Improving menstrual hygiene management in emergency contexts: literature review of current perspectives

Classified as probably not a substantial claim.

There was clear agreement that the needs of the target population should be assessed before designing any intervention.

“There was clear agreement that the needs of the target population should be assessed before designing any intervention.”

May combine two claims.

There is insufficient empirical evidence to establish which interventions are most effective in humanitarian emergencies and which sectors should be responsible for the coordination and implementation of such.

“Although there is insight about which factors should be included in an effective menstrual hygiene intervention, there is insufficient empirical evidence to establish which interventions are most effective in humanitarian emergencies and which sectors should be responsible for the coordination and implementation of such.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Software interventions should focus on education in the usage of materials to manage menstruation hygienically and education about the female body's biological processes.

“Software interventions should focus on education in the usage of materials to manage menstruation hygienically and education about the female body’s biological processes.”

May combine two claims.

From the seven reviews found in the search, only two focused on MHM in emergency contexts, four included some component of MHM mainly within WASH in emergency contexts, and one included MHM within the reproductive health and protection sectors in a humanitarian context.

“From the seven reviews found in the search, only two focused on MHM in emergency contexts,4,6 four included some component of MHM, mainly within water, hygiene and sanitation (WASH) in emergency contexts,10,13–15 and one include MHM within the reproductive health and protection sectors in a humanitarian context.16”

• cites [4] Sommer M Menstrual hygiene management in humanitarian emergencies: gaps and recommendations Waterlines 2012 31 83 104Not checked yet

  Not checked in the free run.

• cites [6] Sommer M Schmitt ML Clatworthy D Bramucci G Wheeler E Ratnayake R What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? Waterlines 2016 35 245 264Not checked yet

  Not checked in the free run.

• cites [10] Sommer M Ferron S Cavill S House S Violence, gender and WASH: spurring action on a complex, under-documented and sensitive topic Environ Urban 2015 27 105 116Not checked yet

  Not checked in the free run.

• cites [13] Brown J Cavill S Cumming O Jeandron A Water, sanitation, and hygiene in emergencies: summary review and recommendations for future research Waterlines 2012 31 11 29Not checked yet

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• cites [14] Gul M Gul E Gilbert B Studying detriments to WASH response in vulnerable women populations during flood emergencies in Pakistan: a review of interventions through a climate risk lens Proceedings of the National Symposium on Climate Change Vulnerability Mapping of Water Resources of Pakistan May 30th, 2016 Islamabad, PakistanNot checked yet

  Not checked in the free run.

• cites [15] Ersel M Water and sanitation standards in humanitarian action Turk J Emerg Med 2015 15 27 33 27437529 PMC4910130Not checked yet

  Not checked in the free run.

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

Of the 16 peer-reviewed papers, nine were original research studies and seven were literature reviews.

“Nine of the peer-reviewed papers (see Table 2) were original research studies and seven were literature reviews (not shown in tables).”

May combine two claims.

Strategies aimed at making menstrual materials more affordable, accessible, and less damaging to the environment have emerged in recent years, although gaps in research examining the development of innovative, sustainable, and affordable products continue to exist.

“Strategies aimed at making menstrual materials more affordable, accessible, and less damaging to the environment have emerged in recent years,4,7,27,32–34 although gaps in research examining the development of innovative, sustainable, and affordable products continue to exist.27”

• cites [4] Sommer M Menstrual hygiene management in humanitarian emergencies: gaps and recommendations Waterlines 2012 31 83 104Not checked yet

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• cites [7] Biran A Curtis V Gautam OP Background paper on measuring WASH and food hygiene practices: definition of goals to be tackling post-2015 by the Joint Monitoring Programme Available from: https://www.ircwash.org/resources/background-paper-measuring-wash-and-food-hygiene-practices-definition-goals-be-tackled Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [27] Swedish International Development Cooperation Agency Health: both a prerequisite and an outcome of sustainable development 2016 Available from: https://www.sida.se/contentassets/2d05faf3aebc4092a0ef96439c026262/18565.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

• cites [32] Keith B Girls’ and women’s right to menstrual health: evidence and opportunities 2016 Available from: https://www.path.org/publications/files/RH_outlook_mh_022016.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

• cites [33] Musaazi MK Mechtenberg AR Nakibuule J Quantification of social equity in life cycle assessment for increased sustainable production of sanitary products in Uganda J Clean Prod 2015 96 569 579Not checked yet

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• cites [34] Israr H Nasir SS Low cost handmade sanitary pads! From design to production: a step forward in menstrual hygiene promotion in Pakistan 2012 Available from: https://sanitationupdates.files.word-press.com/2012/07/menstrual_hygiene_pakistan20121.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

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

Government subsidization and tax reduction/removal on menstrual products were mentioned strategies for improving access to required absorbents.

