators for adolescent (10-19 years) health measurement proposed by the Global Action for Measurement of Adolescent health advisory group and partners, building on previous work identifying 33 core measurement areas and mapping 413 indicators across these areas. METHODS The indicator selection process considered inputs from a broad range of stakeholders through a structured four-step approach: (1) definition of selection criteria and indicator scoring; (2) development of a draft list of indicators with metadata; (3) collection of public feedback through a survey; and (4) review of the feedback and finalization of the indicator list. As a part of the process, measurement gaps were also identified. RESULTS Fifty-two priority indicators were identified, including 36 core indicators considered to be most important for measuring the health of all adolescents, one alternative indicator for settings where measuring the core indicator is not feasible, and 15 additional indicators for settings where further detail on a topic would add value. Of these indicators, 17 (33%) measure health behaviors and risks, 16 (31%) health outcomes and conditions, eight (15%) health determinants, five (10%) systems performance and interventions, four (8%) policies, programmes, laws, and two (4%) subjective well-being. DISCUSSION A consensus list of priority indicators with metadata covering the most important health issues for adolescents was developed with structured inputs from a broad range of stakeholders. This list will now be pilot tested to assess the feasibility of indicator data collection to inform global, regional, national, and sub-national monitoring.
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Affiliation(s)
- Andrew D. Marsh
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland,Address correspondence to: Andrew D. Marsh, Ph.D., Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, 20, Avenue Appia, CH-1211, Geneva, Switzerland.
| | - Ann-Beth Moller
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Elizabeth Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Peter Azzopardi
- Global Adolescent Health group, Burnet Institute, Melbourne, Victoria, Australia,Adolescent Health and wellbeing program, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Mariame Guèye Ba
- University Cheikh Anta Diop of Dakar, Faculty of Medicine, Pharmacy and Odontology/Gynecology, Dakar, Senegal,Obstetrics Clinic, University Teaching Hospital A. Le Dantec, Dakar, Senegal
| | - Valentina Baltag
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
| | - Krishna Bose
- Bill and Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Liliana Carvajal
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Saeed Dastgiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Lucy Fagan
- UN Major Group for Children and Youth, London, United Kingdom,Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jane Ferguson
- Independent Consultant, Adolescent Health, Tannay, Switzerland
| | | | | | - Ann Hagell
- Association for Young People's Health, London, United Kingdom
| | - Jo Inchley
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Debra Jackson
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom,School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Anna E. Kågesten
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Aveneni Mangombe
- Zimbabwe LSHTM Research Partnership, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Alison Morgan
- Global Financing Facility, The World Bank Group, Washington, District of Columbia,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Holly Newby
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
| | - Linda Schultz
- Global Financing Facility, The World Bank Group, Washington, District of Columbia
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Ilene Speizer
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
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22
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Lane B, Perez-Brumer A, Parker R, Sprong A, Sommer M. Improving menstrual equity in the USA: perspectives from trans and non-binary people assigned female at birth and health care providers. Cult Health Sex 2022; 24:1408-1422. [PMID: 34365908 PMCID: PMC9912750 DOI: 10.1080/13691058.2021.1957151] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
Menstruation research has largely focused on addressing menstrual management barriers facing cisgender women and girls in low and middle-income countries. Scant literature has assessed the menstrual management needs of trans and non-binary people assigned female at birth. To better understand these frequently invisibilised menstruation-related needs, we conducted a multi-method qualitative study in New York City which included: 17 in-depth interviews across trans and non-binary people (n = 10) and health care providers who serve them (n = 7); and seven anonymous post-interview participatory writing responses with trans and non-binary participants to further elucidate their lived experiences with menstrual management. Lack of health care provider transgender competency, public toilet design (i.e. gaps in cubicle doors and lack of in-cubicle menstrual product disposal bins), and the social dynamics of public toilets (i.e. work and school) were identified as significant barriers to managing menstruation safely and accessibly for trans and non-binary people. These findings have important implications for healthcare policy, public toilet legislation and advancing menstrual equity in the USA.
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Affiliation(s)
- Benjamin Lane
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amaya Perez-Brumer
- Division of Social and Behavioural Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Richard Parker
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Institute for the Study of Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Brazilian Interdisciplinary AIDS Association, ABIA, Rio de Janeiro, Brazil
| | - Amelia Sprong
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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23
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Sommer M, Phillips-Howard PA, Gruer C, Schmitt ML, Nguyen AM, Berry A, Kochhar S, Gorrell Kulkarni S, Nash D, Maroko AR. Menstrual Product Insecurity Resulting From COVID-19‒Related Income Loss, United States, 2020. Am J Public Health 2022; 112:675-684. [PMID: 35319956 PMCID: PMC8961817 DOI: 10.2105/ajph.2021.306674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To identify key effects of the pandemic and its economic consequences on menstrual product insecurity with implications for public health practice and policy. Methods. Study participants (n = 1496) were a subset of individuals enrolled in a national (US) prospective cohort study. Three survey waves were included (March‒October 2020). Menstrual product insecurity outcomes were explored with bivariate associations and logistic regression models to examine the associations between outcomes and income loss. Results. Income loss was associated with most aspects of menstrual product insecurity (adjusted odds ratios from 1.34 to 3.64). The odds of not being able to afford products for those who experienced income loss was 3.64 times (95% confidence interval [CI] = 2.14, 6.19) that of those who had no income loss and 3.95 times (95% CI = 1.78, 8.79) the odds for lower-income participants compared with higher-income participants. Conclusions. Pandemic-related income loss was a strong predictor of menstrual product insecurity, particularly for populations with lower income and educational attainment. Public Health Implications. Provision of free or subsidized menstrual products is needed by vulnerable populations and those most impacted by pandemic-related income loss.(Am J Public Health. 2022;112(4):675-684. (https://doi.org/10.2105/AJPH.2021.306674).
