Menstrual characteristics and associations with sociodemographic factors and self-rated health in Spain: a cross-sectional study.

BACKGROUND: Evidence on how menstrual characteristics may differ based on socioeconomic factors and self-rated health is significantly scarce. The main aim of this study was to investigate the associations between menstrual characteristics, sociodemographic factors and self-rated health among women and people who menstruate (PWM) aged 18-55 in Spain. METHODS: This cross-sectional study includes data from an online survey collected in March-July 2021 across Spain. Descriptive statistical analyses and multivariate logistic regression models were performed. RESULTS: The analyses included a total of 19,358 women and PWM. Mean age at menarche was 12.4 (SD = 1.5). While 20.3% of our participants experienced a menstrual abundance over 80 ml, 64.1% reported having menstrual blood clots; 6.4% menstruated for longer than 7 days. 17.0% had menstrual cycles that were shorter than 21 days or longer than 35 days. Reports of moderate (46.3%) and high (22.7%) intensity menstrual pain were common. 68.2% of our participants experienced premenstrual symptoms in all or most cycles. The odds for lighter menstrual flow, shorter bleeding days and menstrual cycles were higher as age increased, and amongst participants with less educational attainment. Caregivers presented higher odds for abundant menstrual flow and longer menstruations. Reporting financial constraints and a poorer self-rated health were risk factors for abundant menstrual flow, menstrual blood clots, shorter/longer menstruations and menstrual cycles, premenstrual symptoms, moderate and intense menstrual pain. CONCLUSIONS: This study suggests that age, educational attainment, caregiving, experiencing financial hardship and a poorer self-rated health may shape or mediate menstrual characteristics. It thus highlights the need to investigate and address social inequities of health in menstrual research.

Perspectives on menstrual policymaking and community-based actions in Catalonia (Spain): a qualitative study.

BACKGROUND: Menstrual research and policymaking have become imperative worldwide. It is necessary that these are informed by women and people who menstruate (PWM) alongside expert professionals and activists. METHODS: The main aim of this study was to identify and propose policies and community-based actions to address menstrual inequity and promote menstrual health in Catalonia (Spain). This study consisted of two qualitative studies: (a) 34 individual photoelicitation interviews with women and PWM, (b) a World Café study with 22 professionals and activists. Sampling for both studies was purposive and selective. Recruitment was conducted through healthcare centres, social media, key contacts, and snowball sampling techniques. Data were collected in December 2020-September 2022, and analysed using Framework Analysis. RESULTS: Participants considered the implementation of menstrual policies that address the taboo and stigma of menstruation to be crucial. They stressed the need for menstrual education, which should be integrated into formal education curricula. Participants, and especially women and PWM, highlighted the need to improve the access and quality of healthcare services, so that the menstrual cycle and menstruation are seen as health indicators. Health professionals should encourage agentic informed decisions, hence why both participant groups considered menstrual health education amongst health professionals to be pivotal. Taking action to improve the access and affordability of menstrual products was also imperative for participants, especially for socioeconomically vulnerable populations. Participants agreed on guaranteeing fully equipped menstrual management facilities, and and professionals discussed gender-neutral and sex-segregated bathrooms. Workplace menstrual policies to accommodate and ensure menstrual self-care were also suggested. CONCLUSIONS: Our study highlights the need for multi-dimensional menstrual policies. These should include actions to address menstrual taboo and stigma, to promote menstrual education that goes beyond the hegemonic biomedical prism, to improve the access and quality of menstrual health services, along with policies ensuring adequate menstrual management facilities in public spaces and the access to menstrual products. Policymaking should also focus on how to ensure menstrual management and care in workplaces. Menstrual policies and community-based actions should be framed within intersectionality, to consider how societal structures of power and oppression influence menstrual experiences.

RESUMEN: INTRODUCCIóN: Siendo la investigación y la implementación de políticas menstruales imprescindibles, es necesario que estos procesos estén informados por mujeres y personas que menstrúan (PM), así como por profesionales expertas y activistas. MéTODOS: El objetivo principal de este estudio fue identificar y proponer políticas y acciones comunitarias para abordar la inequidad menstrual y promover la salud menstrual en Cataluña (España). Este estudio consistió en dos estudios cualitativos: (a) 34 entrevistas individuales de fotoelicitación con mujeres y PM, (b) un World Café con 22 profesionales y activistas. El muestreo para ambos estudios fue intencional y selectivo. El reclutamiento se realizó a través de centros de salud, redes sociales, contactos clave y técnicas de bola de nieve. Los datos se recogieron entre diciembre de 2020 y septiembre de 2022 y se analizaron mediante Framework Analysis. RESULTADOS: Las participantes consideraron crucial la implementación de políticas menstruales para abordar el tabú y el estigma menstrual. Destacaron la necesidad de una educación menstrual, que debería integrarse en los currículums escolares. Las participantes, y especialmente las mujeres y PM, resaltaron la necesidad de mejorar el acceso y la calidad de los servicios de salud, de manera que el ciclo menstrual y la menstruación sean consideradas indicadores de salud. Mencionaron que el personal sanitario debe fomentar las decisiones informadas, de ahí que ambos grupos de participantes consideraran fundamental la educación sobre la salud menstrual entre los profesionales de la salud. También, para las participantes fue imperativo asegurar el acceso y asequibilidad de productos menstruales, especialmente para las poblaciones socioeconómicamente vulnerabilizadas. Las participantes estuvieron de acuerdo en la necesidad de garantizar espacios equipadas para el manejo menstrual, y se llevaron a cabo debates entre las profesionales sobre los baños inclusivos y segregados por sexo. También se sugirieron y debatieron políticas menstruales en entornos laborales, para adaptar y garantizar el autocuidado menstrual. CONCLUSIONES: Nuestro estudio destaca la necesidad de políticas menstruales multidimensionales. Estas deberían incluir acciones para abordar el tabú y el estigma menstrual, promover una educación menstrual que vaya más allá de la perspectiva biomédica hegemónica, mejorar el acceso y la calidad de los servicios de salud menstrual, junto con políticas para garantizar la disponibilidad de instalaciones adecuadas para el manejo menstrual en espacios públicos, así como el acceso a productos menstruales. La creación de políticas también debería centrarse en cómo garantizar el manejo y los cuidados menstruales en entornos laborales. Finalmente, estas políticas menstruales y acciones comunitarias deben enmarcarse desde la interseccionalidad, para considerar cómo las estructuras y poderes sociales operan e influyen en las experiencias menstruales.

