Schoolgirls’ experience and appraisal of menstrual absorbents in rural Uganda: a cross-sectional evaluation of reusable sanitary pads
Open accessAbstract
BACKGROUND: Governments, multinational organisations, and charities have commenced the distribution of sanitary products to address current deficits in girls' menstrual management. The few effectiveness studies conducted have focused on health and education outcomes but have failed to provide quantitative assessment of girls' preferences, experiences of absorbents, and comfort. Objectives of the study were, first, to quantitatively describe girls' experiences with, and ratings of reliability and acceptability of different menstrual absorbents. Second, to compare ratings of freely-provided reusable pads (AFRIpads) to other existing methods of menstrual management. Finally, to assess differences in self-reported freedom of activity during menses according to menstrual absorbent. METHODS: Cross-sectional, secondary analysis of data from the final survey of a controlled trial of reusable sanitary padand puberty education provision was undertaken. Participants were 205 menstruating schoolgirls from eight schools in rural Uganda. 72 girls who reported using the intervention-provided reusable pads were compared to those using existing improvised methods (predominately new or old cloth). RESULTS: Schoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities, less difficulties changing absorbents, and less disgust with cleaning absorbents. There were no significant differences in reports of outside garment soiling (OR 1.00 95%CI 0.51-1.99), or odour (0.84 95%CI 0.40-1.74) during the last menstrual period. When girls were asked if menstruation caused them to miss daily activities there were no differences between those using reusable pads and those using other existing methods. However, when asked about activities avoided during menstruation, those using reusable pads participated less in physical sports, working in the field, fetching water, and cooking. CONCLUSIONS: Reusable pads were rated favourably. This translated into some benefits for self-reported involvement in daily activities, although reports of actual soiling and missing activities due to menstruation did not differ. More research is needed comparing the impact of menstrual absorbents on girls' daily activities, and validating outcome measures for menstrual management research.
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Written from the paper’s full text.
TL;DR
In a cross-sectional follow-up survey of 205 menstruating schoolgirls in rural Uganda, girls using intervention-provided reusable pads rated them more reliable, easier to change, and less disgusting to wash than existing improvised methods. However, actual reports of garment soiling, odour, and missing activities due to menstruation did not differ, while some activity-avoidance patterns favoured reusable pad users.
Key findings
- Reusable pad users reported higher perceived reliability across activities than girls using existing improvised methods: e.g., going to school 90.1% vs 53.8% (OR 7.86, 95%CI 3.30–18.74), going to the farm 88.6% vs 60.0% (OR 5.17, 95%CI 2.25–11.89), and walking a long distance 75.7% vs 37.7% (OR 5.14, 95%CI 2.62–10.08).
- Reusable pads were rated easier to manage: 41.0% vs 7.6% said changing at school was “not a problem at all” (OR 8.44, 95%CI 3.18–22.43), and 22.5% vs 48.2% reported feeling disgusted by washing the absorbent (OR for not disgusted 3.20, 95%CI 1.58–6.46).
- There were no significant differences in outside garment soiling during the last menstrual period (OR 1.00, 95%CI 0.51–1.99) or odour (OR 0.84, 95%CI 0.40–1.74), and no differences in whether menstruation caused girls to miss daily activities.
- Among girls who reported avoiding activities while menstruating, reusable pad users were less likely to avoid physical sports/exercise (10.4% vs 36.8%, OR 5.00, 95%CI 1.75–14.28), working in the field/garden (2.1% vs 29.4%, OR 19.58, 95%CI 2.53–151.85), fetching water (18.8% vs 41.2%, OR 3.03, 95%CI 1.27–7.25), and cooking (8.3% vs 26.5%, OR 3.96, 95%CI 1.25–12.59).
- Of 91 girls appraising the reusable pads, 92.3% liked them “very much”; 45.5% said they could afford them, 52.3% said they could not, and 80.7% were “very” or “extremely” likely to buy them if they had 15,000 UGX.
Methods
- Cross-sectional secondary analysis of final survey data from the Menstruation and the Cycle of Poverty quasi-randomised trial, conducted in Kamuli district, rural Uganda; 205 menstruating schoolgirls from eight schools were included.
- The main comparison was 72 girls reporting intervention-provided reusable pads (AFRIpads) as their usual absorbent versus 111 girls using existing improvised methods (new cloth, old cloth, or other methods such as toilet paper, underwear alone, mattress, or sponge); 18 disposable sanitary pad users were displayed separately.
- Analyses used Stata 14.0, with descriptive statistics, binary logistic regressions for dichotomous outcomes, and t-tests for continuous outcomes; the study reported insufficient power to compare all five absorbent types statistically.
Limitations
- The paper states the study was cross-sectional, that socio-demographic differences likely existed between absorbent groups, and that the sample likely had higher attendance and more favourable circumstances than girls who had dropped out of school.
- The paper states social-desirability bias was possible because surveys were administered verbally in schools by local research assistants, some of whom had provided the pads, and because the local NGO was well known; it also states the sample was too small to compare all absorbents, especially disposable pads, and that future cross-sectional comparisons should adjust for socio-demographic confounds.
- Evident from the text: outcomes relied on self-report rather than objective measures of absorbency or fluid retention, and the paper itself notes discrepancies between girls’ high reliability ratings and their reported soiling/odour, suggesting possible biased or desired responses.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 18 cited sources checked · 0 supported · 0 flagged
- Findingown data
Girls using reusable pads were more likely to report that changing their absorbent at school was 'not a problem at all' than girls using existing improvised methods.
“Girls using reusable pads reported that it took them less time to change, and were more likely to report that it was “not a problem at all” to change at school.”
Quote in the paperSubstantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
- Findingown data
When girls were asked if menstruation caused them to miss daily activities, there were no differences between those using reusable pads and those using other existing methods.
“When girls were asked if menstruation caused them to miss daily activities there were no differences between those using reusable pads and those using other existing methods.”
Quote in the paperNot a substantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
- Findingown data
Girls using reusable pads reported that it took them less time to change their absorbent than girls using existing improvised methods.
“Girls using reusable pads reported that it took them less time to change, and were more likely to report that it was “not a problem at all” to change at school.”
Quote in the paperSubstantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
- Findingown data
There were no significant differences between girls using reusable pads and girls using existing improvised methods in reports of odour during the last menstrual period (OR 0.84, 95% CI 0.40-1.74).
“There were no significant differences in reports of outside garment soiling (OR 1.00 95%CI 0.51–1.99), or odour (0.84 95%CI 0.40–1.74) during the last menstrual period.”
Quote in the paperNot a substantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
- Findingown data
Girls using reusable pads were less likely to report that they could go a whole day without changing their absorbent than girls using existing improvised methods.
“They were less likely to report that they could go a whole day without changing their absorbent.”
Quote in the paperNot a substantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
- Findingown data
The study included 205 menstruating schoolgirls from eight schools in rural Uganda.
“Participants were 205 menstruating schoolgirls from eight schools in rural Uganda.”
Quote in the paperSubstantial claim - Findingown data
Girls using reusable pads reported less disgust with cleaning absorbents than girls using existing improvised methods.
“Schoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities, less difficulties changing absorbents, and less disgust with cleaning absorbents.”
Quote in the paperSubstantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
- Findingown data
There were no significant differences between girls using reusable pads and girls using existing improvised methods in reports of outside garment soiling during the last menstrual period (OR 1.00, 95% CI 0.51-1.99).
“There were no significant differences in reports of outside garment soiling (OR 1.00 95%CI 0.51–1.99), or odour (0.84 95%CI 0.40–1.74) during the last menstrual period.”
