SuSanA - Forum Kunena Site Syndication Fri, 09 Dec 2016 15:23:27 +0000 Kunena 1.6 SuSanA - Forum en-gb Re: studies on MHM and schoolgirls' health and schooling - by: JenniferRubli
This is such a great discussion happening here!

The issue of deliberate absenteeism is interesting and very important, especially as, as has been mentioned in this thread, in the virtual MHM conference, and in several recent studies, absenteeism does not seem to be a valid indicator; an RCT in Nepal (Oster & Thornton, 2010) showed that providing girls with pads had no significant effect on absenteeism. And as Penny mentioned, we have also seen girls unwilling to disclose menstruation as the reason they are absent, if school records are being used.

Femme has found that there are larger issues beyond supplying a method of menstrual management that need to be addressed, one reason we ask students WHY they were absent (it includes things like pain, fear of leaking, embarrassment, etc). Schoolgirls report pain and/or discomfort in prevalences up to 100%. All schoolgirls mention boys' teasing and unfriendly school atmosphere. We came across an headmaster who did not allow menstruating girls to attend, because there was no disposal system, and disposable pads were filling up and blocking the latrines. Poor WASH facilities inhibit girls' ability to change pads, and they will go home early so as still be be marked 'present.' They might be at school, but not concentrating, not raising their hand, not willing to sit down or go up to the blackboard, and so developing indicators that are a more valid, reliable measure of their situation in school is something we're working on.

Menstrual hygiene management (MHM) Wed, 07 Dec 2016 08:29:00 +0000
Re: studies on MHM and schoolgirls' health and schooling - by: Camilla
I appreciate your elaborate answer. Thank you.

We also encounter similar difficulties in regards to attendance.

In complete agreement regarding doing research focusing on "self-efficacy, self-esteem, dignity, well-being, ability to concentrate in class". When I worked with Peepoople we did a nice SROI study. I like that methodology.

What I have encountered when discussing the provision of menstrual solutions to underprivileged adolescent girls (not only cups) with different donors and organizations is the necessity to confirm girls attendance in school is increased.

A person who works at Unicef expressed this as key to get them on board.

As we interview each girl we train before starting the education part it is easy to integrate a baseline study in our program.

Our target for next year is to reach 10 000 girls.

If you know of any masters student or university who is interested in supporting us to start an attendance study please let me know.

With warm regards

Menstrual hygiene management (MHM) Wed, 07 Dec 2016 08:13:05 +0000
Re: studies on MHM and schoolgirls' health and schooling - by: PennyPH
Many thanks for your interest and response.

Regarding the question - why has the cup not shown clear evidence of a reduction in absence is an important observation. we concluded we did not have adequate reporting on absence in any of the groups to analyse the effect. We try to address the absence question in our 'discussion' section - as girls and parents in the very same study during focus group discussions reported they were less absent from school. Generating high quality information on changes in absence rates over time has proved tricky for us, and I think also for a number of other researchers. During our study, there were a number of school closures due to teacher strikes, council elections, as well as exams and holidays so the amount of time spent in school was less. As there was a strong safety component to our study, we had study nurses regularly in the schools, including in control schools - this was well received by the girls, and we conjecture that this (in all groups) may have improved their liking of school and thus attendance. We also wonder if girls were not willing to disclose when and reasons for absence in case it got back to the teachers. Lastly, we have to consider that absence may be due to so many different factors, in some school settings, that provision of a menstrual product alone may not generate clear cut data - for example, if girls are absent due to menstrual period pains (but would also leak had they gone to school) - they would respond equally in all treatment groups including intervention - and also may answer a questionnaire stating the reason they were absent was 'illness' rather than menstruation.