Menstruation and social inequities in Spain: a cross-sectional online survey-based study.

BACKGROUND: Available research suggests that menstrual inequity has an impact on (menstrual) health outcomes and emotional wellbeing. It is also a significant barrier to achieve social and gender equity and compromises human rights and social justice. The aim of this study was to describe menstrual inequities and their associations with sociodemographic factors, among women and people who menstruate (PWM) aged 18-55 in Spain. METHODS: A cross-sectional survey-based study was conducted in Spain between March and July 2021. Descriptive statistical analyses and multivariate logistic regression models were performed. RESULTS: A total of 22,823 women and PWM were included in the analyses (Mean age = 33.2, SD = 8.7). Over half of the participants had accessed healthcare services for menstruation (61.9%). The odds for accessing menstrual-related services were significantly higher among participants with university education (aOR: 1.48, 95% CI, 1.13-1.95). Also, 57.8% reported having had partial or no menstrual education pre-menarche, with odds being higher among participants born in non-European or Latin American countries (aOR: 0.58, 95% CI, 0.36-0.93). Lifetime self-reported menstrual poverty was between 22.2-39.9%. Main risk factors for menstrual poverty were identifying as non-binary (aOR: 1.67, 95% CI, 1.32-2.11), being born in non-European or Latin American countries (aOR: 2.74, 95% CI, 1.77-4.24), and not having a permit to reside in Spain (aOR: 4.27, 95% CI, 1.94-9.38). Completed university education (aOR: 0.61, 95% CI, 0.44-0.84) and no financial hardship < 12 months (aOR: 0.06, 95% CI, 0.06-0.07) were protective factors for menstrual poverty. Besides, 75.2% reported having overused menstrual products due to lack of access to adequate menstrual management facilities. Menstrual-related discrimination was reported by 44.5% of the participants. Non-binary participants (aOR: 1.88, 95% CI, 1.52-2.33) and those who did not have a permit to reside in Spain (aOR: 2.11, 95% CI, 1.10-4.03) had higher odds of reporting menstrual-related discrimination. Work and education absenteeism were reported by 20.3% and 62.7% of the participants, respectively. CONCLUSIONS: Our study suggests that menstrual inequities affect a high number of women and PWM in Spain, especially those more socioeconomically deprived, vulnerabilised migrant populations and non-binary and trans menstruators. Findings from this study can be valuable to inform future research and menstrual inequity policies.

RESUMEN: INTRODUCCIóN: Investigación previa disponible indica que la inequidad menstrual tiene un impacto en los resultados de salud (menstrual) y en el bienestar emocional. Es también una barrera para la equidad social y de género. El objetivo de este estudio es evaluar la inequidad menstrual y las asociaciones con factores sociodemográficos, en mujeres y personas que menstrúan entre 18-55 años en España. MéTODOS: Este es un estudio transversal, basado en una encuesta, llevado a cabo en España entre marzo y julio de 2021. Se realizaron análisis descriptivos y modelos de regresión logística multivariados.  RESULTADOS: Los análisis se realizaron con los datos de 22,823 mujeres y personas que menstrúan. Más de la mitad de las participantes habían accedido a servicios sanitarios para la menstruación (60.5%). La probabilidad de acceder a servicios sanitarios para la menstruación fue significativamente más alta en participantes con educación universitaria (aOR: 1.48, 95% CI, 1.13-1.95). El 57.8% informó no haber tenido educación menstrual o que ésta fuera parcial, pre-menarquia; la probabilidad fue más alta en participantes que no habían nacido en países europeos o latinoamericanos (aOR: 0.58, 95% CI, 0.36-0.93). La pobreza menstrual durante el ciclo vital se reportó en el 22.2-39.9% de las participantes. Los principales factores de riesgo fueron identificarse como persona no binaria (aOR: 1.67, 95% CI, 1.32-2.11), nacer en países fuera de Europa o Latinoamérica (aOR: 2.74, 95% CI, 1.77-4.24), y no tener papeles para residir en España (aOR: 4.27, 95% CI, 1.94-9.38). Tener estudios universitarios (aOR: 0.61, 95% CI, 0.44-0.84) y no haber reportado problemas económicos en los últimos 12 meses (aOR: 0.06, 95% CI, 0.06-0.07) fueron factores protectores para la pobreza menstrual. Además, el 74.6% indicó haber sobreutilizado productos menstruales por no haber tenido acceso a espacios adecuados para el manejo menstrual. El 42.6% de las participantes comunicaron experiencias de discriminación menstrual. Participantes no binarios (aOR: 1.88, 95% CI, 1.52-2.33) y aquellas que no tenían papeles (aOR: 2.11, 95% CI, 1.10-4.03) presentaron una mayor probabilidad de indicar discriminación menstrual. El absentismo laboral y escolar fue indicado por el 18.3% y el 56.6% de las participantes respectivamente. CONCLUSIONES: Nuestro estudio sugiere que la inequidad menstrual afecta a un número significativo de mujeres y personas que menstrúan en España y, especialmente, a aquellas en situaciones de mayor deprivación socioeconómica, algunos colectivos vulnerabilizados de personas migradas, y a personas no binarias y trans que menstrúan. Los resultados de este estudio pueden ser útiles para investigación futura, así como para el desarrollo de políticas públicas de equidad menstrual.

