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Cited by 144Menstrual Health and DisordersDisaster Response and ManagementGender Studies and Social Issues

Menstrual hygiene management among women and adolescent girls in the aftermath of the earthquake in Nepal

Open access
Budhathoki, Shyam Sundar, Bhattachan, Meika, Castro-Sánchez, Enrique, Sagtani, Reshu Agrawal, Rayamajhi, Rajan Bikram, Rai, Pramila, Sharma, Gaurav·2018·BMC Women's Health
DOI 10.1186/s12905-018-0527-yPMC PMC5797351
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Abstract

BACKGROUND: Menstrual hygiene management (MHM) is an essential aspect of hygiene for women and adolescent girls between menarche and menopause. Despite being an important issue concerning women and girls in the menstruating age group MHM is often overlooked in post-disaster responses. Further, there is limited evidence of menstrual hygiene management in humanitarian settings. This study aims to describe the experiences and perceptions of women and adolescent girls on menstrual hygiene management in post-earthquake Nepal. METHODS: A mixed methods study was carried out among the earthquake affected women and adolescent girls in three villages of Sindhupalchowk district of Nepal. Data was collected using a semi-structured questionnaire that captured experiences and perceptions of respondents on menstrual hygiene management in the aftermath of the Nepal earthquake. Quantitative data were triangulated with in-depth interview regarding respondent's personal experiences of menstrual hygiene management. RESULTS: Menstrual hygiene was rated as the sixth highest overall need and perceived as an immediate need by 18.8% of the respondents. There were 42.8% women & girls who menstruated within first week of the earthquake. Reusable sanitary cloth were used by about 66.7% of the respondents before the earthquake and remained a popular method (76.1%) post-earthquake. None of the respondents reported receiving menstrual adsorbents as relief materials in the first month following the earthquake. Disposable pads (77.8%) were preferred by respondents as they were perceived to be clean and convenient to use. Most respondents (73.5%) felt that reusable sanitary pads were a sustainable choice. Women who were in the age group of 15-34 years (OR = 3.14; CI = (1.07-9.20), did not go to school (OR = 9.68; CI = 2.16-43.33), married (OR = 2.99; CI = 1.22-7.31) and previously used reusable sanitary cloth (OR = 5.82; CI = 2.33-14.55) were more likely to use the reusable sanitary cloth. CONCLUSIONS: In the immediate aftermath of the earthquake, women and girls completely depended on the use of locally available resources as adsorbents during menstruation. Immediate relief activities by humanitarian agencies, lacked MHM activities. Understanding the previous practice and using local resources, the reusable sanitary cloth is a way to address the menstrual hygiene needs in the post-disaster situations in Nepal.

AI snapshot

Written from the paper’s full text.

TL;DR

This mixed-methods study in three earthquake-affected villages of Sindhupalchowk, Nepal, found that menstrual hygiene management was a lower-priority but pressing need after the 2015 earthquake, with relief materials lacking menstrual adsorbents. Women and girls largely relied on reusable cloth, and the authors argue MHM should be integrated into disaster relief using culturally appropriate, sustainable local options.

Key findings

  • Menstrual hygiene was the sixth highest perceived immediate need, listed by 18.8% of respondents; food (97.4%), shelter (75.2%), water (63.2%), clothes (47.0%), and information about family/relatives (29.9%) ranked higher.
  • None of the 117 respondents received menstrual adsorbents as relief material in the first month after the earthquake; 49.6% received soap, and adequate privacy for MHM was available to 42.7%. Reusable cloth use rose from 66.7% before the earthquake to 76.1% after it, while disposable pad use was 23.9%.
  • Disposable pads were preferred by 77.8% of respondents for being clean, hygienic, easy to use, and comfortable, but 73.5% perceived reusable cloth as a sustainable choice in disasters.
  • Reusable cloth use after the earthquake was associated with age 25–34 years (OR = 3.14; CI 1.07–9.20), no schooling (OR = 9.68; CI 2.16–43.33), being married (OR = 2.99; CI 1.22–7.31), and prior reusable cloth use (OR = 5.82; CI 2.33–14.55).