As such, we feel for comparison studies, particularly in a setting such as ours, that markers of success of the intervention may be better focused on 'hard' outcomes that we can measure more objectively. further studies on absence are of course very welcome, but should not be the only consideration - studies on self-efficacy, self-esteem, dignity, well-being, ability to concentrate in class, ability to reach potential are all important questions. We have a new publication just coming out on research priorities on MHM which we will share very soon.

best wishes

Liverpool School of Tropical Medicine]]>
Menstrual hygiene management (MHM) Wed, 07 Dec 2016 07:17:00 +0000
Re: studies on MHM and schoolgirls' health and schooling - by: muench
Thanks for posting this paper here. I have moved two earlier posts to the beginning of this thread because they fist very well to this topic.
I repeat here something from my post in July:

Assumption/Myth #4. Girls in developing countries are dropping out of school due to lack of menstrual products and toilets

--> It's one of these statements that we often read about and which somehow makes sense intuitively but which is actually not proven and might not be true after all.

You also point this out in your paper where you said:

Lack of quantifiable school absence here and in other pilot studies,10 ,51 contrasts with girls',3–5 ,10 and parents narratives.37 It is unclear if girls in this environment exaggerate missed time when in focus groups but not in structured questionnaires,15 if girls avoid reporting reasons that are associated with stigma (such as teenage pregnancy), fear repercussions when reporting absence (which we consider possible in our study), or if menstrual absence due to abdominal cramps or other reasons over-ride any menstrual product effect.15 ,23 Further research is needed to better quantify the effects of menstrual interventions on school absence, and it seems prudent that studies validate their measurement tools in pilot studies and spot-checks.

This makes a lot of sense.

I had also exchanged e-mails with Marni Sommer about this - I asked her if this was a topic at the recent MHM Virtual conference and she said:
I don’t think that the conference actually had any presentations that ultimately delved into that issue. There was some discussion of the need to move beyond the focus on absenteeism given the challenge of getting accurate attendance data for so many reasons – and the existing evidence having its limitations. I am not sure the studies have been done yet to really answer that question with certainty – although certainly plenty of girls have articulated across various countries that it’s an issue. However I think many of us would like to see an expansion of the interest to look at other measures that might better capture the impact (e.g. educational engagement, self-efficacy managing menstruation in school, etc)

By the way, I noticed you used the term "school attrition" in your paper title. This term was new to me in this context and you only used it once more in your paper where you wrote:
school attrition (drop-out, absence)

Is "attrition" therefore a better word to use than "absenteeism"?

Menstrual hygiene management (MHM) Tue, 06 Dec 2016 22:33:35 +0000
Re: studies on MHM and schoolgirls' health and schooling - by: Camilla
Thank you for your great and important research.

The Cup is working in Kenya since spring 2015 and we are distributing menstrual cups and comprehensive education including human rights, sex ed, MHM etc. We also train the parents and boys. Most of the 5500 girls we have trained are between 11-16.

Transactional sex is common in Nairobi slums and we welcome an in-depth study focusing on this problem as most girls are not aware of the dangers of HIV, STDs and unwanted pregnancy (or unsafe abortions).

My question is, why isnt the introduction of menstrual solutions affecting attendance in school at high level?

We have all been informed this is such a common practice. Or is this where the transactional sex plays in?

Warm regards

Menstrual hygiene management (MHM) Tue, 06 Dec 2016 10:12:28 +0000
Re: Reply: studies on MHM and schoolgirls' health and schooling - by: PennyPH
Thank you for your questions. I see you have response already, which is good for opening the forum for discussion.

1. The RTI* prevalence (so could have been acquired 'anytime' as opposed to within a specific time, as we were unable to measure at baseline) was 26%. We only measured candida albican and bacterial vaginosis. note that 71% of RTI were bacterial vaginosis, with a prevalence of 18.5% of all girls.

2. You raise questions about the hymen. We recognise this could be a concern with regard to understanding of virginity. We explained at public meetings (parents) and directly to girls about this, using very similar explaination as noted by the other respondee (Jen) below.