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Affiliation(s)
- Marni Sommer
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Penelope A Phillips-Howard
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Caitlin Gruer
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Margaret L Schmitt
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Angela-Maithy Nguyen
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Amanda Berry
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Shivani Kochhar
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Sarah Gorrell Kulkarni
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Denis Nash
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Andrew R Maroko
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
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Schmitt ML, Booth K, Sommer M. A Policy for Addressing Menstrual Equity in Schools: A Case Study From New York City, U.S.A. Front Reprod Health 2022; 3:725805. [PMID: 36303999 PMCID: PMC9580679 DOI: 10.3389/frph.2021.725805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/22/2021] [Indexed: 12/03/2022] Open
Abstract
There has been a growth in menstrual equity policy advancements in the U.S.A. in recent years; with much of the new legislation prioritizing the needs of adolescent girls in schools. New York City, a predecessor of this movement, was the first U.S.A. locality to pass such legislation in 2016. The aim of this case study was to better understand the various factors which led to the development, passage and initial implementation of New York City's Menstrual Equity in Schools Policy. Data collection methods included a desk review and qualitative assessment with several actors involved across the policy and introduction phases. Key findings included (1) the utility of community narratives and a pilot project as a means for overcoming initial skepticisms, proving feasibility, and generating support; (2) the importance of policy champions for overcoming fiscal objections and navigating political discourse; and (3) lessons learned from early implementation efforts, including variance in awareness and distribution models. This case study yields valuable insights into the practical considerations when designing or implementing policies aimed at tackling issues of menstrual equity within school settings.
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Affiliation(s)
- Margaret L. Schmitt
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- *Correspondence: Margaret L. Schmitt
| | - Kathleen Booth
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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Hoppes E, Nwachukwu C, Hennegan J, Blithe DL, Cordova-Gomez A, Critchley H, Doncel GF, Dorflinger LJ, Haddad LB, Mackenzie ACL, Maybin JA, Moley K, Nanda K, Sales Vieira C, Vwalika B, Kibira SPS, Mickler A, OlaOlorun FM, Polis CB, Sommer M, Williams KM, Lathrop E, Mahajan T, Rademacher KH, Solomon M, Wilson K, Wilson LC, Rountree L. Global research and learning agenda for building evidence on contraceptive-induced menstrual changes for research, product development, policies, and programs. Gates Open Res 2022; 6:49. [PMID: 35614964 PMCID: PMC9114387 DOI: 10.12688/gatesopenres.13609.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Contraceptive-induced menstrual changes (CIMCs) can affect family planning (FP) users' lives in both positive and negative ways, resulting in both opportunities and consequences. Despite this, and despite the important links between FP and menstrual health (MH), neither field adequately addresses CIMCs, including in research, product development, policies, and programs globally. Methods: In November 2020, a convening of both MH and FP experts reviewed the existing evidence on CIMCs and identified significant gaps in key areas. Results: These gaps led to the establishment of a CIMC Task Force in April 2021 and the development of the Global Research and Learning Agenda: Building Evidence on Contraceptive-Induced Menstrual Changes in Research, Product Development, Policies, and Programs Globally (the CIMC RLA) , which includes four research agendas for (1) measurement, (2) contraceptive research and development (R&D) and biomedical research, (3) social-behavioral and user preferences research, and (4) programmatic research. Conclusions: Guided by the CIMC RLA, researchers, product developers, health care providers, program implementers, advocates, policymakers, and funders are urged to conduct research and implement strategies to address the beneficial and negative effects of CIMCs and support the integration of FP and MH. CIMCs need to be addressed to improve the health and well-being of women, girls, and other people who menstruate and use contraceptives globally. Disclaimer : The views expressed in this article are those of the authors. Publication in Gates Open Research does not imply endorsement by the Gates Foundation.
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Affiliation(s)
| | - Chukwuemeka Nwachukwu
- United States Agency for International Development (USAID), Washington, District of Columbia, 20523, USA
| | - Julie Hennegan
- Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Amanda Cordova-Gomez
- United States Agency for International Development (USAID), Washington, District of Columbia, 20523, USA
| | - Hilary Critchley
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Gustavo F Doncel
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia, 23507, USA
| | | | - Lisa B Haddad
- Center for Biomedical Research, Population Council, New York, New York, 10017, USA
| | | | - Jacqueline A Maybin
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Kelle Moley
- Bill & Melinda Gates Foundation, Seattle, Washington, 98109, USA
| | | | - Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Bellington Vwalika
- Departments of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Alexandria Mickler
- United States Agency for International Development (USAID), Washington, District of Columbia, 20523, USA
| | | | | | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, 10032, USA
| | | | - Eva Lathrop
- Population Services International, Washington, District of Columbia, 20526, USA
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Gruer C, Goss T, Schmitt ML, Sommer M. Menstrual Equity Initiatives at USA Universities: A Multiple Case Study of Common Obstacles and Enabling Factors. Front Reprod Health 2021; 3:787277. [PMID: 36304028 PMCID: PMC9580624 DOI: 10.3389/frph.2021.787277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In recent years there has been growing momentum in the USA around addressing issues of “menstrual equity” and “period poverty,” including a proliferation of university-level initiatives seeking to provide access to free menstrual products. This multiple case study examined four such efforts at a diversity of tertiary institutions to identify the factors that facilitated or impeded success. Methods: We conducted a qualitative multiple case study, including a desk review and key informant interviews with student and administrative actors from universities with free menstrual product initiatives. We sought to identify key learning regarding common challenges and obstacles, enabling factors which supported success and sustainability, and practical learning for future initiatives. From the desk review, four schools (n = 4) were purposively selected to represent a range of geographic regions, student population size, and university type. Purposive sampling was used to identify students and administrators engaged in the menstrual equity initiatives on each campus (n = 20; 4–6 per school). Data from the desk review and interviews were analyzed using thematic analysis. Results: Key themes included (1) the critical role of champions, (2) the importance of social and financial support, (3) challenges diffusing menstrual equity from pilot to scale, and (4) recommendations for future initiatives. University initiatives varied greatly in terms of their scope, funding, and implementation strategy. Conclusion: This multiple case study provides valuable insights regarding the facilitating factors and obstacles faced by initiatives providing free menstrual products at universities. To date, these initiatives have proven successful across the four case studies; however, in most cases, the scope of the initiatives was constrained by limited resources and sustainability concerns. Future campus menstrual equity strategies would benefit from cross-institutional learning and dialogue highlighting design and implementation successes and challenges.