Methods

  • Mixed-methods study among 117 women and adolescent girls in three villages of Sindhupalchowk district, Nepal (Chautara, Kubhinde, and Pipaldanda), with data collected 16–29 August 2015, about three months after the 25 April 2015 earthquake.
  • Purposive sampling was used to invite 127 eligible participants; 117 agreed, giving a response rate of 92.1%. Quantitative data came from a semi-structured questionnaire and were analyzed in SPSS v21.
  • Qualitative data came from brief in-depth interviews with 5 respondents who menstruated on the day of or within the first week after the earthquake; transcripts were analyzed using thematic analysis.

Limitations

  • The paper states that the study was conducted in one earthquake-affected district and may not be generalizable to all of Nepal; because the setting was predominantly rural, findings may be particularly unsuitable to urban areas.
  • The paper also states potential recall bias cannot be overlooked because it asked about first menstrual period management after the earthquake and was conducted three months later.
  • Evident from the text: the qualitative component included only 5 in-depth interviews, and the reported odds ratios are unadjusted, limiting the strength and transferability of the findings.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12905-018-0527-y

Cites

28 of 28 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 41 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Married women and girls were more likely to use reusable sanitary cloth (OR = 2.99; CI = 1.22-7.31) than unmarried women and girls.

    “Married women & girls used reusable sanitary cloth 3 times more (OR = 2.99; CI = 1.22-7.31) than those who were unmarried.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Respondents' recall of menstrual practices, needs, and experiences from the earthquake period is accurate.
  • Findingown data

    About 66.7% of respondents used reusable sanitary cloth before the earthquake.

    “Reusable sanitary cloth were used by about 66.7% of the respondents before the earthquake”
    • Also stated in: § Results · plain
      “About 67% of respondents reported using a reusable cloth as a sanitary adsorbent during menstruation regularly before the earthquake.”
    • Also stated in: § Results · plain
      “Reusable Cloth | 78 (66.7%)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Respondents' recall of menstrual practices, needs, and experiences from the earthquake period is accurate.
  • Findingown data

    None of the respondents reported receiving menstrual adsorbents as relief materials in the first month following the earthquake.

    “None of the respondents reported receiving menstrual adsorbents as relief materials in the first month following the earthquake.”
    • Also stated in: § Results · plain
      “Within the first month of the earthquake, none of the respondents reported having received any menstrual hygiene adsorbents within the distributed relief materials.”
    • Also stated in: § Results · plain
      “Did not receive | 117 (100.0%)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Respondents' recall of menstrual practices, needs, and experiences from the earthquake period is accurate.
  • Findingown data

    Disposable pads were preferred by 77.8% of respondents.

    “Disposable pads (77.8%) were preferred by respondents”
    • Also stated in: § Results · plain
      “Majority of respondents (77.8%) preferred disposable pads as adsorbents”
    • Also stated in: § Results · plain
      “Disposable Pads | 91 (77.8%)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Respondents' recall of menstrual practices, needs, and experiences from the earthquake period is accurate.
  • Findingown data

    Women and girls who used reusable sanitary cloth prior to the earthquake were more likely to use reusable sanitary cloth post-earthquake (OR = 5.82; CI = 2.33-14.55) than those who used disposable pads prior to the earthquake.

    “Women & girls who used reusable sanitary cloth prior to earthquake used reusable sanitary cloth 5 times more (OR = 5.82; CI = 2.33-14.55) than those who used disposable pads prior to the earthquake (Table 4).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Respondents' recall of menstrual practices, needs, and experiences from the earthquake period is accurate.
  • May combine two claims. 27
  • Classified as probably not a substantial claim. 18

  • May combine two claims.

    Findingreasoning

    In the study setting, it was still possible for women to share problems with friends and get some help when available.

    “it was still possible for women to share problems with friends and get some help when available.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Women and girls in the post-earthquake setting were unable to openly discuss their menstruation, leading to delays in seeking adsorbents.

    “…sanitary pads did not strike my mind until four days after the earthquake during afternoon when my periods began. My brother asked me if there was a problem as I was staying inside for a long time. I just couldn’t say out loud that I started my periods.”
    • Also stated in: § Personal hygiene related issues · plain
      “She could not tell her mother or other friends, as she felt that everyone was stressed and overwhelmed by the chaos surrounding the earthquake.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Women had to improvise by making reusable sanitary towels from sarees or cloths, or obtain through their own networks of friends and relatives.

