A qualitative exploration of menstruation-related restrictive practices in Fiji, Solomon Islands and Papua New Guinea

May combine two claims.

Women in PNG and SI had mixed attitudes about restrictions on daily living activities such as cooking and cleaning; some accepted them as traditional culture, some welcomed the time away from household responsibilities, while others considered them a 'waste of time' and 'boring'.

“When women in PNG and SI were asked how they felt about restrictions on daily living activities such as cooking and cleaning, attitudes were mixed. Some accepted the restrictions as part of traditional culture or customs, some welcomed the time away from household responsibilities, while others stated that being prevented from undertaking certain tasks was a ‘waste of time’ and could be incredibly”

May combine two claims.

Women in rural SI commonly viewed not being able to attend or fully participate in church as an unwanted restriction, and felt embarrassment at having to sit at the back of the church because that would make it obvious to others that they were menstruating.

“However, women in rural SI commonly viewed not being able to attend or fully participate in church as an unwanted restriction, and there was a feeling of embarrassment at having to sit at the back of the church because that would make it obvious to others that they were menstruating.”

May combine two claims.

It was unclear whether the restriction on sexual intercourse during menstruation was adhered to in SI and Fiji, although some men in PNG reported that sex was still practiced when their partners were menstruating.

“It was unclear whether this restriction was adhered to in SI and Fiji, although some men in PNG reported that sex was still practiced when their partners were menstruating.”

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

Men in urban PNG suggested that a woman should notify her partner if she is menstruating to avoid misunderstanding, so that the man knows why she is declining sex and does not 'start beating' her.

“There was also a suggestion by men in urban PNG that a woman should notify her partner if she is menstruating to avoid misunderstanding, so that the man knows why she is declining sex and does not ‘start beating’ her.”

May combine two claims.

In some very remote parts of SI and PNG, women and girls reported staying in a separate women's house ('haus meri') every month for the duration of their menstrual period, although this practice is increasingly uncommon.

“In some very remote parts of SI and PNG, women and girls reported staying in a separate women’s house (‘haus meri’) every month for the duration of their menstrual period, although this practice is increasingly uncommon.”

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

One healthcare worker reported that Hindu women would take the oral contraceptive pill to delay menstruation in order to attend important religious ceremonies.

“One healthcare worker reported that Hindu women would take the oral contraceptive pill to delay menstruation in order to attend important religious ceremonies.”

May combine two claims.

Indo-Fijian women of Hindu faith described not being able to go to temple or pray at home while menstruating; this was an unwanted restriction for some, while others accepted it as part of their religious beliefs.

“Indo-Fijian women of Hindu faith also described not being able to go to temple or pray at home while menstruating. This was described as an unwanted restriction for some, while others accepted it as part of their religious beliefs.”

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

One female participant in rural PNG reported a belief that women should stay home from work altogether when they were menstruating due to their unavoidable proximity to men; other study participants did not voice this perspective.

“One female participant in rural PNG reported a belief that women should stay home from work altogether when they were menstruating due to their unavoidable proximity to men. Other study participants did not voice this perspective.”

May combine two claims.

Restrictive practices were more frequently reported in PNG and SI than Fiji, and more common in rural compared with urban sites.

“Restrictive practices were more frequently reported in PNG and SI than Fiji, and more common in rural compared with urban sites.”

May combine two claims.

Some women in rural SI described not being able to attend church when they were menstruating because they were 'dirty'; others suggested that church attendance is acceptable, as long as women sit at the back on a bench allocated for menstruating women and do not deliver Bible readings or take Holy Communion.

“Some women in rural SI described not being able to attend church when they were menstruating because they were ‘dirty’; others suggested that church attendance is acceptable, as long as women sit at the back on a bench allocated for menstruating women and do not deliver Bible readings or take Holy Communion.”

May combine two claims.

Participants identified other restrictions, such as not being able to attend church or hygienically wash menstrual hygiene materials, as unwanted, in some cases impacting on participation in school, work and community life.

“However participants identified other restrictions, such as not being able to attend church or hygienically wash menstrual hygiene materials, as unwanted, in some cases impacting on participation in school, work and community life.”

May combine two claims.

Indo-Fijian women of Hindu faith held similar beliefs that menstrual blood is dirty, and reported that menstruating women should not cook food for their husband if he is a priest, or touch food being taken to the temple.

