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Cited by 111Menstrual Health and DisordersGender Studies and Social IssuesHypothalamic control of reproductive hormones

’It’s like a burden on the head’: Redefining adequate menstrual hygiene management throughout women’s varied life stages in Odisha, India.

Open access
MacRae, Elizabeth R., Clasen, Thomas, Dasmohapatra, Munmun, Caruso, Bethany A.·2019·PLOS ONE
DOI 10.1371/journal.pone.0220114PMC PMC6675075
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Abstract

There has been growing recognition of menstrual hygiene management (MHM) as a significant public health issue. However, research has predominately focused on the experiences of adolescent girls in school settings. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India at various life stages with a view toward improving international monitoring of MHM. Focus group discussions and in-depth interviews were conducted to understand women's experiences of menstruation across four life stages (unmarried women, recently married women, married women, and older women). Thematic analysis was used to identify menstruation-related challenges and needs. We found women voiced needs that aligned with those captured by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) definition for MHM: access to clean materials, privacy for changing materials, soap and water for bathing, and disposal facilities for materials. However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible. Additionally, we identified needs that extend beyond the existing definition: pain management, social support, and an enabling sociocultural environment. Overall, women representing all life stages discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials. Cloth management challenges were most acute for unmarried and recently married women, who were concerned that practices could reveal their menstrual status and harm their reputations, thus informing their preference for disposable materials, if attainable. We propose a revised definition of adequate MHM for this population that more comprehensively captures their needs. This definition may also prove useful for other populations, future research, creating measures of assessment, and guiding interventions and program priorities.

AI snapshot

Written from the paper’s full text.

TL;DR

This qualitative study in rural Odisha, India, finds women across life stages face the menstrual hygiene management (MHM) challenges captured by the WHO/UNICEF JMP definition, but also need comfortable and reliable materials, broader privacy, private and safe disposal, pain management, social support, and an enabling sociocultural environment. The authors propose a revised, expanded definition of adequate MHM for this population.

Key findings

  • Women’s needs aligned with the JMP definition—clean materials, privacy for changing, soap and water for bathing, and disposal facilities—but extended beyond it: materials needed to be comfortable and reliable; soap and water were needed for washing clothing, bedding, and materials and for managing urination/defecation; privacy was needed for bathing, washing, drying, storing, disposing, urination, and defecation; disposal needed to be private and safe; and pain management, social support, and an enabling sociocultural environment were additional needs.
  • Cloth use was common: 54% of FLI and 54% of FGD participants used cloth; exclusive cloth use was reported by 68% of married women in FLIs and 87% in FGDs, and by 94% of older women in FLIs and 100% in FGDs. A mix of cloth and pads was most common among unmarried women (63% FLIs, 52% FGDs) and recently married women (67% FLIs), while exclusive pad use was a minority (13% FLIs, 18% FGDs).
  • Among menstruating women with latrines, 66% of FLI and 100% of FGD participants claimed to use latrines during menstruation, but activity-specific use was low: 94% of FLI and 62% of FGD participants never used latrines for urination; 94% of FLIs and 95% of FGDs never for bathing; 79% of FLIs and 63% of FGDs never for cleaning; and 80% of FLIs and 71% of FGDs never for changing materials.
  • Cloth management challenges were most acute for unmarried and recently married women, who worried that practices could reveal their menstrual status and harm their reputations, informing a preference for disposable pads if attainable. Women in all life stages discussed bathing, pain, and washing, drying, and storing cloth, and older women no longer menstruating still reported these issues as persistent.

Methods

  • Qualitative study conducted in 12 rural Odisha communities in March–April 2014 as part of a broader sanitation study; participants were over age 18 and purposively sampled by life stage: unmarried women, recently married women (past 3 years), married women (over 3 years), and older women (over 49).
  • Data included 68 of 69 free-list interviews (16 unmarried, 12 recently married, 22 married, 18 older) and 8 focus group discussions with 46 participants (23 unmarried, 16 married, 7 older; recently married women did not participate in FGDs because family members did not give permission). FLIs were conducted in 8 communities and FGDs in 4; a brief demographic and menstruation survey preceded each.
  • Interviews and FGDs were recorded, translated and transcribed into English, managed and coded in MAXQDA with a deductive and inductive codebook, and analyzed using thematic analysis by life stage; results were presented using the JMP MHM framework, and a revised definition and conceptual framework were proposed.

Limitations

  • The paper states that the study engaged rural women in Odisha exclusively, so findings are limited to this population; it did not intentionally sample castes equally or include specific caste questions; recently married women did not participate in FGDs, though 12 were interviewed in FLIs; FGDs had mixed-caste groups, which may have affected openness; not all caste categories were represented for each life stage; and adolescent girls were not included.
  • The paper also states that older women were no longer menstruating and provided retrospective insights, and that the research could not compare adolescent girls’ experiences with those of the women studied.
  • Evident from the text: the design is cross-sectional and qualitative, relying on self-reported experiences of a sensitive topic, which may invite social desirability bias; no quantitative measures or causal inferences are made, and findings may not generalize beyond this population and context.

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

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0220114

Cites

60 of 60 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 165 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Women in rural Odisha require soap and water for more than bathing.

    “However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible.”
    Quote in the paperSubstantial claim
  • Findingown data

    Unmarried and recently married women in rural Odisha were concerned that cloth management practices could reveal their menstrual status and harm their reputations.

    “Cloth management challenges were most acute for unmarried and recently married women, who were concerned that practices could reveal their menstrual status and harm their reputations, thus informing their preference for disposable materials, if attainable.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The four life stage categories (unmarried, recently married, married, older) capture diversity of MHM experience.
  • Findingown data

    Women in rural Odisha require menstrual materials that are not only clean but also comfortable and reliable.

    “However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible.”
    Quote in the paperSubstantial claim
  • Findingown data

    Women in rural Odisha have a need for pain management that extends beyond the existing JMP definition for MHM.

    “Additionally, we identified needs that extend beyond the existing definition: pain management, social support, and an enabling sociocultural environment.”
    Quote in the paperSubstantial claim
  • Findingown data

    Women in rural Odisha require disposal facilities that are private and safe, not just accessible.

    “However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible.”
    Quote in the paperSubstantial claim
  • The quote only partly states this claim. 2
  • May combine two claims. 68
  • Classified as probably not a substantial claim. 53

  • The quote only partly states this claim.

    Findingown data

    Women representing all life stages in rural Odisha discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials.

    “Overall, women representing all life stages discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The four life stage categories (unmarried, recently married, married, older) capture diversity of MHM experience.

  • The quote only partly states this claim.

    Findingown data

    Cloth management challenges were most acute for unmarried and recently married women in rural Odisha.

    “Cloth management challenges were most acute for unmarried and recently married women, who were concerned that practices could reveal their menstrual status and harm their reputations, thus informing their preference for disposable materials, if attainable.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The four life stage categories (unmarried, recently married, married, older) capture diversity of MHM experience.