Quote in the paperNot a substantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
- Findingown data
Girls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities than girls using existing improvised methods.
“Schoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities, less difficulties changing absorbents, and less disgust with cleaning absorbents.”
Quote in the paperSubstantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
- Findingown data
There was no difference in girls reporting that there were activities or settings they avoided while menstruating.
“Similarly, there was no difference in girls reporting that there were activities or settings they avoided while menstruating.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
There were no differences between reusable pads and existing methods in fear that sanitary protection would fall out of underwear.
“there were no differences in reports of experiencing actual panty or outer garment soiling, odour, or fear that sanitary protection would fall out of underwear.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
Among girls who reported avoiding activities or settings, those using existing methods were more likely to report avoiding working in the field or garden.
“girls using existing methods were more likely to report avoiding physical sports or exercise, working in the field or garden, fetching water, or cooking.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
There were no differences between reusable pads and existing methods in reported concerns about odour.
“There were also no differences in reported concerns about odour.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
Among girls who reported avoiding activities or settings, those using existing methods were more likely to report avoiding physical sports or exercise.
“girls using existing methods were more likely to report avoiding physical sports or exercise, working in the field or garden, fetching water, or cooking.”
- Also stated in: § Discussion · plain
“Girls using existing methods had 5.00 times higher odds of avoiding physical sports and exercise”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Also stated in: § Discussion · plain
- Findingown data
Girls using reusable pads were more likely than those using cloth to report that they were not disgusted by washing their absorbent.
“Girls using the reusable pads were more likely to report that they were not disgusted by washing their absorbent, in contrast to those using cloth.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
Girls using reusable pads reported significantly higher perceptions of reliability across all listed activities than those using existing methods.
“Girls using reusable pads reported significantly higher perceptions of reliability across all listed activities than those using existing methods.”
Quote in the paperSubstantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
The difference between the proportion of girls reporting boys teased girls about their menstruation, favouring existing methods, was not statistically significant (p = .208).
“Despite a large (almost 10%) difference between the proportion of girls reporting boys teased girls about their menstruation, favouring existing methods, this difference was not significant (although trended towards significance, p = .208).”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
There were no differences between reusable pads and existing methods in reported avoidance of going to school.
“There were no differences in reported avoidance of being around males, playing with other children, or other going to school.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
There were no differences between reusable pads and existing methods in reported avoidance of playing with other children.
“There were no differences in reported avoidance of being around males, playing with other children, or other going to school.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
There were no differences between reusable pads and existing methods in reported avoidance of being around males.
“There were no differences in reported avoidance of being around males, playing with other children, or other going to school.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
Girls using reusable pads were more likely than those using cloth to report never wearing them damp.
“they were more likely to report never wearing them damp.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
The reusable pads tested (AFRIpads) received favourable ratings.
“The reusable pads tested here, AFRIpads, received favourable ratings.”
Quote in the paperSubstantial claim - Findingown data
There were no differences between reusable pads and existing methods in reports of experiencing actual outer garment soiling.
“there were no differences in reports of experiencing actual panty or outer garment soiling”
Quote in the paperSubstantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
There were no differences between reusable pads and existing methods in reports of experiencing actual panty soiling.
“there were no differences in reports of experiencing actual panty or outer garment soiling”
Quote in the paperSubstantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
There were no significant differences in the daily activities girls reported their menstruation caused them to miss.
“There were no significant differences in the daily activities girls reported their menstruation caused them to miss.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
There were no differences between reusable pads and existing methods in reported odour.
“there were no differences in reports of experiencing actual panty or outer garment soiling, odour, or fear that sanitary protection would fall out of underwear.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
A total of 116 girls (63.4%, excluding those using sanitary pads) reported that there were activities or settings they avoided when menstruating.
“A total of 116 girls (63.4%, excluding those using sanitary pads) reported that there were activities or settings they avoided when menstruating.”
Quote in the paperNot a substantial claim - Findingown data
Among girls who reported avoiding activities or settings, those using existing methods were more likely to report avoiding cooking.
“girls using existing methods were more likely to report avoiding physical sports or exercise, working in the field or garden, fetching water, or cooking.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
Among girls who reported avoiding activities or settings, those using existing methods were more likely to report avoiding fetching water.
“girls using existing methods were more likely to report avoiding physical sports or exercise, working in the field or garden, fetching water, or cooking.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
Girls using reusable pads were much more likely than those using existing methods to report that leaking was 'not a problem at all'.
“They were also much more likely to report that leaking was “not a problem at all”.”
Quote in the paperSubstantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
Additional sensitivity analyses including girls using disposable sanitary pads in the comparison group found no difference in the pattern of observed effects.
“Additional sensitivity analyses (available from corresponding author on request) included girls using disposable sanitary pads in the comparison group as a treatment-as-usual comparison and found no difference in the pattern of observed effects.”
Quote in the paperNot a substantial claim - Findingown data
Girls using reusable pads reported longer drying times than those using cloth.
“Although those using the pads reported longer drying times”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
Perceptions of reliability ranged from 68 to 90% for those using reusable pads compared to 29-54% for those using existing improvised methods.
“Perceptions of reliability across ranged from 68 to 90% for those using reusable pads compared to 29–54% for those using existing improvised methods.”
Quote in the paperSubstantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
No girls reported using inserted methods.
“No girls reported using inserted methods.”
Quote in the paperNot a substantial claim - Findingown data
Girls reported the lowest reliability of absorbents when sitting for a long time (68 and 36% for pads and existing improvised methods, respectively).
“Girls reported the lowest reliability of absorbents when sitting for a long time (68 and 36% for pads and existing improvised methods, respectively), one of the main school activities.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
Girls rated reliability when they needed to be gone from home for a long time as 76 and 41% for reusable pads and improvised methods, respectively.
“Similarly, girls rated reliability when they needed to be gone from home for a long time as 76 and 41% for reusable pads and improvised methods”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
There were no differences in reported outer garment soiling during the last menses (44% for both those using reusable pads and those using improvised methods).
“there were no differences in reported outer garment soiling during the last menses (44% for both those using reusable pads and those using improvised methods).”
Quote in the paperSubstantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
Among the highest ratings of 90 and 54% reliability were for protection from soiling when going to school.
“Interestingly, among the highest ratings of 90 and 54% reliability were for protection from soiling when going to school.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
Girls using reusable pads had 8.44 times higher odds of reporting leaking was not a problem.
“While girls using reusable pads had 8.44 times higher odds of reporting leaking was not a problem”
Quote in the paperSubstantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingnone given
Only a very small group used disposable sanitary pads.
“Only a very small group used disposable sanitary pads”
Quote in the paperNot a substantial claim - Findingown data
Similar rates of odour and concern about odour were reported for reusable pads and other absorbents.
“Similar rates of odour and concern about odour were reported for reusable pads and other absorbents.”
Quote in the paperNot a substantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Findingown data
There was an almost 10% higher report of teasing amongst those using the trial-provided reusable pads, although not statistically significant.
“Although not statistically significant, there was an almost 10% higher report of teasing amongst those using the trial-provided reusable pads.”
Quote in the paperSubstantial claim- Rests on an assumption: Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
- Interpretationown data
Reusable pads were rated favourably by the schoolgirls.
“Reusable pads were rated favourably.”
Quote in the paperSubstantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
- Interpretationreasoning
The favourable ratings of reusable pads translated into some benefits for self-reported involvement in daily activities.
“This translated into some benefits for self-reported involvement in daily activities, although reports of actual soiling and missing activities due to menstruation did not differ.”