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Affiliation(s)
- Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- *Correspondence: Caitlin Gruer
| | - Taylor Goss
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Margaret L. Schmitt
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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Babbar K, Martin J, Ruiz J, Parray AA, Sommer M. Menstrual health is a public health and human rights issue. Lancet Public Health 2021; 7:e10-e11. [PMID: 34717798 PMCID: PMC8552814 DOI: 10.1016/s2468-2667(21)00212-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Karan Babbar
- Ravi J Matthai Centre for Educational Innovation, Indian Institute of Management, Ahmedabad, Gujarat 380015, India; Pandemic Periods, Glasgow, UK.
| | | | | | - Ateeb Ahmad Parray
- Pandemic Periods, Glasgow, UK; Center of Excellence for Gender, Sexual and Reproductive Health and Rights, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Diana J. Mason
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC
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Sommer M, Ibitoye M, Likindikoki S, Parker R. Participatory Methodologies With Adolescents: A Research Approach Used to Explore Structural Factors Affecting Alcohol Use and Related Unsafe Sex in Tanzania. J Prim Prev 2021; 42:363-384. [PMID: 32206980 PMCID: PMC7508787 DOI: 10.1007/s10935-020-00586-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Multiple methodological approaches have been used to explore adolescent alcohol use and related sexual behaviors, ranging from surveys to assessments of alcohol outlet density. Although surveys can capture the extent of alcohol use, they do not allow for a contextualized understanding of young people's voiced experiences with alcohol, including sociocultural, gendered and environmental pressures to consume, and related engagement in sex. The mapping of alcohol outlets provides physical density information, but infrequently from youths' perspectives. Traditional qualitative methods like in-depth interviews and focus group discussions do allow for a more nuanced understanding of adolescents' experiences, but they can be limited by the use of semi-structured guides that may negatively impact the fluidity of discussion. We seek to contribute to the methodological approaches utilized with adolescents by demonstrating how contextualized data were captured from Tanzanian adolescents' experiences of alcohol and sex, which are sensitive topics in many African countries. We collected data in secondary schools and youth centers across four sites in Dar es Salaam, the largest and most diverse city in Tanzania. As a complement to in-depth interviews, archival reviews, and a systematic mapping of alcohol availability, participatory methodologies such as photovoice, story writing, and drawing allowed Tanzanian youth to offer more honest, descriptions of lived experiences with their physical and social environment in relation to alcohol use and related sexual behavior patterns. Through participatory methods, study participants were able to discuss behaviors that are viewed as social transgressions, sensitive topics like violence in relation to sex, and views around their own self-agency. The use of a methodological toolkit including participatory methodologies enabled youth to trust the researchers and share sensitive information in a relatively short period of time, overcoming some of the challenges of traditional qualitative methods.
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Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA.
| | - Mobolaji Ibitoye
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA
| | - Samuel Likindikoki
- Muhumbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Richard Parker
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA
- Institute for the Study of Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Maroko AR, Hopper K, Gruer C, Jaffe M, Zhen E, Sommer M. Public restrooms, periods, and people experiencing homelessness: An assessment of public toilets in high needs areas of Manhattan, New York. PLoS One 2021; 16:e0252946. [PMID: 34161351 PMCID: PMC8221515 DOI: 10.1371/journal.pone.0252946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
Access to safe, clean water and sanitation is globally recognized as essential for public health. Public toilets should be accessible to all members of a society, without social or physical barriers preventing usage. A public toilet facility's design and upkeep should offer privacy and safety, ensure cleanliness, provide required sanitation-related resources, and be gender equitable, including enabling comfortable and safe management of menstruation. Menstrual hygiene management (MHM) refers to the need to ensure that girls, women and all people who menstruate have access to clean menstrual products, privacy to change the materials as often as needed, soap and water for washing the body as required, and access to facilities to dispose of used materials. Challenges around menstruation faced by people experiencing homelessness, which tend to be greater than those facing the general population, include inadequate toilet and bathing facilities, affordability issues around menstrual products, and menstrual stigma. Public toilets are a vital resource for managing menstruation, particularly for vulnerable populations without reliable access to private, safe, and clean spaces and menstrual products. This mixed-methods study sought to: 1) understand the lived experiences of MHM among people experiencing homelessness in New York City with respect to public toilets; 2) describe general and MHM-related characteristics of public toilets in high need areas of Manhattan and analyze their interrelationships; and 3) examine the associations among neighborhood-level demographics and the public toilet characteristics in those areas. Qualitative methods included key informant interviews (n = 15) and in-depth interviews (n = 22) with people with experience living on the street or in shelters, which were analyzed using Malterud's 'systematic text condensation' for thematic cross-case analysis. Quantitative methods included audits and analyses of public toilet facilities (n = 25) using traditional statistics (e.g., Spearman's correlations) and spatial analyses (e.g., proximity buffers). Qualitative findings suggest cleanliness, access to restrooms, and availability of resources are critical issues for the participants or prospective users. Quantitative analyses revealed insufficiently provided, maintained, and resourced public toilets for managing menstruation in high-needs areas. Findings also suggest that toilets with more MHM-related resource availability, such as menstrual products and toilet stall disposal bins, were more difficult to access. Neighborhood-level characteristics showed a potential environmental injustice, as areas characterized by higher socioeconomic status are associated with more access to MHM-specific resources in public restrooms, as well as better overall quality.
