Unveiling disparities: a non-linear decomposition analysis of the gap in menstrual hygiene material use between adolescent women in Aspirational and the remaining districts of India.

This study aimed to investigate the factors contributing to the gap in the use of hygienic materials during menstruation to collect blood among adolescent women between Aspirational and the remaining districts of India. The study sample consisted of 114805 adolescent women (20835 women from 112 Aspirational districts and 93970 women from 595 remaining districts) from the National Family Health Survey-5. Fairlie decomposition was used to identify and measure the factors contributing to the gap in the use of hygienic materials between Aspirational and the remaining districts of India. This study determined that the use of hygienic materials during menstruation varied significantly between Aspirational and the remaining districts. While only 37% of adolescent women used hygienic materials in Aspirational districts, almost 52% did so in the remaining districts. Seventy-five per cent of Aspirational districts (84 of 112 districts) reported less than 50% use of hygienic materials, which is lower than the national average and the average of the remaining districts. It was revealed that nearly 90% of the total explained gap between the two groups was accounted for by household wealth, place of residence, exposure to mass media, and education level. Wealth was the main contributor to the gap, explaining about 46% of the difference in hygienic materials use between Aspirational and the remaining districts, followed by the place of residence (18%), exposure to mass media (15%), and education level (11%). Findings suggest that targeted interventions to improve access to hygienic materials among adolescent women in Aspirational districts, particularly those in the northern states of Uttar Pradesh, Bihar, and Chhattisgarh, are necessary. Policy efforts should focus on women from poor households, improving access to education, and expanding mass media exposure in Aspirational districts to reduce the gap in menstrual hygiene practices among adolescent women in India.

Menstrual hygiene management among reproductive-aged women with disabilities in Bangladesh.

Background: Women with disabilities in low- and middle-income countries face unique challenges in managing menstruation, affecting their health, dignity, and quality of life. Aim: This study aimed to explore menstrual hygiene management (MHM) practices among reproductive-aged women with disabilities in Bangladesh and its impact on social participation. Methods: We analyzed data from 51,535 women from the 2019 Multiple Indicator Cluster Survey (MICS). The outcome variables were: (i) material used to manage blood flow while menstruating (appropriate, inappropriate), (ii) availability of a private place for washing and changing menstruation rags (yes, no), and (iii) impact on attendance of social activities, school, or work during menstruation (yes, no). Disability status was considered as a major explanatory variable and categorized as no disabilities, moderate disabilities, and severe disabilities. Associations of outcome variables with explanatory variables were determined using a multilevel mixed-effects binary logistic regression model adjusted for individual-level factors, household-level factors, and community-level factors. Results: Among the sample, 2.7% reported severe disability and 19.2% moderate disabilities, with vision-related disabilities (12.2%) being the most prevalent, followed by cognitive (9.5%) and walking disabilities (8.2%). Overall, 4% reported using inappropriate materials for menstrual flow, rising to 8.0% among those with severe disabilities and 5.8% for moderate disabilities. Women with moderate to severe disabilities had 33%-47% lower odds of using appropriate materials and 34%-44% lower odds of having a private place to change at home. Additionally, women with severe disabilities were 1.66 times more likely to report that menstruation impacted their social activities. Conclusion: Women with disabilities in Bangladesh face significant barriers to effective MHM. Addressing these issues requires targeted interventions, including disability-inclusive menstrual health education, improved access to menstrual products and sanitation facilities, and community initiatives to reduce stigma.

WASH services and menstrual hygiene management among reproductive age females in the IDPs camps of Shire town in Tigray region of Ethiopia: a cross- sectional study.