Quote in the paperSubstantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
- Interpretationown data
Reports of actual soiling and missing activities due to menstruation did not differ between girls using reusable pads and girls using existing methods.
“This translated into some benefits for self-reported involvement in daily activities, although reports of actual soiling and missing activities due to menstruation did not differ.”
Quote in the paperSubstantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
- Premisecitation
In low-income contexts, women struggle to manage menstruation in effective and hygienic ways.
“There is increasing recognition that in low-income contexts, women struggle to manage menstruation in effective and hygienic ways [1].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] Sommer M, Hirsch JS, Nathanson C, Parker RG. Comfortably, safely, and without shame: defining menstrual hygiene management as a public health issue. Am J Public Health. 2015;105(7):1302–11. source
Not checked in the free run.
- Premisecitation
Trials and observational studies have often overlooked girls' perceptions of absorbent acceptability, reliability and comfort, as well as absorbents' impact on self-efficacy.
“Trials and observational studies have often overlooked girls’ perceptions of absorbent acceptability, reliability and comfort, as well as absorbents’ impact on self-efficacy.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [2] Winkler I, Roaf V. Bringing the Dirty Bloody Linen Out of its Closet—Menstrual Hygiene as a Priority for Achieving Gender Equality. Cardozo Journal of Law and Gender. 2015. Available at http://www.ssrn.com/abstract=2575250 . Accessed Nov 2015.
Not checked in the free run.
- cites [13] Hennegan JM. Menstrual hygiene management and human rights: the case for an evidence-based approach. Under review.
Not checked in the free run.
- Study design and conductnone given
There was insufficient power to compare differences in experience and reliability across the 5 absorbent types.
“However, there was insufficient power to compare differences in experience and reliability across the 5 absorbent types.”
Quote in the paperSubstantial claim - Premisecitation
A recent systematic review of studies evaluating the effectiveness of menstrual product provision interventions found few rigorous trials had been conducted.
“A recent systematic review of studies evaluating the effectiveness of such interventions found few rigorous trials had been conducted [5].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Hennegan J, Montgomery P. Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in Low and middle income countries? a systematic review. Plos one. 2016;11(2):e0146985. source
Not checked in the free run.
- Interpretationreasoning
The high reliability ratings for going to school are highly suggestive of girls providing biased, desired responses.
“This is highly suggestive of girls providing biased, desired responses.”
Quote in the paperNot a substantial claim - Study design and conductreasoning
The verbal administration method was vulnerable to social-desirability in girls' reports.
“However, this method was vulnerable to social-desirability in girls’ reports, as noted above.”
Quote in the paperNot a substantial claim - Interpretationown data
The provision of sanitary products in schools may leave girls vulnerable to teasing about menstruation if interventions draw attention to, or 'outs', menstruating girls.
“this finding cautions that the provision of sanitary products in schools may leave girls vulnerable to teasing about menstruation if interventions draw attention to, or ‘outs’, menstruating girls.”
Quote in the paperSubstantial claim - Study design and conductreasoning
The study was unable to test if girls would have rated other provided products more highly because AFRIpads were the only product provided.
“As AFRIpads were the only product provided in the intervention, this study was unable to test if girls would have rated other provided products more highly (e.g., other types of reusable pad, reusable menstrual underwear, tampons).”
Quote in the paperNot a substantial claim - Study design and conductnone given
The reusable pads were provided as part of a quasi-randomised trial to girls in 4 of the 8 study schools.
“the reusable pads were provided as part of a quasi-randomised trial to girls in 4 of the 8 study schools.”
Quote in the paperSubstantial claim - Study design and conductreasoning
Social-desirability in reporting may have been exacerbated by asking questions in the school setting.
“Social-desirability in reporting may have been exacerbated by asking questions in the school setting.”
Quote in the paperNot a substantial claim - Interpretationcitation
There are discrepancies between girls' perceptions of absorbents and their lived experience.
“they also highlight issues with current outcome assessment in menstrual management research and discrepancies between girls’ perceptions of absorbents and their lived experience [13, 21].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [13] Hennegan JM. Menstrual hygiene management and human rights: the case for an evidence-based approach. Under review.
Not checked in the free run.
- cites [21] Hennegan JM, Dolan C, Wu M, Scott L, Montgomery P. Measuring the prevalence and impact of poor menstrual hygiene management: a quantitative survey of schoolgirls in rural Uganda. BMJ Open. In Press. doi: 10.1136/bmjopen-2016-012596 . source
Not checked in the free run.
- Premisecitation
No trials to date have assessed potential harms of menstrual management interventions in low income contexts.
“No trials to date have assessed potential harms of menstrual management interventions in low income contexts, [5]”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Hennegan J, Montgomery P. Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in Low and middle income countries? a systematic review. Plos one. 2016;11(2):e0146985. source
Not checked in the free run.
- Interpretationown data
These high proportions suggest that the provision of better absorbents may not be sufficient to protect against embarrassment.
“These high proportions suggest that the provision of better absorbents may not be sufficient to protect against embarrassment.”
Quote in the paperSubstantial claim - Study design and conductnone given
The sample size of this study was insufficient to assess outcomes across all absorbents.
“The sample size of this study was insufficient to assess outcomes across all absorbents.”
Quote in the paperSubstantial claim - Interpretationown data
Comparison between reusable pads and existing methods revealed fewer differences than expected in daily activities.
“Despite issues of outcome assessment, comparison between reusable pads and existing methods revealed fewer differences than expected in daily activities.”
Quote in the paperSubstantial claim - Interpretationcitation
The similar rates of odour could reflect other aspects of menstrual hygiene management such as washing and drying, which were not improved by pad provision.
“This could reflect other aspects of menstrual hygiene management such as washing and drying, which were not improved by pad provision [21].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [21] Hennegan JM, Dolan C, Wu M, Scott L, Montgomery P. Measuring the prevalence and impact of poor menstrual hygiene management: a quantitative survey of schoolgirls in rural Uganda. BMJ Open. In Press. doi: 10.1136/bmjopen-2016-012596 . source
Not checked in the free run.
- Premisecitation
The primary outcomes of the trial found no difference between reusable pads and puberty education in improving school attendance.
“Whilst the primary outcomes of the trial found no difference between reusable pads and puberty education in improving school attendance”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14] Montgomery P, Hennegan JM, Dolan C, Wu M, Steinfield L, Scott L. Menstruation and the cycle of poverty: a cluster quasi-randomised control trial of sanitary pad and puberty education provision in Uganda. Plos one. 2016. doi: 10.1371/journal.pone.0166122 . source
Not checked in the free run.
- May combine two claims. 21
- Classified as probably not a substantial claim. 19
- The quote only partly states this claim. 3
May combine two claims.
Findingown dataOf 201 girls who answered questions about their most frequently used absorbent, 72 (35.8%) used reusable pads, 30 (14.9%) new cloth, 62 (30.9%) old cloth, 18 (9.0%) disposable sanitary pads, and 19 (9.5%) other methods including toilet paper, underwear alone, mattress, or sponge.
“201 girls answered questions about the type of absorbent they used most frequently. Of these, 72 girls (35.8%) used reusable pads, 30 (14.9%) new cloth, 62 (30.9%) old cloth, 18 (9.0%) disposable sanitary pads, and 19 (9.5%) ‘other’ methods including toilet paper, underwear alone, mattress, or sponge.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataAmong girls who did not receive reusable pads, new cloth was more often provided by mothers, and old cloth was more often obtained by girls themselves.