  • May combine two claims.

    Findingown data

    Women needed others to retrieve water for them because they were not allowed to touch water during menstruation due to contamination perceptions.

    “Women needed others to retrieve water for them; they were not allowed to touch water given perceptions that doing so during this state would contaminate the water source.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Materials impacted women's management of other needs, frustrating the processes of urinating and defecating.

    “Materials impacted women’s management of other needs, frustrating the processes of urinating and defecating.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Women's material use varied by life stage, but the manner in which they used their latrines during menstruation was fairly uniform.

    “Specifically, women’s material use varied by life stage, but the manner in which they used their latrines during menstruation was fairly uniform.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The four life stage categories (unmarried, recently married, married, older) capture diversity of MHM experience.

  • May combine two claims.

    Findingown data

    Women perceived harms connected to their lack of privacy for disposal and took specific steps to mitigate those harms.

    “Beyond the absence of specific disposal facilities, women perceived harms connected to their lack of privacy for disposal and took specific steps to mitigate those harms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Seasons further complicated private drying practices, with monsoons making drying difficult and summers allowing quick drying.

    “Seasons further complicated private drying practices. Women found drying cloth during the summers to be quick, allowing for more regular washing, but were concerned about drying materials during monsoons. Cloth would not dry if outside in the rain, protected places to dry cloth were limited, and cloth could become dirty again due to weather conditions:”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Sixty-nine percent of FLI participants and 80% of FGD participants were still experiencing monthly menstruation at the time of the study.

    “Sixty-nine percent of FLI participants and 80% of FGD participants were still experiencing monthly menstruation at the time of the study (Table 2)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The use of pads depended on availability and accessibility, as many women could not purchase pads due to markets being far or household economic restrictions.

    “The use of pads depended on availability and accessibility, as many women could not purchase pads, due to markets being as far as 5–6 kilometers away, or had household level economic restrictions:”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Women understood that drying cloth in the sunlight could prevent germs from developing on the cloth that may result in infection, yet the need to hide cloths prevented this practice.

    “Women understood that drying cloth in the sunlight could prevent germs from developing on the cloth that may result in infection, yet the need to hide cloths prevented this practice.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Some women mentioned challenges accessing soap, including absence of soap and financial restrictions.

    “A few women mentioned challenges accessing soap: one MW reflected on the absence of soap during menstruation and three other women (one RMW, two MW) expressed financial restrictions related to buying soap.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All groups expressed concerns about washing, drying, and storing cloth used for menstruation, along with managing bathing practices during menstruation.

    “All groups expressed concerns about washing, drying, and storing cloth used for menstruation, along with managing bathing practices during menstruation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Women generally felt cloth was problematic to clean, dry, and store, and wanted to use pads instead.

    “Generally, women felt cloth was problematic to clean, dry, and store, and wanted to use pads instead, which could be disposed of after use.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Exclusive use of disposable pads was reported by only a minority of participants (13% in FLIs, 18% in FGDs), most often by unmarried (13% in FLIs, 35% in FGDs) and recently married (25% in FLIs) women.

    “Exclusive use of disposable pads was reported by only a minority of participants (13% in FLIs, 18% in FGDs), most often by unmarried (13% in FLIs, 35% in FGDs) and recently married (25% in FLIs) women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Women worried cloth would change positions, fall out of their underwear, or become saturated while moving or sleeping, causing stains on clothes and bedding.

    “Women worried cloth would change positions, fall out of their underwear, or become saturated while moving or sleeping, causing stains on clothes and bedding.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Beyond the need for privacy to change materials, women articulated the desire for privacy for bathing, washing, drying, storing, and disposing of materials, urination, and defecation.

    “Beyond the need for privacy to change materials, women articulated the desire for privacy for bathing, washing, drying, storing, and disposing of materials, urination, and defecation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Overall, 54% of women in FLIs and 54% of women in FGDs indicated that they used cloth for managing menstruation.

    “Overall, according to the pre-qualitative survey, 54% of women in FLIs and 54% of women in FGDs indicated that they used cloth for managing menstruation”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Women wanted to hide their cloth from men to prevent shame and felt they may be using dirty, germ-infested locations.

    “Women wanted to hide their cloth from men to prevent shame and, in doing so, felt they may be using dirty, germ-infested locations:”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Women in this study had many questions about the menstrual cycle and worried that something might be wrong with their bodies.

    “Women in this study had many questions about the menstrual cycle. They sought clarity about pain and menstrual irregularity and worried that something might be wrong with their bodies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Unmarried women (UMW) and recently married women (RWM) preferred pads more than married women (MW) and older women (OW), due to challenges with cleaning, drying, and storing reusable cloth.

    “Concerns about access to materials were primarily expressed by UMW and RWM as they, more than MW and OW, preferred pads. Much of this preference stemmed from challenges related to cleaning, drying, and storing reusable cloth.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Women in this study did not report accessing specific facilities for disposal of menstrual materials; they disposed of materials in various places outside the home.

    “Women in this study did not report accessing specific facilities for disposal. Rather, they disposed of their menstrual materials in a variety of places outside of the home and in the surrounding environment, including the pond, river, jungle, or buried in the ground.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Women worried cloth would become dirty between periods and used practices for storing and assuring cloth cleanliness before use.

    “Women also worried cloth would become dirty between periods and came up with practices for storing and assuring cloth cleanliness before use:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Recently married women (RMW) faced specific barriers to pad access, including mobility restrictions and moving to a new village that did not sell pads.

    “RMW faced specific barriers to pad access. Due to mobility restrictions, one RMW depended on others to purchase pads and because she felt embarrassed to request them, she used cloth available at the house. Another RMW had to switch to using cloths after marriage because she moved to a new village that did not sell pads.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    None of the older women (over age 49) were still experiencing menstruation, but they still provided insights about their experiences when they were menstruating.

    “However none of the older women (over age 49) were still experiencing menstruation, but still provided insights about their experiences when they were menstruating.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All unmarried and recently married participants, and the majority of women married over three years (86% in FLIs, 88% in FGDs), were still experiencing monthly menstruation.

    “this included all participants who were unmarried and recently married, and the majority of women married over three years (86% in FLIs, 88% in FGDs).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Some women expressed how menstrual pain negatively affected their ability to complete regular household tasks, maintain healthy behaviors, move normally, and care for their children, resulting in stress.

    “Some women expressed how this pain negatively affected their ability to complete regular household tasks (e.g., cook, harvest crops), maintain healthy behaviors such as eating and sleeping, move normally (e.g., ride a bike), and care for their children, which could further result in “tension” or stress:”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Women in Odisha were specifically concerned about the reliability of materials to prevent leaks and stains, the comfort or lack thereof that they may experience, and compatibility of their materials with other daily needs, including mobility, work, urination, and defecation.