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Affiliation(s)
- Andrew R. Maroko
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States of America
| | - Kim Hopper
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Maayan Jaffe
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Erica Zhen
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States of America
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Macura B, Del Duca L, Soto A, Carrard N, Gosling L, Hannes K, Thomas J, Sara L, Sommer M, Waddington HS, Dickin S. PROTOCOL: What is the impact of complex WASH interventions on gender and social equality outcomes in low- and middle-income countries? A mixed-method systematic review protocol. Campbell Syst Rev 2021; 17:e1164. [PMID: 37051177 PMCID: PMC8356345 DOI: 10.1002/cl2.1164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
| | - Laura Del Duca
- Stockholm Environment InstituteStockholmSweden
- Institute of Development StudiesUniversity of SussexBrightonUK
| | | | - Naomi Carrard
- Institute for Sustainable FuturesUniversity of TechnologySydneyAustralia
| | | | - Karin Hannes
- Research group SoMeTHin'K (Social, Methodological and Theoretical Innovation Kreative), CESO, Faculty of Social SciencesKU LeuvenLeuvenBelgium
| | - James Thomas
- Department of Social Science, EPPI‐CentreUCL Institute of EducationLondonUK
| | | | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public HealthColumbia UniversityNew York CityNew YorkUSA
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Gruer C, Hopper K, Smith RC, Kelly E, Maroko A, Sommer M. Seeking menstrual products: a qualitative exploration of the unmet menstrual needs of individuals experiencing homelessness in New York City. Reprod Health 2021; 18:77. [PMID: 33849575 PMCID: PMC8042836 DOI: 10.1186/s12978-021-01133-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background There has been increasing recognition that certain vulnerable populations in the United States of America struggle to meet their menstruation-related needs, including people experiencing homelessness. Media and policy attention on this subject has focused on the provision of free menstrual products to vulnerable populations, including a New York City legislative bill, which guarantees access to menstrual products for Department of Homeless Services shelter residents (Intros 1123-A). Methods This qualitative study explored the challenges people experiencing homelessness in New York City face in accessing menstrual products. Data collection was conducted from June to August 2019 and included: Semi-structured key informant interviews with staff from relevant government agencies and homeless service providers (n = 15), and semi-structured in-depth interviews with individuals with experience living on the street and in shelters (n = 22). Data were analysed using thematic analysis. Results Key themes that emerged included: (1) insufficient and inconsistent access to menstrual products; (2) systemic challenges to providing menstrual products; and (3) creative solutions to promote access to menstrual products. Both shelter- and street-living individuals reported significant barriers to accessing menstrual products. While both populations struggle, those in shelters were more likely to be able to purchase menstrual products or access free products at their shelter, while those living on the streets were more likely to have to resort to panhandling, theft, or using makeshift materials in place of menstrual products. Across both populations, individuals described barriers to accessing free products at shelters and service providers, primarily due to distribution systems that rely on gatekeepers to provide a few pads or tampons at a time, sometimes of inadequate quality and only upon request. Shelters and service providers also described challenges providing these products, including inconsistent supply. Conclusion These findings highlight the critical importance of expanding and improving initiatives seeking to provide access to menstrual products for vulnerable populations. Despite policy level efforts to support menstrual product access, individuals experiencing homelessness in New York City, whether living in shelters or on the street, are often not able to access the menstrual products that they need to manage their monthly menstrual flow.
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Affiliation(s)
- Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA.
| | - Kim Hopper
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA
| | - Rachel Clark Smith
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA
| | - Erin Kelly
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA
| | - Andrew Maroko
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY School of Public Health, 55 W. 125th Street, Room 508, New York, NY, 10027, USA
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA
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Liu D, Schmitt M, Nowara A, Magno C, Ortiz R, Sommer M. The evolving landscape of menstrual product advertisements in the United States: 2008-2018. Health Care Women Int 2021; 44:537-565. [PMID: 33825618 DOI: 10.1080/07399332.2021.1884251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
As menstrual product advertising evolves within the United States, it is important to understand how advertising messages, which have been shown to impact self-esteem and feelings of shame, may be influencing young people today. We analyzed menstrual product advertising over ten years (2008-2018) through a survey (n = 198) and focus groups (n = 21) with college and graduate student-aged adults. Three themes emerged: an emphasis on femininity and shame; the presence and role of men in the menstrual process; and racial, gender and body type inclusivity. Advertising shifts toward messages of inclusivity may positively influence young people's perceptions toward their bodies and menstruation.
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Affiliation(s)
- Danting Liu
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Margaret Schmitt
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Azure Nowara
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Cathryn Magno
- Faculty of Lettres, University of Fribourg, Fribourg, Switzerland
| | - Rebecca Ortiz
- Newhouse School, Syracuse University, Syracuse, New York, USA
| | - Marni Sommer
- Mailman School of Public Health, Columbia University, New York, New York, USA
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Schmitt ML, Wood OR, Clatworthy D, Rashid SF, Sommer M. Innovative strategies for providing menstruation-supportive water, sanitation and hygiene (WASH) facilities: learning from refugee camps in Cox's bazar, Bangladesh. Confl Health 2021; 15:10. [PMID: 33637096 PMCID: PMC7912835 DOI: 10.1186/s13031-021-00346-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background There is growing attention to addressing the menstrual hygiene management (MHM) needs of the over 21 million displaced adolescent girls and women globally. Current approaches to MHM-related humanitarian programming often prioritize the provision of menstrual materials and information. However, a critical component of an MHM response includes the construction and maintenance of water, sanitation and hygiene (WASH) facilities, including more female-friendly toilets. This enables spaces for menstruating girls and women to change, dispose, wash and dry menstrual materials; all of which are integral tasks required for MHM. A global assessment identified a number of innovations focused on designing and implementing menstruation-supportive WASH facilities in the Rohingya refugee camps located in Cox’s Bazar (CXB), Bangladesh. These pilot efforts strove to include the use of more participatory methodologies in the process of developing the new MHM-supportive WASH approaches. This study aimed to capture new approaches and practical insights on innovating menstrual disposal, waste management and laundering in emergency contexts through the conduct of a qualitative assessment in CXB. Methods The qualitative assessment was conducted in the Rohingya refugee camps in CXB in September of 2019 to capture new approaches and practical insights on innovating for menstrual disposal, waste management and laundering. This included Key Informant Interviews with 19 humanitarian response staff from the WASH and Protection sectors of a range of non-governmental organizations and UN agencies; Focus Group Discussions with 47 Rohingya adolescent girls and women; and direct observations of 8 WASH facilities (toilets, bathing, and laundering spaces). Results Key findings included: one, the identification of new female-driven consultation methods aimed at improving female beneficiary involvement and buy-in during the design and construction phases; two, the design of new multi-purpose WASH facilities to increase female beneficiary usage; three, new menstrual waste disposal innovations being piloted in communal and institutional settings, with female users indicating at least initial acceptability; and four, novel strategies for engaging male beneficiaries in the design of female WASH facilities, including promoting dialogue to generate buy-in regarding the importance of these facilities and debate about their placement. Conclusions Although the identified innovative participatory methodologies and design approaches are promising, the long term viability of the facilities, including plans to expand them, may be dependent on the continued engagement of girls and women, and the availability of resources.
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Affiliation(s)
- Margaret L Schmitt
- Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA.
| | - Olivia R Wood
- Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA
| | - David Clatworthy
- International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA
| | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, Bangladesh
| | - Marni Sommer
- Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA.