“Government subsidization and tax reduction/removal on menstrual products were also mentioned strategies for improving access to required absorbents.12,27”

• cites [12] Balls E Menstrual hygiene management 2017 Available from: http://menstrualhygieneday.org/wp-content/uploads/2017/01/SHARE_-MHM_policybrief_2017.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [27] Swedish International Development Cooperation Agency Health: both a prerequisite and an outcome of sustainable development 2016 Available from: https://www.sida.se/contentassets/2d05faf3aebc4092a0ef96439c026262/18565.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

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

A recent review of Oxfam programs reported that cash programs were found to be more likely to contribute to restoring dignity in displaced populations and that there was little evidence of neglected hygiene-related purchasing through the use of cash models.

“A recent review of Oxfam programs30 reported that cash programs were found to be more likely to contribute to restoring dignity in displaced populations and that there was little evidence of neglected hygiene-related purchasing through the use of cash models.”

• cites [30] Ferron S Enabling Access to Non-Food Items in an Emergency Response: A Review of Oxfam Programmes Oxford Oxfam 2017Not checked yet

  Not checked in the free run.

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

Ensuring access to appropriate absorbent and supportive menstrual materials is the most widely articulated requirement for MHM.

“What is likely the most obvious and thus the most widely articulated requirement for MHM is ensuring access to appropriate absorbent and supportive menstrual materials.”

May combine two claims.

Humanitarian interventions include provision of MH materials through distribution of individual items or in the form of 'dignity kits,' or the provision of cash or vouchers for individual purchasing.

“Humanitarian interventions include provision of MH materials through distribution of individual items or in the form of “dignity kits,”20–22,24 or the provision of cash or vouchers for individual purchasing.”

• cites [20] Krause S Williams H Onyango MA Reproductive health services for Syrian refugees in Zaatri Camp and Irbid City, Hashemite kingdom of Jordan: an evaluation of the Minimum Initial Services Package Confl Health 2015 9 S4 25798190 PMC4331816Not checked yet

  Not checked in the free run.

• cites [21] Budhathoki SS Bhattachan M Pokharel P Bhadra M van Teijlingen E Reusable sanitary towels: promoting menstrual hygiene in post-earthquake Nepal J Fam Plann Reprod Health Care 2017 43 157 159 27507295Not checked yet

  Not checked in the free run.

• cites [22] Thapa SB Acharya G Women’s health is not in focus in disaster zones: lessons from the Nepal earthquake J Fam Plann Reprod Health Care 2017 43 92 93 27940443Not checked yet

  Not checked in the free run.

• cites [24] Schmitt ML Clatworthy D Ratnayake R Understanding the menstrual hygiene management challenges facing displaced girls and women: findings from qualitative assessments in Myanmar and Lebanon Confl Health 2017 11 19 29046714 PMC5641996Not checked yet

  Not checked in the free run.

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

The need to evaluate the appropriateness of dignity-kit contents in differing contexts was expressed, and should also consider the available sanitation infrastructure.

“The need to evaluate the appropriateness of dignity-kit contents in differing contexts was expressed,4 and should also consider the available sanitation infrastructure.”

• cites [4] Sommer M Menstrual hygiene management in humanitarian emergencies: gaps and recommendations Waterlines 2012 31 83 104Not checked yet

  Not checked in the free run.

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

Dignity kits are basic hygiene items packaged for distribution, and are reported to alleviate difficult purchasing decisions associated with low resources and competing priorities that populations often face in emergency contexts.

“Dignity kits, which were piloted in 2012, are basic hygiene items packaged for distribution, and are reported to alleviate difficult purchasing decisions associated with low resources and competing priorities that populations often face in emergency contexts.28”

• cites [28] Rohwerder B Non-food items (NFIs) and the needs of women and girls in emergencies 2014 Available from: http://www.ids.ac.uk/publication/non-food-items-nfis-and-the-needs-of-women-and-girls-in-emergencies Accessed January 29, 2018Not checked yet

  Not checked in the free run.

