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

In the paper

“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].”

What the sources say

• Partly supported

  The Results (Hygiene during menstruation) identify lack of privacy as a barrier to bathing, and the Discussion says privacy affects cleaning and drying menstrual cloths. The copy does not specifically connect privacy to urination or defecation during menstruation, or establish the full set of needs for Odisha specifically. (LLM, conf=0.85)

  cites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open sourceExperimental — accuracy not yet measured
• Partly supported

  The Results (Sanitation behaviors; page unavailable) examine menstruation alongside bathing, urination, and defecation among women in Odisha, and report that menstruation was among the activities associated with the least freedom. The Introduction identifies privacy as a contributor to sanitation-related stress, but our copy does not specifically describe a need for privacy while washing, drying, or storing menstrual cloth, or during each listed activity while menstruating. (LLM, conf=0.82)

  cites [44] KR Hulland, 2015, Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India, PLoS One sourceExperimental — accuracy not yet measured
• Partly supported

  Sections 3.2 and 3.3.2 describe privacy as a concern across sanitation activities beyond changing clothes, including bathing, urination, defecation, and menstrual management. Section 3.3.1 mentions washing and drying menstrual cloths, but the passages do not mention storing them or specifically link privacy during bathing, urination, and defecation to menstruation. (LLM, conf=0.85)

  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 sourceExperimental — accuracy not yet measured

In the paper

“Overall, women representing all life stages discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials.”

In the paper

“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.”

In the paper

“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.”

In the paper

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

In the paper

“Specifically, women’s material use varied by life stage, but the manner in which they used their latrines during menstruation was fairly uniform.”

In the paper

“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.”

In the paper

“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:”

In the paper

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

In the paper

“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:”

In the paper

“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.”

In the paper

“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.”

In the paper

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

In the paper

“Generally, women felt cloth was problematic to clean, dry, and store, and wanted to use pads instead, which could be disposed of after use.”

In the paper

“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.”

In the paper

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

In the paper

“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.”

In the paper

“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”

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“Women also worried cloth would become dirty between periods and came up with practices for storing and assuring cloth cleanliness before use:”

In the paper

“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.”

In the paper

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

In the paper

“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).”

In the paper

“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:”

In the paper

“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.”

In the paper

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

In the paper

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

In the paper

“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:”

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

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

In the paper

“We propose a revised definition of adequate MHM for this population that more comprehensively captures their needs.”

In the paper

“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].”

What the sources say

• Not checked yetcites [7] M Sommer, 2013, Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls, Am J Public Health source
• Not checked yetcites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source
• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [14] LC Loughnan, 2016, What can existing data on water and sanitation tell us about menstrual hygiene management?, Waterlines source
• Not checked yetcites [15] UNICEF. WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference. 2014.
• Not checked yetcites [16] UNICEF. WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference. 2012.
• Not checked yetcites [17] UNICEF. WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference. 2013.
• Not checked yetcites [18] UNICEF. WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference. 2015.

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [2] M Sommer, 2015, Putting menarche and girls into the global population health agenda, Reproductive health source
• Not checked yetcites [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 yetcites [4] BA Caruso, 2013, WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An assessment of menstrual hygiene management in schools
• Not checked yetcites [5] JL Long, 2015, Developing games as a qualitative method for researching menstrual hygiene management in rural Bolivia, Waterlines source
• Not checked yetcites [6] T Mahon, 2010, Menstrual hygiene in South Asia: a neglected issue for WASH (water, sanitation and hygiene) programmes, Gender & Development source
• Not checked yetcites [7] M Sommer, 2013, Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls, Am J Public Health source
• Not checked yetcites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source
• Not checked yetcites [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 yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [2] M Sommer, 2015, Putting menarche and girls into the global population health agenda, Reproductive health source
• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [34] E Wilson, 2018, Dismantling menstrual taboos to overcome gender inequality, The Lancet Child & Adolescent Health source
• Not checked yetcites [35] M Crawford, 2014, This is a natural process’: managing menstrual stigma in Nepal, Culture, Health & Sexuality source

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [2] M Sommer, 2015, Putting menarche and girls into the global population health agenda, Reproductive health source
• Not checked yetcites [7] M Sommer, 2013, Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls, Am J Public Health source
• Not checked yetcites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source
• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [23] MA Farage, 2011, Cultural aspects of menstruation and menstrual hygiene in adolescents, Expert Rev Obstet Gynecol source
• Not checked yetcites [24] A Khanna, 2005, Menstrual Practices and Reproductive Problems:A Study of Adolescent Girls in Rajasthan, Journal of Health Management source
• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [32] M Sommer, 2016, A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools, PLoS Med source

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [44] KR Hulland, 2015, Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India, PLoS One source
• Not checked yetcites [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 yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source

In the paper

“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).”