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Carney A, Kaaya S, Kajula L, Ibitoye M, Marwerwe G, Sommer M. ‘Most of the Youth Are Drinking Because They Have Nothing to Do’: How Idle Time Facilitates Adolescent Alcohol Use in Urban Tanzania. Journal of Child & Adolescent Substance Abuse 2021. [DOI: 10.1080/1067828x.2021.1888169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Allison Carney
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sylvia Kaaya
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lusajo Kajula
- Office of Research – Innocenti, UNICEF, Dar es Salaam, Tanzania
| | - Mobolaji Ibitoye
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Schmitt ML, Hagstrom C, Nowara A, Gruer C, Adenu-Mensah NE, Keeley K, Sommer M. The intersection of menstruation, school and family: Experiences of girls growing up in urban cities in the U.S.A. International Journal of Adolescence and Youth 2021. [DOI: 10.1080/02673843.2020.1867207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Margaret L. Schmitt
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christine Hagstrom
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Azure Nowara
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Nana Ekua Adenu-Mensah
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Katie Keeley
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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Plesons M, Patkar A, Babb J, Balapitiya A, Carson F, Caruso BA, Franco M, Hansen MM, Haver J, Jahangir A, Kabiru CW, Kisangala E, Phillips-Howard P, Sharma A, Sommer M, Chandra-Mouli V. The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research. Reprod Health 2021; 18:31. [PMID: 33557877 PMCID: PMC7869499 DOI: 10.1186/s12978-021-01082-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/18/2021] [Indexed: 11/29/2022] Open
Abstract
In recognition of the opportunity created by the increasing attention to menstrual health at global, regional, and national levels, the World Health Organization’s Department of Sexual and Reproductive Health and Research and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction convened a global research collaborative meeting on menstrual health in adolescents in August 2018. Experts considered nine domains of menstrual health (awareness and understanding; stigma, norms, and socio-cultural practices; menstrual products; water and sanitation; disposal; empathy and support; clinical care; integration with other programmes; and financing) and answered the following five questions: (1) What is the current situation? (2) What are the factors contributing to this situation? (3) What should the status of this domain of adolescent menstrual health be in 10 years? (4) What actions are needed to achieve these goals? (5) What research is needed to achieve these goals? This commentary summarizes the consensus reached in relation to these questions during the expert consultation. In doing so, it describes the state of adolescent menstrual health in low- and middle-income countries and sets out suggestions for action and research that could contribute to meeting the holistic menstrual health needs of adolescent girls and others who menstruate worldwide.
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Affiliation(s)
- Marina Plesons
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Archana Patkar
- Gender, Human Rights and Community Engagement Department, UNAIDS, Geneva, Switzerland
| | - Jenelle Babb
- Regional Bureau for Education for the Asia-Pacific, UNESCO, Bangkok, Thailand
| | | | - Flo Carson
- Foreign, Commonwealth and Development Office, London, UK
| | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | | | | | | | - Andisheh Jahangir
- WoMena Knowledge Management Team, WoMena Denmark, Copenhagen, Denmark
| | | | - Ephraim Kisangala
- African Centre for Systematic Review and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Aditi Sharma
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, State College, USA
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, New York, USA
| | - Venkatraman Chandra-Mouli
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Sommer M, Zulaika G, Schmitt ML, Khandakji S, Phillips-Howard PA. : Advancing the measurement agenda for menstrual health and hygiene interventions in low- and middle-income countries. J Glob Health 2021; 10:010323. [PMID: 32257146 PMCID: PMC7100917 DOI: 10.7189/jogh.10.010323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Margaret L Schmitt
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Samantha Khandakji
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
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Sommer M, Caruso BA, Torondel B, Warren EC, Yamakoshi B, Haver J, Long J, Mahon T, Nalinponguit E, Okwaro N, Phillips-Howard PA. Menstrual hygiene management in schools: midway progress update on the "MHM in Ten" 2014-2024 global agenda. Health Res Policy Syst 2021; 19:1. [PMID: 33388085 PMCID: PMC7776301 DOI: 10.1186/s12961-020-00669-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/13/2020] [Indexed: 11/24/2022] Open
Abstract
Progress has been made in recent years to bring attention to the challenges faced by school-aged girls around managing menstruation in educational settings that lack adequate physical environments and social support in low- and middle-income countries. To enable more synergistic and sustained progress on addressing menstruation-related needs while in school, an effort was undertaken in 2014 to map out a vision, priorities, and a ten-year agenda for transforming girls' experiences, referred to as Menstrual Hygiene Management in Ten (MHM in Ten). The overarching vision is that girls have the information, support, and enabling school environment for managing menstruation with dignity, safety and comfort by 2024. This requires improved research evidence and translation for impactful national level policies. As 2019 marked the midway point, we assessed progress made on the five key priorities, and remaining work to be done, through global outreach to the growing network of academics, non-governmental organizations, advocates, social entrepreneurs, United Nations agencies, donors, and national governments. This paper delineates the key insights to inform and support the growing MHM commitment globally to maximize progress to reach our vision by 2024. Corresponding to the five priorities, we found that (priority 1) the evidence base for MHM in schools has strengthened considerably, (priority 2) global guidelines for MHM in schools have yet to be created, and (priority 3) numerous evidence-based advocacy platforms have emerged to support MHM efforts. We also identified (priority 4) a growing engagement, responsibility, and ownership of MHM in schools among governments globally, and that although MHM is beginning to be integrated into country-level education systems (priority 5), resources are lacking. Overall, progress is being made against identified priorities. We provide recommendations for advancing the MHM in Ten agenda. This includes continued building of the evidence, and expanding the number of countries with national level policies and the requisite funding and capacity to truly transform schools for all students and teachers who menstruate.
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Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University, New York, NY, United States of America.
| | - Bethany A Caruso
- Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Belen Torondel
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elodie C Warren
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | | | - Jackie Haver
- Save the Children US, Washington, DC, United States of America
| | - Jeanne Long
- Save the Children US, Washington, DC, United States of America
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Sommer M, Kaaya S, Kajula L, Marwerwe G, Hamisi H, Parker R. Social and structural determinants of youth alcohol use in Tanzania: The role of gender, social vulnerability and stigma. Glob Public Health 2021; 16:75-87. [PMID: 32744916 PMCID: PMC7790840 DOI: 10.1080/17441692.2020.1801792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Adolescent alcohol use remains an under-addressed population health issue across Africa. Although the literature explores the intersection of alcohol use and vulnerability to HIV and AIDS, there is limited evidence on the gendered uptake and use of alcohol among adolescents. Capturing adolescents' voiced experiences about the societal influences shaping their alcohol usage is essential for identifying contextually relevant interventions to reduce their vulnerability to alcohol and related risky behaviours, such as unsafe sex. We conducted qualitative research in urban Tanzania, including key informant interviews, systematic mapping of alcohol availability, in-depth interviews with adolescents in and out of school and adults, and participatory methodologies with adolescents ages 15-19. The findings described here were drawn from the participatory methodologies (n = 177); and in-depth interviews with adolescents (n = 24) and adults (n = 24). Three key themes emerged: (1) boys' increased social vulnerability to alcohol consumption; (2) the ways in which stigma shapes girls' alcohol usage; and (3) how gendered perceptions of alcohol use reinforce societal inequalities. There exists an urgent need to address the social and gendered vulnerabilities of youth in Africa to the uptake and use of alcohol, and identify interventions that reshape notions of masculinity increasing boy's vulnerability to use.