    “Women in Odisha were specifically concerned about the reliability of materials to prevent leaks and stains, the comfort or lack thereof that they may experience, and compatibility of their materials with other daily needs, including mobility, work, urination, and defecation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Women experienced discomfort using cloth, including smell, thickness, and heaviness, making sitting and standing difficult.

    “Women experienced discomfort using a cloth–it smelled and felt thick and heavy in their underwear–making sitting and standing difficult.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Women of all life stages required the support and physical assistance of others during menstruation, which is not accounted for in the JMP definition.

    “Women of all life stages required the support and physical assistance of others during menstruation, which is not accounted for in the JMP definition:”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Women were restricted from participating in puja during menstruation and needed others to perform it on their behalf.

    “Additionally, women were restricted from participating in puja, daily rituals in the home performed by women, during menstruation and needed others to perform it on their behalf:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Women were restricted from entering the kitchen, preparing food, and touching utensils while menstruating, so others completed this work.

    “Women were restricted from entering the kitchen, preparing food, and touching utensils while menstruating, so others in the household completed this work.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Unmarried and recently married women in this population face social and financial restrictions to acquiring pads, requiring them to seek support to get materials they want.

    “Unmarried and recently married women in this population face social and financial restrictions to acquiring pads, requiring them to seek support to get materials they want.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Women provided detailed accounts of physical pain during menstruation, including both menstrual pain and the previously noted pain from uncomfortable materials, which affected women's ability to move, work, and eat normally.

    “Women provided detailed accounts of physical pain during menstruation, including both menstrual pain and the previously noted pain from uncomfortable materials, which affected women’s ability to move, work, and eat normally.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Our findings present another dimension of inadequate information about menstruation, specifically regarding irregularity and menstrual pain, both of which led to fear and worry for women in this study that something was wrong with their bodies.

    “However, our findings present another dimension of inadequate information about menstruation, specifically regarding irregularity and menstrual pain, both of which led to fear and worry for women in this study that something was wrong with their bodies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Women in this study experienced a range of restrictions during menstruation and relied on others to manage their household and menstruation-related obligations.

    “Women in this study experienced a range of restrictions during menstruation and relied on others to manage their household and menstruation-related obligations.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The revised definition of adequate MHM proposed for this population more comprehensively captures their needs than the existing JMP definition.

    “We propose a revised definition of adequate MHM for this population that more comprehensively captures their needs.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The four life stage categories (unmarried, recently married, married, older) capture diversity of MHM experience.
    • Rests on an assumption: The JMP definition is a valid benchmark for assessing MHM needs in this population.

  • May combine two claims.

    Premisecitation

    Structural challenges to MHM include inadequate provision of clean water and soap, sanitation infrastructure, private places to clean and change, and disposal facilities.

    “Structural challenges include inadequate provision of clean water and soap, sanitation infrastructure, private places to clean and change, and disposal facilities [7, 8, 11–22].”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [7] M Sommer, 2013, Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls, Am J Public Health source

      Not checked in the free run.

    • cites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source

      Not checked in the free run.

    • cites [11] M Sommer, 2015, Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue, Am J Public Health source

      Not checked in the free run.

    • cites [12] M Sommer, 2014, A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia, Compare: A Journal of Comparative and International Education source

      Not checked in the free run.

    • cites [13] J Haver, 2013, WASH in Schools Empowers Girls' Education in Masbate Province and Metro Manila, Philippines An Assessment of Menstrual Hygiene Management in Schools, WASH in Schools Empowers Girls' Education in Masbate Province and Metro Manila, Philippines An Assessment of Menstrual Hygiene Management in Schools

      Not checked in the free run.

    • cites [14] LC Loughnan, 2016, What can existing data on water and sanitation tell us about menstrual hygiene management?, Waterlines source

      Not checked in the free run.

    • cites [15] UNICEF. WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference. 2014.

      Not checked in the free run.

    • cites [16] UNICEF. WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference. 2012.

      Not checked in the free run.

    • cites [17] UNICEF. WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference. 2013.

      Not checked in the free run.

    • cites [18] UNICEF. WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference. 2015.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Experiencing menstruation without proper structural environments, resources, information, and support may negatively impact women and girls' sense of agency, self-esteem, confidence, bodily autonomy, educational experiences, and participation, and may influence negative health outcomes associated with risky sexual behaviors.

    “Experiencing menstruation without proper structural environments, resources, information, and support may impact women and girls’ sense of agency, self-esteem, confidence, bodily autonomy, educational experiences, and influence participation in and negative health outcomes associated with risky sexual behaviors [1–10].”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [1] PA Phillips-Howard, 2016, Menstrual hygiene management among adolescent schoolgirls in low- and middle-income countries: research priorities, Global health action source

      Not checked in the free run.

    • cites [2] M Sommer, 2015, Putting menarche and girls into the global population health agenda, Reproductive health source

      Not checked in the free run.

    • cites [3] MU Alam, 2017, Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey, BMJ open source

      Not checked in the free run.

    • cites [4] BA Caruso, 2013, WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An assessment of menstrual hygiene management in schools

      Not checked in the free run.

    • cites [5] JL Long, 2015, Developing games as a qualitative method for researching menstrual hygiene management in rural Bolivia, Waterlines source

      Not checked in the free run.

    • cites [6] T Mahon, 2010, Menstrual hygiene in South Asia: a neglected issue for WASH (water, sanitation and hygiene) programmes, Gender & Development source

      Not checked in the free run.

    • cites [7] M Sommer, 2013, Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls, Am J Public Health source

      Not checked in the free run.

    • cites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source

      Not checked in the free run.

    • cites [9] PA Phillips-Howard, 2015, Menstrual Needs and Associations with Sexual and Reproductive Risks in Rural Kenyan Females: A Cross-Sectional Behavioral Survey Linked with HIV Prevalence, Journal of Women’s Health source

      Not checked in the free run.

    • cites [10] PA Phillips-Howard, 2016, Menstrual cups and sanitary pads to reduce school attrition, and sexually transmitted and reproductive tract infections: a cluster randomised controlled feasibility study in rural Western Kenya, BMJ open source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The taboo and stigma around menstruation can lead to secrecy, shame, decreased mobility, social and religious restrictions, and impacts on confidence and self-efficacy.

    “Further, the taboo and stigma around menstruation can lead to secrecy, shame, decreased mobility, social and religious restrictions, and impacts on confidence and self-efficacy [2, 11, 21, 26, 34, 35].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [2] M Sommer, 2015, Putting menarche and girls into the global population health agenda, Reproductive health source

      Not checked in the free run.

    • cites [11] M Sommer, 2015, Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue, Am J Public Health source

      Not checked in the free run.

    • cites [21] L Mason, 2013, 'We keep it secret so no one should know'—a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya, PLoS One source

      Not checked in the free run.

    • cites [26] 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 source

      Not checked in the free run.

    • cites [34] E Wilson, 2018, Dismantling menstrual taboos to overcome gender inequality, The Lancet Child & Adolescent Health source

      Not checked in the free run.

