A systematic review of menstrual hygiene management (MHM) during humanitarian crises and/or emergencies in low- and middle-income countries

Abstract

BackgroundPoor menstrual hygiene management (MHM) is linked to adverse health, and quality of life, particularly during emergencies. Although in recent times increased emphasis is being laid upon MHM during humanitarian crises—pandemics, disasters and conflicts, the essential components of complete MHM during an emergency are not clearly spelt out. We conducted a systematic review to examine, analyse and describe the existing evidence related to the challenges experienced by women and girls in practicing MHM during humanitarian crises and / or public health emergencies.MethodsWe followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines and registered in PROSPERO (CRD42022328636). We searched online repositories: PubMed, Embase, and PsycINFO for articles published between January 2000 and April 2022. For presenting key findings, we used the descriptive statistics and thematic analysis approach.ResultsWe identified a total of 1,078 published articles, out of which 78 were selected for a full-text review, and finally 21 articles were included. The pooled prevalence of lack of access to sanitary pads during humanitarian crises was 34 percent (95 percent CI 0.24–0.45). The prevalence of safe and proper sanitary pad disposal practices ranged from 11 to 85 per cent, with a pooled prevalence of 54 per cent (95 per cent CI 0.21–86). Qualitative analyses projected three themes that emerged on MHM during humanitarian crises (1) Availability and affordability of menstrual products, and accessibility to water, sanitation and health (WASH) services, (2) Availability of support system and coping with “period poverty,” and (3) Gender dimensions of menstrual hygiene management. Most studies reported non-availability of MHM products and WASH services during emergencies. Existence of barriers at systemic and personal level posed challenges in practicing menstrual hygiene. Privacy was identified as a common barrier, as emergency shelters were reportedly not women-friendly.ConclusionAvailability of limited evidence on the subject is suggestive of the need to invest resources for strengthening primary research in low- and middle-income countries and more specifically during emergencies. Context-specific state level policies on MHM during emergencies would help to guide district and sub-district managers in strengthening systems and address barriers for the provision of MHM services during emergencies.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022328636, identifier CRD42022328636.

Menstrual health: Inequities in a cohort of menstruating people in the Brazilian southeastern region

“…Evidence of impaired MHM does not relate solely to unfavorable health and psychological factors but also to social and cultural effects that prejudice the QoL of women 24 . Our research shows that the risk of not having adequate conditions for menstrual hygiene at home increases by 2.6% for every one‐point drop in the environmental QoL score.…”

“…17 Evidence of impaired MHM does not relate solely to unfavorable health and psychological factors but also to social and cultural effects that prejudice the QoL of women. 24 Our research shows that the risk of not having adequate conditions for menstrual hygiene at home increases by 2.6% for every one-point drop in the environmental QoL score. In relation to MHM, researchers not only have to understand whether women have the required products, privacy, washing, and disposal facilities, but also to consider the systemic context in which menstruation occurs.…”

Menstrual health and hygiene among young Palestinian female university students in the West Bank: a cross-sectional study

“…Women who live under humanitarian crisis and/or emergencies face various barriers to access sanitary pads, menstrual products and disposal mechanism, inadequate availability of WASH facilities, could not afford soap to wash hands and face difficulties using menstrual hygiene kits that were distributed without instructions. 24 The Palestinian population has been continuously described as ‘young’. According to the United Nations, adolescence is defined as those within the age range 10–19 years and youth is defined as those within the age range 15–24 years, regardless of marital or economic status.…”

“…The oPt is an LMIC with an ongoing and protracted conflict for more than 70 years. Women who live under humanitarian crisis and/or emergencies face various barriers to access sanitary pads, menstrual products and disposal mechanism, inadequate availability of WASH facilities, could not afford soap to wash hands and face difficulties using menstrual hygiene kits that were distributed without instructions 24. The Palestinian population has been continuously described as ‘young’.…”

Menstrual Health and Hygiene Amongst Adolescent Girls and Women of Reproductive Age: A Cross Sectional Study From Odisha, India

“…In Odisha state, the focus of menstrual health and hygiene (MHH) research is centered around adolescent girls in school settings; and considerably less attention has been given to women's experience of MHH at other life stages. Some studies have also aimed to focus on menstruation-related experiences at the workplace and in emergency situations (13) (14). However, there is scant evidence on holistic understanding of the practices and the predictors of menstrual health.…”