Menstrual health and management during the COVID-19 syndemic in the Barcelona area (Spain): A qualitative study.

BACKGROUND: Available evidence suggests that menstrual health and management have been impaired during the COVID-19 syndemic. However, research in this area is scarce, and it is failing to voice the experiences of women and people who menstruate regarding their menstrual experiences. OBJECTIVES: This study aimed to explore the experiences of menstrual health and menstrual management among women and people who menstruate in the Barcelona area (Spain) during the COVID-19 syndemic. DESIGN: This is a qualitative study, conducted taking a critical feminist approach, is embedded in the 'Equity and Menstrual Health in Spain' project. METHODS: It includes photo-elicitation individual interviews with 34 women and people who menstruate in the area of Barcelona (Spain). Data were collected in person and through telephone calls between December 2020 and February 2021. Analyses were performed using Thematic Analysis. RESULTS: Main findings navigated through the menstrual changes experienced by some participants, especially women living with long COVID-19, and the barriers to access healthcare and menstrual products during COVID-19. While some participants experienced menstrual poverty, this did not appear to be exacerbated during COVID-19. Instead, access to menstrual products was compromised based on products' availability and mobility restrictions. Menstrual management and self-care were generally easier, given that menstrual experiences were almost exclusively relegated to private spaces during lockdown periods. CONCLUSIONS: Our findings highlight the need to further research and policy efforts towards promoting menstrual health and equity, considering social determinants of health, and taking intersectional and gender-based approaches. These strategies should be further encouraged in social and health crises such as the COVID-19 syndemic.

[Characteristics of the migrant women attended by the Reproductive Health Care Services of the Catalan Health Institute.] / Características de las mujeres migradas atendidas por los Servicios de Salud Reproductiva del Institut Català de la Salut.

OBJECTIVE: The feminization of migration, the need to provide health care to an increasingly diverse population, seeking optimal health data led to considering this research. The objective was to determine the characteristics (socio-demographic profile, obstetric and gynecological record, and monitoring) of migrated pregnant women with a pregnancy process completed in 2019 in Catalonia compared to native women, in public centers (ASSIR-ICS). METHODS: This descriptive study was based on computerized clinical records of women in the 28 centers dependent on the ICS. A descriptive analysis of the variables was carried out to compare the origin of the pregnant women. The Pearson Chi-Square test at 5% and the corrected standardized residual was used to compare the groups and an analysis of variance for the comparison of means also at 5%. RESULTS: 36.315 women were analyzed and the resulting mean age was 31.1 years. The BMI at the beginning of pregnancy was 25.4 on average. Smoking habit was 18.1% among Spanish 17.3% among European. Sexist violence was 4% in Latin American women, being statistically higher than the rest. The risk of preeclampsia was 23.4% in sub-Saharan women. Gestational diabetes was diagnosed mainly among Pakistanis (18.5%). The prevalence of Sexually Transmitted Infections (STIs) was detected in Latin Americans (8.6%), Spanish (5.8%) and Europeans (4.5%). Sub-Saharan women performed insufficient ultrasound control (58.2%) and had the lowest percentage of visits with 49.5%. Pregnancy monitoring was insufficient in 79.9% of all rural pregnant women. CONCLUSIONS: There are differences derived from the geographical origins of pregnant women that condition access to health services.