    • cites [35] M Crawford, 2014, This is a natural process’: managing menstrual stigma in Nepal, Culture, Health & Sexuality source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Women and girls face information and social support challenges: girls are often unprepared, uninformed, misinformed, and lack adequate support for understanding and managing menarche, menstruation, and puberty, resulting in fear, uncertainty, and potentially harmful behaviors.

    “In addition to these structural and resource barriers, women and girls face information and social support challenges: girls are often unprepared, uninformed, misinformed, and lack adequate support for understanding and managing menarche, menstruation, and puberty, resulting in fear, uncertainty, and potentially harmful behaviors, like risky sex, reduced bathing, and limited food and water intake”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [1] PA Phillips-Howard, 2016, Menstrual hygiene management among adolescent schoolgirls in low- and middle-income countries: research priorities, Global health action source

      Not checked in the free run.

    • cites [2] M Sommer, 2015, Putting menarche and girls into the global population health agenda, Reproductive health source

      Not checked in the free run.

    • cites [7] M Sommer, 2013, Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls, Am J Public Health source

      Not checked in the free run.

    • cites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source

      Not checked in the free run.

    • cites [11] M Sommer, 2015, Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue, Am J Public Health source

      Not checked in the free run.

    • cites [12] M Sommer, 2014, A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia, Compare: A Journal of Comparative and International Education source

      Not checked in the free run.

    • cites [21] L Mason, 2013, 'We keep it secret so no one should know'—a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya, PLoS One source

      Not checked in the free run.

    • cites [23] MA Farage, 2011, Cultural aspects of menstruation and menstrual hygiene in adolescents, Expert Rev Obstet Gynecol source

      Not checked in the free run.

    • cites [24] A Khanna, 2005, Menstrual Practices and Reproductive Problems:A Study of Adolescent Girls in Rajasthan, Journal of Health Management source

      Not checked in the free run.

    • cites [26] 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 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Much of the literature on MHM centers on education and barriers for girls in school settings, in particular how the experience of menstruation in unsupportive environments can result in poor educational and social outcomes.

    “As a result, much of the literature on MHM centers on education and barriers for girls in school settings, in particular how the experience of menstruation in unsupportive environments can result in poor educational and social outcomes [11, 31, 32].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [11] M Sommer, 2015, Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue, Am J Public Health source

      Not checked in the free run.

    • cites [31] 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 source

      Not checked in the free run.

    • cites [32] M Sommer, 2016, A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools, PLoS Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Studies in India, and Odisha specifically, have explored women's MHM challenges beyond adolescence, but have focused primarily on issues related to WASH conditions.

    “Studies in India, and Odisha specifically, have explored women’s MHM challenges beyond adolescence, but have focused primarily on issues related to water, sanitation, and hygiene (WASH) conditions, including sanitation insecurity, experiences with sanitation-related psychosocial stress, and reproductive tract infections [19, 28, 44–46].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [19] BA Caruso, 2017, Understanding and defining sanitation insecurity: women's gendered experiences of urination, defecation and menstruation in rural Odisha, India, BMJ global health source

      Not checked in the free run.

    • cites [28] P Das, 2015, Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India, PLoS One source

      Not checked in the free run.

    • cites [44] KR Hulland, 2015, Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India, PLoS One source

      Not checked in the free run.

    • cites [45] KC Sahoo, 2015, Sanitation-related psychosocial stress: A grounded theory study of women across the life-course in Odisha, India, Soc Sci Med source

      Not checked in the free run.

    • cites [46] BA Caruso, 2017, Assessing Women's Negative Sanitation Experiences and Concerns: The Development of a Novel Sanitation Insecurity Measure, Int J Environ Res Public Health source

      Not checked in the free run.

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

    Premisecitation

    According to a systematic review, only half of girls in India reported being informed about menstruation prior to menarche and a quarter of girls reported missing school during menstruation.

    “According to a systematic review, only half of girls in India reported being informed about menstruation prior to menarche and a quarter of girls reported missing school during menstruation [8].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Women were purposively sampled for variation in life stage: unmarried women living with parents, recently married women (past 3 years), married women over 3 years, and women older than 49 years.

    “Women were purposively sampled for variation in life stage: (1) unmarried women (UMW) living with their parents, (2) women who had recently (past 3 years) married (RMW), (3) women married (MW) over 3 years, and (4) women older than 49 years (OW).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The four life stage categories (unmarried, recently married, married, older) capture diversity of MHM experience.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Communities were purposively selected for variation by previous intervention status, toilet coverage, water access, and geographic conditions.

    “Communities were purposively selected for variation by previous intervention status, toilet coverage, water access, and geographic conditions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Menstruation concerns extend beyond adolescence and WASH.

    “Yet, menstruation concerns extend beyond adolescence and WASH.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [45] KC Sahoo, 2015, Sanitation-related psychosocial stress: A grounded theory study of women across the life-course in Odisha, India, Soc Sci Med source

      Not checked in the free run.

    • cites [46] BA Caruso, 2017, Assessing Women's Negative Sanitation Experiences and Concerns: The Development of a Novel Sanitation Insecurity Measure, Int J Environ Res Public Health source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Inadequate facilities in schools for water, sanitation, private changing, and disposal, and gendered and unsupportive school environments can lead to school absenteeism and potential disruptions in academic engagement and progress.

    “Inadequate facilities in schools for water, sanitation, private changing, and disposal, and gendered and unsupportive school environments can lead to school absenteeism and potential disruptions in academic engagement and progress [2–8, 11–13, 15–18, 21, 26, 30, 36, 37].”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [2] M Sommer, 2015, Putting menarche and girls into the global population health agenda, Reproductive health source

      Not checked in the free run.

    • cites [3] MU Alam, 2017, Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey, BMJ open source

      Not checked in the free run.

    • cites [4] BA Caruso, 2013, WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An assessment of menstrual hygiene management in schools

      Not checked in the free run.

    • cites [5] JL Long, 2015, Developing games as a qualitative method for researching menstrual hygiene management in rural Bolivia, Waterlines source

      Not checked in the free run.

    • cites [6] T Mahon, 2010, Menstrual hygiene in South Asia: a neglected issue for WASH (water, sanitation and hygiene) programmes, Gender & Development source

      Not checked in the free run.

    • cites [7] M Sommer, 2013, Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls, Am J Public Health source

      Not checked in the free run.

    • cites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source

      Not checked in the free run.

    • cites [11] M Sommer, 2015, Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue, Am J Public Health source

      Not checked in the free run.

    • cites [12] M Sommer, 2014, A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia, Compare: A Journal of Comparative and International Education source

      Not checked in the free run.

    • cites [13] J Haver, 2013, WASH in Schools Empowers Girls' Education in Masbate Province and Metro Manila, Philippines An Assessment of Menstrual Hygiene Management in Schools, WASH in Schools Empowers Girls' Education in Masbate Province and Metro Manila, Philippines An Assessment of Menstrual Hygiene Management in Schools

      Not checked in the free run.