    “Hence, women had to improvise by making reusable sanitary towels from sarees or cloths, or obtain through their own networks of friends and relatives.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The quantitative findings reveal that MHM as a priority was not immediately addressed, but women and girls also list MHM material as less pressing compared to other general needs in the immediate post-earthquake situation.

    “The quantitate findings reveal that MHM as a priority that was not immediately addressed, however women and girls also list MHM material as less pressing compared to other general needs in immediate post-earthquake situation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The qualitative data presents evidence that for menstruating women, it was a challenge in timely accessing the material as well as availability of private space for MHM activities.

    “The qualitative data presents evidence that for the menstruating women, it indeed was a challenge in timely accessing the material as well as availability of private space for the MHM activities.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among respondents who preferred disposable pads, the reported reasons included being clean, hygienic, easy to use, and comfortable.

    “Majority of respondents (77.8%) preferred disposable pads as adsorbents, as they were perceived to be cleaner, more hygienic, easier to use and more comfortable than alternative options.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Respondents' recall of menstrual practices, needs, and experiences from the earthquake period is accurate.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Respondents felt that only women would be able to relate to the suffering they had to endure as a result of the lack of resources and privacy.

    “respondents felt that only women would be able to relate to the suffering they had to endure as a result of the lack of resources and privacy”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Field notes confirmed there was no designated space for waste disposal and used pads were disposed in open space nearby the place where women and girls went to change pads.

    “Field notes corresponded with the qualitative expression of the disposal of used pads. There was no designated space for waste disposal and used pads were disposed in open space nearby the place where women and girls went to change the pads.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most respondents in our study referred using reusable instead of disposable sanitary pads, as these were unavailable despite being more convenient.

    “Most respondents in our study referred using reusable instead of disposable sanitary pads, as these were unavailable despite being more convenient”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Quantitative data were triangulated with in-depth interviews regarding respondents' personal experiences of menstrual hygiene management.

    “Quantitative data were triangulated with in-depth interview regarding respondent’s personal experiences of menstrual hygiene management.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    There is limited evidence on menstrual hygiene management in humanitarian settings and especially in the aftermath of the earthquake in Nepal.

    “Further, there is limited evidence of menstrual hygiene management in humanitarian settings.”
    • Also stated in: § Background · plain
      “Although, there are some studies on menstrual hygiene management in Nepal, there is limited evidence on menstrual hygiene management especially in the aftermath of the earthquake in Nepal [12, 13, 21, 31].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [12] Sapkota D, Sharma D, Budhathoki SS, Khanal VK, Pokharel HP. Knowledge and practices regarding menstruation among school going adolescents of rural Nepal. J Kathmandu Med Coll. 2013;2(3):117–21.

      Not checked in the free run.

    • cites [13] Budhathoki SS, Bhattachan M, Pokharel PK, Bhadra M, van Teijlingen E. Reusable sanitary towels: promoting menstrual hygiene in post-earthquake Nepal. J Fam Plan Reprod Heal Care. 2017;43:157–9. source

      Not checked in the free run.

    • cites [21] Adhikari P, Kadel B, Dhungel S, Mandak A. Knowledge and practice regarding menstrual hygiene in rural adolescent girls of Nepal. Kathmandu Univ Med J. 2007;5(19):382–6.

      Not checked in the free run.

    • cites [31] Auemaneekul N, Bhandari S, Kerdmongkol P. Menstrual hygiene practices among adolescents in a Rural District of Nepal. Asia J Public Heal. 2013;4:8–15.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The questionnaire was translated into Nepali using the translation-back translation method.

    “The questionnaire was finalised in English and then translated into Nepali before the data collection using the translation-back translation method.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Thematic saturation was considered once the analysis of data offered no new information and a redundancy of categories.

    “Thematic saturation was considered once the analysis of data offered no new information and a redundancy of categories.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The research team were external to the ongoing relief operations and had no influence on their logistics or other conflict of interests.

    “The research team were external to the ongoing relief operations and had no influence on their logistics or other conflict of interests.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    There is limited access to reproductive health services and safe menstrual hygiene materials during disasters.