Menstruation is a natural cyclic occurrence experienced by reproductive age females in a good health which deemed a proper management, otherwise, it ends with various health complications and impaired quality of life. The aim of this study was to investigate the menstrual hygiene management practice and its determinant factors among reproductive age females living in the IDPs camps of Shire town, Northern Ethiopia. A cross-sectional study was conducted among 633 reproductive age females in Shire town from May to June 2022. Data were entered, cleaned, and analyzed using SPSS version 23. Descriptive analysis and binary and multivariable logistic regression were conducted to obtain the descriptive findings and to investigate the strength of the association respectively. P-value < 0.05 was considered statistically significant. The prevalence of good menstrual hygiene management practice among the reproductive age females was 41.9% (95% CI, 38-45.8%). Menstrual hygiene management practice was significantly (p < 0.05) associated with access to sanitary materials, educational level, availability of continuous water supply and sex-separated latrines. The results of this study demonstrated that more than a half of the reproductive age females did not have good menstrual hygiene management practices. Consequently, it is recommended to work collaboratively to enhance the menstrual hygiene practice, especially in IDPs camps.

Assessing the effectiveness of menstrual health education in Japan: A non-randomized comparative study of adolescent girls with typical development and those with intellectual disabilities and high support needs.

This study elucidates the effectiveness of a menstrual education program with segmented MHM procedure on the MHM skills of girls with intellectual disabilities/HSN compared with those with typical development. Participants in a nonrandomized comparative study included nine adolescent girls with intellectual disabilities/HSN and ten with typical development. They practiced MHM on dolls three times: before, immediately after, and three months after participating in the educational program. Although the total MHM scores were significantly higher after both groups attended the program, the girls with intellectual disabilities/HSN had significantly lower total and mean scores on MHM items than girls with typical development. They still required instruction on the majority of the items after 3 months. Meanwhile, girls with intellectual disabilities/HSN showed a significant improvement in napkin changing skills and maintained post-course scores 3 months later, similar to those with typical development.

Promoting menstrual health and hygiene-insights from the 2023 World Menstrual Hygiene Day celebration events in the Hohoe municipality in Ghana.

The 2023 World Menstrual Hygiene Day (WMHD) celebration at the University of Health and Allied Sciences (UHAS) sought to create awareness about menstruation. Toward normalizing menstruation, the 3-day event brought together key stakeholders and engaged community members on various topics relating to menstruation. Among the stakeholders were basic school teachers (13), school children (155), in a 2:1 female vs. male ratio within the ages of 10-17 years, School Health and Education Program Coordinators (2), Health Officers (4), Academicians (15), University students (35), Media representatives (3), and Civil society representatives (130). Particular among these discussions were the biology of menstruation, nutrition related facts during menstruation, sociocultural, and mental health issues surrounding menstruation. These discussions were intended to incite more conversations about menstruation, and contribute toward the agenda 2030 goal of making menstruation a normal fact of life. The paper describes activities conducted to improve menstrual health, reduce period poverty, and involve men in breaking the stigma around menstruation. This contributes to creating supportive environments for menstruating individuals. Meanwhile, the lessons from the activities to celebrate WMHD in Ghana are relevant for other communities to consider replicating with consideration for contextual differences.

Development and validation of a survey instrument for reusable sanitary products toward sustainable menstrual hygiene.

The predominant use of disposable, non-organic menstrual products has significant environmental impacts due to waste and resource depletion. Concerns over the environmental, economic, and health implications of menstrual hygiene management (MHM) have highlighted the need to explore sustainable options like reusable sanitary pads (RSPs). Despite their benefits, the adoption of RSPs is limited by a lack of awareness, availability, cost, and research. This study emphasizes the need for the development of an instrument that can capture the effectiveness, safety, and user satisfaction of RSPs, addressing a significant gap in the literature. Using a convenient sampling method, data were collected through a structured offline survey and the sample comprised 446 South Asian women of reproductive age. The instrument included 15 items designed to measure factors such as comfort, hygiene, convenience, and environmental consciousness. The instrument's reliability and validity are thoroughly assessed using reliability and factor analysis to ensure its effectiveness in capturing the multifaceted dimensions of MHM product choices. The study revealed that the overwhelming majority of women would prefer the option of RSPs that are comfortable, accessible, and easy to use and dispose of. The findings aim to provide a validated tool for manufacturers, policymakers, and researchers to evaluate reusable pads, promoting their broader acceptance and adoption of a sustainable and equitable approach to menstrual hygiene.

Caring for Women in an Active War Zone.