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

    Premisecitation

    Improper cleaning and drying of reusable menstrual materials may potentially lead to infection, although more research is needed to substantiate this connection.

    “the improper cleaning and drying of these materials for reuse may potentially lead to infection, although more research is needed to substantiate this connection [27–29].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [27] KK Baker, 2017, From menarche to menopause: A population-based assessment of water, sanitation, and hygiene risk factors for reproductive tract infection symptoms over life stages in rural girls and women in India, PLoS One source

      Not checked in the free run.

    • cites [28] P Das, 2015, Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India, PLoS One source

      Not checked in the free run.

    • cites [29] C Sumpter, 2013, A systematic review of the health and social effects of menstrual hygiene management, PLoS One source

      Not checked in the free run.

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

    Study design and conductown data

    Data from 68 of 69 FLIs and 8 FGDs were included in the analysis.

    “Data from 68 of 69 FLIs (16 UMW, 12 RMW, 22 MW, 18 OW) and 8 FGDs (each group had 5 to 7 participants; 23 UMW, 16 MW, 7 OW) were included in the analysis.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    One interview with an older woman was excluded because she did not complete the portion of the interview related to menstruation.

    “One interview with an OW was excluded because she did not complete the portion of the interview related to menstruation because she needed to attend to a domestic matter.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    Oral consent was approved because it was anticipated that not all women in the communities engaged would be literate and asking them to sign a document they are not able to read could instigate feelings of vulnerability.

    “Oral consent was approved as it was anticipated that not all women in the communities engaged would be literate and asking them to sign a document they are not able to read could instigate feelings of vulnerability.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationown data

    The JMP definition lacks consideration for how reliable, comfortable, or compatible menstrual materials should be with women's lives, or if they should be accessible.

    “While the JMP definition indicates that materials should collect and absorb blood, there is no consideration for how reliable, comfortable, or compatible these materials should be with women’s lives, or even if they be accessible.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The Emory University Institutional Review Board and KIIT University Ethics Review Committee approved study protocols.

    “The Emory University Institutional Review Board (Atlanta, Georgia, USA; IRB00072840) and KIIT University Ethics Review Committee (Bhubaneswar, India; KIMS/KIIT/IEC/795/2014) approved study protocols.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    FGD participants were 18 to 70 years old, 98% were Hindu, 98% had at least some primary education, 70% had water within their household compound, and 59% had a toilet within their household compound.

    “FGD participants were 18 to 70 years old, 98% were Hindu, 98% had at least some primary education, 70% had water within their household compound, and 59% had a toilet within their household compound (Table 1).”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    FLIs were conducted in eight communities and FGDs in four different communities (12 total) to enable new voices and opinions to be represented in the data.

    “FLIs were conducted in eight communities and FGDs were conducted in four different communities (12 total) to enable new voices and opinions to be represented in the data.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    Women provided oral consent prior to participation.

    “Women provided oral consent prior to participation.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationown data

    Concerns surrounding physical pain and the need for social support were expressed by women in this study and are additions to the definition for adequate MHM.

    “Concerns surrounding physical pain and the need for social support were expressed by women in this study and are presented below as additions to the definition for adequate MHM.”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    A minimum of 64 one-on-one interviews, with two women of each life stage per community, was targeted due to the recommendation of 30 interviews for free-listing data collection as well as the variability in the sample.

    “A minimum of 64 one-on-one interviews, with two women of each life stage per community, was targeted due to the recommendation of 30 interviews for free-listing data collection as well as the variability in the sample [54].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] SP Borgatti, 1999, Elicitation techniques for cultural domain analysis Enhanced ethnographic methods: audiovisual techniques, focused group interviews, and elicitation techniques ethnographer toolkit, Elicitation techniques for cultural domain analysis Enhanced ethnographic methods: audiovisual techniques, focused group interviews, and elicitation techniques ethnographer toolkit

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationown data

    The JMP definition does not address pain and discomfort during menstruation.

    “The JMP definition does not address pain and discomfort during menstruation, however a general sense of discomfort was frequently expressed by women in this study.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    A total of eight FGDs were held throughout four communities: four for UMW and four for ever-married women, with 5-7 participants each to allow them to comfortably share on the sensitive topic.

    “A total of eight FGDs were held throughout four communities: four for UMW and four for women who were ever-married (RMW, MW, OW), with 5–7 participants each to allow them to comfortably share on the sensitive topic [55].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [55] MM Hennink, 2007, International focus group research: A handbook for the health and social sciences 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 conductown data

    In the FLIs, women's ages ranged from 18 to 75, 100% were Hindu, 76% had at least some primary education, 63% had water within their household compound, and 54% had a toilet within their household compound.

    “In the FLIs, women’s ages ranged from 18 to 75, 100% were Hindu, 76% had at least some primary education, 63% had water within their household compound, and 54% had a toilet within their household compound (Table 1).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Recently married women did not participate in the FGDs, as their family members did not give permission.

    “Recently married women did not participate in the FGDs, as their family members did not give permission.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The need for soap and water extends to washing clothing, bedding, and materials, and managing urination and defecation while menstruating, beyond bathing.

    “The JMP specifically articulates the need for soap and water for washing the body during menstruation, however we found the need for soap and water extends to washing clothing, bedding, and materials, and managing urination and defecation while menstruating, as noted above.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    Data were collected by two female Research Assistants from Odisha fluent in English and Odia, one experienced in qualitative methods and the other an experienced journalist, both trained in qualitative methods and research ethics.

    “Data were collected through free-list interviews (FLIs) and focus group discussions (FGDs) by two female Research Assistants in their late twenties from Odisha who were fluent in English and Odia, the local language. One was experienced in qualitative methods while the other was an experienced journalist. Both were engaged in a multi-day training on qualitative methods and research ethics.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The need for privacy beyond changing and inclusive of bathing, urination and defecation while menstruating, and washing, drying, and storing cloth, has been noted by other studies in India and Odisha specifically.

    “The need for privacy beyond changing and inclusive of bathing, urination and defecation while menstruating, and washing, drying, and storing cloth, has been noted by other studies in India and Odisha specifically [8, 44, 45].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source

      Not checked in the free run.

    • cites [44] KR Hulland, 2015, Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India, PLoS One source

      Not checked in the free run.

    • cites [45] KC Sahoo, 2015, Sanitation-related psychosocial stress: A grounded theory study of women across the life-course in Odisha, India, Soc Sci Med source

      Not checked in the free run.

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

    Premisecitation

    Research from Kenya found women and girls engage in transactional sex to access pads because of economic barriers, putting them at risk for sexually transmitted infections.

    “Research from Kenya found women and girls engage in transactional sex to access pads because of economic barriers, putting them at risk for sexually transmitted infections [9, 56].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [9] PA Phillips-Howard, 2015, Menstrual Needs and Associations with Sexual and Reproductive Risks in Rural Kenyan Females: A Cross-Sectional Behavioral Survey Linked with HIV Prevalence, Journal of Women’s Health source

      Not checked in the free run.