“Indo-Fijian women of Hindu faith held similar beliefs, and reported that menstruating women should not cook food for their husband if he is a priest, or touch food being taken to the temple.”

May combine two claims.

In SI and PNG the traditional restriction on sexual intercourse was generally linked to beliefs about women being dirty or unclean during menstruation and causing harm to men, although in PNG some men believed a woman was at higher risk of becoming pregnant when menstruating.

“In SI and PNG the traditional restriction on sexual intercourse was generally linked to beliefs about women being dirty or unclean during menstruation and causing harm to men, although in PNG some men believed a woman was at higher risk of becoming pregnant when menstruating.”

May combine two claims.

Women and girls in PNG stated that traditional restrictions on cooking and housework were becoming less common and were often not adhered to, particularly in urban areas.

“Women and girls in PNG also stated that these traditional restrictions on cooking and housework were becoming less common and were often not adhered to, particularly in urban areas.”

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

Men in rural SI believed that not attending church while menstruating was a preference among women, relating to the challenges in managing bleeding without access to good quality sanitary products.

“Men in rural SI believed that not attending church while menstruating was a preference among women, relating to the challenges in managing bleeding without access to good quality sanitary products.”

May combine two claims.

This belief traditionally restricted the mobility of menstruating girls and women; male and female participants in PNG and SI mentioned that menstruating women were not supposed to 'sit close to men' or 'walk in front of men', and should avoid places where men or boys gather.

“This belief traditionally restricted the mobility of menstruating girls and women, and male and female participants in PNG and SI mentioned that menstruating women were not supposed to ‘sit close to men’ or ‘walk in front of men’, and should avoid places where men or boys gather.”

The quote only partly states this claim.

In Fiji, many respondents, including community and religious leaders, cited the Bible's Book of Leviticus as a rationale for avoiding sex during menstruation.

“In Fiji, many respondents, including community and religious leaders, cited the Bible’s Book of Leviticus as a rationale.”

May combine two claims.

In Fiji, teasing and harassment was less commonly reported, but some girls described harassment at school, linking it to bribes and absenteeism.

“While teasing and harassment was less commonly reported in Fiji, some girls did describe harassment at school, linking it to bribes and absenteeism.”

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

In Fiji, girls explained that spot checks (random bag checks) add to the problem of teasing and harassment.

“Girls in Fiji also explained that the practice of ‘spot checks’ (random checks of school bags for items that are not allowed such as mobile phones) adds to this problem.”

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

Men interviewed suggested teasing was related to a lack of knowledge about menstruation among men and boys.

“The men interviewed suggested that teasing was related to a lack of knowledge about menstruation among men and boys.”

May combine two claims.

Teasing and harassment by boys was reported by girls in all three countries but was much more common in PNG and SI.

“Teasing and harassment by boys was reported by girls in all three countries but was much more common in PNG and SI.”

May combine two claims.

In rural and urban SI and PNG, women and girls reported drying menstrual cloths outside under a larger cloth out of direct sunlight, or inside the house to be secretive.

“In rural and urban settings in SI and PNG, women and girls spoke of drying cloths used for managing menstrual bleeding outside on a line underneath a larger piece of cloth (out of direct sunlight), while others are more secretive and dry cloths inside the house.”

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

This 6pm time point has general cultural significance for Indo-Fijians, for example children are not allowed to play outside after this time, but for women the restriction is followed more strictly during menstruation.

“This time point has general cultural significance for Indo-Fijians, for example children are not allowed to play outside after this time, but for women the restriction is followed more strictly during menstruation.”

May combine two claims.

In SI, some participants described washing commercial pads before burning, explained as a measure to reduce smell or related to black magic.

“This practice was also described in SI, where some explained it as a measure to reduce smell, while others related it to ‘black magic’.”

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

Rabian women in Fiji described not being allowed to pick fruit from plants because the plants would die.

“A similar belief exists among women of Rabian culture (a small Fijian ethnic group with descendants from Kiribati; Rabian women in formal employment participated in FGDs at both the rural and urban sites in Fiji) who described not being allowed to pick fruit from plants because the plants would die.”

The quote only partly states this claim.

In rural PNG, some women and girls are not allowed to work in the garden while menstruating.