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Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Sylvia Kaaya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lusajo Kajula
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Graca Marwerwe
- Independent Research Consultant, Dar es Salaam, Tanzania
| | - Hassan Hamisi
- Independent Research Consultant, Dar es Salaam, Tanzania
| | - Richard Parker
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
- Institute for the Study of Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- ABIA, Brazilian Interdisciplinary AIDS Association, Rio de Janeiro, Brazil
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Sommer M, Torondel B, Hennegan J, Phillips-Howard PA, Mahon T, Motivans A, Zulaika G, Gruer C, Haver J, Caruso BA. How addressing menstrual health and hygiene may enable progress across the Sustainable Development Goals. Glob Health Action 2021; 14:1920315. [PMID: 34190034 PMCID: PMC8253211 DOI: 10.1080/16549716.2021.1920315] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022] Open
Abstract
There is increasing global attention to the importance of menstrual health and hygiene (MHH) for the lives of those who menstruate and gender equality. Yet, the global development community, which focuses on issues ranging from gender to climate change to health, is overdue to draw attention to how addressing MHH may enable progress in attaining the Sustainable Development Goals (SDGs). To address this gap, we undertook a collective exercise to hypothesize the linkages between MHH and the 17 SDGs, and to identify how MHH contributes to priority outcome measures within key sectoral areas of relevance to menstruating girls in low- and middle-income countries. These areas included Education, Gender, Health (Sexual and Reproductive Health; Psychosocial Wellbeing), and Water, Sanitation and Hygiene (WASH). These efforts were undertaken from February - March 2019 by global monitoring experts, together with select representatives from research institutions, non-governmental organizations, and governments (n = 26 measures task force members). Through this paper we highlight the findings of our activities. First, we outline the existing or potential linkages between MHH and all of the SDGs. Second, we report the identified priority outcomes related to MHH for key sectors to monitor. By identifying the potential contribution of MHH towards achieving the SDGs and highlighting the ways in which MHH can be monitored within these goals, we aim to advance recognition of the fundamental role of MHH in the development efforts of countries around the world.
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Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | | | | | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | | | - Bethany A. Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
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Critchley HOD, Babayev E, Bulun SE, Clark S, Garcia-Grau I, Gregersen PK, Kilcoyne A, Kim JYJ, Lavender M, Marsh EE, Matteson KA, Maybin JA, Metz CN, Moreno I, Silk K, Sommer M, Simon C, Tariyal R, Taylor HS, Wagner GP, Griffith LG. Menstruation: science and society. Am J Obstet Gynecol 2020; 223:624-664. [PMID: 32707266 PMCID: PMC7661839 DOI: 10.1016/j.ajog.2020.06.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/13/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022]
Abstract
Women's health concerns are generally underrepresented in basic and translational research, but reproductive health in particular has been hampered by a lack of understanding of basic uterine and menstrual physiology. Menstrual health is an integral part of overall health because between menarche and menopause, most women menstruate. Yet for tens of millions of women around the world, menstruation regularly and often catastrophically disrupts their physical, mental, and social well-being. Enhancing our understanding of the underlying phenomena involved in menstruation, abnormal uterine bleeding, and other menstruation-related disorders will move us closer to the goal of personalized care. Furthermore, a deeper mechanistic understanding of menstruation-a fast, scarless healing process in healthy individuals-will likely yield insights into a myriad of other diseases involving regulation of vascular function locally and systemically. We also recognize that many women now delay pregnancy and that there is an increasing desire for fertility and uterine preservation. In September 2018, the Gynecologic Health and Disease Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development convened a 2-day meeting, "Menstruation: Science and Society" with an aim to "identify gaps and opportunities in menstruation science and to raise awareness of the need for more research in this field." Experts in fields ranging from the evolutionary role of menstruation to basic endometrial biology (including omic analysis of the endometrium, stem cells and tissue engineering of the endometrium, endometrial microbiome, and abnormal uterine bleeding and fibroids) and translational medicine (imaging and sampling modalities, patient-focused analysis of menstrual disorders including abnormal uterine bleeding, smart technologies or applications and mobile health platforms) to societal challenges in health literacy and dissemination frameworks across different economic and cultural landscapes shared current state-of-the-art and future vision, incorporating the patient voice at the launch of the meeting. Here, we provide an enhanced meeting report with extensive up-to-date (as of submission) context, capturing the spectrum from how the basic processes of menstruation commence in response to progesterone withdrawal, through the role of tissue-resident and circulating stem and progenitor cells in monthly regeneration-and current gaps in knowledge on how dysregulation leads to abnormal uterine bleeding and other menstruation-related disorders such as adenomyosis, endometriosis, and fibroids-to the clinical challenges in diagnostics, treatment, and patient and societal education. We conclude with an overview of how the global agenda concerning menstruation, and specifically menstrual health and hygiene, are gaining momentum, ranging from increasing investment in addressing menstruation-related barriers facing girls in schools in low- to middle-income countries to the more recent "menstrual equity" and "period poverty" movements spreading across high-income countries.