    • cites [56] K Oruko, 2015, 'He is the one who is providing you with everything so whatever he says is what you do': A Qualitative Study on Factors Affecting Secondary Schoolgirls' Dropout in Rural Western Kenya, PLoS One source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Additional restrictions may exist for women as they seek to hide menstrual status from boys as well.

    “however additional restrictions may exist for women as they seek to hide menstrual status from boys as well.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The lack of privacy for these management activities and for coping with pain threatens women's ability to keep their menstrual status hidden, resulting in feelings of shame.

    “The lack of privacy for these management activities and for coping with pain threatens women’s ability to keep their menstrual status hidden, resulting in feelings of shame.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Concerns about the reliability of materials, whether cloth or commercial products, have been discussed widely in research with girls in school who describe distraction and reduced participation because they are worried about leaks that could reveal their menstrual status and cause shame.

    “Concerns about the reliability of materials, whether cloth or commercial products, have been discussed widely in research with girls in school who describe distraction and reduced participation because they are worried about leaks that could reveal their menstrual status and cause shame [4, 21, 57].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [4] BA Caruso, 2013, WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An assessment of menstrual hygiene management in schools

      Not checked in the free run.

    • cites [21] L Mason, 2013, 'We keep it secret so no one should know'—a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya, PLoS One source

      Not checked in the free run.

    • cites [57] L Mason, 2015, Adolescent schoolgirls' experiences of menstrual cups and pads in rural western Kenya: a qualitative study, Waterlines source

      Not checked in the free run.

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

    Premisecitation

    Shame about menstruation is common across contexts and has been perceived as an inevitable part of the social order, and thus has garnered less attention and action.

    “As Sommer et al (2015) have noted, this shame is common across contexts and has been “perceived as an inevitable part of the social order”, and thus has garnered less attention and action [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] M Sommer, 2015, Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue, Am J Public Health source

      Not checked in the free run.

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

    Interpretationcitation

    Several of these needs and concerns have been noted elsewhere, suggesting applicability to other populations and contexts.

    “Several of these needs and concerns have been noted elsewhere, suggesting applicability to other populations and contexts:”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source

      Not checked in the free run.

    • cites [31] 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 source

      Not checked in the free run.

    • cites [45] KC Sahoo, 2015, Sanitation-related psychosocial stress: A grounded theory study of women across the life-course in Odisha, India, Soc Sci Med source

      Not checked in the free run.

    • cites [9] PA Phillips-Howard, 2015, Menstrual Needs and Associations with Sexual and Reproductive Risks in Rural Kenyan Females: A Cross-Sectional Behavioral Survey Linked with HIV Prevalence, Journal of Women’s Health source

      Not checked in the free run.

    • cites [56] K Oruko, 2015, 'He is the one who is providing you with everything so whatever he says is what you do': A Qualitative Study on Factors Affecting Secondary Schoolgirls' Dropout in Rural Western Kenya, PLoS One source

      Not checked in the free run.

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

    Premisecitation

    The worry about infection from drying cloth in hidden and dark places is consistent with findings reported from India, Tanzania, and South Asia.

    “which is consistent with findings reported from India, Tanzania, and South Asia [6, 8, 12, 20].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [6] T Mahon, 2010, Menstrual hygiene in South Asia: a neglected issue for WASH (water, sanitation and hygiene) programmes, Gender & Development source

      Not checked in the free run.

    • cites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source

      Not checked in the free run.

    • cites [12] M Sommer, 2014, A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia, Compare: A Journal of Comparative and International Education source

      Not checked in the free run.

    • cites [20] D Joshi, 2011, hygiene and appropriate sanitation: experiences and perceptions of the urban poor, Environ Urban source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Women's inability to manage menstruation is constrained by their inability to control resources, move freely, and make decisions about and independently act on their personal needs.

    “Women’s inability to manage menstruation is constrained by their inability to control resources (e.g., to purchase materials and soap), move freely (e.g., to access markets, get water, find privacy to bathe and wash, socialize), and make decisions about and independently act on their personal needs (e.g., to bathe without need for social support).”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Research with adolescent girls in Kenya has documented how materials can be painful, itchy, and cause rashes and sores, representing an unnecessary additional burden to have to cope with regularly for a normal part of life.

    “Similar to findings from this study, research with adolescent girls in Kenya has also documented how materials can be painful, itchy, and cause rashes and sores, representing an unnecessary additional burden to have to cope with regularly for a normal part of life [57].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] L Mason, 2015, Adolescent schoolgirls' experiences of menstrual cups and pads in rural western Kenya: a qualitative study, Waterlines source

      Not checked in the free run.

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

    Premisecitation

    Studies have explored the connection between the type and condition of materials with urogenital infections.

    “Studies have explored the connection between the type and condition of materials with urogenital infections”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [6] T Mahon, 2010, Menstrual hygiene in South Asia: a neglected issue for WASH (water, sanitation and hygiene) programmes, Gender & Development source

      Not checked in the free run.

    • cites [27] KK Baker, 2017, From menarche to menopause: A population-based assessment of water, sanitation, and hygiene risk factors for reproductive tract infection symptoms over life stages in rural girls and women in India, PLoS One source

      Not checked in the free run.

    • cites [28] P Das, 2015, Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India, PLoS One source

      Not checked in the free run.

    • cites [29] C Sumpter, 2013, A systematic review of the health and social effects of menstrual hygiene management, PLoS One source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The sociocultural perception of menstruation as polluting drives women's behaviors and compromises their ability to manage.

    “Further, the sociocultural perception of menstruation as polluting further drives women’s behaviors and compromises their ability to manage.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Concerns for appropriate disposal have been voiced by girls in Ghana who worried about infertility if animals touched their pads and girls in Bolivia who believed they could get cancer if they burned their menstrual blood.

    “Concerns for appropriate disposal have been voiced by girls in Ghana who worried about infertility if animals touched their pads and girls in Bolivia who believed they could get cancer if they burned their menstrual blood [12, 67].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [12] M Sommer, 2014, A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia, Compare: A Journal of Comparative and International Education source

      Not checked in the free run.

    • cites [67] J Long, 2013, WASH in Schools Empowers Girls’ Education in Rural Cochabamba, Bolivia: An assessment of menstrual hygiene management in schools

      Not checked in the free run.

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

    Study design and conductreasoning

    A key strength of this study is its reliance on two methods of qualitative data collection: individual interviews and FGDs.

    “A key strength of this study is its reliance on two methods of qualitative data collection: individual interviews and FGDs.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Many researchers have explored girls' fear and confusion at menarche due to insufficient information and preparation.

    “Many researchers have explored girls’ fear and confusion at menarche due to insufficient information and preparation [4, 12, 21, 23, 67, 69].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [4] BA Caruso, 2013, WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An assessment of menstrual hygiene management in schools

      Not checked in the free run.