    “Further, there is limited access to reproductive health services and safe menstrual hygiene materials during disasters [23].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Anwar J, Mpofu E, Matthews LR, Shadoul AF, Brock KE. Reproductive health and access to healthcare facilities: risk factors for depression and anxiety in women with an earthquake experience. BMC Public Health. 2011;11:523. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Young adolescent girls tend to be less prepared for menstrual hygiene management and suffer from anxiety, apprehensions, fear and shame during their menses.

    “Young adolescent girls tend to be less prepared for MHM and suffer from anxiety, apprehensions, fear and shame during their menses [12, 19].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [12] Sapkota D, Sharma D, Budhathoki SS, Khanal VK, Pokharel HP. Knowledge and practices regarding menstruation among school going adolescents of rural Nepal. J Kathmandu Med Coll. 2013;2(3):117–21.

      Not checked in the free run.

    • cites [19] Sommer M, Caruso BA, Sahin M, Calderon T, Cavill S, Mahon T, et al. A time for global action: addressing girls’ menstrual hygiene management needs in schools. PLoS Med. 2016;13(2):e1001962. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Our use of in-depth interviews illuminated the findings from the quantitative data and facilitated its understanding.

    “our use of in-depth interviews illuminated the findings from the quantitative data and facilitated its understanding.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Reusable cloth adsorbents might not be hygienic and could potentially lead to infections.

    “these adsorbents might not be hygienic and could potentially lead to infections [3, 18].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [3] Sumpter C, Torondel B. A systematic review of the health and social effects of menstrual hygiene management. PLoS One. 2013;8(4):e62004. source

      Not checked in the free run.

    • cites [18] Das P, Baker KK, Dutta A, Swain T, Sahoo S, Das BS, et al. Menstrual hygiene practices, WASH access and the risk of urogenital infection in women from Odisha. India PLoS One. 2015;10(6):1–16.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Informed consent was obtained from all participants according to their literacy and age, with written consent for literate participants, witnessed thumb print for illiterate women, and assent plus parental permission for respondents aged 15-17 years.

    “Written informed consent was obtained from all literate participants. For women unable to read, the information sheet was read out and the research objectives, expected roles of participants and voluntary nature of participation was explained in the presence of a literate female elder. A thumb print was obtained and this was countersigned by another witness. For respondents between 15 and 17 years”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Ethical approval for the research was obtained from the Institutional Review Committee of B P Koirala Institute of Health Sciences.

    “Ethical approval for this research was obtained from the Institutional Review Committee of B P Koirala Institute of Health Sciences (Ref: IRC/634/015), Dharan, Nepal.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The response rate was 92.1%, with 117 of 127 eligible individuals agreeing to participate.

    “The research team identified 127 eligible individuals, of whom 117 agreed to participate (response rate 92.1%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The questionnaire was pretested with women and adolescent girls in temporary settlement areas of Kathmandu (n = 20) to ensure socio-cultural acceptability and that it answered the research question.

    “Pretesting of the questionnaire was conducted with women and adolescent girls residing in temporary settlement areas of Kathmandu (n = 20) to ensure that questions were socio-culturally acceptable and completely answered our research question.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Face-to-face interviews were conducted by female interviewers who were graduate medical and nursing professionals given 3-4 hours of orientation on quantitative and qualitative questions before data collection.

    “Face-to-face interview conducted by female interviewers are graduate medical and nursing professionals who were given 3-4 h orientation on both quantitative and qualitative questions before the data collection by the research team.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Women and girls in low income settings have low awareness on hygienic practices and lack culturally appropriate materials for menstrual hygiene management.

    “Women and girls in low income settings have low awareness on hygienic practices and lack culturally appropriate materials for menstrual hygiene management (MHM) practices [3–5].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [3] Sumpter C, Torondel B. A systematic review of the health and social effects of menstrual hygiene management. PLoS One. 2013;8(4):e62004. source

      Not checked in the free run.

    • cites [4] McMahon SA, Winch PJ, Caruso BA, Obure AF, Ogutu EA, Ochari IA, et al. “The girl with her period is the one to hang her head” reflections on menstrual management among schoolgirls in rural Kenya. BMC Int Health Hum Rights. 2011;11(1):7. source

      Not checked in the free run.