“some women and girls in rural parts of PNG are not allowed to work in the garden”

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

Some indicated not swimming in the sea was a disadvantage because they were unable to go fishing when menstruating.

“some indicated that not swimming in the sea was a disadvantage, as they were unable to go fishing when menstruating.”

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

Women of Rabian culture mentioned not combing their hair during menstruation due to a belief that it would fall out.

“Women of Rabian culture mentioned not combing their hair during menstruation due to a belief that it would fall out.”

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

Many viewed these restrictions as positive, believing it would keep them in good health.

“While many viewed these restrictions as positive, believing it would keep them in good health”

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

Some Hindu Indo-Fijians reported reusable cloths hanging outside must be brought inside before 6pm, otherwise evil spirits will make them sick.

“reusable cloths hanging outside must be brought inside before this time, otherwise evil spirits will make them sick.”

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

In Fiji, it was perceived that bathing in cold water causes stomach cramps or pain.

“It was also perceived that bathing in cold water causes stomach cramps/pain.”

May combine two claims.

Fear of staining and leakage was reported to impact on girls' attendance at school on days of heavy bleeding and potentially affect concentration and participation.

“Fear of staining and leakage was also reported to impact on girls’ attendance at school on days of heavy bleeding and potentially affect their ability to concentrate and participate in class.”

May combine two claims.

Participants suggested this contributed to absenteeism from school and some described reduced active participation in class activities for fear of being harassed.

“Participants suggested that this contributed to absenteeism from school and some described reduced active participation in class activities for fear of being harassed.”

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

For many women and girls, especially those in low and middle-income countries, menstruation presents numerous challenges including discriminatory attitudes, beliefs, social norms and taboos; lack of access to affordable and effective menstrual hygiene materials; and lack of access to appropriate WASH facilities.

“However for many women and girls, especially those in low and middle-income countries, menstruation presents numerous challenges. These include: discriminatory attitudes, beliefs, social norms and taboos relating to menstruation; lack of access to affordable and effective menstrual hygiene materials; and lack of access to appropriate water, sanitation and hygiene (WASH) facilities [2–7].”

• cites [2] 2015, Menstrual Hygiene Management in Indonesia: Understanding practices, determinants and impacts among adolescent school girls (Final report)Not checked yet

  Not checked in the free run.

• cites [3] Caruso B, Fehr A, Inden K, Sahin M, Ellis A, Andes K, et al. WASH in schools in Freetown, Sierra Leone: An assessment of Menstrual Hygiene Management in schools. 2013.Not checked yet

  Not checked in the free run.

• cites [4] A Geertz, 2016, An Opportunity to Address Menstrual Health and Gender EquityNot checked yet

  Not checked in the free run.

• cites [5] S House, 2012, Menstrual Hygiene Matters: a resource for improving menstrual hygiene around the worldNot checked yet

  Not checked in the free run.

• cites [6] S Tamiru, 2015, Towards a sustainable solution for school menstrual hygiene management: cases of Ethiopia, Uganda, South-Sudan, Tanzania, and Zimbabwe, Waterlines sourceNot checked yet

  Not checked in the free run.

• cites [7] V. Tjon A Ten, 2007, Menstrual hygiene: a neglected condition for the achievement of several millennium development goals, Europe External Policy AdvisorsNot checked yet

  Not checked in the free run.

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

Data collectors received three days of training on the background and purpose of the research, qualitative data collection principles, participatory tools, and ethical considerations.

“Three of the authors (LN, YM and CH) provided three days of training to all data collectors on the background and purpose of the research, the principles of qualitative data collection including the roles of facilitators and note takers, use of participatory tools and ethical considerations.”

Classified as probably not a substantial claim.

Ethical approval was received from relevant committees.

“Ethical approval for the study was received from the Solomon Islands Health Research and Ethics Review Board, Fiji National Health Research and Ethics Review Committee, Fiji Ministry of Education Heritage and Arts, PNG Department of Education Research and Evaluation Steering Committee, PNG National Department of Health Medical Research Advisory Committee and the Alfred Hospital Ethics Committee (M”

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

When menstruating, girls may be expected to stay away from their peer group, avoid male community members, and not visit certain locations, such as churches.

“When menstruating, girls may be expected to stay away from their peer group, avoid male community members, and not visit certain locations, such as churches [12].”