In the paper

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

In the paper

“Yet, menstruation concerns extend beyond adolescence and WASH.”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [2] M Sommer, 2015, Putting menarche and girls into the global population health agenda, Reproductive health source
• Not checked yetcites [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 yetcites [4] BA Caruso, 2013, WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An assessment of menstrual hygiene management in schools
• Not checked yetcites [5] JL Long, 2015, Developing games as a qualitative method for researching menstrual hygiene management in rural Bolivia, Waterlines source
• Not checked yetcites [6] T Mahon, 2010, Menstrual hygiene in South Asia: a neglected issue for WASH (water, sanitation and hygiene) programmes, Gender & Development source
• Not checked yetcites [7] M Sommer, 2013, Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls, Am J Public Health source
• Not checked yetcites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source
• Not checked yetcites [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 yetcites [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 yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [29] C Sumpter, 2013, A systematic review of the health and social effects of menstrual hygiene management, PLoS One source

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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).”

In the paper

“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.”

In the paper

“Women provided oral consent prior to participation.”

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [55] MM Hennink, 2007, International focus group research: A handbook for the health and social sciences source

In the paper

“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).”

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“however additional restrictions may exist for women as they seek to hide menstrual status from boys as well.”

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [4] BA Caruso, 2013, WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An assessment of menstrual hygiene management in schools
• Not checked yetcites [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 yetcites [57] L Mason, 2015, Adolescent schoolgirls' experiences of menstrual cups and pads in rural western Kenya: a qualitative study, Waterlines source

In the paper

“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].”

What the sources say

• Not checked yetcites [11] M Sommer, 2015, Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue, Am J Public Health source

In the paper

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

What the sources say

• Not checked yetcites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source
• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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

In the paper

“which is consistent with findings reported from India, Tanzania, and South Asia [6, 8, 12, 20].”

What the sources say

• Not checked yetcites [6] T Mahon, 2010, Menstrual hygiene in South Asia: a neglected issue for WASH (water, sanitation and hygiene) programmes, Gender & Development source
• Not checked yetcites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source
• Not checked yetcites [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 yetcites [20] D Joshi, 2011, hygiene and appropriate sanitation: experiences and perceptions of the urban poor, Environ Urban source

In the paper

“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).”

In the paper

“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].”

What the sources say

• Not checked yetcites [57] L Mason, 2015, Adolescent schoolgirls' experiences of menstrual cups and pads in rural western Kenya: a qualitative study, Waterlines source

In the paper

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

What the sources say

• Not checked yetcites [6] T Mahon, 2010, Menstrual hygiene in South Asia: a neglected issue for WASH (water, sanitation and hygiene) programmes, Gender & Development source
• Not checked yetcites [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 yetcites [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 yetcites [29] C Sumpter, 2013, A systematic review of the health and social effects of menstrual hygiene management, PLoS One source

In the paper

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

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [67] J Long, 2013, WASH in Schools Empowers Girls’ Education in Rural Cochabamba, Bolivia: An assessment of menstrual hygiene management in schools

In the paper

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

In the paper

“Many researchers have explored girls’ fear and confusion at menarche due to insufficient information and preparation [4, 12, 21, 23, 67, 69].”

What the sources say

• Not checked yetcites [4] BA Caruso, 2013, WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An assessment of menstrual hygiene management in schools
• Not checked yetcites [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 yetcites [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 yetcites [23] MA Farage, 2011, Cultural aspects of menstruation and menstrual hygiene in adolescents, Expert Rev Obstet Gynecol source
• Not checked yetcites [67] J Long, 2013, WASH in Schools Empowers Girls’ Education in Rural Cochabamba, Bolivia: An assessment of menstrual hygiene management in schools
• Not checked yetcites [69] V Trinies, 2015, Uncovering the challenges to menstrual hygiene management in schools in Mali, Waterlines source

In the paper

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

In the paper

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

In the paper

“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].”

What the sources say

• Not checked yetcites [34] E Wilson, 2018, Dismantling menstrual taboos to overcome gender inequality, The Lancet Child & Adolescent Health source

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [8] AM van Eijk, 2016, Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis, BMJ open source
• Not checked yetcites [14] LC Loughnan, 2016, What can existing data on water and sanitation tell us about menstrual hygiene management?, Waterlines source
• Not checked yetcites [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 yetcites [62] M Schmitt, 2018, Making the Case for a Female-Friendly Toilet, Water source

In the paper

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

In the paper

“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.”

In the paper

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

In the paper

“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.”

In the paper

“Notably, research in Bangladesh found girls who had restrictions imposed on them were at greater odds of missing school during their periods [3].”

What the sources say

• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

In the paper

“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.”

In the paper

“As reported in another study in India, hiding signs of menstruation from men made washing cloth more difficult [61].”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

“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.”

In the paper

“Researchers have previously engaged the JMP definition quantitatively to guide research and assessment [72]”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”