    • cites [5] Arumugam B, Nagalingam S, Varman PM, Ravi P, Ganesan R. Menstrual hygiene practices: is it practically impractical ? Intern J Med Public Heal. 2014;4(4):472–6. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Our findings indicate that whilst MHM activities are felt as important priorities for women and girls, they are often overlooked during disasters.

    “Our findings indicate that whilst MHM activities are felt as important priorities for women and girls, they are often overlooked during disasters.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Although MHM needs are specific to a subgroup of the population, they appeared as an immediate pressing requisite for the women affected in the post-earthquake scenario.

    “Although menstrual hygiene management needs are only specific to a subgroup of the population, they appear as an immediate pressing requisite for the women affected”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Our finding on the use of reusable sanitary towels is in concordance with practices reported by others in rural areas of Nepal.

    “Our finding on the use of reusable sanitary towels is in concordance with practices reported by others in rural areas of Nepal [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Sapkota D, Sharma D, Budhathoki SS, Khanal VK, Pokharel HP. Knowledge and practices regarding menstruation among school going adolescents of rural Nepal. J Kathmandu Med Coll. 2013;2(3):117–21.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Women and girls in India report disposal of used sanitary pads in inappropriate places.

    “Women and girls in India also report disposal of used sanitary pads in inappropriate places [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] van Eijk AM, Sivakami M, Thakkar MB, Bauman A, Laserson KF, Coates S, et al. Menstrual hygiene management among adolescent girls in India : a systematic review and meta-analysis. BMJ Open. 2016;6:e010290. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Such low attention could also point to societal taboos and inadequate sensitivity on MHM within the wider society.

    “Such low attention could also point to societal taboos and inadequate sensitivity on MHM within the wider society [9, 19, 37].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [9] Ranabhat C, Kim C-B, Choi EH, Aryal A, Park MB, Doh YA. Chhaupadi culture and reproductive health of women in Nepal. Asia-Pacific J Public Heal. 2015;27(7):785–95. source

      Not checked in the free run.

    • cites [19] Sommer M, Caruso BA, Sahin M, Calderon T, Cavill S, Mahon T, et al. A time for global action: addressing girls’ menstrual hygiene management needs in schools. PLoS Med. 2016;13(2):e1001962. source

      Not checked in the free run.

    • cites [37] Sommer M, Kjellen M, Pensulo C. Girls’ and women’s unmet needs for menstrual hygiene management (MHM): the interactions between MHM and sanitation systems in low-income countries. J Water Sanit Hyg Dev. 2013;3(3):283–97. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Research from elsewhere supports that menstrual hygiene being exclusively a feminine need is lesser priority in humanitarian responses, whereas food and security needs expressed by participants are the fundamental immediate needs for everyone.

    “Research from elsewhere also supports that menstrual hygiene being exclusively a feminine need is lesser priority in humanitarian responses whereas, the food and security needs expressed by participants are the fundamental immediate needs for everyone [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Travers CL. No one cares we’re bleedling: the place of menstrual management in humanitarian response [dissertation]. Uppsala: Uppsala Universitet; 2015.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    As the study setting was predominantly rural, the findings may be particularly unsuitable to urban areas of the country.

    “As our study setting was predominantly rural, our findings may be particularly unsuitable to urban areas of the country.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Reusable sanitary towels seem to be more easily available, and are perhaps a sustainable and culturally suitable alternative in the Nepalese context.

    “Reusable sanitary towels seem to be more easily available, and are perhaps a sustainable and culturally suitable alternative in the Nepalese context.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The choice of materials for adsorbents is made based on the availability of materials and the privacy for MHM activities.

    “The choice of materials for adsorbents is made based on the availability of materials and the privacy for MHM activities”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    As menstruation comes along with cultural and religious taboo, the MHM needs is present as a silent need, which is addressed by the use of local materials and resources in immediate post-disaster situations.

    “As menstruation comes along with cultural and religious taboo, the MHM needs is present as a silent need, which is addressed by the use of local materials and resources in immediate post-disaster situations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The study was conducted in one earthquake-affected district of Nepal and may not therefore be generalizable to all other areas of Nepal.