OBJETIVO: La feminización de la migración y la necesidad de dar asistencia sanitaria a una población cada vez más diversa, buscando unos datos óptimos de salud, llevó a plantearse esta investigación. El objetivo fue determinar las características (perfil socio-demográfico, antecedentes obstétricos-ginecológicos y el seguimiento) de gestantes migradas con un proceso de embarazo finalizado en 2019 en Cataluña frente a las autóctonas, en centros públicos (ASSIR-ICS). METODOS: Este estudio descriptivo se basó en los registros de historia clínica informatizada de mujeres en veintiocho centros dependientes del ICS. Se analizaron las variables según la procedencia de las gestantes y se utilizó la prueba de Ji Cuadrado de Pearson al 5% acompañada del residuo estandarizado corregido para compararlas, así como el análisis de la varianza para la comparación de medias también al 5%. RESULTADOS: Se analizaron 36.315 registros con edad media de 31,1 años. El IMC al inicio de gestación fue de 25,4. El consumo de tabaco fue del 18,1% entre españolas y del 17,3% en el resto de las europeas. El cribado de violencia machista llegó al 4% en latinoamericanas, siendo estadísticamente superior al resto. El riesgo de preeclampsia fue del 23,4% en subsaharianas. La diabetes gestacional fue diagnosticada principalmente entre paquistaníes (18,5%). La prevalencia de Infecciones de Transmisión Sexual (ITS) fue del 8,6% en latinoamericanas, del 5,8% en españolas y del 4,5% en europeas. Las subsaharianas (58,2%) realizaron un control insuficiente de ecografías y un menor porcentaje de visitas con un 49,5%. El seguimiento del embarazo fue insuficiente en el 79,9% del total de las gestantes rurales. CONCLUSIONES: Existen diferencias derivadas del origen geográfico de las gestantes que condicionan el acceso a los servicios sanitarios.

Características de las mujeres migradas atendidas por los Servicios de Salud Reproductiva del Institut Català de la Salut / Characteristics of the migrant women attended by the Reproductive Health Care Services of the Catalan Health Institute

Fundamentos: La feminización de la migración y la necesidad de dar asistencia sanitaria a una población cada vez más diversa, buscandounos datos óptimos de salud, llevó a plantearse esta investigación. El objetivo fue determinar las características (perfil socio-demográfico,antecedentes obstétricos-ginecológicos y el seguimiento) de gestantes migradas con un proceso de embarazo finalizado en 2019 en Cataluñafrente a las autóctonas, en centros públicos (ASSIR-ICS). Métodos: Este estudio descriptivo se basó en los registros de historia clínica informatizada de mujeres en veintiocho centros dependientesdel ICS. Se analizaron las variables según la procedencia de las gestantes y se utilizó la prueba de Ji Cuadrado de Pearson al 5% acompañadadel residuo estandarizado corregido para compararlas, así como el análisis de la varianza para la comparación de medias también al 5%. Resultados: Se analizaron 36.315 registros con edad media de 31,1 años. El IMC al inicio de gestación fue de 25,4. El consumo de tabacofue del 18,1% entre españolas y del 17,3% en el resto de las europeas. El cribado de violencia machista llegó al 4% en latinoamericanas, siendoestadísticamente superior al resto. El riesgo de preeclampsia fue del 23,4% en subsaharianas. La diabetes gestacional fue diagnosticada principalmente entre paquistaníes (18,5%). La prevalencia de Infecciones de Transmisión Sexual (ITS) fue del 8,6% en latinoamericanas, del 5,8% enespañolas y del 4,5% en europeas. Las subsaharianas (58,2%) realizaron un control insuficiente de ecografías y un menor porcentaje de visitascon un 49,5%. El seguimiento del embarazo fue insuficiente en el 79,9% del total de las gestantes rurales. Conclusiones: Existen diferencias derivadas del origen geográfico de las gestantes que condicionan el acceso a los servicios sanitarios.(AU)

Background: The feminization of migration, the need to provide health care to an increasingly diverse population, seeking optimal healthdata led to considering this research. The objective was to determine the characteristics (socio-demographic profile, obstetric and gynecological record, and monitoring) of migrated pregnant women with a pregnancy process completed in 2019 in Catalonia compared to native women,in public centers (ASSIR-ICS). Methods: This descriptive study was based on computerized clinical records of women in the 28 centers dependent on the ICS. A descriptiveanalysis of the variables was carried out to compare the origin of the pregnant women. The Pearson Chi-Square test at 5% and the correctedstandardized residual was used to compare the groups and an analysis of variance for the comparison of means also at 5%. Results: 36.315 women were analyzed and the resulting mean age was 31.1 years. The BMI at the beginning of pregnancy was 25.4 onaverage. Smoking habit was 18.1% among Spanish 17.3% among European. Sexist violence was 4% in Latin American women, being statisticallyhigher than the rest. The risk of preeclampsia was 23.4% in sub-Saharan women. Gestational diabetes was diagnosed mainly among Pakistanis(18.5%). The prevalence of Sexually Transmitted Infections (STIs) was detected in Latin Americans (8.6%), Spanish (5.8%) and Europeans (4.5%).Sub-Saharan women performed insufficient ultrasound control (58.2%) and had the lowest percentage of visits with 49.5%. Pregnancy monitoring was insufficient in 79.9% of all rural pregnant women. Conclusions: There are differences derived from the geographical origins of pregnant women that condition access to health services.(AU)

"Maternal Vaccination Greatly Depends on Your Trust in the Healthcare System": A Qualitative Study on the Acceptability of Maternal Vaccines among Pregnant Women and Healthcare Workers in Barcelona, Spain.