Emergency nursing in Gaza's war zone presents innumerable challenges when caring for female patients in a depleted health care system. Negative health outcomes specifically impact women of all ages due to lack of access to menstrual products, prenatal and primary care, private bathrooms, medication, essential nutrition, and clean water. The massive destruction of infrastructure and consequent internal displacement of millions has led to a rise in infectious diseases. The few remaining functional hospitals depend heavily on foreign medical delegations for supplies, which results in a lack of standardized treatment for women's health complaints. Emergency departments must also navigate overcrowding, lack of basic supplies and specialists, and prioritization of daily mass casualty incidents from nearby explosions. These obstacles make treatment, discharge teaching, and follow-up care for women's health difficult to implement. Despite these arduous circumstances, Gazan health care professionals find innovative solutions to improve outcomes and reduce harm while honoring the cultural and religious preferences of their female patients.

Fighting for menstrual equity through period product pantries.

BACKGROUND: Menstruators facing period poverty often struggle with menstrual hygiene and waste management, which can result in harmful short- and long-term health outcomes such as urinary tract infections, yeast infections, and vulvar contact dermatitis. Research indicates that 42% of menstruators in the United States have difficulty affording period products. Traditional methods of distributing period products through social services may unintentionally undermine menstruators' agency, leading to disempowerment and inefficient resource allocation. Period product pantries are a novel approach aimed at addressing period poverty, inequity, and inadequate menstrual health education in the United States. OBJECTIVES: This paper aims to examine the development, organization, and implementation of two distinct period product pantry networks in Ohio and New York. It seeks to compare the advantages and challenges of grassroots versus nonprofit-led models and to provide practical insights for future pantry operators. DESIGN: The study examines two models of period product pantries: a grassroots effort led by three local residents in Ohio and an initiative spearheaded by a nonprofit organization in New York. The design includes a comparative analysis of both models' organization, funding methods, and operational structures. METHODS: The authors gathered data on the construction, operation, and usage of two pantry networks, focusing on factors such as accessibility, community engagement, and sustainability. The study employed a combination of qualitative methods, including interviews with organizers, and a review of organizational documents to analyze the effectiveness and scalability of each model. RESULTS: Both pantry networks increased accessibility to period products in low socioeconomic neighborhoods, which are disproportionately affected by period poverty. The grassroots model, while resource-limited, fostered strong community ties and local engagement. The nonprofit-led model benefited from dedicated staff and a more stable funding structure but faced bureaucratic challenges. Despite their differences, both models demonstrated the potential to empower menstruators by preserving their dignity and autonomy. CONCLUSIONS: Period product pantries represent an innovative and equitable approach to addressing period poverty and inequity. The analysis of the two models offers valuable insights for organizations and individuals interested in establishing similar initiatives. While each model has its unique benefits and challenges, both are effective in empowering menstruators and providing accessible menstrual hygiene products to those in need. REGISTRATION: Not applicable.

Fighting for menstrual equity through period product pantriesPeriod product pantries are a new way to help people who can't afford period products and don't have enough education about menstrual health in the U.S. Many people who experience period poverty, or trouble getting products like pads and tampons, also face barriers to staying clean and managing period waste. This can cause health issues like infections. About 42% of people who get periods in the U.S. say they've had trouble paying for these products. Period product pantries are different from older methods of getting free products, like through social services, because they let people get what they need without feeling embarrassed or losing their sense of control. This paper looks at two types of period pantries: one started by three local people in Ohio and another run by a nonprofit group in New York. Both help people in neighborhoods where it's hard to afford period products. The paper talks about how these pantries were set up, how they are funded, and what worked well or didn't. The goal is to show how these pantries can be a good, fair way to help people while giving advice to others who might want to start their own pantries.

Prevalence and factors associated with unmet need for menstrual hygiene management in six countries in Sub-Saharan Africa: A multilevel analysis.