I attach a paper of ours on the focus group discussions we had with girls and parents, on their perceptions and response to provision of cups and pads. Note girls assented to take part after they understand the study, and had parenbtal consent (approval) also.

Best wishes
Penelope Phillips-Howard
Liverpool School of Tropical Medicine

*RTI - reproductive tract infection]]>
Menstrual hygiene management (MHM) Wed, 30 Nov 2016 09:49:23 +0000
Re: studies on MHM and schoolgirls' health and schooling - by: PennyPH
Thank you for your feedback on our study.

By 'transactional sex' we mean girls that have sexual intercourse with males who provide them with money or products that they cannot afford. They are not 'commercial sex' workers. We think 'transactional sex' is not the best way of describing for the girls in our study area, however, as the girls are impoverished and vulnerable, and thus can be coerced by males into having sex to obtain basic necessities (such as sanitary pads). We would like to further study and better understand this as a social, wellbeing and public health issue.

To my knowledge, there are no studies in Muslim countries, or among a range of populations with different cultures, which is indeed a shortfall. There is likely a hesitancy to test among some cultures because an insertable product may be considered unacceptable by the community, and leaders - but as there is no actual data we do not know if this is true or not.

Best wishes
Penelope Phillips-Howard
Liverpool School of Tropical Medicine]]>
Menstrual hygiene management (MHM) Wed, 30 Nov 2016 09:32:34 +0000
Re: Reply: studies on MHM and schoolgirls' health and schooling - by: JenniferRubli
You bring up an interesting point regarding the hymen and its connotations with virginity. This is an issue that Femme International has come across, and one of the reasons menstrual cups should not be distributed without an education component.

In our workshops, we have a section on the hymen, talking about what it is and how it is never truly 'closed' as that would completely block off the vagina, and emphasising that virginity has to do with sexual acts whereas the hymen is tissue. Sensitising the greater community (including boys, parents, etc) increases uptake of menstrual cup use.

Also, we have found that primary-age girls prefer reusable pads, whereas older girls and women are more likely to prefer a cup.

Menstrual hygiene management (MHM) Wed, 30 Nov 2016 06:32:00 +0000
Reply: studies on MHM and schoolgirls' health and schooling - by: Dirk Thank you for this very interesting information.
2 Questions:
  1. What was the percentage of girls who got RTI?*
  2. It is sometimes feared to give menstrual cups to Primary School girls, as the cup might damage the hymen. Any information on this from your study?


Dirk Ullerich
Welthungerhilfe Moroto/ Uganda

* RTI = Reproductive tract infection (added by moderator)]]>
Menstrual hygiene management (MHM) Sun, 27 Nov 2016 07:27:46 +0000
Re: studies on MHM and schoolgirls' health and schooling - by: F H Mughal
This is an interesting and informative study. However, I do not quite understand, what do you mean by “transactional sex.” Is it dating, or the commercial sex?

Is there a similar study in a Muslim country? How would the religious beliefs impact, or influence, your study.

Best regards,

F H Mughal]]>
Menstrual hygiene management (MHM) Sun, 27 Nov 2016 06:31:16 +0000
Studies on MHM and schoolgirls' health and schooling - and possible impact or otherwise on absenteeism - by: PennyPH
We have now just published the results of our pilot study which explored the acceptability, use and safety of menstrual cups and sanitary pads against 'usual practice'controls among primary schoolgirls in rural Kenya.