“For girls who did not receive reusable pads, new cloth was more often provided by mothers, and old cloth more often obtained by girls themselves.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Findingown dataIn the analysis, 72 girls who reported using the intervention-provided reusable pads were compared to those using existing improvised methods, predominately new or old cloth.
“72 girls who reported using the intervention-provided reusable pads were compared to those using existing improvised methods (predominately new or old cloth).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataGirls using new cloth reported having more cloth and using more pieces per day than girls using old cloth.
“Girls using new cloth reported having more cloth, and using more pieces per day.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataAll girls in the sample (100%) stated they had underwear, and 97.6% reported wearing underwear with sanitary protection.
“100% of girls in the sample stated that they had underwear and 97.6% reported that they wore underwear with sanitary protection.”
Quote in the paperNot a substantial claimMay combine two claims. The quote only partly states this claim.
Findingown dataWhen asked about activities avoided during menstruation, girls using reusable pads participated less in physical sports, working in the field, fetching water, and cooking than girls using other existing methods.
“However, when asked about activities avoided during menstruation, those using reusable pads participated less in physical sports, working in the field, fetching water, and cooking.”
Quote in the paperNot a substantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.
Findingown dataFew girls reported sharing cloth with anyone else in their household.
“Few girls reported sharing cloth.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataWhen asked how long it took them to get to school, 37.7% reported an 11-30-min walk, 37.7% a 31-60-min walk, 19.8% less than 10 min, and 4.8% longer than 1 h.
“When asked how long it took them to get to school 37.7% reported an 11–30-min walk, 37.7% a 31–60-min walk, and smaller proportions reported a walk less than 10 min (19.8%) or longer than 1 h (4.8%).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataGirls' self-reported age ranged from 10 to 19 years (mean = 14.20, SD = 1.12), with the majority (86.9%) aged 13 to 15.
“Girls’ self-reported age ranged from 10 to 19 years (Mean = 14.20,SD = 1.12), with the majority (86.9%) aged 13 to 15.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataMost girls were in upper primary school (P5: 21.5%, P6: 44.9%, P7: 24.9%) and attended the same school last year (94.6%).
“Most girls were in upper primary school (Primary class (P) 5: 21.5, P6: 44.9, P7: 24.9%) and attended the same school last year (94.6%).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataGirls reported liking the reusable pads, although half reported that they would not be able to afford them.
“Girls reported liking the reusable pads, although half reported that they would not be able to afford them.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataGirls stated they would be likely to spend money on these products if they had the funds available.
“Girls stated they would be likely to spend money on these products if they had the funds available”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe average age at menarche was 12.82 years (SD = 1.28).
“The average age at menarche was 12.82 years (SD = 1.28).”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Interpretationown dataGirls using reusable pads reported less difficulty changing absorbents than girls using existing improvised methods.
“Schoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities, less difficulties changing absorbents, and less disgust with cleaning absorbents.”
Quote in the paperSubstantial claim- Rests on an assumption: The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe study was conducted and reported according to best practice guidelines in the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement.
“This study was conducted and reported according to best practice guidelines in the Strengthening the Reporting of Observational studies in Epidemiology statement [20].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology [STROBE] statement: guidelines for reporting observational studies. Gac Sanit. 2008;22(2):144–50. 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 conductcitationQualitative feasibility and acceptability work was undertaken prior to trial implementation, both in the local area and similar regions, and shaped question development.
“Qualitative feasibility and acceptability work was undertaken prior to trial implementation, both in the local area, and similar regions (see [16]). This further shaped question development, as did existing menstrual hygiene literature.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [16] Scott L, Montgomery P, Stenfield L, Dolan C, Dopson S. Sanitary pad acceptability and sustainability study. Oxford: University of Oxford; 2013. source
Not checked in the free run.
May combine two claims.
PremisecitationThe review identified only 3 studies of menstrual product provision, each assessing a different product: menstrual cups, disposable sanitary pads, and home-made reusable pads.
“The review identified only 3 studies of menstrual product provision, each assessing a different product; menstrual cups, [9] disposable sanitary pads, [10] and home-made reusable pads [11].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [9] Oster E, Thornton R. Menstruation, sanitary products, and school attendance: evidence from a randomized evaluation. Am Econ J Appl Econ. 2011;3:91–100. source
Not checked in the free run.
- cites [10] Montgomery P, Ryus CR, Dolan CS, Dopson S, Scott LM. Sanitary pad interventions for girls’ education in Ghana: a pilot study. Plos one. 2012;7(10):e48274. source
Not checked in the free run.
- cites [11] Wilson E, Reeve J, Pitt A. Education. Period. Developing an acceptable and replicable menstrual hygiene intervention. Dev Pract. 2014;24(1):63–80. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationCore survey items had been piloted in Ghana.
“Core items had been piloted in Ghana [10, 15].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [10] Montgomery P, Ryus CR, Dolan CS, Dopson S, Scott LM. Sanitary pad interventions for girls’ education in Ghana: a pilot study. Plos one. 2012;7(10):e48274. source
Not checked in the free run.
- cites [15] Dolan CS, Ryus CR, Dopson S, Montgomery P, Scott L. A blind spot in girls’ education: menarche and its webs of exclusion in Ghana. J Int Dev. 2014;26(5):643–57. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningGiven the low literacy rate in the area, verbal administration of the survey was likely to be more reliable than written surveys.
“Given the low literacy rate in the area, verbal administration of the survey was likely to be more reliable than written surveys”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningTogether study findings reveal the importance of considering the full story of menstrual management when assessing interventions.
“Together study findings reveal the importance of considering the full story of menstrual management when assessing interventions.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductreasoningGirls who were not included in the trial but moved to intervention schools by March 2014 may also have received pads or have been surveyed and so were included here.
“It should also be noted that girls who were not included in the trial, but moved to intervention schools by March 2014 may also have received pads or have been surveyed and so were included here.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductreasoningAlthough girls were taken aside to ask questions, there were many others around which may have primed social norms and led to biases towards expected responses.
“Although girls were taken aside to ask questions there were many others around which may have primed social norms and led to biases towards expected responses.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Interpretationown dataThe above ratings indicate positive perceptions of reliability of the reusable pads, and may indicate better performance.
“The above ratings indicate positive perceptions of reliability of the reusable pads, and may indicate better performance.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataFindings suggest that the provision of pads alone may not be sufficient to reduce garment soiling and that more detailed work is needed.
“Findings also suggest that the provision of pads alone may not be sufficient to reduce garment soiling and that more detailed work is needed.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductreasoningMany interviewing research assistants were the same as those who had provided the pads, which may have also biased girls towards favourable reports.
“Many interviewing research assistants were the same as those who had provided the pads, which may have also biased girls towards favourable reports.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationPrimary trial outcomes reporting the same improvements in school attendance following reusable pad provision as puberty education do not reveal improvements to girls' confidence in absorbents, disgust in washing, difficulties changing absorbents, or participation in other activities.
“Primary trial outcomes reporting the same improvements in school attendance following reusable pad provision as puberty education, [14] do not reveal improvements to girls’ confidence in absorbents, disgust in washing, difficulties changing absorbents, or participation in other activities.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14] Montgomery P, Hennegan JM, Dolan C, Wu M, Steinfield L, Scott L. Menstruation and the cycle of poverty: a cluster quasi-randomised control trial of sanitary pad and puberty education provision in Uganda. Plos one. 2016. doi: 10.1371/journal.pone.0166122 . 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 conductreasoningThe use of local research assistants to administer surveys was advantageous in use of the local language and access to the population.