    • cites [12] M Sommer, 2014, A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia, Compare: A Journal of Comparative and International Education source

      Not checked in the free run.

    • cites [21] L Mason, 2013, 'We keep it secret so no one should know'—a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya, PLoS One source

      Not checked in the free run.

    • cites [23] MA Farage, 2011, Cultural aspects of menstruation and menstrual hygiene in adolescents, Expert Rev Obstet Gynecol source

      Not checked in the free run.

    • cites [67] J Long, 2013, WASH in Schools Empowers Girls’ Education in Rural Cochabamba, Bolivia: An assessment of menstrual hygiene management in schools

      Not checked in the free run.

    • cites [69] V Trinies, 2015, Uncovering the challenges to menstrual hygiene management in schools in Mali, Waterlines source

      Not checked in the free run.

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

    Study design and conductreasoning

    For each life stage, not all caste categories were represented, which may limit the breadth of the results.

    “For each life stage, not all caste categories were represented, which may limit the breadth of the results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The FGDs had mixed-caste groups, which may have affected the openness to which participants expressed their thoughts.

    “The FGDs had mixed-caste groups, which may have affected the openness to which participants expressed their thoughts.”
    Quote in the paperNot a substantial claim

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

    Interpretationcitation

    Such concerns may also be attributed to perceptions of regular menstruation as symbolic of women's abilities to be fecund and therefore their ability to be good wives and mothers.

    “Such concerns may also be attributed to perceptions of regular menstruation as symbolic of women’s abilities to be fecund and therefore their ability to be good wives and mothers [34].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] E Wilson, 2018, Dismantling menstrual taboos to overcome gender inequality, The Lancet Child & Adolescent Health source

      Not checked in the free run.

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

    Interpretationcitation

    A focus on private, safe, and separate disposal facilities, where materials can be confined and out of view of others, may reduce women's concerns about menstrual materials being accessed by animals, contaminating others through contact, or revealing their menstrual status if seen in the open.

    “A focus on private, safe, and separate disposal facilities, where materials can be confined and out of view of others, may reduce women’s concerns about menstrual materials being accessed by animals, contaminating others through contact, or revealing their menstrual status if seen in the open.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationown data

    The findings demonstrate the need for access to "female-friendly toilets" with disposal bins inside.

    “Our findings contribute detailed accounts of disposal practices and further demonstrate the need for access to “female-friendly toilets” with disposal bins inside [8, 14, 21, 62].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source

      Not checked in the free run.

    • cites [14] LC Loughnan, 2016, What can existing data on water and sanitation tell us about menstrual hygiene management?, Waterlines source

      Not checked in the free run.

    • cites [21] L Mason, 2013, 'We keep it secret so no one should know'—a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya, PLoS One source

      Not checked in the free run.

    • cites [62] M Schmitt, 2018, Making the Case for a Female-Friendly Toilet, Water source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    This study engaged rural women in Odisha exclusively and the findings are limited to this population.

    “This study engaged rural women in Odisha exclusively and the findings are limited to this population”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    While various castes and tribes were represented in the study population, we did not intentionally sample to have castes equally represented or include specific questions about caste to enable identification of varied practices, experiences, and concerns by caste.

    “While various castes and tribes were represented in the study population, we did not intentionally sample to have castes equally represented or include specific questions about caste to enable identification of varied practices, experiences, and concerns by caste.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Restrictions related to menstruation permeate other facets of life and can result in missed opportunities.

    “Restrictions related to menstruation permeate other facets of life and can result in missed opportunities.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    RMW did not participate in FGDs, however they are represented in the FLI sampling frame (12 interviews with RMW), so we do not believe this exclusion impacted our findings.

    “RMW did not participate in FGDs, however they are represented in the FLI sampling frame (12 interviews with RMW), so we do not believe this exclusion impacted our findings.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Research in Bangladesh found girls who had restrictions imposed on them were at greater odds of missing school during their periods.

    “Notably, research in Bangladesh found girls who had restrictions imposed on them were at greater odds of missing school during their periods [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] MU Alam, 2017, Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey, BMJ open source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Research from other fields has found women's reports of pain to not be taken seriously, causing them to endure pain unnecessarily for extended periods or to not receive needed treatment.

    “Research from other fields has found women’s reports of pain to not be taken seriously, causing them to endure pain unnecessarily for extended periods or to not receive needed treatment [68].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68] DE Hoffmann, 2001, The Girl Who Cried Pain: A Bias against Women in the Treatment of Pain, The Journal of Law, Medicine & Ethics source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    Knowledge about the process of menstruation that includes information beyond the most typical patterns and how to manage menstrual pain could help improve women's experience of MHM.

    “Knowledge about the process of menstruation that includes information beyond the most typical patterns and how to manage menstrual pain could help improve women’s experience of MHM.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    This research did not capture the experiences of adolescent girls, so it could not compare their experiences to those of the women in this study.

    “Finally, this research did not capture the experiences of adolescent girls, so it could not compare their experiences to those of the women in this study.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    As reported in another study in India, hiding signs of menstruation from men made washing cloth more difficult.

    “As reported in another study in India, hiding signs of menstruation from men made washing cloth more difficult [61].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] H Thakur, 2014, Knowledge, Practices, and Restrictions Related to Menstruation among Young Women from Low Socioeconomic Community in Mumbai, India, Frontiers in public health 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 conductreasoning

    The FGDs took place following the FLIs and corroborated findings from the interviews, contributing to the study's validity.

    “The FGDs took place following the FLIs and corroborated findings from the interviews, contributing to the study’s validity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Given our findings, a broader definition for MHM may better capture the range of menstruation-related needs of women and further the discourse on MHM in the sector and is an important first step for creating appropriate measures to assess the extent that these experiences and circumstances may actually contribute to negative health outcomes.

    “Given our findings, we posit that a broader definition for MHM may better capture the range of menstruation-related needs of women and further the discourse on MHM in the sector and is an important first step for creating appropriate measures to assess the extent that these experiences and circumstances may actually contribute to negative health outcomes.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Researchers have previously engaged the JMP definition quantitatively to guide research and assessment.

    “Researchers have previously engaged the JMP definition quantitatively to guide research and assessment [72]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [72] J Hennegan, 2016, Measuring the prevalence and impact of poor menstrual hygiene management: a quantitative survey of schoolgirls in rural Uganda, BMJ open source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Experiences of shame, restrictions, and fear may be hard to capture in a definition, however are integral to women's experience of menstruation as well as their overall health and well-being.

    “Experiences of shame, restrictions, and fear may be hard to capture in a definition, however are integral to women’s experience of menstruation as well as their overall health and well-being.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Our expanded definition for adequate MHM can inform monitoring efforts, program priorities, measures of assessment, and future research to account for the scope of menstrual management needs of women in Odisha, and potentially beyond.

