Menstrual Needs and Associations with Sexual and Reproductive Risks in Rural Kenyan Females: A Cross-Sectional Behavioral Survey Linked with HIV Prevalence

Abstract

Background: Females in low and middle income countries (LMICs) have difficulty coping with menstrual needs, but few studies have examined the social or health implications of these needs.Methods: Responses from 3418 menstruating females aged 13–29 years were extracted from an HIV and behavioral risks cross-sectional survey conducted in rural western Kenya. We examined sanitary products used, provision of products from sexual partners or from transactional sex, and demographic and sexual exposures.Results: Overall, 75% of females reported using commercial pads and 25% used traditional materials such as cloth or items like paper or tissue, with 10% of girls <15 years old depending on makeshift items. Two-thirds of females with no education relied on traditional items. Having attended secondary school increased the odds of using commercial pads among married (adjusted odds ratios [AOR] 4.8, 95% confidence interval [CI] 3.25–7.12) and single females (AOR 2.17, 95% CI 1.04–4.55). Married females had lower odds of pad use if they reported early (<12 years of age) compared with later (≥18 years) sexual debut (64% vs. 78%, AOR 0.45, 95% CI 0.21–0.97). Two-thirds of pad users received them from sexual partners. Receipt was lower among married females if partners were violent (AOR 0.67, 95% CI 0.53–0.85). Receipt among single females was higher if they had two or more sexual partners in the past year (AOR 2.11, 95% CI 1.04–4.29). Prevalence of engaging in sex for money to buy pads was low (1.3%); however, 10% of 15-year-olds reported this, with girls ≤15 having significantly higher odds compared with females over 15 (AOR 2.84, 95% CI 0.89–9.11). The odds of having transactional sex for pads was higher among females having two or more partners in the past 12 months (AOR 4.86, 95% CI 2.06–11.43).Conclusions: Menstrual needs of impoverished females in rural LMICs settings likely leads to increased physical and sexual harms. Studies are required to strengthen knowledge and to evaluate interventions to reduce these harms.

Menstrual cups and sanitary pads to reduce school attrition, and sexually transmitted and reproductive tract infections: a cluster randomised controlled feasibility study in rural Western Kenya

“…In this area, girls have little access to hygienic menstrual products,3 23 24 36 and are frequently exposed to sexual harms,3 22–24 reflected in the rapid increase in HIV and herpes simplex virus type 2 (HSV-2) prevalence in girls between 13 and 18 years of age from ∼1% to 12.8% and 9% to 40%, respectively 22…”

“…20–24 In western Kenya, where HIV incidence rises sharply among adolescent girls,22 10% of girls 15 years or younger admitted having transactional sex to obtain money to buy pads 24. Such behaviour can contribute to girls' exposure to STI,25 HIV,22 pregnancy and subsequent school dropout 23.…”

Menstrual hygiene management among adolescent schoolgirls in low- and middle-income countries: research priorities

“…This includes strengthening the body of knowledge around MHM's impact on school dropout, absence, and other measureable school indicators (such as stress, self-confidence, and self-efficacy). Efforts to specifically explore the impact of poor MHM on girls’ SRH are also needed to define its contribution toward sexual exposure (18, 19), and subsequent increased risk of schoolgirl pregnancies and sexually transmitted infections (23). Laboratory-based support is required given the limited predictability of girls’ (and women's) reported symptomatology (17, 23, 28).…”

“…A sole focus on school misses exploration of important health effects on girls’ SRH and wider effects on girls’ life chances; while pilot studies have explored this (33), verification through larger trials is required. As well as the effect of transactional sex for menstrual products (18, 19), the potential for unintended pregnancy due to a lack of girls’ understanding between the menstrual cycle and fertility has been documented (34), but not studied further.…”

“…In addition, a lack of adequate sanitary hygiene products forces some girls to use unhygienic materials (11, 13, 15, 16), potentially increasing urogenital symptoms and infections (17). New but limited evidence suggests that this need leads adolescent girls to engage in transactional sex in order to buy menstrual products (18, 19). Moreover, inadequate social support, ongoing gender inequality, and social and hygiene taboos around menstruation in numerous countries leave girls experiencing shame, fear, and confusion when trying to cope with their menstrual flow (9–15, 20, 21).…”