    “It was conducted in one earthquake-affected district of Nepal and may not therefore be generalizable to all other areas of Nepal.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Immediate measures during disasters are considered possible using locally available cloth as adsorbents.

    “Immediate measures during disasters are considered possible using locally available cloth as adsorbents [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Budhathoki SS, Bhattachan M, Pokharel PK, Bhadra M, van Teijlingen E. Reusable sanitary towels: promoting menstrual hygiene in post-earthquake Nepal. J Fam Plan Reprod Heal Care. 2017;43:157–9. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the south Asian context, especially in India and Nepal, menstruation comes with many social restrictions including for religious rituals.

    “In the south Asian context especially in India and Nepal, menstruation comes with many social restrictions including for religious rituals [9, 12, 38].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [9] Ranabhat C, Kim C-B, Choi EH, Aryal A, Park MB, Doh YA. Chhaupadi culture and reproductive health of women in Nepal. Asia-Pacific J Public Heal. 2015;27(7):785–95. source

      Not checked in the free run.

    • cites [12] Sapkota D, Sharma D, Budhathoki SS, Khanal VK, Pokharel HP. Knowledge and practices regarding menstruation among school going adolescents of rural Nepal. J Kathmandu Med Coll. 2013;2(3):117–21.

      Not checked in the free run.

    • cites [38] Caruso BA, Clasen TF, Hadley C, Yount KM, Haardörfer R, Rout M, et al. Understanding and defining sanitation insecurity: women’s gendered experiences of urination, defecation and menstruation in rural Odisha. India BMJ Glob Heal. 2017;2(4):e000414. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    The menstruating girl not being able to discuss the need for materials to manage her periods expressed in this study is an example of how silent the women and girls are about menstruation and related matters.

    “The menstruating girl not being able to discuss the need for materials to manage her periods expressed in this study is an example of how silent the women and girls are about menstruation and related matters.”
    Quote in the paperNot a substantial claim
38 of 38

  • The paper relies on this without support.

    The three study villages and the 117 respondents are representative of women and adolescent girls in post-earthquake Nepal, so that findings can be generalized to the wider affected population.

    “This study was conducted amongst 117 women and adolescent girls in three villages of Sindhupalchowk district of Nepal.”
    “In the immediate aftermath of the earthquake, women and girls completely depended on the use of locally available resources as adsorbents during menstruation.”

  • The paper relies on this without support.

    Respondents' recall of menstrual practices, needs, and experiences from the earthquake period is accurate.

    “Data was collected using a semi-structured questionnaire that captured experiences and perceptions of respondents on menstrual hygiene management in the aftermath of the Nepal earthquake.”
    “When respondents were asked to recall up to five immediate needs following the earthquake”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In humanitarian contexts, changed access to materials was salient in women's experiences as they adapted to new management practices or were unable continue their past preferred behaviours.

    “In humanitarian contexts, changed access to materials was salient in women’s experiences as they adapted to new management practices or were unable continue their past preferred behaviours [40, 83].”

    From Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis (2019) · cites this paper as [40]

  • A small fraction (6%) of studies focused on the role of MHM, where women reported a lack of proper MHM products, such as clean pads, in addition to private areas and an absence of water provisioning for cleaning and sanitation needs.

    “A small fraction (6%) of studies focused on the role of MHM, where women reported a lack of proper MHM products, such as clean pads, in addition to private areas and an absence of water provisioning for cleaning and sanitation needs (Khan et al., 2017;Budhathoki et al., 2018;Davis et al., 2018).”

    From A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health (2020) · cites this paper as Budhathoki et al., 2018

  • The absence of safe, secure, and private latrines forces women and girls to avoid practicing sustainable sanitation, hygiene, and MHM due to fear of violence or stigmatization.

    “The absence of such facilities forces women and girls to avoid practicing sustainable sanitation, hygiene, and MHM due to a fear of violence, or as a result of stigmatization (Kwiringira et al., 2014;Khan et al., 2017;Budhathoki et al., 2018;Davis et al., 2018;Winter et al., 2019).”