• cites [12] S. Tamiru, 2014, Girls in Control: Compiled Findings from Studies on Menstrual Hygiene Management of SchoolgirlsNot checked yet

  Not checked in the free run.

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

Question guides were translated into local languages and back-translated into English to confirm accuracy.

“English question guides were translated into local language/s and back-translated into English to confirm accuracy.”

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

In some cultures, menarche signifies readiness for sexual activity and marriage, with particular implications for sexual and reproductive health as well as educational attainment.

“In some cultures, menarche signifies readiness for sexual activity and marriage, with particular implications for sexual and reproductive health as well as educational attainment [18–20].”

• cites [18] JR Glynn, 2010, Age at menarche, schooling, and sexual debut in northern Malawi, PLoS One sourceNot checked yet

  Not checked in the free run.

• cites [19] M Ibitoye, 2017, Early menarche: A systematic review of its effect on sexual and reproductive health in low- and middle-income countries, PLoS One sourceNot checked yet

  Not checked in the free run.

• cites [20] M. Sommer, 2013, Menarche: a missing indicator in population health from low-income countries, Public Health Rep sourceNot checked yet

  Not checked in the free run.

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

Facilitators were always the same sex as FGD or interview participants.

“Facilitators were always the same sex as FGD or interview participants.”

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

In some contexts, including in the Pacific, menstrual taboos and norms direct girls and women to avoid cooking or eating certain foods, and in some cases, to avoid bathing during menstruation.

“In some contexts, including in the Pacific, menstrual taboos and norms direct girls and women to avoid cooking or eating certain foods, and in some cases, to avoid bathing during menstruation [21].”

• cites [21] 2016, Menstrual Hygiene Management: Learning Brief from the Pacific Regional Learning EventNot checked yet

  Not checked in the free run.

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

Preliminary data analysis involved daily debriefing with the local research team.

“This involved daily debriefing with the local research team where detailed field notes from data collectors were discussed and emerging themes identified.”

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

Stigma and silence around menstruation can contribute to gender inequality that discriminates against women and girls throughout the lifecycle.

“Where this is the case, stigma and silence around menstruation can contribute to gender inequality that discriminates against women and girls throughout the lifecycle [13].”

• cites [13] Winkler. Taking the Bloody Linen out of the Closet–Menstrual Hygiene as a Priority for Achieving Gender Equality.Not checked yet

  Not checked in the free run.

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

Written parental consent and assent were obtained for schoolgirls; written informed consent was obtained from all other participants.

“The research team obtained written parental consent for all schoolgirls as well as assent from the girls themselves. Written informed consent was obtained from all other participants.”

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

The coding framework was tested and revised in collaboration with two members of the research team before being systematically applied line-by-line.

“The coding framework was tested and revised in collaboration with two members of the research team (CH for SI and Fiji; and YM for PNG) before the three authors (LN and CH for SI and Fiji; LN and YM for PNG) systematically applied the coding framework line-by-line using qualitative data management software NVivo 10 (QSR International) for PNG and Fiji, and manual coding for SI.”

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

FGDs and interviews were conducted in private locations to maximise confidentiality.

“The local research team undertook all FGDs and interviews in private locations to maximise confidentiality.”

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

All FGDs were sex-segregated to ensure participants felt comfortable to openly share.

“All FGDs were sex-segregated with efforts made to ensure homogeneity of socio-economic status, community hierarchy and age (although this was often difficult in practice) to ensure that all FGD participants felt comfortable to openly share his or her thoughts and opinions.”

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

Restrictions may include diminished mobility, seclusion, dietary restrictions, or being prevented from fully participating in community life.

“Restrictions may include diminished mobility, seclusion, dietary restrictions, or being prevented from fully participating in community life [10].”

• cites [10] Mahon Trs, 2015, Menstrual hygiene matters: Training guide for practitionersNot checked yet

  Not checked in the free run.

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

People in some settings believe that menstruation is dirty and that menstruating women are unclean.

“For example, people in some settings believe that menstruation is dirty and that menstruating women are unclean [2, 8, 9].”

• cites [2] 2015, Menstrual Hygiene Management in Indonesia: Understanding practices, determinants and impacts among adolescent school girls (Final report)Not checked yet

  Not checked in the free run.