BACKGROUND: Menstruation is a normal biological process experienced by more than 300 million women globally every day. Women require clean menstrual absorbents that can be changed as often as needed in a private and safe place with proper hygiene and disposal facilities. These needs must be met consistently throughout the duration of the menstrual cycle. Access to menstrual needs is crucial for women's health, wellbeing, and dignity. This study assessed the prevalence and factors associated with unmet need for menstrual hygiene management (MHM) in Ethiopia, Kenya, Uganda, Burkina Faso, Ghana, and Niger. METHODS: We used data from the Performance Monitoring for Action (PMA) 2020 surveys. We defined the unmet need for MHM as the "lackof resources, facilities and supplies for MHM." Sample characteristics were summarised using frequencies and percentages, while prevalence was summarised using proportions and their respective confidence intervals (CI). Factors associated with unmet need for MHM were assessed using multilevel logistic regression models. RESULTS: The study included 18,048 women of reproductive age from the six countries. The prevalence of unmet need for MHM was highest in Burkina Faso (74.8%), followed by Ethiopia (69.9%), Uganda (65.2%), Niger (57.8%), Kenya (53.5%), and lowest in Ghana (34.2%). Unmet need for MHM was consistently higher among uneducated and multiparous women, those who reused MHM materials, practiced open defecation, and lived in rural areas across all six countries. The odds of unmet need for MHM were higher among younger women under 35 years, unmarried women, those with lower education levels, and those from poorer households. Similarly, the reuse of MHM materials, use of shared or non-improved toilet facilities, and open defecation increased the odds of unmet need for MHM. In contrast, the presence of handwashing facilities reduced the odds of unmet need for MHM. CONCLUSION: More than half of the women in five of the six countries have an unmet need for MHM, with significantly higher odds among younger women, those with low wealth status, the unmarried, and those with inadequate access to sanitary facilities. This study highlights the state of period poverty in Sub-Saharan Africa. Efforts to end period poverty should consider MHM needs as an integrated whole, as addressing each need in isolation is insufficient.

Intra- and inter-examiner Reproducibility of the menstrual hygiene management skills' rating by prepubescent girls in Japan.

Prepubescent girls with intellectual disabilities and high support needs encounter difficulties with menstrual hygiene management (MHM) and require individualized education. However, no clear methodology exists for assessing the reliability and validity of premenstrual MHM skills. We developed a 17-item MHM assessment tool to determine the intra- and inter-examiner reproducibility of MHM skills. Prepubescents-9 with intellectual disabilities and 10 with typical development-were educated on menstruation and assessed by three examiners. The intra-class correlation coefficient (ICC) showed high reproducibility, with intra-examiner reproducibility (ICC [1.1]) ranging from 0.87 to 0.99, regardless of disability. Conversely, inter-examiner reproducibilities were ICC (2.1) = 0.69-0.92 and 0.50-0.94 and Kappa coefficients were 0.54-0.81 and 0.37-1.00 for girls with intellectual disability and others, respectively. Items such as lowering underwear and wrapping napkins were less reproducible despite disability. Ability did not affect reproducibility and was useful for identifying MHM changes pre- and post-menstrual education.

The Impact of Saline Water on Women's Health in the Coastal Region of Bangladesh: Special Attention on Menstrual Hygiene Practices.

Introduction Salinity intrusion is the most common global concern along coastlines, but it can happen inland also. The lack of freshwater is the primary issue affecting the coastal areas. Many health problems are prevalent among the inhabitants due to their frequent use of salted water. The health of women living along the coastline is getting progressively compromised due to salinity intrusion. Objectives The study aims to determine menstrual health practices and other health problems faced by women in the coastal region of Bangladesh. Methods The study was conducted using a survey research design from May 2023 to October 2023 on rural women aged 18 to 45 years, who lived in the Bangladeshi village of Koyra Upazila in the Khulna district. The sample size of the study was 101. Open- and closed-ended questions from a planned interview schedule were used to gather primary data. Additional information from appropriate sources, e.g., newspapers, publications, and books, was utilized to enhance the comprehensiveness of statistical analysis and support rationality. A p-value of 0.05 was considered significant. Statistical analysis was performed using STATA version 15 (StataCorp LLC, College Station, TX). Results Menstrual hygiene practices showed a higher prevalence of using fabric rags and reusing them after rinsing them in salt water (72.3%) than sanitary pads (25.7%). It was observed that the risk of diarrhea among tubewell water and rainwater users was significantly lowered by 0.25 times (95% CI = 0.06, 0.99; p = 0.049) and 0.06 times (95% CI = 0.01, 0.43; p = 0.005), respectively, compared to pond water users. Conclusion Salinity has a significant impact on the livelihoods and health of coastal women. The village women are unaware of the health risks of excessive saline water use. Establishing an adequate supply of freshwater reservoirs for the entire community throughout the year is an alternative for women to use as a source of water for hygiene necessities.

