Menstrual health and hygiene among Indigenous Australian girls and women: barriers and opportunities

Abstract

Health inequities inhibit global development and achievement of the Sustainable Development Goals. One gendered health area, Menstrual Health & Hygiene (MHH), has received increasing attention in Low- and Middle-Income Countries as a barrier to health, wellbeing, and gender equity. Recent anecdotal evidence in Australia highlights that MHH also present challenges to High Income Countries, particularly among underrepresented populations, such as Indigenous Australian peoples, people from low socio-economic backgrounds, or communities that are remotely located. In this article, we chart the emergence of attention to MHH in the Australian context and highlight key considerations for the conduct of research with Aboriginal and Torres Strait Islander Peoples within the culturally- and gender-sensitive area of MHH. Further we draw on insights offered by a partnership between female Aboriginal and Torres Strait Islander leaders, NGO stakeholders, and non-Indigenous researchers. Through a convening (yarning circle) held in March 2018, the group identified multiple socioecological considerations for MHH research and practice, including: affordability and access to menstrual products, barriers to knowledge and culturally sensitive education, infrastructure and supply chain challenges, and the necessity of Indigenous-led research and community-driven data collection methods in addressing the sensitive topic. We draw together these insights to develop recommendations for future research, advocacy, and action in Australia.

Enabling factors for sustainable menstrual hygiene management practices: a rapid review

“…Women face logistical challenges in storing and transporting menstrual products as secrecy around purchasing sanitary items, overcrowded housing, living across multiple residences, high financial costs, lack of privacy for safe keeping of personal items, sufficient female-friendly infrastructure (e.g., working toilets, accessible disposal facilities, privacy) [7]. The MHH content and material should be dealt with sensitivity and should be made available to all genders.…”

“…Additionally, vending machines that provide free MHH products may improve access for girls while in school. Still, more evidence is needed to inform knowledge of the effectiveness and implementation of the strategy before scaling up [7]. It is assumed that young girls learn about their menstruation from their mothers.…”

“…School girls have specific needs to manage their menstruation at school to keep them in school. [4,14,15,36] A need for more target-oriented research and generating more specific data to help evaluate the awareness level of the respondents [15] Menstrual History Age at Menarche Awareness about menstruation, Experiences and perceptions about menstruation Awareness and education on MHH Information about menstruation in School /college curriculum Perception/awareness of men /boys regarding menstruation Socio-cultural factors that influence menstrual practices 86% of the participants disclosed that their family members, relatives, and neighbours were reluctant to discuss puberty and menstruation Girls reported that the schoolboys teased them for staining their clothing All the students perceived puberty and menstruation as a matter of shame, and to avoid teasing, not discuss menstruation-related matters with the opposite sex [34] Menstrual education is transferred by the older females in the family when menarche is reached, but not beforehand [14,35] Awareness helps in improving MHM [14] There is a need for in-depth education about the basic biology behind menstruation [17] Lack of sufficient pubertal and menstruation information in the school curriculum, thus lacking MHM knowledge Irresponsible attitude of teachers towards puberty and menstruation and they give the topic for self-study [31] Boys laughed at girls when teachers were taking puberty and menstruation classes [34] A need for creating culturally sensitive puberty education for girls and boys, emphasising that MHH content and material should be dealt with sensitivity, and should be made available to all the genders [7] Menstrual The difficulties in storing and transporting products because of overcrowded housing, living across multiple residences, and lack of privacy for safe keeping of personal items [7] The status of menstruating women restricts their consumption choice, as the deeply rooted socio-cultural taboos reinforce traditional gender norms creating conditions for resisting change (Meenakshi, 2020) The factors influencing use of modern methods of managing MHM depend on the status of education and access to media [5,15] Majority of consumers attach importance to comfort, volume, and duration of blood absorption to selecting menstrual products [25] A need for future research on the use of menstrual cups in comparison with other products at different times of the menstrual cycle and study the changes over time [26] Importance of understanding the price/cost/expenditure per month on menstrual products [36] The amount ...…”

Water, Sanitation, and Women’s Empowerment: A systematic review and qualitative metasynthesis

“…Women and girls have described sanitation conditions as undesirable, dirty, disgusting, and nauseating 99,121,130,154,156,157,159,171,174,203,205,206,[208][209][210]212,213,215,[221][222][223]226,227,230,233,237 and lacking resources like disposal bins, soap, sufficient water, and buckets for washing or bathing, which are also needed during menstruation. 99,130,157,171,176,189,193,201,207,208,212,213,215,232,[238][239][240] Women used less preferred locations and sources for sanitation 116,156,159,183,…”

Significance of Education for Sustainable Menstrual Hygiene Management Practices: A rapid review

“…On average, women use 6-8 sanitary napkins per cycle, generating approximately 125 kg of menstrual waste during the menstruating period [3]. Each used disposed menstrual pad takes 500 to 800 years to decompose as 90% of the menstrual pads are made of plastic [4].…”