You can access the full article using the web-link below:

Menstrual cups and sanitary pads to reduce school attrition, and sexually transmitted and reproductive tract infections: a cluster randomised controlled feasibility study in rural Western Kenya

In summary - we conducted a feasibility study on the effect of menstrual hygiene on schoolgirls' school and health (reproductive/sexual) outcomes,using a 3-arm single-site open cluster randomized controlled study design in 30 primary schools in rural western Kenya. Girls recruited were provided a menstrual cup, or monthly sanitary pads, against ‘usual practice’ controls. All participants received puberty education pre-intervention, and hand wash soap during intervention. Schools received hand wash soap. We measured school attrition (drop-out, absence) as primary outcomes, and sexually transmitted infection (STI) and reproductive tract infection (RTI) as key secondary outcomes, and toxic shock syndrome, and vaginal Staphylococcus aureus as safety outcomes. Of 751 girls enrolled we were able to follow-up 644 girls for a mean of 10.9 months. Cups or pads did not reduce school dropout risk. Self-reported absence was rarely reported and not assessable. Prevalence of STIs in the end-of-study survey was significantly lower in cup and pad users compared with controls. Overall RTI prevalence did not differ, but 71% of RTI were from bacterial vaginosis, which was significantly less prevalent in girls using cups compared with pads, and lower also than controls among girls followed for 9 months or longer. No adverse events were identified. The paper discusses the strengths and weaknesses of the methods used, and the possible implications of the study results (recognising it was a pilot study not a full trial).

Our study concluded that menstrual cups and sanitary pad provision to schoolgirls for ∼1 school-year was associated with a lower STI risk, and cups with a lower bacterial vaginosis risk, but in this small sample there was no evidence of association with school dropout. A large-scale trial on menstrual cups is warranted.

We hope you find the article interesting, and hope it contributes toward the scanty literature available on the potential health effects of menstrual hygiene products.

With best wishes

Dr Penelope A Phillips-Howard
Department of Clinical Sciences
Liverpool School of Tropical Medicine, Liverpool, UK]]>
Menstrual hygiene management (MHM) Fri, 25 Nov 2016 17:34:15 +0000
Re: MHM success stories from Ethiopia - by: rubika109 Greeting

Thank you very much for your comprehensive information. I got your points which really helpful for us. Thank you again
Menstrual hygiene management (MHM) Sun, 13 Nov 2016 00:28:40 +0000
Re: MHM success stories from Ethiopia - by: kitesab Greeting
In our MHM intervention we use:

1. We disseminate MHM messages by fliers, brouchers and bill boards in local languages with in the school community as well as for the large communities .
2. There is 1-5 development army structure in schools and all the school children are members for this 1-5 development army. we work through the school WASH and girl club on this development army
To break the silence around MHM in the community We further did

3. Conduct mass menstrual hygiene campaign in the community.
4. We also work closely with religious institution like with orthodox, Muslims, protestant. First of all we gave training for their leaders and they further they gave awareness on this agenda for their followers
5. advocate the importance on MHM intervention and finally the political leaders accept the agenda and after that they integrate with their regular programs

However I find it worthless sending you the materials prepared in local languages. Therefore try to understand the points I am write above and incorporate for your further intervention.

With kind regards
Bacha Kitesa ,MPH, chief environmental Health professional
Urban WASH Officer at World Vision International]]>
Menstrual hygiene management (MHM) Wed, 09 Nov 2016 09:11:11 +0000
Re: MHM success stories from Ethiopia - by: rubika109 Greeting from Nepal

First I would like to introduce myself. I am Rubika from Nepal working in HELVETAS Swiss Intercooperation Nepal for WASH programme. We are also going to focus on MHM in School WASH programme. Looking to your post on success story , I found very interesting. Could you please share more information/ materials (IEC/training/awareness/orientation materials) if you have.

Thank you and looking forward to hear from you.

Kind regards]]>
Menstrual hygiene management (MHM) Fri, 04 Nov 2016 03:15:47 +0000
Re: [SuSanA forum] MHM success stories from Ethiopia (Menstrual hygiene management (MHM)) - by: kitesab Greeting!
Wel-come! I am happy to get such organization who work on HMM. Where is the presentation? I am 123 Km from Addis Ababa capital city of Ethiopia. how could I contact your person(director)? who cover my travel expense?

Bacha, MPH, chief Environmental Health
Menstrual hygiene management (MHM) Thu, 03 Nov 2016 10:01:23 +0000