The World Health Organization (WHO) identified vaccine hesitancy as one of the top 10 threats to global health in 2019. Health promotion and education have been seen to improve knowledge and uptake of vaccinations in pregnancy. This qualitative study was conducted based on phenomenology, a methodological approach to understand first-hand experiences, and grounded theory, an inductive approach to analyse data, where theoretical generalisations emerge. Data were collected through semi-structured interviews with pregnant women attending antenatal care services and healthcare workers (HCWs) in Barcelona, Spain. Interviews were audio-recorded, transcribed, and coded, and notes were taken. Inductive thematic analysis was performed, and data were manually coded. Pertussis was reported as the most trusted vaccine among pregnant women due to its long-standing background as a recommended vaccine in pregnancy. The influenza vaccine was regarded as less important since it was perceived to cause mild disease. The COVID-19 vaccine was the least trustworthy for pregnant women due to uncertainties about effectiveness, health effects in the mid- and long-term, the fast development of the vaccine mRNA technology, and the perceptions of limited data on vaccine safety. However, the necessity to be vaccinated was justified by pregnant women due to the exceptional circumstances of the COVID-19 pandemic. The recommendations provided by HCW and the established relationship between the HCW, particularly midwives, and pregnant women were the main factors affecting decision-making. The role of mass media was perceived as key to helping provide reliable messages about the need for vaccines during pregnancy. Overall, vaccines administered during pregnancy were perceived as great tools associated with better health and improved quality of life. Pregnancy was envisioned as a vulnerable period in women's lives that required risk-benefits assessments for decision-making about maternal vaccinations. A holistic approach involving the community and society was considered crucial for health education regarding maternal vaccines in support of the work conducted by HCWs.

Perceptions of COVID-19 Maternal Vaccination among Pregnant Women and Healthcare Workers and Factors That Influence Vaccine Acceptance: A Cross-Sectional Study in Barcelona, Spain.

COVID-19 is associated with poor maternal and pregnancy outcomes. COVID-19 vaccination is recommended in Spain, yet vaccination rates in pregnancy are suboptimal. This study investigates the perceptions of pregnant women and healthcare workers (HCW) regarding COVID-19 vaccination. A web-based cross-sectional quantitative study was conducted in 2021-2022 among 302 pregnant women and 309 HCWs in the Catalan public health system. Most pregnant women (83%) and HCWs (86%) were aware of COVID-19 maternal vaccines. The recommendation of the COVID-19 vaccination by an HCW was identified as the greatest facilitator for maternal vaccine uptake, while the fear of harming the foetus was the most significant barrier reported for rejecting vaccination. HCWs recognised they received limited information and training about COVID-19 vaccination in pregnancy, which hindered them from providing informed recommendations. This study highlights that information and education on COVID-19 vaccines to pregnant women and health professionals are pivotal to ensuring informed decision-making and increasing vaccine uptake.

Endometriosis prevalence and incidence trends in a large population-based study in Catalonia (Spain) from 2009 to 2018.

OBJECTIVE: Endometriosis greatly impacts women's health and quality of life. However, research on the prevalence and incidence of endometriosis remains inconclusive. This study assesses time trends in the prevalence and incidence of endometriosis diagnoses in Catalonia (Spain) from 2009 to 2018, considering differences by age and socioeconomic status. METHODS: Population-based cohort study using data from the Information System for Research in Primary Care (SIDIAP) database. Data were included from over 2.4 million women aged 15-55 years between 1 January 2006 and 31 December 2018. RESULTS: A total of 2,337,717 women were selected as the incident population; 0.7% had an endometriosis diagnosis. Median (interquartile range) age at diagnosis was 37 (32-43) years. Most women were European (92.3%) and lived in urban areas (73.6%). Overall prevalence of endometriosis consistently increased during the 2009-2018 period, and it was 1.24% in 2018. Trends were the highest for women with less socioeconomic deprivation and for the 35-44 years age group. Median incidence rates were 94.9 (92.6-102.9) per 100,000 women-years, being the highest in women aged 35-44 years throughout the whole study period. Overall, incidence increased between 2015 and 2017, and plateaued or decreased in 2018. Incidence rates in women from the most deprived and rural areas were lower, although incidence time trends by socioeconomic status were unclear. CONCLUSION: Healthcare services and public health strategies need to be strengthened to ensure timely endometriosis diagnosis and treatment. Special attention should be given to the most affected populations and the social inequities of health.

Self-Reported Menstrual Alterations During the COVID-19 Syndemic in Spain: A Cross-Sectional Study.

Introduction: Available evidence suggests that there might be an association between the stressors experienced during the COVID-19 syndemic and changes in menstrual patterns. The aim of this study was to assess self-reported menstrual alterations during the COVID-19 syndemic among women and people who menstruate aged 18-55 in Spain. Materials and Methods: A cross-sectional online survey-based study was conducted (March-July 2021). Descriptive statistics were calculated and multivariate logistic regression models were constructed. This study was conducted as part of the "Equity and Menstrual Health in Spain" research project. Results: Among participants (N=17,455), 39.4% reported menstrual alterations since the start of the syndemic. Participants self-reporting long COVID-19 presented higher odds of menstrual alterations (aOR: 1.34, 95% CI, 1.15-1.57). In participants with no history of COVID-19, the risk for self-reported menstrual alterations was significantly higher based on employment situation, among participants experiencing financial issues (eg, financial issues always/many times <12 months: aOR: 1.68, 95% CI, 1.48-1.90), poorer self-perceived health (eg, poor: aOR: 2.00, 95% CI, 1.31-3.07), and those diagnosed with polycystic ovary syndrome (aOR: 1.13, 95% CI, 1.02-1.26). Among participants with a self-reported COVID-19 diagnosis, factors that significantly increased the odds for menstrual alterations were experiencing financial strains (eg, financial issues always/many times <12 months: aOR: 1.53, 95% CI, 1.09-2.14), poorer self-perceived health (eg, poor: aOR: 3.09, 95% CI, 1.01-9.52). Overall, factors that decreased the odds of reporting menstrual alterations included age >25, being a carer, not having a gynecological condition and using hormonal contraception. Discussion and conclusions: Findings suggest an impact of the COVID-19 syndemic on menstrual patterns. Social inequities in reporting menstrual alterations were identified. While the risk of reporting menstrual alterations was higher among participants with long COVID-19, evidence is not conclusive. Further research on menstrual health in the context of COVID-19 is needed, also to inform policy and practice.

