Qualitative study exploring the barriers to menstrual hygiene management faced by adolescents and young people with a disability, and their carers in the Kavrepalanchok district, Nepal

Abstract

Background: Menstrual hygiene management (MHM) is a recognised public health, social and educational issue, which must be achieved to allow the realisation of human rights. People with disabilities are likely to experience layers of discrimination when they are menstruating, but little evidence exists.Methods: The study aims to investigate barriers to MHM that people with disabilities and their carers, face in the Kavrepalanchok, Nepal, using qualitative methods. Twenty people with disabilities, aged 15-24, who menstruate and experience ‘a lot of difficulty’ or more across one or more of the Washington Group functional domains were included, as well as 13 carers who provide menstrual support to these individuals. Purposeful sampling was applied to select participants. Different approaches were used to investigating barriers to MHM and triangulate data: in-depth interviews, PhotoVoice and ranking, market survey, product attribute assessment and user preference with ranking, observation of the water, sanitation and hygiene (WASH) facilities used. We analysed data thematically, using Nvivo 11.Results: Barriers to MHM experienced by people with disabilities differ according to the impairment. Inaccessible WASH facilities were a major challenge for people with mobility, self-care and visual impairments. People with intellectual impairments had difficulty accessing MHM information and their carers despaired when they showed their menstrual blood to others, which could result in abuse. No support mechanisms existed for carers for MHM, who overwhelmed and isolated. Menstrual discomfort was a major challenge; these were managed with home remedies, or not at all. Most participants followed menstrual restrictions, which were widespread and expected, for fear of being cursed if they did not. As disability is often viewed as a curse, this demonstrates the layers of discrimination faced.Conclusion: Issues related to MHM for people with disabilities is more complex than for others in the population due to the additional disability discrimination and impairment experienced. Research exploring these issues must be conducted in different settings, and MHM interventions, tailored for impairment type and carers requirements, must be developed. Attention to, and resourcing for disability inclusive MHM must be prioritised to ensure ‘no one is left behind’.

“The weather is not good”: exploring the menstrual health experiences of menstruators with and without disabilities in Vanuatu

“…For instance, people with disabilities were stopped using public toilets in a study in Uganda because it was believed that disability is 'dirty' and 'contagious' [16,17]. Therefore, menstruators with disabilities may experience a compounded sense of shame and discrimination with both disability and menstruation considered taboo in many settings [18][19][20][21][22]. These issues negatively impact menstruators' ability to participate fully in daily life: the latest Joint Monitoring report highlights that women with disabilities were 50% less likely to participate in usual activities when they were menstruating compared to those without disabilities [4].…”

“…Menstruators with disabilities, especially those with intellectual impairments, often receive little or no information about menstruation, or how to manage it hygienically and with dignity [18]. Furthermore, approximately 190 million people with disabilities rely on informal or professional caregivers for assistance, which may include supporting menstrual health [24].…”

Water, women and disability: Using mixed-methods to support inclusive WASH programme design in Vanuatu

“…To investigate knowledge of disability, incontinence and menstruation, training and resources provided on these topics; services provided to people with and without disabilities, and caregivers, and provision of incontinence and / or menstrual materials 1 healthcare professional, working in a rural location 1 healthcare professional, working in an urban location To explore WASH service implementation, knowledge of the issues faced by people with and without disabilities, how to address them, and challenges related to doing that 2 professionals working in the WASH sector * PhotoVoice is a visual research methodology, in which participants are loaned a camera, shown how to take photos and asked to take photos that represent their experiences related to the study issues [38] . The methodology has been used to explore WASH issues, including MHM and incontinence, in Nepal [39] , Kenya [40] , Malawi [5] , Pakistan [41] and Ghana [42] .…”

Status of Menstrual Dignity during the COVID-19 Pandemics

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The pandemic has been exacerbating existing inequalities between women and men in almost all areas of life [3]. However, menstrual discrimination (taboos, stigma, abuses, restrictions, discriminations) has not been studied in the context of the pandemic at least in Asia in spite of the well published earlier concerns in regard to the politics of menstruation during the pandemic by Jahan [11], by the first data published by Aolymat on women in Jordan [12] and several other authors [13][14][15].Therefore, this study was conducted to fill this gap mainly by contributing to a better understanding of menstrual dignity and the experiences of women and LGBTQI during menstruation and observed changes during the COVID-19 pandemic.

MethodologyThe study adopted a mixed-method qualitative method integrating qualitative components based on open questions with a short structured questionnaire to elicit general social data and basic information on menstruation related health literacy developed for the study. We also decided to use a multi/transcultural approach by recruiting participants from different countries and cultures as culture has been identified as a major factor in menstrual practices and related

…”

“…The pandemic has been exacerbating existing inequalities between women and men in almost all areas of life [3]. However, menstrual discrimination (taboos, stigma, abuses, restrictions, discriminations) has not been studied in the context of the pandemic at least in Asia in spite of the well published earlier concerns in regard to the politics of menstruation during the pandemic by Jahan [11], by the first data published by Aolymat on women in Jordan [12] and several other authors [13][14][15].…”