    “Our expanded definition for adequate MHM can inform monitoring efforts, program priorities, measures of assessment, and future research to account for the scope of menstrual management needs of women in Odisha, and potentially beyond.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Our definition, though particularly suitable to the Indian context, may be more comprehensive in other locations as well since many of our modifications and additions have been identified in studies from various locations.

    “however our definition, though particularly suitable to the Indian context, may be more comprehensive in other locations as well since many of our modifications and additions have been identified in studies from various locations.”
    Quote in the paperNot a substantial claim
99 of 99

  • The authors state this as an assumption.

    The four life stage categories (unmarried, recently married, married, older) capture diversity of MHM experience.

    “Sampling across these categories was believed to capture diversity of MHM experience.”

  • The paper relies on this without support.

    Women's reports about the concerns of 'women in this community' accurately reflect community norms.

    “Specifically, women first were asked to list the concerns that “women in this community” experienced while menstruating”
    “The FGDs were conducted to gather greater detail about women’s concerns and determine if the concerns were normative within the community.”

  • The paper relies on this without support.

    The JMP definition is a valid benchmark for assessing MHM needs in this population.

    “The resulting themes and issues are described and presented utilizing the JMP framework.”

  • The paper relies on this without support.

    The participants in this study are representative of women in rural Odisha.

    “The findings from this research demonstrate that women in rural Odisha face the challenges to adequate menstrual hygiene management codified in the JMP definition [47].”

  • The authors state this as an assumption.

    Definitions designed to inform research require testing in order to determine if they are adequate.

    “However, definitions designed to inform research require testing in order to determine if they are adequate.”

  • The authors state this as an assumption.

    Specific quantitative measures of MHM per the JMP definition have yet to be codified and used widely.

    “Specific quantitative measures of MHM per this definition have yet to be codified and used widely, making an evaluation of the definition all the more timely in both our population of interest and elsewhere.”
6 of 6

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?

  • Family members (often husbands, fathers, and in-laws) restricted water fetching and sanitation-related movements, most intensely for unmarried daughters and recently married and pregnant women, less intensely for women of lower castes and widows.

    “Research in India found that family members (often husbands, fathers, and in-laws) restricted water fetching and sanitation-related movements, most intensely for unmarried daughters [174,182,190] and recently married and pregnant women, [178, 182, 189] (less intensely for women of lower castes [135] and widows [174]).”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [178]

  • Movement restrictions influenced women and girls' access to water and defecation, urination, and menstrual management locations, and are most widely reported in India.

    “Movement restrictions influenced women and girls' access to water [101, 110, 178] and defecation, urination, and menstrual management locations, and are most widely reported in India [62, 135, 174, 181, 182, 184, 187], [101,110,187,[189][190][191].”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [178]

  • Women qualitatively reported perceived linkages between various illnesses and their water and sanitation environments, including diarrhea, vomiting, dysentery, cholera, hepatitis, schistosomiasis, and skin diseases due to polluted water, and diarrhea due to limitations on hygiene in times of water scarcity.

    “Women reported experiencing or fearing diarrhea, vomiting, dysentery, cholera, hepatitis, schistosomiasis, and skin diseases due to polluted water, [65,70,86,111,144,177,178,197,199,214,220,225,231,248,259,273,288] and experiencing diarrhea due to limitations on hygiene in times of water scarcity [70,123,202].”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [178]

  • Fears or experiences of harm from domestic and wild animals and insects were reported for both water collection and sanitation activities; women and girls reported fear and actual experiences of injury at and when accessing sanitation locations, regardless of sanitation type.

    “Fears or experiences of harm from domestic and wild animals and insects were reported for both water collection and sanitation activities [62, 135, 143, 170, 172-174, 177-179, 184, 187, 189-191, 198, 201, 214, 226, 229, 257, 258, 296].Women and girls reported fear and actual experiences of injury at and when accessing sanitation locations, regardless of sanitation type [135, 168, 172, 174, 184, 18”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [178]

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.

  • FLI cleaning responses do not match the exclusion note

    Minor

    Table 2 lists 14 FLI responses across the three cleaning-cloth/pad categories. Its note says 20 of 68 FLI participants had missing data and 33 were not applicable, which would leave 15 responses.

  • FGD cloth-use percentage differs from Table 2

    Minor

    The results state that 54% of FGD participants used cloth, but Table 2 reports 51% for the FGD cloth category. The 54% figure matches the FLI category instead.

  • The paper says the JMP definition omits discomfort, but quotes it including discomfort

    Minor

    The paper says the JMP definition does not address discomfort during menstruation, although the definition quoted earlier explicitly includes managing menstruation "without discomfort or fear." It may not address pain specifically, but the claim about discomfort is too broad.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. J Haver, 2013, WASH in Schools Empowers Girls' Education in Masbate Province and Metro Manila, Philippines An Assessment of Menstrual Hygiene Management in Schools, WASH in Schools Empowers Girls' Education in Masbate Province and Metro Manila, Philippines An Assessment of Menstrual Hygiene Management in Schools
  2. UNICEF. WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference. 2014.
  3. UNICEF. WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference. 2012.
  4. UNICEF. WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference. 2013.
  5. UNICEF. WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference. 2015.
  6. 2014, ‘MHM in Ten’: Advancing the MHM Agenda in WASH in Schools, ‘MHM in Ten’: Advancing the MHM Agenda in WASH in Schools
  7. SP Borgatti, 1999, Elicitation techniques for cultural domain analysis Enhanced ethnographic methods: audiovisual techniques, focused group interviews, and elicitation techniques ethnographer toolkit, Elicitation techniques for cultural domain analysis Enhanced ethnographic methods: audiovisual techniques, focused group interviews, and elicitation techniques ethnographer toolkit, 15

Cited by

Sorted by citations

Related

Authors
MacRae, E. R., Clasen, T., Dasmohapatra, M., & Caruso, B. A.
Affiliations
  • Emory University (US)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
MacRae, Elizabeth R.
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2019-08-01
Volume
14
Issue
8
Pages
e0220114
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0220114
PMC
PMC6675075
OpenAlex
W2965517785
Cited by
111
References
60
Citations by year
2026: 14 · 2025: 15 · 2024: 14 · 2023: 21 · 2022: 11 · 2021: 22 · 2020: 13 · 2019: 1
FWCI
10.82
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Bill and Melinda Gates Foundation
  • Kalinga Institute of Industrial Technology
  • National Institutes of Health
  • National Institute of General Medical Sciences (GM000680, K12GM000680)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
  • Social Sciences › Gender Studies › Gender Studies and Social Issues
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Keywords
menstrual hygiene management, life stages, rural women, privacy, menstrual pain management, social stigma, sociocultural norms, Odisha
MeSH terms
Adolescent, Adult, Aged, Female, Humans, Hygiene, India, Health Knowledge, Attitudes, Practice, Menstruation, Middle Aged, Rural Population, Sanitation, Social Support, Water Supply, Focus Groups, Menstrual Hygiene Products, Young Adult

About these checks

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

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

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

Statistics and arithmetic are recomputed, not judged.

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

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