Menstrual health among adolescents and young adults in rural Haiti

Emily R Rupe, Jonathan Rodean, Emily A Hurley, Melissa K Miller, Marie Daphnee Boncoeur, Abbey R Masonbrink, Emily R Rupe, Jonathan Rodean, Emily A Hurley, Melissa K Miller, Marie Daphnee Boncoeur, Abbey R Masonbrink

Abstract

Background: Adolescent and young adult (AYA) females in low- and middle-income countries often face disparities in menstrual health (MH). Poor MH and lack of sexual and reproductive health education leads to school absenteeism, increasing risk for adverse psychosocial and educational outcomes. Further, disasters (e.g., earthquakes) are linked with unsafe living environments and sanitation facilities for women. We sought to describe MH perspectives and practices among AYAs in rural Haiti.

Methods: We conducted a cross-sectional survey in two rural communities in Haiti. AYA females aged 14-24 years completed questions on demographics, the Menstrual Practice Needs Scale (36 items; MPNS-36) and the Menstrual Practices Questionnaire (4 items). We performed descriptive statistics and Chi square or Fisher's Exact tests to compare responses among sub-groups.

Results: Among 200 respondents, the median age was 20 years (IQR 17-22). 51% (95% CI 44%, 58%; 102/200) were currently attending school at least 3 days/week and 97% (94%, 99%; 193/200) were not married. According to the MPNS-36, 68% (62%, 74%; 136/200) of participants had unmet MH needs. Seventy-one (77%) reused some of their menstrual materials during their last menstruation. During their last menstruation, 44% (37%, 50%; 87/200) reported they often or always skipped school because they had their menses, and 31% (25%, 37%; 62/200) sometimes skipped. Many felt always or often worried that someone or something would harm them while they were changing their menstrual materials at home and at school.

Conclusions: Among AYAs in rural Haiti, three-quarters reported menses-related school absenteeism and two-thirds had unmet MH needs. AYA females often lacked a safe environment to change their menstrual materials. Given recent disasters in Haiti, (August 2021 earthquake), safe environments for MH are critically needed to offset risk for poor psychosocial and health outcomes. Future efforts to improve MH among AYAs in Haiti are needed to ensure access to MH resources and school attendance.

Conflict of interest statement

The authors have no conflicts of interest to report.

© 2022. The Author(s).