Understanding period product use among young women in rural and urban India from a geospatial perspective.

Ensuring proper menstrual hygiene management remains a significant challenge for young women in India. The term "exclusive use of hygienic period products during menstruation" refers to relying solely on period products like sanitary pads, tampons, or menstrual cups. Poor menstrual hygiene practices not only increase the risk of reproductive tract infections but also lead to various negative health outcomes, including discomfort and potential complications. This study explores factors associated with the exclusive use of period products during menstruation aged 15-24, investigates geographic disparities, examines rural-urban gaps, and assesses inequality in India. Utilizing data from the fifth National Family Health Survey (NFHS-5), responses from 2,41,180 women aged 15 to 24 were analysed using logistic regression and multivariate decomposition analyses to explore socioeconomic predictors. Moran's I statistics also assessed spatial dependency, while Lorenz curves and Gini coefficients measured inequality. Quintile and LISA maps visualized regional disparities. The study found that 76.15% of women in India reported exclusive use of hygienic period products during menstruation. Rural areas reported a lower percentage of exclusive use of hygienic period products (72.32%) during menstruation compared to urban areas (89.37%). Key factors associated with the exclusive use of hygienic period products among 15-24-year-old women in India include age, education, place of residence, wealth, access to media, and healthcare discussions. Geographically, central districts exhibited the lowest coverage (< 65%), while the Southern region reported the highest (> 85). The GINI coefficient of 0.39 highlighted moderate inequality in distribution. Decomposition analysis revealed that household wealth contributed 49.25% to rural-urban differences, followed by education (13.41%), media access (7.97%), and region (4.97%). This study highlights significant regional disparities and low utilization of hygienic period products among young women in India, particularly in central districts. Policymakers should prioritize interventions targeting these regions, addressing socio-economic disparities. Strategies to promote education, improve media access, and enhance household wealth can facilitate menstrual hygiene adoption. Initiatives to reduce sanitary napkin costs and increase accessibility, particularly in rural areas, are crucial to mitigating geographical disparities nationwide.

Menstrual cup adoption among reproductive age women in India: a systematic review and meta-analysis.

This systematic review and meta-analysis aim to synthesize the information on menstrual cup adoption among reproductive-age women in India. A comprehensive search was conducted in four databases following PRISMA 2020 guidelines. A total of 18 articles were included in this review. The findings of the studies were described narratively, and meta-analysis and sensitivity analysis were also performed. The pooled prevalence of knowledge regarding menstrual cups among women in the included studies was 35 percent (CI: 0.23-.49). Just 5 percent (CI: 0.02-0.12) of women use menstrual cups. Only 24 percent (CI: 0.17-0.33) of the women who used menstrual cups reported leakage as one of the key barriers or issues to menstrual cup use. Nevertheless, 62 percent (CI: 0.42-0.78) of non-users have a pooled prevalence expressing willingness to use in the future. The price was found to be both a motivating and discouraging factor for using menstruation cups. Currently, menstrual cup use among Indian women and girls is very low. However, user reviews suggest that menstrual cups are an appealing and safer replacement for conventional period supplies. To fully realize the potential of menstruation cups, significant education, and awareness efforts are required to ensure proper usage. Furthermore, initiatives to lower the initial cost of menstruation cups are critical.

Menstrual hygiene behaviour among the tribal married women aged 15 to 49 years: A cross-sectional study in a community development block of Paschim Bardhaman District, West Bengal.

