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Do Menstrual Hygiene Management Interventions Improve Education and Psychosocial Outcomes for Women and Girls in Low and Middle Income Countries? A Systematic Review

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  • Julie Hennegan
  • Paul Montgomery

Abstract

Background: Unhygienic and ineffective menstrual hygiene management has been documented across low resource contexts and linked to negative consequences for women and girls. Objectives: To summarise and critically appraise evidence for the effectiveness of menstruation management interventions in improving women and girls’ education, work and psychosocial wellbeing in low and middle income countries. Methods: Structured systematic searches were conducted in peer-reviewed and grey literature to identify studies evaluating education and resource provision interventions for menstruation management. Individual and cluster randomised controlled trials were eligible for inclusion, as were non-randomised controlled trials. Study characteristics, outcomes and risk of bias were extracted using a piloted form. Risk of bias was independently assessed by two researchers. Results: Eight studies described in ten citations were eligible for inclusion. Studies were highly heterogeneous in design and context. Six included assessment of education-only interventions, and three provided assessment of the provision of different types of sanitary products (menstrual cups, disposable sanitary pads, and reusable sanitary pads). A moderate but non-significant standardised mean difference was found for the two studies assessing the impact of sanitary pad provision on school attendance: 0.49 (95%CI -0.13, 1.11). Included studies were heterogeneous with considerable risk of bias. Trials of education interventions reported positive impacts on menstrual knowledge and practices, however, many studies failed to assess other relevant outcomes. No trials assessed or reported harms. Conclusions: There is insufficient evidence to establish the effectiveness of menstruation management interventions, although current results are promising. Eight trials have been conducted, but a high risk of bias was found and clinical heterogeneity precluded synthesis of most results. Whilst trials provided some indication of positive results, further research is needed to establish the role of menstruation hygiene management in education performance, employment and other psychosocial outcomes. This review provides a concise summary of present trials and highlights improvements for future work.

Suggested Citation

  • Julie Hennegan & Paul Montgomery, 2016. "Do Menstrual Hygiene Management Interventions Improve Education and Psychosocial Outcomes for Women and Girls in Low and Middle Income Countries? A Systematic Review," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-21, February.
    • Handle: RePEc:plo:pone00:0146985
    DOI: 10.1371/journal.pone.0146985
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    Cited by:

    1. Kumar, Rahul & Maity, Bipasha, 2022. "Cultural norms and women’s health: Implications of the practice of menstrual restrictions in Nepal," World Development Perspectives, Elsevier, vol. 27(C).
    2. Stephanie Psaki & Nicole Haberland & Barbara Mensch & Lauren Woyczynski & Erica Chuang, 2022. "Policies and interventions to remove gender‐related barriers to girls' school participation and learning in low‐ and middle‐income countries: A systematic review of the evidence," Campbell Systematic Reviews, John Wiley & Sons, vol. 18(1), March.
    3. Margarita Garfias Royo & Elinor Parrott & Emily-Marie Pacheco & Imaduddin Ahmed & Ella Meilianda & Intan Kumala & Rina Suryani Oktari & Helene Joffe & Priti Parikh, 2022. "A Structured Review of Emotional Barriers to WASH Provision for Schoolgirls Post-Disaster," Sustainability, MDPI, vol. 14(4), pages 1-20, February.
    4. Silvia Castro & Kristina Czura, 2021. "Social Norms and Misinformation: Experimental Evidence on Learning about Menstrual Health Management in Rural Bangladesh," CESifo Working Paper Series 9081, CESifo.
    5. Castro, Silvia & Czura, Kristina, 2021. "Social Norms and Information in Menstrual Health Management," VfS Annual Conference 2021 (Virtual Conference): Climate Economics 242423, Verein für Socialpolitik / German Economic Association.
    6. Julie Hennegan & Linnea Zimmerman & Alexandra K. Shannon & Natalie G. Exum & Funmilola OlaOlorun & Elizabeth Omoluabi & Kellogg J. Schwab, 2018. "The Relationship between Household Sanitation and Women’s Experience of Menstrual Hygiene: Findings from a Cross-Sectional Survey in Kaduna State, Nigeria," IJERPH, MDPI, vol. 15(5), pages 1-19, May.
    7. Siobhan K. Yilmaz & Alok K. Bohara & Soumi Roy Chowdhury, 2020. "Touch for Health: Use of Pavlovian Processes with Physical Touch as a Means to Improve Menstrual Hygiene Management Initiatives, Measured by Willingness to Pay," PharmacoEconomics - Open, Springer, vol. 4(2), pages 263-276, June.
    8. Ernestina Coast & Samantha R. Lattof & Joe Strong, 2019. "Puberty and menstruation knowledge among young adolescents in low- and middle-income countries: a scoping review," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(2), pages 293-304, March.
    9. Rahul Kumar & Bipasha Maity, 2020. "Menstrual Restrictions and Women's Health in Nepal," Working Papers 45, Ashoka University, Department of Economics.
    10. Tavishi Tewary & Vranda Jain & Nandini Agarwal, 2021. "Moving Towards Menstrual Hygiene: Awareness and Acceptance of Sanitary Napkins at Bottom of the Pyramid," International Journal of Business and Economics, School of Management Development, Feng Chia University, Taichung, Taiwan, vol. 20(1), pages 73-91, June.
    11. Padmalaya Das & Danielle Lisnek & Krushna Chandra Sahoo & Shalini Sinha & JyotiRanjan Mohanty & Pranati Sahoo & Bibiana Bilung & Bijaya Panda & Clare Tanton & Belen Torondel, 2021. "Identifying Risk Factors for Lower Reproductive Tract Infections among Women Using Reusable Absorbents in Odisha, India," IJERPH, MDPI, vol. 18(9), pages 1-15, April.
    12. Punita Bhatt & Supriya Garikipati, "undated". "Culture, Collectivism and Empowerment: The Role of Feminist Ideologies in Women’s Work and Organization," Working Papers 202108, University of Liverpool, Department of Economics.
    13. Yasmin Mohamed & Kelly Durrant & Chelsea Huggett & Jessica Davis & Alison Macintyre & Seta Menu & Joyce Namba Wilson & Mary Ramosaea & Michael Sami & Dani J Barrington & Donna McSkimming & Lisa Natoli, 2018. "A qualitative exploration of menstruation-related restrictive practices in Fiji, Solomon Islands and Papua New Guinea," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-19, December.
    14. Vishna Shah & Helen Nabwera & Bakary Sonko & Fatou Bajo & Fatou Faal & Mariama Saidykhan & Yamoundaw Jallow & Omar Keita & Wolf-Peter Schmidt & Belen Torondel, 2022. "Effects of Menstrual Health and Hygiene on School Absenteeism and Drop-Out among Adolescent Girls in Rural Gambia," IJERPH, MDPI, vol. 19(6), pages 1-23, March.
    15. Jasmin Foster & Paul Montgomery, 2021. "A Study of Environmentally Friendly Menstrual Absorbents in the Context of Social Change for Adolescent Girls in Low- and Middle-Income Countries," IJERPH, MDPI, vol. 18(18), pages 1-8, September.
    16. Supriya Garikipati & Penelope A. Phillips-Howard, 2022. "Information, Choice and Menstrual Outcomes: Evidence from a CommunityBased Intervention in Indi," Working Papers 202211, University of Liverpool, Department of Economics.
    17. Paul Montgomery & Julie Hennegan & Catherine Dolan & Maryalice Wu & Laurel Steinfield & Linda Scott, 2016. "Menstruation and the Cycle of Poverty: A Cluster Quasi-Randomised Control Trial of Sanitary Pad and Puberty Education Provision in Uganda," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-26, December.
    18. Biljana Macura & Laura Del Duca & Adriana Soto & Naomi Carrard & Louisa Gosling & Karin Hannes & James Thomas & Lewnida Sara & Marni Sommer & Hugh S. Waddington & Sarah Dickin, 2021. "PROTOCOL: What is the impact of complex WASH interventions on gender and social equality outcomes in low‐ and middle‐income countries? A mixed‐method systematic review protocol," Campbell Systematic Reviews, John Wiley & Sons, vol. 17(2), June.
    19. Supriya Garikipati & Penelope A. Phillips-Howard, "undated". "What’s the Bleeding Problem? Period Poverty, Information Failure and Consumer Preferences in the Global South," Working Papers 202107, University of Liverpool, Department of Economics.
    20. Deena Mehjabeen & Erin C. Hunter & Mehjabin Tishan Mahfuz & Moshammot Mobashara & Mahbubur Rahman & Farhana Sultana, 2022. "A Qualitative Content Analysis of Rural and Urban School Students’ Menstruation-Related Questions in Bangladesh," IJERPH, MDPI, vol. 19(16), pages 1-15, August.

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