References

    1. Hennegan J, Winkler IT, Bobel C, et al. Menstrual health: a definition for policy, practice, and research. Sex Reprod Health Matters. 2021;29(1):31–38. doi: 10.1080/26410397.2021.1911618.
    1. El-Gilany AH, Badawi K, El-Fedawy S. Menstrual hygiene among adolescent schoolgirls in Mansoura, Egypt. Reprod Health Matters. 2005;13:147–152. doi: 10.1016/S0968-8080(05)26191-8.
    1. Martin. Water and Sanitation. United Nations Sustainable Development. . Accessed April 8, 2022.
    1. Sommer M, Caruso BA, Sahin M, et al. A time for global action: addressing girls’ menstrual hygiene management needs in schools. PLoS Med. 2016;13(2):e1001962. doi: 10.1371/journal.pmed.1001962.
    1. Anaba EA, Udofia EA, Manu A, Daniels AA, Aryeetey R. Use of reusable menstrual management materials and associated factors among women of reproductive age in Ghana: analysis of the 2017/18 Multiple Indicator Cluster Survey. BMC Womens Health. 2022;22(1):92. doi: 10.1186/s12905-022-01670-9.
    1. Adika VO, Yabga, et al. Perception and behaviour on use of sanitary pads during menstruation among adolescent school girls in Bayelsa State, Nigeria. Adv Appl Sci Res. 2011;2(6):0–0.
    1. Pednekar S, Some S, Rivankar K, Thakore R. Enabling factors for sustainable menstrual hygiene management practices: a rapid review. Discov Sustain. 2022;3(1):28. doi: 10.1007/s43621-022-00097-4.
    1. Achuthan K, Muthupalani S, Kolil VK, Bist A, Sreesuthan K, Sreedevi A. A novel banana fiber pad for menstrual hygiene in India: a feasibility and acceptability study. BMC Womens Health. 2021;21(1):129. doi: 10.1186/s12905-021-01265-w.
    1. Egyptian Fertility Care Society . Prevalence of female reproductive infections in Dakahlia Governorate. EFCS Cairo: Published online; 1999.
    1. Ram P, Patel R. Factors associated with disposable menstrual absorbent use among young women in India. Int Perspect Sex Reprod Health. 2020;46:223. doi: 10.1363/46e0320.
    1. Mason L, Nyothach E, Alexander K, et al. ‘We keep it secret so no one should know’—a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya. PLoS ONE. 2013;8(11):e79132. doi: 10.1371/journal.pone.0079132.
    1. Benshaul-Tolonen A, Zulaika G, Sommer M, Phillips-Howard PA. Measuring menstruation-related absenteeism among adolescents in low-income countries. In: Bobel C, Winkler IT, Fahs B, Hasson KA, Kissling EA, Roberts TA, editors. The Palgrave handbook of critical menstruation studies. Palgrave Macmillan; 2020.
    1. Hennegan J, Dolan C, Wu M, Scott L, Montgomery P. Measuring the prevalence and impact of poor menstrual hygiene management: a quantitative survey of schoolgirls in rural Uganda. BMJ Open. 2016;6(12):e012596. doi: 10.1136/bmjopen-2016-012596.
    1. Das P, Baker KK, Dutta A, et al. Menstrual hygiene practices, WASH access and the risk of urogenital infection in women from Odisha, India. PLoS ONE. 2015;10(6):e0130777. doi: 10.1371/journal.pone.0130777.
    1. Kerubo E, Laserson KF, Otecko N, et al. Prevalence of reproductive tract infections and the predictive value of girls’ symptom-based reporting: findings from a cross-sectional survey in rural western Kenya. Sex Transm Infect. 2016;92(4):251–256. doi: 10.1136/sextrans-2015-052371.
    1. Austrian K, Kangwana B, Muthengi E, Soler-Hampejsek E. Effects of sanitary pad distribution and reproductive health education on upper primary school attendance and reproductive health knowledge and attitudes in Kenya: a cluster randomized controlled trial. Reprod Health. 2021;18(1):179. doi: 10.1186/s12978-021-01223-7.
    1. Thakre SB, Thakre SS, Reddy M, Rathi N, Pathak K, Ughade S. Menstrual hygiene: knowledge and practice among adolescent school girls of Saoner, Nagpur District. J Clin Diagn Res. 2011;5:7.
    1. Sommer M. Ideologies of sexuality, menstruation and risk: girls’ experiences of puberty and schooling in northern Tanzania. Cult Health Sex. 2009;11(4):383–398. doi: 10.1080/13691050902722372.
    1. Kumbeni MT, Ziba FA, Apenkwa J, Otupiri E. Prevalence and factors associated with menstruation-related school absenteeism among adolescent girls in rural northern Ghana. BMC Womens Health. 2021;21(1):279. doi: 10.1186/s12905-021-01418-x.
    1. Mohammed S, Larsen-Reindorf RE, Awal I. Menstrual hygiene management and school absenteeism among adolescents in Ghana: results from a school-based cross-sectional study in a rural community. Int J Reprod Med. 2020;2020:e6872491. doi: 10.1155/2020/6872491.
    1. Tegegne T, Sisay M. Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia. BMC Public Health. 2014;14:1118. doi: 10.1186/1471-2458-14-1118.
    1. Vashisht A, Pathak R, Agarwalla R, Patavegar BN, Panda M. School absenteeism during menstruation amongst adolescent girls in Delhi, India. J Fam Community Med. 2018;25(3):163–168. doi: 10.4103/jfcm.JFCM_161_17.
    1. Davis J, Macintyre A, Odagiri M, et al. Menstrual hygiene management and school absenteeism among adolescent students in Indonesia: evidence from a cross-sectional school-based survey. Trop Med Int Health. 2018;23(12):1350–1363. doi: 10.1111/tmi.13159.
    1. Hennegan J, Montgomery P. Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low and middle income countries? A systematic review. PLoS ONE. 2016;11(2):e0146985. doi: 10.1371/journal.pone.0146985.