Background: Menstrual hygiene management is integrally associated with reproductive health of women. Menstrual health and hygiene needs, particularly of tribal women still remain unmet for many reasons. Inappropriate menstrual behaviour leads to adverse health consequences. Objectives: This study aimed to ascertain the menstrual hygiene behaviour of tribal married women aged 15 to 49 years and its correlates. Methods: A descriptive cross-sectional study was conducted from May 2019 to April 2020 in the Barabani block of Paschim Bardhaman district, West Bengal. A calculated sample of 530 women was selected randomly from 10 tribal villages of the study area; they were interviewed through a pre-designed schedule for socio-demographic and menstrual hygiene behaviour characteristics. Menstrual hygiene management score was derived based on five essential components- hygienic absorbents, hygienic disposal of absorbents, frequency of changing of absorbents, cleaning of external genitalia and source of water for cleaning; menstrual hygiene behaviour was categorised as favourable and unfavourable. Bivariate and multivariable logistic regression was performed using SPSS v. 20. Results: All 530 women were Hindu and belonged to Santhal ethnicity; 53.4% were illiterate. Sanitary pads were used by 43.8% of women; 63% practised indiscriminate throwing for disposal of absorbents; 86% practised appropriate changing of absorbents. Overall, 63% had favourable menstrual hygiene management behaviour, and the literacy status of women was found to be a significant predictor. Conclusion: Unfavourable menstrual practices are still widely prevalent among tribal women, mainly attributable to lack of knowledge. Awareness generation should be focused on improving those practices, which would also result in the improvement of general health conditions.

Investigation of Menstrual Hygiene and Self-Care Skills of Adolescent Girls with Autism Spectrum Disorder: Mother Views.

PURPOSE: Puberty a period of transition from childhood to adulthood, poses problems that are difficult to manage for typically developing adolescents, but even more difficult for adolescents with autism. It is vital that girls with autism spectrum disorder (ASD), like their typically developing peers, are able to manage these physiological processes in a healthy way and learn self-care and hygiene behaviours without being dependent on others. Given the contribution of mothers to the menstrual hygiene and self-care skills of adolescent girls, this study aims to explore the views of mothers. METHODS: The study is a case study designed in the qualitative research model. The research was carried out with the participation of 10 mothers met the necessary criteria and agreed to take part in the study voluntarily. The data obtained were subjected to descriptive and thematic analysis. Codes, sub-themes and main themes were created. RESULTS: The research identifies the themes of self-care and menstrual hygiene, preparations made during menstruation, behavioral problems in adolescents, the person who carries out hygiene and self-care, and situations that tire/strain mothers during menstruation. CONCLUSION: At the end of the research, it was concluded that the adolescent girls with ASD are mostly unable to perform their self-care and hygiene adequately, and that the mothers do nothing to prepare their daughters for adolescence. It was also concluded that the most stressful situation for mothers during adolescence is usually the difficulty their daughters have in using sanitary pads, cleaning armpits and genital hair, and bathing.

[Risks of urogenital infections and expulsion associated with the combination of an IUD and a menstrual cup]. / Étude RIESC : risques d'infections uro-génitales et d'expulsion dans l'association stérilet et coupe menstruelle.

OBJECTIVES: The increase in intrauterine devices (IUDs) contraception, and the growing use of reusables menstrual hygiene products such as the menstrual cup, necessitates an assessment of the implications of their co-use. The objectives are to assess whether women with IUDs who use menstrual cups have an increased risk of IUD expulsion and/or a change in the risk of upper and lower urogenital tract infections compared to women who use other menstrual hygiene products. METHOD: An observational, prospective, multicenter study was conducted in France between 2020 and 2023. Participants were recruited by health professionals and data were collected by telephone questionnaire at the time of IUD insertion and at one year. The primary endpoints were the occurrence of IUD expulsion and the occurrence of urogenital tract infections in menstrual cup users compared to non-users. RESULTS: One hundred and three women out of 119 included were analyzed, 25 of them were regular menstrual cup users and five experienced IUD expulsion. Among regular users, 12% experienced IUD expulsion compared to 2.6% among non-users, with no statistically significant difference (Chi2=3.65; P=0.056). Regarding urogenital tract infections, nine women (36%) of the regular menstrual cup users had urogenital infections, compared with 27 (34.6%) of the non-users or not regular users, with no statistically significant difference. CONCLUSION: The tendency of menstrual cup users to expel their IUDs is a reason for caution, although it is not sufficient to contraindicate co-use. Physicians should therefore systematically screen such co-use and inform patients of the risks and monitoring instructions.