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

Understanding the cultural beliefs and practices of populations, examining menstrual product appropriateness in specific contexts, adapting interventions adequately to the physical environment, proper coordination of actors, and clear guidance for monitoring and evaluating programs are among the gaps identified.

“Understanding the cultural beliefs and practices of populations, examining menstrual product appropriateness in specific contexts, adapting interventions adequately to the physical environment, proper coordination of actors, and clear guidance for monitoring and evaluating programs are among the gaps identified.”

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

From the gray literature, 4 were master's theses, 11 guidelines, and 20 nongovernmental organization (NGO) reports.

“From the gray literature, 4 were master’s theses, 11 guidelines (see Table 3), and 20 nongovernmental organization (NGO) reports (communications, policy briefs, evaluations, and case studies).”

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

Reusable menstrual pads, menstrual underwear, and menstrual cups are viewed as sustainable and ecologically friendly options, although not often available to populations in low-income settings.

“Reusable menstrual pads, menstrual underwear, and menstrual cups are viewed as sustainable and ecologically friendly options, although not often available to populations in low-income settings.27”

• cites [27] Swedish International Development Cooperation Agency Health: both a prerequisite and an outcome of sustainable development 2016 Available from: https://www.sida.se/contentassets/2d05faf3aebc4092a0ef96439c026262/18565.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

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

In total, 51 documents were included in this review, of which 16 were peer-reviewed papers and 35 were gray literature.

“In total, 51 documents were included in this review.”

• Also stated in: § Description of articles included in the review · plain

  “Of the 51 articles included in the review, 16 were peer-reviewed papers, 35 were gray literature.”

May combine two claims.

Product choice comes with economic and environmental impact at both the individual and global levels.

“Product choice comes with economic and environmental impact at both the individual and global levels.7”

• cites [7] Biran A Curtis V Gautam OP Background paper on measuring WASH and food hygiene practices: definition of goals to be tackling post-2015 by the Joint Monitoring Programme Available from: https://www.ircwash.org/resources/background-paper-measuring-wash-and-food-hygiene-practices-definition-goals-be-tackled Accessed January 28, 2018Not checked yet

  Not checked in the free run.

May combine two claims.

Incorporating menstrual education into school curricula was a consensus for most addressing this subject, and both requires and contributes to overcoming taboos associated with the topic of menstruation.

“Incorporating menstrual education into school curricula was a consensus for most addressing this subject,12,19,27 and both requires and contributes to overcoming taboos associated with the topic of menstruation.”

• cites [12] Balls E Menstrual hygiene management 2017 Available from: http://menstrualhygieneday.org/wp-content/uploads/2017/01/SHARE_-MHM_policybrief_2017.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [19] Parker AH Smith JA Verdemato T Cooke J Webster J Carter RC Menstrual management: a neglected aspect of hygiene interventions Disaster Prev Manag 2014 23 437 454Not checked yet

  Not checked in the free run.

• cites [27] Swedish International Development Cooperation Agency Health: both a prerequisite and an outcome of sustainable development 2016 Available from: https://www.sida.se/contentassets/2d05faf3aebc4092a0ef96439c026262/18565.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

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

Benner et al reported that Burmese refugee girls living in camps in Thailand tended to be informed by their mothers about body changes, but apparently little information was given on menstrual issues.

“Benner et al17 reported that Burmese refugee girls living in camps in Thailand tended to be informed by their mothers about body changes, but apparently little information was given on menstrual issues.”

• cites [17] Benner M Townsend J Kaloi W Reproductive health and quality of life of young Burmese refugees in Thailand Confl Health 2010 4 5 20338037 PMC2907534Not checked yet

  Not checked in the free run.

May combine two claims.

Several case studies described how consultation with beneficiaries led to improved user satisfaction, although links to health or social outcomes were not made in any of these studies.

“Several case studies described how consultation with beneficiaries led to improved user satisfaction, although links to health or social outcomes were not made in any of these studies.25,38,39”

• cites [25] de Lange R Lenglet A Fesseletet JF Keeping it simple: a gender-specific sanitation tool for emergencies Waterlines 2014 33 45 54Not checked yet

  Not checked in the free run.