“The use of local research assistants to administer surveys was advantageous in use of the local language and access to the population.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
Interpretationown dataDifferences in responses to prompted and volunteered items demonstrate the need for more careful and validated outcome assessment in this field.
“Differences in responses to items ‘does your menstruation ever cause you to miss/avoid…’ where the list of items was read aloud, and ‘are there activities you avoid while menstruating…’ with volunteered responses, further demonstrates the need for more careful and validated outcome assessment in this field.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationcitationThe present sample is likely to have higher attendance and more favourable circumstances than those who had dropped out of school already.
“Thus the present sample is likely to have higher attendance and more favourable circumstances than those who had dropped out of school already.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [14] Montgomery P, Hennegan JM, Dolan C, Wu M, Steinfield L, Scott L. Menstruation and the cycle of poverty: a cluster quasi-randomised control trial of sanitary pad and puberty education provision in Uganda. Plos one. 2016. doi: 10.1371/journal.pone.0166122 . source
Not checked in the free run.
May combine two claims.
Interpretationown dataFrequencies suggest that disposable pads may have been more favourable than reusable pads in some areas, but there was insufficient power to compare these.
“Frequencies suggest that disposable pads may have been more favourable than reusable pads in some areas, but there was insufficient power to compare these.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable).
Interpretationown dataThis follow-up work reveals other important benefits of pad provision.
“this follow-up work reveals other important benefits of pad provision.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataResults of this study suggest reusable pads are perceived to be more reliable and convenient to manage than girls' existing improvised menstrual absorbents (predominantly cloth) in rural Uganda.
“Results of this study suggest reusable pads are perceived to be more reliable and convenient to manage than girls’ existing improvised menstrual absorbents (predominantly cloth) in rural Uganda.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningFindings suggest that to fully appraise programs providing sanitary products to girls, a wide range of outcomes must be considered.
“Findings suggest that to fully appraise programs providing sanitary products to girls, a wide range of outcomes must be considered.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The girls using reusable pads and those using existing improvised methods are comparable in ways that do not confound the observed differences in experiences and ratings.
“Girls using reusable pads were compared to those using improvised methods using binary logistic regressions for dichotomous outcomes, and t-tests for continuous outcomes.”
The paper relies on this without support.
The present study is the most comprehensive quantitative assessment to date comparing girls’ experiences of different menstrual absorbents in a low income context.
“The present study was the most comprehensive quantitative assessment to date comparing girls’ experiences of different menstrual absorbents in a low income context.”
The paper relies on this without support.
Free distribution of reusable pads as part of the trial means socio-demographic characteristics do not vary between absorbent groups.
“as the reusable pads were distributed free as part of the trial these should not vary according to socio-demographics.”
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?
The methods of managing menstruation seen in this peri-urban secondary school population differed from those in rural Uganda, where most students reported primarily using re-usable pads.
“The methods of managing menstruation seen in this peri-urban secondary school population differed from that in rural Uganda [24, 25], where most students reported primarily using re-usable pads”
From Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study (2018) · cites this paper as [25]
The Results section (“Menstrual absorbents”; page not available) reports that 72 of 201 girls (35.8%) most frequently used reusable pads—not most girls. Another 92 primarily used new or old cloth, which the paper treats as distinct from reusable pads. The paper does not assess the citing study’s peri-urban population. (LLM, conf=0.92)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredAmong 10-19 year old girls in rural schools in Kamuli district, Eastern Uganda, only 9% reported using disposable pads as their main protection.
“among 10–19 year old girls in rural schools in Kamuli district, Eastern Uganda, only 9% of girls reported using disposable pads as their main protection [25].”
From Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study (2018) · cites this paper as [25]
Those using AFRIpads may have been able to change faster, as indicated in quantitative findings, facilitating some girls to change at school in those conditions.
“Those using AFRIpads may have been able to change faster, as indicated in quantitative findings, [17] facilitating some girls to change at school in those conditions.”
From A qualitative understanding of the effects of reusable sanitary pads and puberty education: Implications for future research and practice (2017) · cites this paper as [17]
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.
Abstract reverses the direction of activity avoidance
MajorThe abstract says girls using reusable pads participated less in these activities. The results instead say girls using existing methods were more likely to avoid them, implying greater participation among reusable-pad users.
“However, when asked about activities avoided during menstruation, those using reusable pads participated less in physical sports, working in the field, fetching water, and cooking.”
“Of those who did report avoiding activities or settings, girls using existing methods were more likely to report avoiding physical sports or exercise, working in the field or garden, fetching water, or cooking.”
Old-cloth count does not match its reliability percentage
MinorThe table reports that 2 of 62 old-cloth users considered their absorbent reliable when sitting for a long time. That is 3.2%, not 38.7%.
Reported 38.7 · recomputed 3.225806
“| Sit for a long time | 68.1 (49) | 35.9 (38) | 3.81 (2.02–7.19) | 23.3 (7) | 38.7 (2) | 50.0 (7) | 77.8 (14) |”
Listed alternative absorbents account for only 18 of 23 girls
MinorThe four listed counts for girls who used reusable pads but did not report them as their primary absorbent sum to 18, not the stated 23.
Reported 23 · recomputed 18
“Of the 23 girls who reported using reusable pads but did not report these as their primary menstrual absorbent, six were using new cloth, eight were using old cloth, two were using sanitary pads and two were using other methods.”
Stated range of reusable-pad reliability omits a lower rating
MinorThe discussion gives 68% as the lowest reliability rating for reusable pads, but Table 3 reports 59.2% for being around males.
“Perceptions of reliability across ranged from 68 to 90% for those using reusable pads compared to 29–54% for those using existing improvised methods.”
“| Be around males | 59.2 (42) | 28.6 (30) | 3.62 (1.92–6.83) | 27.6 (8) | 25.8 (16) | 42.9 (6) | 66.7 (12) |”
Changing-time subgroup counts exceed the pooled count
MinorFor changing protection in 0-4 minutes, the disaggregated improvised-method counts are 16, 31 and 8, totaling 55. The pooled count is reported as 54.
Reported 54 · recomputed 55
“| 0–4 min | 69.6 (48) | 49.5 (54) | 2.24 (1.19–4.23) | 53.3 (16) | 50.8 (31) | 44.4 (8) | 44.4 (8) |”
Cites
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, F. T. S. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040296 · Cited by 23,020 · see citing works
A systematic review of the health and social effects of menstrual hygiene management
Sumpter, C., & Torondel, B. (2013) · PLoS ONE · doi:10.1371/journal.pone.0062004 · Cited by 518 · cited 2× · see citing works
“A lack of clean and reliable menstrual absorbents has received much of the attention, with interventions focussed on the provision of these products to improve poor menstrual hygiene and associated consequences [4, 5].”
BackgroundDas, P., Baker, K. K., Dutta, A., Swain, T., Sahoo, S., Das, B. S., Panda, B., Nayak, A., Bara, M., Bilung, B., et al. (2015) · PLOS ONE · doi:10.1371/journal.pone.0130777 · Cited by 441 · cited 1× · see citing works
“This has been linked to negative impacts on health, education and wellbeing [2, 3].”
BackgroundVon Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2008) · Gaceta Sanitaria · doi:10.1157/13119325 · Cited by 417 · see citing works
Sommer, M., Hirsch, J. S., Nathanson, C., & Parker, R. G. (2015) · American Journal of Public Health · doi:10.2105/ajph.2014.302525 · Cited by 401 · see citing works
Hennegan, J., & Montgomery, P. (2016) · PLOS ONE · doi:10.1371/journal.pone.0146985 · Cited by 333 · cited 3× · see citing works
“A lack of clean and reliable menstrual absorbents has received much of the attention, with interventions focussed on the provision of these products to improve poor menstrual hygiene and associated consequences [4, 5].”