Use and perceptions on reusable and non-reusable menstrual products in Spain: A mixed-methods study.

BACKGROUND: Menstrual products are necessary goods for women and people who menstruate to manage menstruation. Understanding the use and perceptions of menstrual products is key to promote menstrual equity and menstrual health. This study aimed at assessing the use and perceptions on menstrual products among women and people who menstruate aged 18-55 in Spain. METHODS: A mixed-methods study was conducted, including a cross-sectional study (N = 22,823), and a qualitative study (N = 34). RESULTS: Participants used a combination of products. Non-reusable products were the most used, while over half used reusable products. Usage changed when data were stratified by age, gender identification, completed education, country of birth and experiencing financial issues. It also varied between trans and cis participants. Menstrual products' use also shifted based on experiences of menstrual poverty and access to information and products. Overall, reusable products were perceived to be more acceptable than non-reusable. Barriers to use the menstrual cup were also identified, including experiences of menstrual inequity (e.g., menstrual poverty, lack of access to information or menstrual management facilities). CONCLUSION: Perceptions and choices of menstrual products need to be acknowledged, especially when designing and implementing menstrual policies to address menstrual inequity and menstrual health.

Experiences of menstrual inequity and menstrual health among women and people who menstruate in the Barcelona area (Spain): a qualitative study.

INTRODUCTION: Menstrual health and menstrual inequity have been neglected in social, economic, healthcare and political spheres. Although available evidence is scarce, it already suggests a link between experiencing menstrual inequity (which refers to the systematic disparities in accessing menstrual health and education, menstrual products and spaces for menstrual management, among other aspects) and menstrual health outcomes. The aim of this study was to explore experiences of menstrual health and menstrual inequity among women and people who menstruate aged 18-55 in Barcelona and surrounding areas (Spain). METHODS: A qualitative study, using a critical feminist perspective, was conducted. Sampling was purposeful and selective. Recruitment was through sexual and reproductive health centres, social media and snowball sampling techniques. Thirty-four semi-structured photo-elicitation interviews were conducted between December 2020 and February 2021. Interviews took place in sexual and reproductive health centres, public spaces, and by telephone. Data were analysed using Reflexive Thematic Analysis. RESULTS: Three themes were identified: "Systemic neglect of menstruation and the menstrual cycle", "When "the private" becomes public: menstrual management" and "Navigating menstrual health: between medicalization and agency". Experiences of menstrual inequity appeared to be widespread among participants. They referred to the impact of having to conceal menstruation and the barriers to managing menstruation in public spaces. Choosing menstrual products was often influenced by price and availability; several participants reported menstrual poverty. A general lack of menstrual education was described. Menstrual education was usually gained through personal experience and self-learnings, or through families and friends. Menstruation and the menstrual cycle had a significant impact on participants' day-to-day. Accessing and navigating the healthcare system was challenging, as participants mostly reported feeling dismissed and almost exclusively offered hormonal contraception as a panacea to address menstrual health. CONCLUSIONS: The impact of menstrual inequity appears to be far-reaching. Multidimensional structural policies should promote agency in individuals and communities to enable opportunities for menstrual education, access to menstrual products, healthcare services and adequate menstrual-management facilities. Health professionals' training is also necessary to improve access to and quality of menstrual healthcare. Policies need to be inclusive of non-binary and trans people, and vulnerable populations.

[Response of the Catalonia neonatal screening laboratory to the pandemic of SARS-CoV-2.] / Respuesta del Laboratorio de Cribado Neonatal de Cataluña ante la pandemia por SARS-CoV-2.

Faced with the prospect of a collapsed health system due to the COVID-19 pandemic, the professionals involved in the Neonatal Screening Programme (NSP) of Catalonia had to adapt to this situation in a flexible, forceful and efficient manner. The most important goals were to prevent the risk of infection in the professionals, in families and their newborns, as well as to ensure the same effectiveness for the early detection of the diseases included in our programme. To this end, the laboratory was reorganised by dividing the staff into groups and the spaces were redistributed. It was also necessary to modify several protocols and circuits, especially for the management of early discharges from maternity centres, and for the collection of the necessary second samples (from newborns with inconclusive results or for low quality samples). In general, a 36% reduction in the time of arrival of these second samples at the laboratory was achieved with respect to the previous circuit. In the specific case of cystic fibrosis detection, the implementation of a new strategy meant a 100% reduction in the request for second samples and a 70% reduction in the age of diagnosis of the newborn. After evaluating these changes, it can be concluded that in the face of the pandemic, the NSP of Catalonia showed determined leadership, aligning all its professionals, ensuring the continuity of the activity in the programme and generating new opportunities. The new processes and circuits implemented have been definitively consolidated, improving the efficiency of the programme.