    1. Grant M, Lloyd C, Mensch B. Menstruation and school absenteeism: evidence from rural Malawi. Comp Educ Rev. 2015 doi: 10.1086/669121.
    1. Logie CH, Daniel C, Ahmed U, Lash R. ‘Life under the tent is not safe, especially for young women’: understanding intersectional violence among internally displaced youth in Leogane, Haiti. Glob Health Action. 2017;10(sup2):1270816. doi: 10.1080/16549716.2017.1270816.
    1. Logie CH, Okumu M, Latif M, et al. Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study. Confl Health. 2021;15(1):3. doi: 10.1186/s13031-020-00336-3.
    1. Thurston AM, Stöckl H, Ranganathan M. Natural hazards, disasters and violence against women and girls: a global mixed-methods systematic review. BMJ Glob Health. 2021;6(4):e004377. doi: 10.1136/bmjgh-2020-004377.
    1. 2009 UNISDR terminology on disaster risk reduction. . Accessed 2 Oct 2022.
    1. Ghosh S, Sar A. The sendai framework for disaster risk reduction and disaster management plan of Indian railways. Disaster Adv. 2021 doi: 10.25303/148da7921.
    1. Water & Sanitation | Columbia Public Health. . Accessed 24 Oct 2022.
    1. Peragallo Urrutia R, Merisier D, Small M, Urrutia E, Tinfo N, Walmer DK. Unmet health needs identified by Haitian women as priorities for attention: a qualitative study. Reprod Health Matters. 2012;20(39):93–103. doi: 10.1016/S0968-8080(12)39602-X.
    1. Coker-Bolt P, Jansson A, Bigg S, et al. Menstrual education and personal hygiene supplies to empower young women in Haiti. OTJR Occup Particip Health. 2017;37(4):210–217. doi: 10.1177/1539449217719866.
    1. Carver JW, Dévieux JG, Gaston SC, Altice FL, Niccolai LM. Sexual risk behaviors among adolescents in Port-au-Prince, Haiti. AIDS Behav. 2014;18(8):1595–1603. doi: 10.1007/s10461-013-0689-4.
    1. Hennegan J, Nansubuga A, Smith C, Redshaw M, Akullo A, Schwab KJ. Measuring menstrual hygiene experience: development and validation of the Menstrual Practice Needs Scale (MPNS-36) in Soroti, Uganda. BMJ Open. 2020;10(2):e034461. doi: 10.1136/bmjopen-2019-034461.
    1. Haiti: Students Need Safe Water, Toilets. Human Rights Watch. Published October 8, 2014. . Accessed 26 Oct 2022.
    1. Kumar A, Srivastava K. Cultural and social practices regarding menstruation among adolescent girls. Soc Work Public Health. 2011;26(6):594–604. doi: 10.1080/19371918.2010.525144.
    1. Haiti awash in Christian aid, evangelism. NBC News. . Accessed 9 Oct 2022.
    1. Estil K. Link to external site this link will open in a new window. From waste to housing: using plastic waste to build sustainable housing in Haiti. M.U.R.P. Florida Atlantic University. . Accessed 13 Apr 2022.
    1. Climate risk and adaptation country profile: Haiti | GFDRR. . Accessed 13 Apr 2022.
    1. Corburn J, Hildebrand C. Slum sanitation and the social determinants of women’s health in Nairobi, Kenya. J Environ Public Health. 2015;2015:e209505. doi: 10.1155/2015/209505.
    1. Winter SC, Barchi F. Access to sanitation and violence against women: evidence from Demographic Health Survey (DHS) data in Kenya. Int J Environ Health Res. 2016;26(3):291–305. doi: 10.1080/09603123.2015.1111309.
    1. Chikwiri E, Lemmer EM. Gender-based violence in primary schools in the Harare and Marondera Districts of Zimbabwe. J Sociol Soc Anthropol. 2014;5(1):95–107. doi: 10.1080/09766634.2014.11885613.
    1. Emergency response Haiti earthquake, August 2021–February 2022. . Accessed 4 Oct 2022.
    1. Haiti at ‘crossroads’ entering post-earthquake reconstruction. UN News. Published February 16, 2022. . Accessed 4 Oct 2022.
    1. A year after deadly earthquake, Haitians feel ‘abandoned.’ Washington Post. . Accessed 4 Oct 2022.
    1. Soeiro RE, Rocha L, Surita FG, Bahamondes L, Costa ML. Period poverty: menstrual health hygiene issues among adolescent and young Venezuelan migrant women at the northwestern border of Brazil. Reprod Health. 2021;18:238. doi: 10.1186/s12978-021-01285-7.
    1. Logie CH, Daniel C. ‘My body is mine’: qualitatively exploring agency among internally displaced women participants in a small-group intervention in Leogane, Haiti. Glob Public Health. 2016;11(1–2):122–134. doi: 10.1080/17441692.2015.1027249.
    1. Hayden T. Menstrual hygiene management in emergencies: Taking stock of support from UNICEF and partners | WASH Cluster. Published 2012. . Accessed 23 May 2022.
    1. Education | Haiti | U.S. Agency for International Development. Published January 10, 2020. . Accessed 28 Sep 2022.
    1. Sommer M, Figueroa C, Kwauk C, Jones M, Fyles N. Attention to menstrual hygiene management in schools: an analysis of education policy documents in low- and middle-income countries. Int J Educ Dev. 2017;57:73–82. doi: 10.1016/j.ijedudev.2017.09.008.
    1. Sommer M, Caruso BA, Torondel B, et al. Menstrual hygiene management in schools: midway progress update on the “MHM in Ten” 2014–2024 global agenda. Health Res Policy Syst. 2021;19(1):1. doi: 10.1186/s12961-020-00669-8.
    1. Sommer M, Schmitt ML, Clatworthy D, Bramucci G, Wheeler E, Ratnayake R. What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? A global review. Waterlines. 2016;35(3):245–264. doi: 10.3362/1756-3488.2016.024.
    1. Nelis T. Menstrual hygiene management in humanitarian emergencies. Humanitarian Learning Centre; 2018. . Accessed 23 May 2022.

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