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Affiliation(s)
- Hilary O D Critchley
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, United Kingdom.
| | - Elnur Babayev
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Serdar E Bulun
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Iolanda Garcia-Grau
- Igenomix Foundation-Instituto de Investigación Sanitaria Hospital Clínico, INCLIVA, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, School of Medicine, University of Valencia, Valencia, Spain
| | - Peter K Gregersen
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
| | | | | | | | - Erica E Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Kristen A Matteson
- Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Jacqueline A Maybin
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, United Kingdom
| | - Christine N Metz
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
| | - Inmaculada Moreno
- Igenomix Foundation-Instituto de Investigación Sanitaria Hospital Clínico, INCLIVA, Valencia, Spain
| | - Kami Silk
- Department of Communication, University of Delaware, Newark, DE
| | - Marni Sommer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Carlos Simon
- Igenomix Foundation-Instituto de Investigación Sanitaria Hospital Clínico, INCLIVA, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, School of Medicine, University of Valencia, Valencia, Spain; Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | | | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Günter P Wagner
- Department of Ecology and Evolutionary Biology, Department of Obstetrics, Gynecology and Reproductive Sciences, Systems Biology Institute, Yale University, New Haven, CT; Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Linda G Griffith
- Center for Gynepathology Research, Massachusetts Institute of Technology, Cambridge, MA
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Sommer M, Gruer C, Smith RC, Maroko A, Kim Hopper. Menstruation and homelessness: Challenges faced living in shelters and on the street in New York City. Health Place 2020; 66:102431. [PMID: 32987242 DOI: 10.1016/j.healthplace.2020.102431] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/06/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022]
Abstract
A growing literature attests to menstrual management difficulties of girls, women and other people who menstruate. Largely ignored are the menstruation-management needs of people experiencing homelessness. We explored these realities in New York City through in-depth interviews with individuals living on the street and in shelters (n = 22), key informant interviews with staff at government agencies, shelters and service provider organizations (n = 15), and field audits of public toilets. This paper explores both pragmatic difficulties presented by inadequate access to toilets, bathing spaces, and laundering services, and pervasive menstrual stigma. Amplifying the difficulties was near-constant pressure "to pass," as someone who was not homeless in order to enable increased access to toilets, and as someone who was not menstruating, in order to engage in the activities of daily living. Our findings highlight the need for improved quality and accessibility of bathrooms for sheltered and street-dwelling homeless, and expedited access to bathing and laundering. Such actions are essential given the steady increase in homelessness in NYC and - under the long shadow of COVID - especially timely.
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Affiliation(s)
- Marni Sommer
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 W. 168th Street, Room 537, New York, NY 10032, USA.
| | - Caitlin Gruer
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 W. 168th Street, Room 537, New York, NY 10032, USA
| | - Rachel Clark Smith
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 W. 168th Street, Room 537, New York, NY 10032, USA
| | - Andrew Maroko
- Lehman College, CUNY School of Public Health, Department of Environmental, Occupational, and Geospatial Health Sciences, 55 W. 125th Street, Room 508, New York, NY 10027, USA.
| | - Kim Hopper
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 W. 168th Street, Room 537, New York, NY 10032, USA
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Sommer M, Lee C, Liu D, Gruer C. The Extent to Which Menstruation-Related Issues Are Included in Graduate-Level Public Health Curricula. Front Public Health 2020; 8:442. [PMID: 32984243 PMCID: PMC7491256 DOI: 10.3389/fpubh.2020.00442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/17/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives: Menstruation is increasingly recognized as an issue in domestic and global public health. Public health graduates of U.S. schools of public health must have adequate competencies to address menstruation and its implications for health and well-being in their future endeavors in research, practice and policy. This study sought to understand the extent to which U.S. schools currently integrate menstruation-related content (menstrual health, menstrual hygiene, etc.) and related competencies into their curricula. Methods: We reviewed the course directories of the top 20 US schools of public health as ranked in 2018. Courses were selected based on inclusion of menstruation and adolescent health-related search terms. Syllabi were subsequently obtained and analyzed for inclusion of specific menstruation-related terms. Syllabi including these terms were further analyzed to determine the level of inclusion of menstruation-related topics in relation to public health competencies, and the area of specialization. Results: Of an estimated 5,000 courses assessed, 28 included menstruation-related topics. Most frequently, this inclusion was minimal (e.g., a single reading or assignment), and was limited in scope. Content was typically found within global health, environmental health, and maternal and child health. Conclusions: Given growing attention to menstruation domestically and globally, and the limited current inclusion of this issue in US schools of public health curricula, graduates may not be receiving adequate training on a critically important topic of relevance within population health. Schools should consider reviewing their curricula to assess whether there are opportunities to integrate menstruation-related content in relation to the relevant public health competencies.
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Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christina Lee
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Danting Liu
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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Mukherjee A, Lama M, Khakurel U, Jha AN, Ajose F, Acharya S, Tymes-Wilbekin K, Sommer M, Jolly PE, Lhaki P, Shrestha S. Perception and practices of menstruation restrictions among urban adolescent girls and women in Nepal: a cross-sectional survey. Reprod Health 2020; 17:81. [PMID: 32487096 PMCID: PMC7268527 DOI: 10.1186/s12978-020-00935-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background Menstruation, a natural biologic process is associated with restrictions and superstitious beliefs in Nepal. However, factual data on women’s perspectives on menstrual practices and restrictions are scarce. This study aimed to assess socio-cultural perceptions of menstrual restrictions among urban Nepalese women in the Kathmandu valley. Methods Using a clustered random sampling, 1342 adolescent girls and women of menstruating age (≥15 years) from three urban districts in the Kathmandu valley completed a survey related to menstrual practices and restriction. This was a cross-sectional survey study using a customized program allowing pull-down, multiple choice and open-ended questions in the Nepali language. The self-administered questionnaire consisted of 13 demographic questions and 22 questions related to menstruation, menstrual hygiene, socio-cultural taboos, beliefs and practices. Univariate descriptive statistics were reported. Unadjusted associations of socio-cultural practices with ethnicity, education, four major social classes, three major religions, marital status and family type were assessed using logistic regression models. Results More than half (59%) of the participants were aged between 15- < 25 years. The majority were Hindus (84.5%), reported not praying during menstruation (83.1%) and were encouraged by their mothers (72.1%) to practice a range of menstrual restrictions. Purifying either the kitchen, bed, bedsheets or other household things on the fourth day of menstruation was reported by 66.1% of the participants, and 45.4% saw menstruation as a “bother” or “curse.” There were differences among social classes, where participants of the Janajati caste, an indigenous group, were more likely to enter places of worship [OR (95%CI): 1.74 (1.06–2.86)] and pray [OR (95%CI): 1.79 (1.18–2.71)] while menstruating, compared to the Brahmins. Participants with a master’s degree were more likely to pray while menstruating, compared to participants with less than a high school education [OR (95%CI): 2.83 (1.61–4.96)]. Conclusion This study throws light on existing social discriminations, deep-rooted cultural and religious superstitions among women, and gender inequalities in the urban areas of Kathmandu valley in Nepal. Targeted education and awareness are needed to make changes and balance between cultural and social practices during menstruation.