BackgroundSelf-citationMenstruation, Sanitary Products, and School Attendance: Evidence from a Randomized Evaluation
Oster, E., & Thornton, R. (2011) · American Economic Journal: Applied Economics · doi:10.1257/app.3.1.91 · Cited by 231 · cited 2× · see citing works
“Past trials of menstrual product provision have addressed some of these questions with qualitative reports or field observations of product acceptability and uptake [9, 11, 15].”
BackgroundSanitary Pad Interventions for Girls' Education in Ghana: A Pilot Study
Montgomery, P., Ryus, C. R., Dolan, C. S., Dopson, S., & Scott, L. M. (2012) · PLoS ONE · doi:10.1371/journal.pone.0048274 · Cited by 230 · cited 8× · see citing works
“A blind spot in girls’ education: menarche and its webs of exclusion in Ghana.”
BackgroundResultInfluentialSelf-citationGarg, R., Goyal, S., & Gupta, S. (2012) · Maternal and Child Health Journal · doi:10.1007/s10995-011-0798-5 · Cited by 220 · see citing works
Hennegan, J., Dolan, C., Wu, M., Scott, L., & Montgomery, P. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-012596 · Cited by 160 · cited 3× · see citing works
“The menstrual absorbent categories are the same as reported in an additional secondary analysis paper on menstrual hygiene practices [21].”
BackgroundInfluentialSelf-citationMontgomery, P., Hennegan, J., Dolan, C., Wu, M., Steinfield, L., & Scott, L. (2016) · PLOS ONE · doi:10.1371/journal.pone.0166122 · Cited by 132 · cited 8× · see citing works
“The Menstruation and the Cycle of Poverty trial [14] assessed here, conducted a pilot assessment of menstrual products.”
InfluentialSelf-citationA blind spot in girls education: menarche and its webs of exclusion in Ghana
Dolan, C. S., Ryus, C. R., Dopson, S., Montgomery, P., & Scott, L. (2014) · Journal of International Development · doi:10.1002/jid.2917 · Cited by 114 · cited 6× · see citing works
“A blind spot in girls’ education: menarche and its webs of exclusion in Ghana.”
BackgroundInfluentialSelf-citationMurat Sahin, M. S., Linda Mason, L. M., Kayla Laserson, K. L., Kelvin Oruko, K. O., Elizabeth Nyothach, E. N., Kelly Alexander, K. A., Frank Odhiambo, F. O., Alie Eleveld, A. E., Emily Isiye, E. I., Isaac Ngere, I. N., et al. (2015) · Waterlines · doi:10.3362/1756-3488.2015.003 · Cited by 108 · cited 2× · see citing works
“Other studies have found qualitative evidence of acceptability of menstrual cups, but it is unclear if these would be preferred to other methods if offered [17].”
BackgroundMenstrual Hygiene Management and Human Rights: The Case for an Evidence-Based Approach
Hennegan, J. M. (2017) · Women s Reproductive Health · doi:10.1080/23293691.2017.1388720 · Cited by 105 · see citing works
Self-citationWomen's experience of using the Mooncup
Stewart, K., Greer, R., & Powell, M. (2010) · Journal of Obstetrics and Gynaecology · doi:10.3109/01443610903572117 · Cited by 52 · cited 1× · see citing works
“A recent study of women in a high income context, where other products such as pads and tampons are available, found only 55% reported they would continue using a menstrual cup after an acceptability study [18].”
BackgroundMenstrual hygiene management: education and empowerment for girls?
Murat Sahin, M. S., Deepa Joshi, D. J., Gerlinde Buit, G. B., & Diana González-Botero, D. G.-B. (2015) · Waterlines · doi:10.3362/1756-3488.2015.006 · Cited by 47 · see citing works
Education. Period. Developing an acceptable and replicable menstrual hygiene intervention
Wilson, E., Reeve, J., & Pitt, A. (2014) · Development in Practice · doi:10.1080/09614524.2014.867305 · Cited by 43 · see citing works
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Sanitary Pad Acceptability and Sustainability Study - Long Report
Scott, L., Montgomery, P., Steinfeld, L., Dolan, C., & Dopson, S. (2013) · doi:10.35648/20.500.12413/11781/ii161 · Cited by 13 · see citing works
Self-citationSanitary Pad: Acceptability and Sustainability Study
Scott, L. M., Montgomery, P., Steinfield, L. A., Dolan, C. S., Dopson, S., & Hecimovich, J. (2013) · SOAS Research Online (SOAS University of London) · Cited by 12 · see citing works
Self-citation
Flagged first, then by citations
1 of the 22 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- StataCorp. Stata statistical software: release 14. College Station: StataCorp LP; 2015.
Cited by
Sorted by citations
Miiro, G., Rutakumwa, R., Nakiyingi-Miiro, J., Nakuya, K., Musoke, S., Namakula, J., Francis, S., Torondel, B., Gibson, L. J., Ross, D. A., et al. (2018) · BMC Women's Health · doi:10.1186/s12905-017-0502-z · Cited by 297 · see citing works
“Published on UNESCO HIV and Health Education Clearinghouse (https://hivhealthclearinghouse.unesco.org) Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): A feasibility study 2018.”
BackgroundMethodInfluentialCoast, E., Lattof, S. R., & Strong, J. (2019) · International Journal of Public Health · doi:10.1007/s00038-019-01209-0 · Cited by 148 · see citing works
Geere, J.-A. L., Cortobius, M., Geere, J. H., Hammer, C. C., & Hunter, P. R. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2018-000764 · Cited by 106 · see citing works
van Eijk, A. M., Jayasinghe, N., Zulaika, G., Mason, L., Sivakami, M., Unger, H. W., & Phillips‐Howard, P. A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0257610 · Cited by 101 · see citing works
“001) in one Ugandan study [24], and in two Ugandan cohort studies comparing RMPs use at endline against usual product at baseline (20% vs.”
BackgroundResultInfluentialKansiime, C., Hytti, L., Nalugya, R., Nakuya, K., Namirembe, P., Nakalema, S., Neema, S., Tanton, C., Alezuyo, C., Musoke, S. N., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-031182 · Cited by 101 · see citing works
Measurement in the study of menstrual health and hygiene: A systematic review and audit
Hennegan, J. M., Brooks, D. J., Schwab, K. J., & Meléndez‐Torres, G. J. (2020) · PLoS ONE · doi:10.1371/journal.pone.0232935 · Cited by 93 · see citing works
Self-citationHennegan, J., Dolan, C., Steinfield, L., & Montgomery, P. (2017) · Reproductive Health · doi:10.1186/s12978-017-0339-9 · Cited by 83 · see citing works
“Those using AFRIpads may have been able to change faster, as indicated in quantitative findings, [17] facilitating some girls to change at school in those conditions.”