• cites [38] Wicken J Verhagen J Sijbesma C Da Silva C Ryan P Beyond Construction: Use by All London WaterAid 2008Not checked yet

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• cites [39] Rangaswami S Ideas That Work: A Gender, WASH, and Emergencies Toolkit Oxford Oxfam 2010Not checked yet

  Not checked in the free run.

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

It is argued that the taboo that exists toward menstruation has resulted in inadequate acknowledgment of MHM needs in sanitation-system planning and design and that the responsibility for advocacy and change must be incorporated at all levels: from international organizations and governments down to the private sector and individuals.

“It is argued that the taboo that exists toward menstruation has resulted in inadequate acknowledgment of MHM needs in sanitation-system planning and design11 and that the responsibility for advocacy and change must be incorporated at all levels: from international organizations and governments down to the private sector and individuals.2,27,31”

• cites [11] Sommer M Kjellen M Pensulo C Girls’ and women’s unmet needs for menstrual hygiene management (MHM): the interactions between MHM and sanitation systems in low-income countries J Water Sanit Hyg Dev 2013 3 283 297Not checked yet

  Not checked in the free run.

• cites [2] Sommer M Chandraratna S Cavill S Mahon T Phillips-Howard P Managing menstruation in the workplace: an overlooked issue in low- and middle-income countries Int Jr Equity Health 2016 15 86 90 PMC4895811 27268416Not checked yet

  Not checked in the free run.

• cites [27] Swedish International Development Cooperation Agency Health: both a prerequisite and an outcome of sustainable development 2016 Available from: https://www.sida.se/contentassets/2d05faf3aebc4092a0ef96439c026262/18565.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

• cites [31] House S Mahon T Cavill S Menstrual hygiene matters 2012 Available from: https://washmatters.wateraid.org/publications/menstrual-hygiene-matters Accessed January 29, 2018Not checked yet

  Not checked in the free run.

May combine two claims.

Significant progress has been made in advancing refugee rights in the past 20 years, but the need to narrow the gap between MHM policy and practice remains.

“Significant progress has been made in advancing refugee rights in the past 20 years, but the need to narrow the gap between MHM policy and practice remains.46”

• cites [46] Buscher D Refugee women: twenty years on Refug Surv Q 2010 29 4 20Not checked yet

  Not checked in the free run.

May combine two claims.

Discussion on social impacts of menstruation exists, though there remains a lack of research to quantify outcomes.

“Discussion on social impacts of menstruation exists, though there remains a lack of research to quantify outcomes.40”

• cites [40] Hennegan J Montgomery P Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low and middle income countries? A systematic review PLoS One 2016 11 e0146985 26862750 PMC4749306Not checked yet

  Not checked in the free run.

May combine two claims.

Some evidence exists supporting notions that improved menstrual knowledge positively affects MHM and reduces negative psychosocial impact.

“Some evidence exists supporting notions that improved menstrual knowledge positively affects MHM and reduces negative psychosocial impact.40”

• cites [40] Hennegan J Montgomery P Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low and middle income countries? A systematic review PLoS One 2016 11 e0146985 26862750 PMC4749306Not checked yet

  Not checked in the free run.

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

According to one study, taboos with regard to menstruation can have 'detrimental effects on the fulfillment of women and girls' human rights, particularly in low-income settings.'

“According to one study,43 taboos with regard to menstruation can have “detrimental effects on the fulfillment of women and girls’ human rights, particularly in low-income settings.””

• cites [43] Boosey R Wilson E A vicious cycle of silence: what are the implications of the menstruation taboo for the fulfillment of women and girls’ human rights, and to what extent is the menstruation taboo addressed by international human rights law and human rights bodies? 2014 Available from: http://eprints.whiterose.ac.uk/80597/1/A%20vicious%20cycle%20of%20silence%20white%20rose%20report.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

May combine two claims.

Psychosocial stress and a lack of dignity have been associated with an inability to manage menstruation effectively, and depending on the humanitarian setting, needs for managing menstruation can increase risks for female exploitation and sexual violence.

“Not only have psychosocial stress and a lack of dignity been associated with an inability to manage menstruation effectively,35 but depending on the humanitarian setting, needs for managing menstruation can increase risks for female exploitation and sexual violence.6,10”

• cites [35] Mills JE Cumming O The impact of water, sanitation and hygiene on key health and social outcomes: review of evidence 2016 Available from: https://www.unicef.org/wash/files/The_Impact_of_WASH_on_Key_Social_and_Health_Outcomes_Review_of_Evidence.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

• cites [6] Sommer M Schmitt ML Clatworthy D Bramucci G Wheeler E Ratnayake R What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? Waterlines 2016 35 245 264Not checked yet

  Not checked in the free run.