Ante la crisis de un sistema sanitario colapsado debido a la pandemia por la COVID-19, los profesionales implicados en el Programa de Cribado Neonatal (PCN) de Cataluña nos tuvimos que adaptar a dicha situación de forma ágil, contundente y eficiente. Los objetivos prioritarios fueron prevenir el riesgo de contagio tanto en los profesionales sanitarios como en las familias y sus recién nacidos, así como asegurar la misma eficacia para la detección precoz de las enfermedades incluidas en el PCN. Para ello, se reorganizó el laboratorio dividiendo en grupos al personal y se redistribuyeron los espacios. También fue necesario modificar varios protocolos y circuitos, en especial para la gestión de las altas precoces de los centros maternales y para la toma de las segundas muestras necesarias (de recién nacidos que presentaron resultados dudosos o por muestra inválida). En general, se consiguió una reducción del 36% del tiempo de llegada de estas segundas muestras al laboratorio respecto al circuito anterior. Para la detección de la fibrosis quística, la implementación de una nueva estrategia supuso una reducción del 100% en la solicitud de segundas muestras y del 70% en la edad de diagnóstico del recién nacido. Tras la evaluación de estos cambios, se puede concluir que ante la pandemia el PCN de Cataluña mostró un liderazgo decidido, alineando a todos sus profesionales, asegurando la continuidad de la actividad en el programa y generando nuevas oportunidades. Los nuevos procesos y circuitos de trabajo implantados han quedado definitivamente consolidados, mejorando la eficiencia del programa.

Respuesta del laboratorio de cribado neonatal de Cataluña ante la pandemia por SARS-CoV-2 / Response of the Catalonia neonatal screening laboratory to the pandemic of SARS-CoV-2

Ante la crisis de un sistema sanitario colapsado debido a la pandemia por la COVID-19, los profesionales implicados en el Programa de Cribado Neonatal (PCN) de Cataluña nos tuvimos que adaptar a dicha situación de forma ágil, contundente y eficiente. Los objetivos prioritarios fueron prevenir el riesgo de contagio tanto en los profesionales sanitarios como en las familias y sus recién nacidos, así como asegurar la misma eficacia para la detección precoz de las enfermedades incluidas en el PCN. Para ello, se reorganizó el laboratorio dividiendo en grupos al personal y se redistribuyeron los espacios. También fue necesario modificar varios protocolos y circuitos, en especial para la gestión de las altas precoces de los centros maternales y para la toma de las segundas muestras necesarias (de recién nacidos que presentaron resultados dudosos o por muestra inválida). En general, se consiguió una reducción del 36% del tiempo de llegada de estas segundas muestras al laboratorio respecto al circuito anterior. Para la detección de la fibrosis quística, la implementación de una nueva estrategia supuso una reducción del 100% en la solicitud de segundas muestras y del 70% en la edad de diagnóstico del recién nacido. Tras la evaluación de estos cambios, se puede concluir que ante la pandemia el PCN de Cataluña mostró un liderazgo decidido, alineando a todos sus profesionales, asegurando la continuidad de la actividad en el programa y generando nuevas oportunidades. Los nuevos procesos y circuitos de trabajo implantados han quedado definitivamente consolidados, mejorando la eficiencia del programa

Faced with the prospect of a collapsed health system due to the COVID-19 pandemic, the professionals involved in the Neonatal Screening Programme (NSP) of Catalonia had to adapt to this situation in a flexible, forceful and efficient manner. The most important goals were to prevent the risk of infection in the professionals, in families and their newborns, as well as to ensure the same effectiveness for the early detection of the diseases included in our programme. To this end, the laboratory was reorganised by dividing the staff into groups and the spaces were redistributed. It was also necessary to modify several protocols and circuits, especially for the management of early discharges from maternity centres, and for the collection of the necessary second samples (from newborns with inconclusive results or for low quality samples). In general, a 36% reduction in the time of arrival of these second samples at the laboratory was achieved with respect to the previous circuit. In the specific case of cystic fibrosis detection, the implementation of a new strategy meant a 100% reduction in the request for second samples and a 70% reduction in the age of diagnosis of the newborn. After evaluating these changes, it can be concluded that in the face of the pandemic, the NSP of Catalonia showed determined leadership, aligning all its professionals, ensuring the continuity of the activity in the programme and generating new opportunities. The new processes and circuits implemented have been definitively consolidated, improving the efficiency of the programme

Evaluación de la implementación del programa de Preparación para el Nacimiento en Cataluña: características de las matronas y fidelidad al programa / Evaluation of the implementation of the Group Prenatal Care program in Catalonia: characteristics of midwives and fidelity to the program