    From A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health (2020) · cites this paper as Budhathoki et al., 2018

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Age range attached to the 3.14 odds ratio differs from Table 4

    Minor

    The text attributes the 3.14 odds ratio to ages 15-34 relative to ages 15-24, while Table 4 assigns it to ages 25-34 relative to ages 15-24.

  • Percentage choosing "Clean" uses the wrong denominator

    Minor

    Table 3 specifies 91 respondents for reasons for preferring disposable pads. Among those 91, 47 is 51.6%, not the reported 40.2%.

    Reported 40.2 · recomputed 51.648352

  • Oldest age category has different upper bounds

    Minor

    Table 1 labels the 35-person age category as 35-49 years, whereas Table 4 labels the corresponding 35-person category as 35-45 years.

  • Soap receipt percentage is reversed

    Minor

    The text says 50.4% received soap, but Table 3 assigns 50.4% to those who did not receive it and 49.6% to those who did.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. Biran A, Curtis V, Gautam OP, Greenland K, Islam MS, Schmidt W-P, et al. Menstrual Hygiene. In: Background paper on measuring WASH and food hygiene practices–definition of goals to be tackled post 2015 by the joint monitoring Programme. 1st ed. London: London School of Hygiene and Tropical Medicine; 2012. p. 81.
  2. Ten VTA. Menstrual hygiene: a neglected condition for the achievement of seven millennium development goals. Zotermeer: Europe External Policy Advisors; 2007. p. 1–24.
  3. Kaur K, Arora B, Singh GK, Neki NS. Social beliefs and practices associated with menstrual hygiene among adolescent girls of Amritsar, Punjab. India J Int Med Sci Acad. 2012;25(2):69–70.
  4. Travers CL. No one cares we’re bleedling: the place of menstrual management in humanitarian response [dissertation]. Uppsala: Uppsala Universitet; 2015.
  5. Bradshaw S, Fordham M. Women, girls and disasters: a review for DFID. 2013.
  6. Auemaneekul N, Bhandari S, Kerdmongkol P. Menstrual hygiene practices among adolescents in a Rural District of Nepal. Asia J Public Heal. 2013;4:8–15.
  7. Jamieson S. Stinking 10,000 tonne pile of rubbish in great heck. The Telegraph: Yorkshire investigated by Environment Agency; 2015.

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Related

Authors
Budhathoki, S. S., Bhattachan, M., Castro-Sánchez, E., Sagtani, R. A., Rayamajhi, R. B., Rai, P., & Sharma, G.
Affiliations
  • B.P. Koirala Institute of Health Sciences (NP)
  • Patan Academy of Health Sciences (NP)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Budhathoki, Shyam Sundar
ORCID
Venue
BMC Women's Health
Publisher
Springer Science and Business Media LLC
Published
2018-02-02
Volume
18
Issue
1
Pages
33-33
ISSN
1472-6874 (ISSN-L)
DOI
10.1186/s12905-018-0527-y
PMC
PMC5797351
OpenAlex
W2794607260
Semantic Scholar
ddbf120d4fa056489c46a9f5ecfb39b6d8f54fc1
Cited by
144
References
28
Citations by year
2026: 14 · 2025: 29 · 2024: 18 · 2023: 16 · 2022: 22 · 2021: 27 · 2020: 10 · 2019: 6 · 2018: 2
FWCI
10.71
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMC Women s Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • City Research Online (City University London) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Brunel University Research Archive (BURA) (Brunel University London) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Spiral (Imperial College London) (submittedVersion, other-oa)
Funders
  • National Institute for Health and Care Research
  • Florence Nightingale Foundation
  • Imperial College London
  • Public Health England
  • Patient Safety Translational Research Centre
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
  • Health Sciences › Health Professions › Emergency Medical Services › Disaster Response and Management
  • Social Sciences › Gender Studies › Gender Studies and Social Issues
Keywords
menstrual hygiene management, adolescent girls, women, humanitarian aid, menstrual products, disaster response
MeSH terms
Adolescent, Adult, Female, Humans, Hygiene, Health Knowledge, Attitudes, Practice, Menarche, Menstruation, Nepal, Surveys and Questionnaires, Rural Population, Menstrual Hygiene Products, Hygiene Products, Young Adult, Earthquakes

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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