• cites [10] Sommer M Ferron S Cavill S House S Violence, gender and WASH: spurring action on a complex, under-documented and sensitive topic Environ Urban 2015 27 105 116Not checked yet

  Not checked in the free run.

May combine two claims.

Shame, lack of availability of products, inaccessibility due to cost, and prioritizing others' needs over personal menstrual health have all been attributed to unhygienic menstrual practices.

“Shame, lack of availability of products, inaccessibility due to cost, and prioritizing others’ needs over personal menstrual health have all been attributed to unhygienic menstrual practices.7,27,40”

• cites [7] Biran A Curtis V Gautam OP Background paper on measuring WASH and food hygiene practices: definition of goals to be tackling post-2015 by the Joint Monitoring Programme Available from: https://www.ircwash.org/resources/background-paper-measuring-wash-and-food-hygiene-practices-definition-goals-be-tackled Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [27] Swedish International Development Cooperation Agency Health: both a prerequisite and an outcome of sustainable development 2016 Available from: https://www.sida.se/contentassets/2d05faf3aebc4092a0ef96439c026262/18565.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

• cites [40] Hennegan J Montgomery P Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low and middle income countries? A systematic review PLoS One 2016 11 e0146985 26862750 PMC4749306Not checked yet

  Not checked in the free run.

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

Conflicting beliefs about menstruation and MH within a single population are thought to be attributed to modernizing influences and migration.

“This is thought to be attributed to modernizing influences and migration.11”

• cites [11] Sommer M Kjellen M Pensulo C Girls’ and women’s unmet needs for menstrual hygiene management (MHM): the interactions between MHM and sanitation systems in low-income countries J Water Sanit Hyg Dev 2013 3 283 297Not checked yet

  Not checked in the free run.

May combine two claims.

Human-rights themes emerged regularly, from declaring MHM an essential aspect of basic human rights to describing the impact of menstruation on increased sex inequality.

“Human-rights themes emerged regularly, from declaring MHM an essential aspect of basic human rights12 to describing the impact of menstruation on increased sex inequality.1,42”

• cites [12] Balls E Menstrual hygiene management 2017 Available from: http://menstrualhygieneday.org/wp-content/uploads/2017/01/SHARE_-MHM_policybrief_2017.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [1] WHO/UNICEF Joint Monitoring Program for Water Supply and Sanitation Consultation on draft long list of goal, target and indicator options for future monitoring of water, sanitation and hygiene 2012 Available from: http://www.rural-water-supply.net/en/resources/details/378 Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [42] Water Supply and Sanitation Collaborative Council Annual Report: 2016 Geneva WSSCC 2017Not checked yet

  Not checked in the free run.

May combine two claims.

A 2013 evaluation of Minimal Initial Service Package (MISP) activities in a Jordanian refugee camp found inadequate availability of services and supplies for MHM, despite the 2010 addition of an MISP standard stating the need to ensure culturally appropriate MH materials were distributed.

“A 2013 evaluation20 of Minimal Initial Service Package (MISP) activities in a Jordanian refugee camp found inadequate availability of services and supplies for MHM, despite the 2010 addition of an MISP standard stating the need to ensure culturally appropriate MH materials were distributed.47”

• cites [20] Krause S Williams H Onyango MA Reproductive health services for Syrian refugees in Zaatri Camp and Irbid City, Hashemite kingdom of Jordan: an evaluation of the Minimum Initial Services Package Confl Health 2015 9 S4 25798190 PMC4331816Not checked yet

  Not checked in the free run.

• cites [47] Inter-agency Working Group on Reproductive Health in Crises Inter-agency Field Manual on Reproductive Health in Humanitarian Settings: 2010 Revision for Field Review Geneva IAWG 2010 26203479Not checked yet

  Not checked in the free run.

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

The potential consequences for refugee women who have inadequate access to menstrual materials are said to 'undermine(s) their opportunity to participate in community activities, registration, food distribution, training programmes, and employment opportunities.'