• cites [8] R Ahmed, 2008, Menstrual hygiene: Breaking the silence, Menstrual hygiene: Breaking the silenceNot checked yet

  Not checked in the free run.

• cites [9] A Burrows, 2005, Girls' experiences of menarche and menstruation, Journal of Reproductive and Infant Psychology sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Women in workplaces face challenges managing menstruation at work, including lack of time or facilities to change MHM materials, humiliation and embarrassment, which may influence women's participation in the workforce.

“Women in workplaces also face a range of challenges managing menstruation at work, including lack of time or facilities to change MHM materials [28], humiliation and embarrassment [5], which may influence women’s participation in the workforce.”

• cites [28] Her+Project. Female Factory Workers’ Health Needs Assessment: Bangladesh. 2010.Not checked yet

  Not checked in the free run.

• cites [5] S House, 2012, Menstrual Hygiene Matters: a resource for improving menstrual hygiene around the worldNot checked yet

  Not checked in the free run.

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

Data were triangulated between relevant participant groups and across study sites and countries.

“Data were triangulated between relevant participant groups as well as across study sites and countries.”

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

Reduced workforce participation affects women's individual and household income, and has a demonstrated effect on country-level economic growth.

“Reduced workforce participation affects women’s individual and household income [28, 29], and has a demonstrated effect on country-level economic growth [30, 31].”

• cites [28] Her+Project. Female Factory Workers’ Health Needs Assessment: Bangladesh. 2010.Not checked yet

  Not checked in the free run.

• cites [29] 2013, Celebrating Womanhood: How better menstrual hygiene management is the path to better health, dignity and businessNot checked yet

  Not checked in the free run.

• cites [30] S Klasen, 2009, The impact of gender inequality in education and employment on economic growth: new evidence for a panel of countries, Feminist economics sourceNot checked yet

  Not checked in the free run.

• cites [31] 2012, Meeting of the OECD Council at Ministerial LevelNot checked yet

  Not checked in the free run.

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

Data collectors transcribed and translated audio recordings verbatim into English.

“Data collectors transcribed and translated audio recordings verbatim into English.”

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

Themes emerged from the data and were not preconceived prior to data collection.

“The themes explored in this paper emerged from the data and were not preconceived prior to data collection.”

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

In some cases such restrictions are perceived as positive by women and girls, for example providing welcome opportunities to rest and spend time with other women.

“and in some cases such restrictions are perceived as positive by women and girls, for example providing welcome opportunities to rest and spend time with other women [17].”

• cites [17] J. Hoskins, 2002, The menstrual hut and the witch's lair in two eastern Indonesian societies, Ethnology sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Prolonged periods of reduced participation and absenteeism can contribute to school drop-out and reduced educational attainment, with long-term consequences for economic and health outcomes.

“Prolonged periods of reduced participation and absenteeism can contribute to school drop-out and reduced educational attainment [12], with long-term consequences for economic and health outcomes [25–27].”

• cites [12] S. Tamiru, 2014, Girls in Control: Compiled Findings from Studies on Menstrual Hygiene Management of SchoolgirlsNot checked yet

  Not checked in the free run.

• cites [25] E Gakidou, 2010, Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis, The Lancet sourceNot checked yet

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• cites [26] GC Patton, 2016, Our future: a Lancet commission on adolescent health and wellbeing, The LancetNot checked yet

  Not checked in the free run.

• cites [27] UN Women, 2015, Progress of the World’s Women 2015–2016, ChapterNot checked yet

  Not checked in the free run.

May combine two claims.

Mobility restrictions, lack of facilities to manage menstrual bleeding at school, fear of leakage or staining clothes, and harassment by male students and teachers are demonstrated deterrents to girls attending school both globally and in the Pacific.

“Mobility restrictions, lack of facilities to manage menstrual bleeding at school, fear of leakage or staining clothes, and harassment by male students and teachers are demonstrated deterrents to girls attending school both globally [12, 22, 23] and in the Pacific [24].”

• cites [12] S. Tamiru, 2014, Girls in Control: Compiled Findings from Studies on Menstrual Hygiene Management of SchoolgirlsNot checked yet

  Not checked in the free run.

• cites [22] M. Sommer, 2010, Where the education system and women's bodies collide: The social and health impact of girls' experiences of menstruation and schooling in Tanzania, J Adolesc sourceNot checked yet

  Not checked in the free run.