Building a Future for School-Based Menstruation Health and Hygiene (MHH): Evaluating Implementation of a Menstrual Hygiene Management (MHM) Policy in Chicago Public Schools.

Menstrual health and hygiene (MHH) inequities disproportionately impact communities who are marginalized. In 2018, Illinois passed the Learn with Dignity Act (LWDA) requiring schools to provide menstrual products in bathrooms, yet little is known about its impacts. This evaluation examined LWDA implementation across Chicago Public Schools (CPS) and identified barriers, facilitators, and lessons to inform future MHH policy implementations. A qualitative study was conducted by thematically analyzing interviews with CPS staff (n = 36) from October 2020 - September 2021 in partnership with CPS Office of Student Health and Wellness (OSHW). Staff reported inadequate LWDA and MHH education and inconsistent menstrual product availability. Structural, systemic, and cultural implementation barriers hindered student access to products and created inequities based on age, gender, and income. Staff investment and student education were implementation facilitators. Staff awareness of policy implementation protocol, student MHH education, and addressing access inequities are key factors for consideration in future policy implementations. Through the WSCC model, these findings demonstrated the importance of strengthening MHH policies and policy implementation to promote student health, well-being, and educational opportunities.

Tampons as a source of exposure to metal(loid)s.

BACKGROUND: Between 52-86% of people who menstruate in the United States use tampons-cotton and/or rayon/viscose 'plugs'-to absorb menstrual blood in the vagina. Tampons may contain metals from agricultural or manufacturing processes, which could be absorbed by the vagina's highly absorptive tissue, resulting in systemic exposure. To our knowledge, no previous studies have measured metals in tampons. OBJECTIVES: We evaluated the concentrations of 16 metal(loid)s in 30 tampons from 14 tampon brands and 18 product lines and compared the concentrations by tampon characteristics. METHODS: About 0.2 - 0.3 g from each tampon (n = 60 samples) were microwave-acid digested and analyzed by inductively coupled plasma mass spectrometry (ICP-MS) to determine concentrations of arsenic, barium, calcium, cadmium, cobalt, chromium, copper, iron, manganese, mercury, nickel, lead, selenium, strontium, vanadium, and zinc. We compared concentrations by several tampon characteristics (region of purchase, organic material, brand type) using median quantile mixed models. RESULTS: We found measurable concentrations of all 16 metals assessed. We detected concentrations of several toxic metals, including elevated mean concentrations of lead (geometric mean [GM] = 120 ng/g), cadmium (GM = 6.74 ng/g), and arsenic (GM = 2.56 ng/g). Metal concentrations differed by region of tampon purchase (US versus European Union/United Kingdom), by organic versus non-organic material, and for store- versus name-brand tampons. Most metals differed by organic status; lead concentrations were higher in non-organic tampons while arsenic was higher in organic tampons. No categoriy had consistently lower concentrations of all or most metals. DISCUSSION: Tampon use is a potential source of metal exposure. We detected all 16 metals in at least one sampled tampon, including some toxic metals like lead that has no "safe" exposure level. Future research is needed to replicate our findings and determine whether metals can leach out of tampons and cross the vaginal epithelium into systemic circulation.

Disparity by caste and tribe: Understanding women's empowerment and health outcomes in India.