MethodSelf-citationPlesons, M., Patkar, A., Babb, J., Balapitiya, A., Carson, F., Caruso, B. A., Franco, M. M., Hansen, M. M., Haver, J., Jahangir, A., et al. (2021) · Reproductive Health · doi:10.1186/s12978-021-01082-2 · Cited by 82 · see citing works
Tending the ‘monthly flower:’ a qualitative study of menstrual beliefs in Tigray, Ethiopia
Wall, L. L., Gebru, K. T., Desta, A., & Belay, S. (2018) · BMC Women s Health · doi:10.1186/s12905-018-0676-z · Cited by 60 · see citing works
Crankshaw, T. L., Strauss, M., & Gumede, B. (2020) · Reproductive Health · doi:10.1186/s12978-020-0896-1 · Cited by 56 · see citing works
Boakye-Yiadom, A., Aladago, D. A., Beweleyir, J., Mohammed, H., Salifu, M. F., & Asaarik, M. J. A. (2018) · European Scientific Journal ESJ · doi:10.19044/esj.2018.v14n36p467 · Cited by 43 · see citing works
“…found no significant association between sanitary pad provision and school attendance, a randomized control trial (RCT) in Ghana suggested that MHM education together with provision of free pads could improve school attendance among adolescent girls (Montgomery et al., 2012; Hennegan et al., 2016).”
Hennegan, J. M., & Sol, L. (2019) · Culture Health & Sexuality · doi:10.1080/13691058.2019.1580768 · Cited by 51 · see citing works
Self-citationRoxburgh, H., Hampshire, K., Kaliwo, T., Tilley, E., Oliver, D. M., & Quilliam, R. S. (2020) · PLoS ONE · doi:10.1371/journal.pone.0235339 · Cited by 44 · see citing works
“washing and reusing cloth, which generates smaller volumes of waste), but also improve on them by utilising materials with fast drying times and requiring small volumes of water for washing [37, 38].”
BackgroundUse and perceptions on reusable and non-reusable menstrual products in Spain: A mixed-methods study
Medina‐Perucha, L., López‐Jiménez, T., Holst, A. S., Jacques‐Aviñó, C., Munrós-Feliu, J., Bueno, C. M., Valls-Llobet, C., Pinzón-Sanabria, D., Vicente‐Hernández, M. M., & Berenguera, A. (2022) · PLoS ONE · doi:10.1371/journal.pone.0265646 · Cited by 44 · see citing works
“Reusable menstrual pads have already been positively evaluated [35], although their use might not increase social participation during menstruation [36].”
BackgroundHennegan, J. M. (2020) · Springer eBooks · doi:10.1007/978-981-15-0614-7_47 · Cited by 31 · see citing works
Self-citationAsumah, M. N., Abubakari, A., Aninanya, G. A., & Salisu, W. J. (2022) · Pan African Medical Journal · doi:10.11604/pamj.2022.41.146.33492 · Cited by 34 · see citing works
“, [36] where the majority of respondents cleaned their clothes with soap and water.”
BackgroundGirls’ attendance at school after a menstrual hygiene intervention in northern Ethiopia
Belay, S., Kuhlmann, A. S., & Wall, L. L. (2020) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.13127 · Cited by 36 · see citing works
“10,21,22 The menstrual hygiene kits were produced by the Mariam Seba Sanitary Products Factory in Mekelle and were pro - vided to the project at cost.”
MethodAnaba, E. A., Udofia, E. A., Manu, A., Daniels, A. A., & Aryeetey, R. (2022) · BMC Women s Health · doi:10.1186/s12905-022-01670-9 · Cited by 31 · see citing works
“Women and adolescents in low-income countries prefer reusable pads because they are culturally acceptable, user-friendly, affordable, clean, effective, and accessible [11, 15, 16].”
BackgroundHennegan, J. M., Bukenya, J. N., Makumbi, F. E., Nakamya, P., Exum, N. G., Schwab, K. J., & Kibira, S. P. S. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0000589 · Cited by 32 · see citing works
Self-citationAsumah, M. N., Abubakari, A., & Aninanya, G. A. (2022) · Infectious Diseases in Obstetrics and Gynecology · doi:10.1155/2022/7007117 · Cited by 29 · see citing works
“Besides, Hennegan et al. [39] reported that some girls in a boarding school in Uganda were shy to wash their used cloth in public; they washed in the night and dried them in the dormitory.”
BackgroundResultInfluentialLamont, J. M., Wagner, K. M., & Incorvati, C. G. (2019) · Women s Reproductive Health · doi:10.1080/23293691.2018.1556428 · Cited by 31 · see citing works
Mason, L., Nyothach, E., van Eijk, A. M., Obor, D., Alexander, K., Ngere, I., Laserson, K., & Phillips‐Howard, P. A. (2019) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20193506 · Cited by 26 · see citing works
“have been associated with vaginal discharge, leaking, disposal problems, and difficulty (shame and embarrassment) in purchasing.(9,13,19-22) Key concerns also relate to recurring monthly expense and environmental pollutant effects.”
BackgroundBeksinska, M. E., Nkosi, P., Zulu, B., & Smit, J. A. (2020) · The European Journal of Contraception & Reproductive Health Care · doi:10.1080/13625187.2020.1815005 · Cited by 25 · see citing works
Girls’ Menstrual Management in Five Districts of Nepal: Implications for Policy and Practice
Morrison, J., Basnet, M., Bhatt, A., Khimbanjar, S., Chaulagain, S., Sah, N., Baral, S., Mahon, T., & Hodgkin, M. (2018) · Studies in Social Justice · doi:10.26522/ssj.v12i2.1623 · Cited by 24 · see citing works
“Challenges in accessing materials which can be easily washed, dried and disposed of, often mean that girls’ confidence and ability to participate in community and school activities is curtailed (Hennegan, Dolan, Wu, Scott, & Montgomery, 2016; Hennegan & Montgomery, 2016).”
BackgroundDas, P., Lisnek, D., Sahoo, K. C., Sinha, S., Mohanty, J., Sahoo, P., Bilung, B., Panda, B., Tanton, C., & Torondel, B. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094778 · Cited by 21 · see citing works
Hanissa, J., Nasution, A., & Arsyati, A. M. (2017) · HEARTY · doi:10.32832/hearty.v5i2.1057 · Cited by 17 · see citing works
Menstrual hygiene management inequalities among school girls in Badagry, Nigeria
Uwadia, R. C., Oloruntoba, E. O., Wada, O. Z., & Aluko, O. O. (2022) · Tropical Medicine & International Health · doi:10.1111/tmi.13817 · Cited by 20 · see citing works
“Besides recording a significantly lower leakage rate than girls who used just clothes, they also had significantly higher ratings of perceived absorbent reliability, more minor challenges replacing the napkins and less aversion to washing napkins [54].”
BackgroundWorku, Y., Kassa, G. M., Mekonen, B., Desta, M., Bishaw, K. A., Gedfaw, M., Tesfaw, E., Degu, G., & Shiferaw, A. (2024) · BMC Women s Health · doi:10.1186/s12905-024-03265-y · Cited by 21 · see citing works
“This study and one conducted in Mehallm-eda were comparable [21]., Turkish [17], urban Slum [33], Uganda [34] and India [35].”
ResultShrestha, S., Shrestha, S., Ito, Y., Kobayashi, Y., Nishida, K., Kazama, F., & Malla, R. (2021) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2021.100 · Cited by 9 · see citing works
“Over the last few years, more studies have been conducted on the use of sustainable absorbents such as reusable sanitary pads (Hennegan et al. 2016) and many organizations are raising awareness and teaching to prepare them to make menstruation sustainable.”