• cites [23] 2013, Menstrual Hygiene in Schools in 2 countries of Francophone West AfricaNot checked yet

  Not checked in the free run.

• cites [24] Unicef, editor Solomon Islands: Incorporating MHM into national WASH in schools policies and guidelines. 4th MHM Virtual Conference, 22–23 October 2015; 2015.Not checked yet

  Not checked in the free run.

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

Where high levels of stigma and secrecy impede women and girls' ability to manage menstruation with dignity, their basic human rights are compromised.

“Where high levels of stigma and secrecy impede women and girls’ ability to manage their menstruation with dignity, their basic human rights are compromised [13].”

• cites [13] Winkler. Taking the Bloody Linen out of the Closet–Menstrual Hygiene as a Priority for Achieving Gender Equality.Not checked yet

  Not checked in the free run.

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

The number of FGDs and interviews was limited to two or at most three with each participant group in each country due to logistical and financial constraints.

“The number of FGDs and interviews was limited to two or at most three with each participant group in each country (one in each site) due to logistical and financial constraints.”

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

As seen in previous studies in PNG, restrictions on cooking, preparing food and performing household chores were common.

“As seen in previous studies in PNG, restrictions on cooking, preparing food and performing household chores were common [49].”

• cites [49] A Vallely, 2012, Intravaginal practices and microbicide acceptability in Papua New Guinea: implications for HIV prevention in a moderate-prevalence setting, BMC Res Notes sourceNot checked yet

  Not checked in the free run.

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

Not being able to hygienically dry reusable menstrual hygiene products in direct sunlight may increase risk of reproductive tract infections, although definitive evidence for this link is lacking.

“Not being able to hygienically dry reusable menstrual hygiene products in direct sunlight may increase the risk of reproductive tract infections, although definitive evidence for this link is lacking [16].”

• cites [16] C Sumpter, 2013, A systematic review of the health and social effects of menstrual hygiene management, PLoS One sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Some restrictions continue to impact on hygienic and effective management of MHM materials, consumption of specific foods, and in some cases participation in school, work and community life for women and girls.

“some restrictions continue to impact on hygienic and effective management of menstrual hygiene materials, consumption of specific foods and in some cases participation in school, work and community life for women and girls.”

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

Adolescent boys were not interviewed, so it was not possible to explore their perceptions regarding menstruation and menstruation-related teasing.

“Adolescent boys were not interviewed as part of this project, therefore it was not possible to further explore their perceptions regarding menstruation and menstruation-related teasing.”

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

A summary of findings was reviewed for accuracy by local researchers and shared with communities and stakeholders.

“The team leader (LN) produced a summary of findings that was reviewed for accuracy by the local researchers and shared with communities and stakeholders at the conclusion of the data collection in country.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Fijian women and girls may have been less likely to experience and report menstruation-related behavioural restrictions due to social and cultural changes and a move away from traditional lifestyles or cultural differences in perception between countries.

“Fijian women and girls may have been less likely to experience and report menstruation-related behavioural restrictions due to social and cultural changes and a move away from traditional lifestyles or simply cultural differences in the way menstruation is perceived between countries.”

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

A detailed report with findings and recommendations was shared at an in-country workshop for stakeholder and local researcher feedback.

“Once formal data analysis had been completed using the transcripts, LN shared a detailed report with findings and recommendations at an in-country workshop, affording an opportunity for key stakeholders and local researchers to provide feedback.”

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

A survey in Afghanistan found almost 70% of adolescent female research participants dried their menstrual cloths in the shade.

“a survey in Afghanistan found that almost 70% of adolescent female research participants dried their menstrual cloths in the shade [5].”

• cites [5] S House, 2012, Menstrual Hygiene Matters: a resource for improving menstrual hygiene around the worldNot checked yet

  Not checked in the free run.

May combine two claims.

Underlying attitudes and beliefs around menstruation contribute to behavioural restrictions among women and girls in PNG and SI, and to a lesser extent in Fiji.

“Our study found that underlying attitudes and beliefs around menstruation contribute to behavioural restrictions among women and girls in PNG and SI, and to a lesser extent in Fiji.”

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

Sample size (number of study sites and individual participants) reflects a pragmatic approach and need to balance strong research with financial realities of fieldwork.