OBJETIVO: Conocer las características de las matronas y su grado de fidelidad a la metodología, contenidos, actividades y evaluación del programa de Preparación para el Nacimiento (PN) del Departament de Salut de la Generalitat de Catalunya, para la evaluación de su implementación. MÉTODO: Estudio observacional, descriptivo y transversal en 38 unidades de atención a la salud sexual y reproductiva de Cataluña, en el que participaron 334 matronas que dinamizaban grupos de PN. La información se recogió a través de un cuestionario ad hoc y permitió obtener información respecto a variables sociodemográficas, experiencia profesional, formación, conocimiento y utilización del programa, así como variables relacionadas con la fidelidad al mismo. RESULTADOS: Se envió el cuestionario a 451 matronas y lo respondieron 334 (74,1%). El programa lo conocía el 97,6% de las matronas (n= 325), y el 81,4% (n= 272) lo está utilizando. El 49,4% de las matronas realiza el número de sesiones recomendadas y el 85,3% procura una participación activa de las gestantes, aunque el 51,5% utiliza sesiones expositivas. El 64,1% no puede ajustarse al tiempo establecido para cada sesión, y tan sólo un 11,4% evalúa el programa. CONCLUSIONES: Las matronas que utilizan el programa y tienen más años de experiencia mantienen una mayor fidelidad a los contenidos y metodología. La formación previa a la implantación del programa es clave para su conocimiento y utilización, pero requiere mantenerse en el tiempo. Se ha producido una adaptación al programa y las matronas no lo evalúan sistemáticamente, por lo que debe haber una implicación institucional para su ejecución

OBJECTIVE: To know the characteristics of midwives and the degree of fidelity to the methodology, contents, activities and evaluation defined in the Group Prenatal Care prepared by the Department of Health in Catalonia, as the evaluation of the program implementation. METHOD: A descriptive and cross-sectional observational study carried out in 38 units of sexual and reproductive health care of Catalonia, in which 334 midwives who dynamized the Group Prenatal Care participated. The information collected through an ad-hoc questionnaire allowed to obtain information about midwives variables: sociodemographic, professional experience, training, and knowledge and use the program, as well as variables related to fidelity to it. RESULTS: The questionnaire was sent to 451 midwives and they answered 334 (74.1%). The program is known to 97.6% of midwives (n= 325), and 81.4% are using it (n= 272). About the fidelity to the program, 49.4% of midwives performed the recommended number of sessions, 85.3% managed the active participation of pregnant women, although 51.5% used expository sessions. 64.1% couldn't adjust to the timeline established for each session, and only 11.4% evaluate the program. CONCLUSIONS: Midwives who use the program and have more years of experience maintain better fidelity to the content and methodology. The program training before its implementation is a key for the knowledge and use of it, but this training must be maintained over time. Midwives have modified at the convenience the program and systematic evaluation has not been carried out, so there must be an institutional implication for its implementation

Dolor persistente posparto. Tratamiento con procaína subdérmica (terapia neural) / Postpartumchronic pain. Subderma/ procaine treatment - neura/ therapy

OBJETIVO: Evaluar la efectividad de la administración de procaína subdérmica en bajas dosis en la cicatriz del parto vaginal o por cesárea para el alivio del dolor persistente posparto. Pacientes, material y métodos: Estudio observacional y prospectivo de abril de 2014 a marzo de 2016, en mujeres con dolor persistente después de 10 días posparto. Se valoraron: variables demográficas, variables clínicas y obstétricas, motivo de consulta, grado del dolor según la escala visual analógica (EVA), y número de dosis de tratamiento recibidas y coste por dosis. El tratamiento utilizado fue la inyección subdérmica con procaína (1 mg/kg) en sesiones quincenales, hasta conseguir un dolor ≤1 según la EVA. RESULTADOS: Se estudiaron 168 mujeres. La media de dolor antes del tratamiento fue de 5,52 en la escala EVA y de 0,17 al final, con una p <0,001. La edad mostró diferencias significativas interpacientes con una p <0,001, donde las pacientes mayores de 40 años tuvieron una valoración inicial del dolor más alta y por tanto necesitaron más sesiones, aunque también consiguieron un grado de dolor ≤1. El 80,9% de las pacientes terminaron el tratamiento a los 30 días con la tercera sesión. CONCLUSIÓN: La aplicación de procaína subdérmica está asociada a la disminución del dolor persistente posparto

OBJECTIVE: To evaluate effectiveness of low doses of subdermal procaine administered into vaginal labor and C-section scars to alleviate persistent postpartum pain. Subjects, materials and methodology: Observational and prospective study carried out from April 2014 to March 2016 in I 71 women suffering from persistent pain after 10 days of postpartum. Variables taken into account: demographics, clinical and obstetric differences, pain level according to the Visual Analogue Scale (VAS), amount of doses of treatment, and cost per dose. The treatment used was one subdermal injection of procaine ( I mg/kg) every two weeks until achieving a pain level of s I according to the VAS. RESULTS: 168 women were studied. The average pain level before treatment was 5.52 according to the VAS, and 0.17 after treatment (p < 0.00 I ). Age was one of the most significant differences among patients with a p < 0.001. Patients over 40 assessed their initial pain at a higher level and therefore needed more doses. However, they also achieved a pain level of ≤ 1.80.9% of patients finished their treatment after 30 days with their third dose. CONCLUSION: Applying subdermal procaine has shown to be effective in treating persistent postpartum pain

Prescripción enfermera: más barreras para cuidar a las mujeres / No disponible

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