BackgroundAdolescents, menstruation, and physical activity: insights from a global scoping review
Harvey, J., Western, M. J., Townsend, N. P., Francombe-Webb, J., Sebire, S. J., Malkowski, O. S., Remskar, M., Burfitt, E., & Solomon-Moore, E. (2025) · BMC Women s Health · doi:10.1186/s12905-025-03825-w · Cited by 19 · see citing works
Measurement in the study of menstrual health and hygiene: A systematic review and auditPreprint
Hennegan, J. M., Brooks, D. J., Schwab, K. J., & Meléndez‐Torres, G. J. (2019) · doi:10.31235/osf.io/n8j5w · Cited by 6 · see citing works
Self-citationAssefa, G. M., Stulz, V. M., Mengie, G., Atnafe, L., Gezahegn, W., Smet, E., & Muluneh, M. D. (2025) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2025.233 · Cited by 4 · see citing works
Asymmetric Information in Menstrual Health and Implications for Sustainability: Insights from India
Garikipati, S. (2021) · Springer eBooks · doi:10.1007/978-3-030-56371-4_19 · Cited by 3 · see citing works
Sari, Y. M., & Novriyanti, N. (2023) · PubMed Central · doi:10.34763/jmotherandchild.20222601.d-22-00064 · Cited by 4 · see citing works
“Its use is still a common choice because the high leakage factor can cause physical activity inhibition [30].”
BackgroundAyele, A. W. (2025) · SAGE Open · doi:10.1177/21582440251329761 · Cited by 3 · see citing works
“Poor sanitation and a lack of adequate sanitation facilities have far-reaching impacts on health of the society, the economy, and the environment (Amanabo-Arome & Abbas, 2021; Hennegan et al., 2016; Hulton, 2012).”
Keeping African Girls in School with Better Sanitary Care
Tofaris, E., & Dolan, C. (2018) · doi:10.35648/20.500.12413/11781/ii307 · Cited by 3 · see citing works
Self-citationGarikipati, S., & Phillips‐Howard, P. A. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3747091 · Cited by 3 · see citing works
Bisimirwe, C., Maombi, S., Nabuki, S., Mubelelwa, L., Llosa, A. E., & Palacios, L. (2025) · Research Square · doi:10.21203/rs.3.rs-6938601/v1 · Cited by 3 · see citing works
Onasoga, O. A. (2022) · TEXILA INTERNATIONAL JOURNAL OF NURSING · doi:10.21522/tijnr.2015.08.02.art004 · Cited by 2 · see citing works
Fauziah, L. F., Hanim, D., & Pamungkasari, E. P. (2019) · Media Kesehatan Masyarakat Indonesia · doi:10.30597/mkmi.v15i1.5844 · Cited by 2 · see citing works
Menstrual hygiene management in two districts of MalawiPreprint
Hinton, R. G. K., Tremblay-Lévesque, L.-C., Kanjaye, M. B., Macleod, C. J. A., Troldborg, M., & Kalin, R. M. (2024) · medRxiv · doi:10.1101/2024.04.12.24305724 · Cited by 2 · see citing works
Nguegang, F., & Kum, F. V. (2024) · Journal of Behavioral and Experimental Economics · doi:10.1016/j.socec.2024.102302 · Cited by 3 · see citing works
Knowledge on Sanitary Practices and Waste Management Among Sherubtse College GirlsPreprint
Nepal, T. K., Wangmo, S., Gurung, M. L. N., Yangchen, K., Dema, U., & Wangmo, D. (2021) · Preprints.org · doi:10.20944/preprints202102.0479.v1 · Cited by 1 · see citing works
“There are different types of disposable sanitary napkins; Panty liner - designed to absorb daily vaginal discharge, light menstrual flow; Ultrathin - a very thin pad which may be as absorbent with less bulk; Regular - a middle range absorbency pad; Maxi/Super - a large absorbency pad useful for the start of the menstr…”
BackgroundThe Idea of Human Rights in Global Contexts: The Equality Dimension
Frick, M.-L. (2019) · Springer eBooks · doi:10.1007/978-3-030-10785-7_4
Achieving the Promise to Leave No Girl behind in Commonwealth Countries
Gordon, R., Marston, L., Rose, P. M., et al. (2019) · The Round Table · doi:10.1080/00358533.2019.1634890
“In Uganda, secondary school attendance improved by 17 per cent on average when girls were given reusable sanitary pads materials combined with reproductive health education (Hennegan et al., 2016).”
BackgroundRethinking Impact: Applying the Gender Lens
Initiative, T. I. (2019) · doi:10.35648/20.500.12413/11781/ii336
Recipes For Impact: Feed, Thinking, Nourish, Change
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Panggabean, S. M. U., Mutiara, S., & Ramadhaniati, D. (2022) · Jurnal Ilmiah Kebidanan Imelda · doi:10.52943/jikebi.v8i2.1100
Full, free, and informed: defining and operationalising informed choice for menstrual supplies
Wilson, L. C., & Mahajan, T. D. (2025) · Sexual and Reproductive Health Matters · doi:10.1080/26410397.2025.2538357
Bisimirwe, C., Maombi, S., Nabuki, S., Mubelelwa, L., Llosa, A. E., & Palacios, L. (2026) · npj Women s Health · doi:10.1038/s44294-026-00136-9 · Cited by 3 · see citing works
Chatterjee, J. (2026) · Social enterprise journal · doi:10.1108/sej-05-2025-0103 · Cited by 1 · see citing works
A systematic review on effectiveness, safety and adoption of reusable menstrual pads in Africa
Rajah, A. S., Bello, U. L., Ibrahim, A. H., et al. (2026) · Discover Public Health · doi:10.1186/s12982-026-02380-5
“Hennegan et al. [4] likewise found that RMP users were less likely than cloth users to avoid physical activities and more likely to perceive their products as reliable.”
InfluentialSium, M. N. I., Islam, K. S., Hosna, A. U., & Akter, E. (2026) · Biometrical Letters · doi:10.2478/bile-2026-0004
Sirvent-Pinar, M. Á., Oliva, E. M., Garcia-Garcia, A., et al. (2026) · Sexual & Reproductive Healthcare · doi:10.1016/j.srhc.2026.101268
Namazzi, G., Wanyenze, R. W., & Matovu, J. K. B. (2026) · Research Square · doi:10.21203/rs.3.rs-10864550/v1
- Authors
- Hennegan, J., Dolan, C., Wu, M., Scott, L., & Montgomery, P.
- Affiliations
- University of Oxford (GB)
- SOAS University of London (GB)
- University of Illinois Urbana-Champaign (US)
- Corresponding author
- Hennegan, Julie
- Venue
- Reproductive Health
- Published
- 2016-12
- Volume
- 13
- Issue
- 1
- Pages
- 143-143
- ISSN
- 1742-4755 (ISSN-L)
- PMC
- PMC5142137
- OpenAlex
- W2560456328
- Semantic Scholar
- 91aa4343e38b44247456b24c5f90c8a21663d606
- Cited by
- 61
- References
- 22
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 5 · 2023: 1 · 2022: 9 · 2021: 8 · 2020: 7 · 2019: 9 · 2018: 7 · 2017: 2
- FWCI
- 5.95
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Reproductive Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- SOAS Research Online (SOAS University of London) (acceptedVersion)
- SOAS Research Online (SOAS University of London) (acceptedVersion, other-oa)
- SOAS Research Online (SOAS University of London) (submittedVersion, cc-by)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Funders
- Economic and Social Research Council (ES/I034145/1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Health Sciences › Health Professions › General Health Professions › Adolescent Sexual and Reproductive Health
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- female students, menstrual management, puberty education, rural Uganda, adolescent girls
- MeSH terms
- Activities of Daily Living, Adolescent, Adult, Child, Consumer Behavior, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Hygiene, Health Knowledge, Attitudes, Practice, Materials Testing, Menstruation, Patient Education as Topic, Rural Health, Uganda, Equipment Reuse, Menstrual Hygiene Products, Young Adult, Self Report, Culturally Competent Care
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