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Affiliation(s)
- Amrita Mukherjee
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mingma Lama
- Nepal Fertility Care Center (NFCC), Lalitpur, Nepal
| | | | | | - Fatima Ajose
- University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Sanjeev Acharya
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristina Tymes-Wilbekin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marni Sommer
- Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Pauline E Jolly
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pema Lhaki
- Nepal Fertility Care Center (NFCC), Lalitpur, Nepal.
| | - Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Shirota Y, Sommer M, Paulus W. P8 Combining SICF and ICF with QPS boosts excitability increase in the primary motor cortex. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Halawa I, Reichert K, Anil S, Sommer M, Paulus W. P260 Increasing pulse energy of 5Hz rTMS improves its efficacy in inducing excitatory aftereffects. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sommer M, Zulaika G, Schmitt ML, Khandakji S, Neudorf K, Gellis L, Phillips-Howard PA. Improving the impact of menstrual health innovations in low- and middle-income countries: a theory of change and measurement framework. Journal of Global Health Reports 2020. [DOI: 10.29392/001c.12105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Margaret L Schmitt
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Samantha Khandakji
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Kristin Neudorf
- Grand Challenges Canada/Grands Défis Canada, Toronto, Ontario, Canada
| | - Leeat Gellis
- Grand Challenges Canada/Grands Défis Canada, Toronto, Ontario, Canada
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Sommer M, Daly G, Kabiru C, Lhaki P, Okwaro N, Chandra-Mouli V. Strengthening health care worker engagement with early adolescence in low- and middle-income countries: an overdue area for action. Int J Adolesc Med Health 2020; 34:/j/ijamh.ahead-of-print/ijamh-2019-0171/ijamh-2019-0171.xml. [PMID: 32031974 DOI: 10.1515/ijamh-2019-0171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022]
Abstract
The very young adolescent population (ages 10-14) is currently under-served by health care systems, particularly in low- and middle-income countries. Although there is a substantial and growing effort to reach adolescents with the health services and commodities they need, such efforts often overlook the period of early adolescence given this population's lower vulnerability to risk-taking behaviors. However, early adolescence is a period of significant change, with the onset of puberty introducing physiological, emotional, and social changes in girls' and boys' lives. This period also represents a time of intensifying gendered norms, and the transition of youth from childhood focused health care (e.g. deworming programs, nutrition interventions) to additional mid- and older adolescent related care [e.g. human papilloma virus (HPV) vaccine, and contraceptive provision). Strengthening young adolescents' engagement with health care workers around preventative and promotive health behaviors could have profound impacts on their health and wellbeing, which in turn could have cascading effects across the course of their lives. Critically, young adolescents would gain trust in health care systems, and be more likely to return when significant health issues arise later in adolescence or adulthood. Such an effort requires sensitizing health care workers and building their capacity to respond to young adolescents' unique needs, by defining a package of actions that they are mandated to provide, training them, providing them with desk reference tools, and putting in place systems to provide supportive supervision and collaborative learning on the one hand, and encouraging caregivers to connect their pubescent-aged boys and girls with the health care system, on the other hand. This paper presents an argument for increased focus in particular on building attitudes and capacities of health care workers on engaging with early adolescents, applying Principle 3 of the Society of Adolescent Medicine's position paper entitled "Health Care Reform and Adolescents."
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Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University, New York, USA
| | - Garrison Daly
- Mailman School of Public Health, Columbia University, New York, USA
| | | | | | | | - Venkatraman Chandra-Mouli
- WHO Department of Reproductive Health and Research/Human Reproduction Programme, Geneva, Switzerland
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Glass N, Remy MM, Mayo-Wilson LJ, Kohli A, Sommer M, Turner R, Perrin N. Comparative effectiveness of an economic empowerment program on adolescent economic assets, education and health in a humanitarian setting. BMC Public Health 2020; 20:170. [PMID: 32019539 PMCID: PMC7001195 DOI: 10.1186/s12889-020-8219-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescence is a critical period of human development, however, limited research on programs to improve health and well-being among younger adolescents living in conflict-affected and humanitarian settings exists. The purpose of this study was to assess the comparative effectiveness of an economic empowerment program on young adolescent outcomes in a complex humanitarian setting. METHODS This longitudinal, mixed methods study examined the relative effectiveness of an integrated parent (Pigs for Peace, PFP) and young adolescent (Rabbits for Resilience, RFR) animal microfinance/asset transfer program (RFR + PFP) on adolescent outcomes of asset building, school attendance, mental health, experienced stigma, and food security compared to RFR only and PFP only over 24 months. A sub-sample of young adolescents completed in-depth qualitative interviews on the benefits and challenges of participating in RFR. RESULTS Five hundred forty-two young adolescents (10-15 years) participated in three groups: RFR + PFP (N = 178), RFR only (N = 187), PFP only (N = 177). 501 (92.4%) completed baseline surveys, with 81.7% (n = 442) retention at endline. The group by time interaction (24 months) was significant for adolescent asset building (X2 = 16.54, p = .002), school attendance (X2 = 12.33, p = .015), and prosocial behavior (X2 = 10.56, p = .032). RFR + PFP (ES = 0.31, ES = 0.38) and RFR only (ES-0.39, ES = 0.14) adolescents had greater improvement in asset building and prosocial behavior compared to PFP only, respectively. The odds of missing two or more days of school in the past month were 78.4% lower in RFR only and 45.1% lower in RFR + PFP compared to PFP only. No differences between groups in change over time were found for internalizing behaviors, experienced stigma, or food security. Differences by age and gender were observed in asset building, prosocial behavior, school attendance, experienced stigma, and food security. The voices of young adolescents identified the benefits of the RFR program through their ability to pay for school fees, help their families meet basic needs, and the respect they gained from family and community. Challenges included death of rabbits and potential conflict within the household on how to use the rabbit asset. CONCLUSION These findings underscore the potential for integrating economic empowerment programs with both parents and young adolescents to improve economic, educational, and health outcomes for young adolescents growing up in rural and complex humanitarian settings. TRIAL REGISTRATION NCT02008695. Retrospectively registered 11 December 2013.
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Affiliation(s)
- Nancy Glass
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Mitima Mpanano Remy
- Programme d'Appui aux Initiatives Economiques (PAIDEK), Bukavu, Democratic Republic of Congo
| | - Larissa Jennings Mayo-Wilson
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Anjalee Kohli
- Institute of Reproductive Health, Georgetown University, Washington, District of Columbia, USA
| | - Marni Sommer
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Rachael Turner
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nancy Perrin
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
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