“the sample size (both the number of study sites and individual participants) reflects a pragmatic approach and the need to balance strong research with the financial realities of undertaking fieldwork of this nature.”

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

There is limited evidence on quantitative and broader implications of inadequate MHM on participation in workforce and economic impact of reduced attendance at work; further research warranted.

“There is limited evidence on the quantitative and broader implications of inadequate MHM on participation in the workforce and the consequent economic impact of reduced attendance at work; further research into this area is warranted.”

May combine two claims.

This finding and the insinuation from men in urban PNG that women can only refuse sex when menstruating is suggestive of more systemic gender inequalities in this setting, including high levels of violence against women.

“This finding by Vallely et al. and the insinuation from men in urban PNG in our study that women can only refuse sex when menstruating is suggestive of more systemic gender inequalities in this setting, including high levels of violence against women.”

May combine two claims.

These restrictions may be positive and welcome, or negative and unwanted, depending on individual circumstances.

“These restrictions may be positive and welcome, or negative and unwanted, depending on individual circumstances.”

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

A study among schoolgirls in rural Kenya found harassment by boys and sometimes male teachers was common, adding to fear and shame.

“A study among schoolgirls in rural Kenya also found that harassment by boys–and in some cases male teachers–was common, adding to feelings of fear and shame [47].”

• cites [47] SA McMahon, 2011, '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 sourceNot checked yet

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

Schoolgirls in Ethiopia, Tanzania, South Sudan and Zimbabwe report being teased, humiliated and harassed by boys at school during menstruation.

“Schoolgirls in Ethiopia, Tanzania, South Sudan and Zimbabwe also report being teased, humiliated and harassed by boys at school during menstruation [12].”

• cites [12] S. Tamiru, 2014, Girls in Control: Compiled Findings from Studies on Menstrual Hygiene Management of SchoolgirlsNot checked yet

  Not checked in the free run.

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

Reusable, internal products such as menstrual cups have been shown to be acceptable in Nepal and could be considered for the Pacific.

“Reusable, internal products such as menstrual cups have been shown to be acceptable in Nepal and could be considered for the Pacific [55].”

• cites [55] E Oster, 2012, Determinants of Technology Adoption: Peer Effects in Menstrual Cup Take-Up, Journal of the European Economic Association sourceNot checked yet

  Not checked in the free run.

May combine two claims.

While women and girls may themselves decide to withdraw, it is underlying shame and stigma surrounding menstruation that prevents full participation, entrenching isolation and stigmatisation during menstruation.

“it is the underlying shame and stigma surrounding menstruation that prevents women and girls’ full participation, entrenching isolation and stigmatisation during menstruation.”

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

Bodily excretions such as menstrual blood are often considered unclean in Hindu faith, and comparable notions of menstrual impurity have been reported in some Christian communities.

“Bodily excretions such as menstrual blood are often considered unclean in Hindu faith, and comparable notions of menstrual ‘impurity’ have also been reported in some Christian communities [5].”

• cites [5] S House, 2012, Menstrual Hygiene Matters: a resource for improving menstrual hygiene around the worldNot checked yet

  Not checked in the free run.

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

Findings from a study in Eastern Indonesia suggest living separately from men while menstruating can be considered an important opportunity to spend time with other women and to rest.

“findings from a study in Eastern Indonesia suggest that living separately from men while menstruating can also be considered an important opportunity to spend time with other women and to rest [17].”

• cites [17] J. Hoskins, 2002, The menstrual hut and the witch's lair in two eastern Indonesian societies, Ethnology sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

The restrictive practices highlighted by this study vary in public health and individual importance.

“The restrictive practices highlighted by this study vary in public health and individual importance”

May combine two claims.

Available evidence suggests correlation between poor MHM and school absenteeism, but robust data on effectiveness of MHM interventions on attendance are lacking.

“The available evidence suggests a correlation between poor MHM and school absenteeism, however robust data on the effectiveness of MHM interventions on attendance at school are lacking [51–53].”

• cites [51] M Alam, 2017, Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey, BMJ Open sourceNot checked yet

  Not checked in the free run.

• cites [52] E Oster, 2011, Menstruation, sanitary products, and school attendance: Evidence from a randomized evaluation, American Economic Journal: Applied EconomicsNot checked yet

  Not checked in the free run.

• cites [53] J Hennegan, 2016, 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 sourceNot checked yet

  Not checked in the free run.