AIM: Women's empowerment status varies greatly in India according to caste, class, ethnicity and region. This paper aims to investigate the caste/tribe disparity in women's empowerment by region, the main correlates of each domain of empowerment, and the association of women's empowerment with nutritional and health care access outcomes, specifically anaemia, menstrual hygiene, and institutional delivery. METHODOLOGY: Using National Family Health Survey-5 (2019-2021) data, we have created a modified survey-based women's empowerment index (SWPER) using principal component analysis with Oblique varimax rotation. The first four components are interpreted as an attitude to violence, freedom of movement, decision-making power and social independence. Several multivariate regression models were used to understand the factor associated with empowerment and the association of women's empowerment with different health outcomes. RESULTS: The results indicate that women from the forward castes are the most empowered in most domains except decision-making. However, after controlling other background variables, the forward castes women are found to be the most empowered in attitude to violence, whereas Scheduled Castes and Scheduled Tribes women were found to be the most empowered women in decision-making. With regards to social independence, deprived castes women are more empowered than the forward castes women. The likelihood of empowerment in social independence domain increases with increasing wealth. There are wide regional variations in empowerment level between different social groups. Caste/tribe identity plays a significant role in determining health outcomes in India. Among all empowerment domains, social independence emerges as the most significant associated factor with improved health across all caste/tribe groups. CONCLUSION: The path to women's empowerment in India must recognize the intersectionality of caste/tribe identities, and address regional disparities. Social independence emerges as a critical determinant across all caste/tribe groups for improving health. Measures should be taken to empower women through the underlying factors of social independence.

"If I use pad, I feel comfortable and safe": a mixed-method analysis of knowledge, attitude, and practice of menstrual hygiene management among in-school adolescent girls in a Nigerian city.

BACKGROUND: Adolescence is a pivotal stage in human development that presents unique challenges, especially for girls navigating the complexities of menstruation. Despite the importance of menstrual hygiene management for adolescent girls' well-being, this vital aspect of personal health is often overlooked, particularly in regions where cultural stigma prevails. This study examines knowledge, attitude, and practice of menstrual hygiene management among in-school adolescent girls in Abuja, Nigeria. METHODS: The study employed a cross-sectional mixed-method design, integrating quantitative surveys with focus group discussions. A survey was conducted among 420 adolescent girls across four government junior secondary schools through a multistage sampling technique. Also, Focus Group Discussions were conducted among 80 respondents in groups of 10 discussants. The quantitative data set was subjected to descriptive and inferential statistical analysis, while the qualitative data were analysed using content analysis. RESULTS: Findings revealed that the majority (53.45%) of the respondents had good knowledge of menstruation and menstrual hygiene management. Junior Secondary School (JSS) 3 students [OR = 2,09; 95% CI = 1.24-3.52] and those who started menstruation at age 15 years and above [OR = 7.52; 95% CI = 1.43-39.49] were associated with increased odds of having good knowledge of menstrual hygiene management. The attitude of most respondents (70.08%) towards menstrual hygiene management was good. Those in the JSS 3 class [OR = 6.47; 95% CI = 3.34-12.54], respondents who are Muslim [OR = 2.29; 95% CI = 1.63-5.48], and those whose parents had tertiary education [OR = 3.58; 95% CI = 1.25-10.25] were more likely to demonstrate more positive attitudes compared to their counterparts whose parents do not have tertiary education. In relation to practice, about 3 in 5 (57.80%) reportedly practise good menstrual hygiene management. Respondents who practice traditional religion [OR = 0.33; 95% CI = 0.02-4.56] were less likely to practise good menstrual hygiene management, while respondents who are the third child of their parents [OR = 2.09; 95% CI = 1.04-4.23] were more likely to practise menstrual hygiene compared to respondents with other birth orders. Qualitative results showed that participants had good knowledge of menstruation and menstrual hygiene management, and mothers were the main source of menstruation-related information. Participants had mixed feelings and reactions during their first menstruation, with 3 in 5 participants reporting experiencing menstruation-related stigma restrictions when menstruating. CONCLUSIONS: In-school adolescent girls in Abuja, Nigeria, have good menstruation-related knowledge and positive attitudes, as well as practise menstrual hygiene management. Students' class and age at first menstruation were major factors associated with good knowledge of menstruation and menstrual hygiene management; respondents' class, religion and parents' educational qualification were associated with a positive attitude, while respondents' religion and parity line were associated with menstrual hygiene practice. Future interventions should focus on conducting school and community-level awareness programs to increase knowledge and dispel myths and misconceptions about menstruation and menstrual hygiene management.