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Assessing Women’s Menstruation Concerns and Experiences in Rural India: Development and Validation of a Menstrual Insecurity Measure

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  • Bethany A. Caruso

    (Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA)

  • Gerard Portela

    (Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA)

  • Shauna McManus

    (Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA)

  • Thomas Clasen

    (Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA)

Abstract

Qualitative research has documented menstruator’s challenges, particularly in water and sanitation poor environments, but quantitative assessment is limited. We created and validated a culturally-grounded measure of Menstrual Insecurity to assess women’s menstruation-related concerns and negative experiences. With cross-sectional data from 878 menstruating women in rural Odisha, India, we carried out Exploratory (EFA) and Confirmatory (CFA) Factor Analyses to reduce a 40-item pool and identify and confirm the scale factor structure. A 19-item, five factor model best fit the data (EFA: root mean square error of approximation (RMSEA) = 0.027; comparative fit index (CFI) = 0.994; Tucker-Lewis index (TLI) = 0.989; CFA: RMSEA = 0.058; CFI = 0.937; TLI = 0.925). Sub-scales included: Management, Menstrual Cycle Concerns, Symptoms, Restrictions, and Menstruation-Related Bodily Concerns. Those without access to a functional latrine, enclosed bathing space, water source within their compound, or who used reusable cloth had significantly higher overall Menstrual Insecurity scores (greater insecurity) than those with these facilities or using disposable pads. Post-hoc exploratory analysis found that women reporting experiencing tension at menstrual onset or difficulty doing work had significantly higher Menstrual Insecurity scores. This validated tool is useful for measuring Menstrual Insecurity, assessing health inequities and correlates of Menstrual Insecurity, and informing program design.

Suggested Citation

  • Bethany A. Caruso & Gerard Portela & Shauna McManus & Thomas Clasen, 2020. "Assessing Women’s Menstruation Concerns and Experiences in Rural India: Development and Validation of a Menstrual Insecurity Measure," IJERPH, MDPI, vol. 17(10), pages 1-26, May.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:10:p:3468-:d:358709
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    References listed on IDEAS

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    1. Bethany A. Caruso & Thomas Clasen & Kathryn M. Yount & Hannah L. F. Cooper & Craig Hadley & Regine Haardörfer, 2017. "Assessing Women’s Negative Sanitation Experiences and Concerns: The Development of a Novel Sanitation Insecurity Measure," IJERPH, MDPI, vol. 14(7), pages 1-22, July.
    2. Sommer, M. & Hirsch, J.S. & Nathanson, C. & Parker, R.G., 2015. "Comfortably, safely, and without shame: Defining menstrual hygiene management as a public health issue," American Journal of Public Health, American Public Health Association, vol. 105(7), pages 1302-1311.
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    Cited by:

    1. Jui-Che Tu & Ting-Yun Lo & Yi-Ting Lai, 2021. "Women’s Cognition and Attitude with Eco-Friendly Menstrual Products by Consumer Lifestyle," IJERPH, MDPI, vol. 18(11), pages 1-20, May.

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