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

As a qualitative study, results should be considered in context and not interpreted as representative of the population as a whole.

“As a qualitative study, the results should be considered in context and not interpreted as being representative of the population as a whole.”

May combine two claims.

Some restrictions (such as avoidance of iron or protein rich foods) may have a negative impact on physical health; some (such as restrictions on participation in religious events) may impact mental health or social inclusion, while other restrictions may be more benign in their impact (such as restrictions on combing hair); however all restrictions contribute to perceptions of women and girls as '

“some restrictions (such as avoidance of iron or protein rich foods) may have a negative impact on physical health; some (such as restrictions on participation in religious events) may impact mental health or social inclusion, while other restrictions may be more benign in their impact (such as restrictions on combing hair); however all restrictions contribute to perceptions of women and girls as ‘”

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

Literature from other disciplines suggests stigma can have a significant detrimental impact on lives of individuals and if not adequately addressed can impede effectiveness of programmatic solutions.

“literature from other disciplines suggests that stigma can have a significant detrimental impact on the lives of individuals and if not adequately addressed can impede the effectiveness of programmatic solutions [50].”

• cites [50] AP Mahajan, 2008, Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward, AIDS sourceNot checked yet

  Not checked in the free run.

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

There is a degree of sampling bias associated with convenience sampling which could have impacted on participants' responses, potentially by exacerbating social desirability bias or alternatively by increasing honesty and openness due to existing relationships with local research organisations.

“There is also a degree of sampling bias associated with convenience sampling which could have impacted on participants’ responses to our questions, potentially by exacerbating social desirability bias or alternatively by increasing the honesty and openness with which participants responded, due to the existing relationships with local research organisations.”

May combine two claims.

Research only took place in two sites in each country, and cultural and ethnic diversity, differing expressions of gender inequality and vast geographic spread should be acknowledged when interpreting findings.

“This research only took place in two sites in each country, and the cultural and ethnic diversity, differing expressions of gender inequality and the vast geographic spread of communities should be acknowledged when interpreting the findings.”

May combine two claims.

Not being able to fully participate in church activities in a context where religion is important impedes women's ability to participate fully in cultural and community life and reinforces adverse gender norms in which women are perceived as lesser.

“Not being able to fully participate in church activities in a context where religion is an important part of everyday life impedes women’s ability to participate fully in cultural and community life and reinforces adverse gender norms in which women are perceived as lesser.”

May combine two claims.

Particularly in rural PNG and SI, lack of water and sanitation facilities meeting needs of menstruating women and poor access to good quality sanitary products also reduced work attendance and meaningful participation.

“Particularly in rural PNG and SI, a lack of water and sanitation facilities that meet the needs of menstruating women and poor access to good quality sanitary products also reduced work attendance and meaningful participation.”

May combine two claims.

While some restrictions may be desirable or self-imposed, others are unwanted and detrimental to health and wellbeing of individuals and communities.

“While some restrictions may be desirable or self-imposed, others are unwanted and detrimental to the health and wellbeing of individuals and communities.”

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

Not able to include all key stakeholder groups; in particular adolescent boys' voices are missing from the narrative.

“we were not able to include all key stakeholder groups in this research project; in particular adolescent boys’ voices are missing from the narrative.”

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

Broad age range in some FGDs may have impacted on participants' desire to openly respond to questions, particularly for younger girls or women.

“the broad age range in some FGDs may have impacted on participants’ desire to openly respond to questions, particularly for the younger girls or women.”

May combine two claims.

Negative impacts of restrictive practices include exacerbation of shame and stigmatization, prevention from participating in religious activities, and potentially absenteeism from work and school.

“The negative impacts of restrictive practices include exacerbation of shame and stigmatization, prevention from participating in religious activities, and potentially absenteeism from work and school.”

May combine two claims.

These restrictions impact on ability to manage menstruation effectively and with dignity, and fully participate in school, work and broader community life.

“These restrictions impact on their ability to manage menstruation effectively and with dignity, and fully participate in school, work and broader community life.”

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

Due to specific nature of research aims, limited in ability to comprehensively explore all menstruation-related cultural and social norms and taboos.

“Due to the specific nature of the research aims, we were limited in our ability to comprehensively explore all menstruation-related cultural and social norms and taboos.”