“The potential consequences for refugee women who have inadequate access to menstrual materials are said to “undermine(s) their opportunity to participate in community activities, registration, food distribution, training programmes, and employment opportunities.”5”

• cites [5] United Nations High Commissioner for Refugees Global Trends: Forced Displacement in 2016 Geneva UNHCR 2017Not checked yet

  Not checked in the free run.

May combine two claims.

Varied findings across studies demonstrate the extensive range of cultural beliefs and confirm the need for understanding and adapting interventions to specific contexts.

“Varied findings across studies demonstrate the extensive range of cultural beliefs and confirm the need for understanding and adapting interventions to specific contexts.11”

• cites [11] Sommer M Kjellen M Pensulo C Girls’ and women’s unmet needs for menstrual hygiene management (MHM): the interactions between MHM and sanitation systems in low-income countries J Water Sanit Hyg Dev 2013 3 283 297Not checked yet

  Not checked in the free run.

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

Considering whether absorbent menstrual products are supported by adequate sanitation facilities was deemed important when designing interventions.

“Considering whether absorbent menstrual products are supported by adequate sanitation facilities was deemed important when designing interventions.4,6,15,19”

• cites [4] Sommer M Menstrual hygiene management in humanitarian emergencies: gaps and recommendations Waterlines 2012 31 83 104Not checked yet

  Not checked in the free run.

• cites [6] Sommer M Schmitt ML Clatworthy D Bramucci G Wheeler E Ratnayake R What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? Waterlines 2016 35 245 264Not checked yet

  Not checked in the free run.

• cites [15] Ersel M Water and sanitation standards in humanitarian action Turk J Emerg Med 2015 15 27 33 27437529 PMC4910130Not checked yet

  Not checked in the free run.

• cites [19] Parker AH Smith JA Verdemato T Cooke J Webster J Carter RC Menstrual management: a neglected aspect of hygiene interventions Disaster Prev Manag 2014 23 437 454Not checked yet

  Not checked in the free run.

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

Educating populations on how to use products provided in humanitarian responses is important when implementing interventions.

“Educating populations on how to use products provided in humanitarian responses is important when implementing interventions.19,22,31”

• cites [19] Parker AH Smith JA Verdemato T Cooke J Webster J Carter RC Menstrual management: a neglected aspect of hygiene interventions Disaster Prev Manag 2014 23 437 454Not checked yet

  Not checked in the free run.

• cites [22] Thapa SB Acharya G Women’s health is not in focus in disaster zones: lessons from the Nepal earthquake J Fam Plann Reprod Health Care 2017 43 92 93 27940443Not checked yet

  Not checked in the free run.

• cites [31] House S Mahon T Cavill S Menstrual hygiene matters 2012 Available from: https://washmatters.wateraid.org/publications/menstrual-hygiene-matters Accessed January 29, 2018Not checked yet

  Not checked in the free run.

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

Access to information about menstruation and MH is frequently cited as being important and often referred to as 'software interventions.'

“Access to information about menstruation and MH is frequently cited as being important1,4,11,27,28 and often referred to as “software interventions.”40”

• cites [1] WHO/UNICEF Joint Monitoring Program for Water Supply and Sanitation Consultation on draft long list of goal, target and indicator options for future monitoring of water, sanitation and hygiene 2012 Available from: http://www.rural-water-supply.net/en/resources/details/378 Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [4] Sommer M Menstrual hygiene management in humanitarian emergencies: gaps and recommendations Waterlines 2012 31 83 104Not checked yet

  Not checked in the free run.

• cites [11] Sommer M Kjellen M Pensulo C Girls’ and women’s unmet needs for menstrual hygiene management (MHM): the interactions between MHM and sanitation systems in low-income countries J Water Sanit Hyg Dev 2013 3 283 297Not checked yet

  Not checked in the free run.

• cites [27] Swedish International Development Cooperation Agency Health: both a prerequisite and an outcome of sustainable development 2016 Available from: https://www.sida.se/contentassets/2d05faf3aebc4092a0ef96439c026262/18565.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

• cites [28] Rohwerder B Non-food items (NFIs) and the needs of women and girls in emergencies 2014 Available from: http://www.ids.ac.uk/publication/non-food-items-nfis-and-the-needs-of-women-and-girls-in-emergencies Accessed January 29, 2018Not checked yet

  Not checked in the free run.

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

Inadequate access to absorbent materials and disposal methods can perpetuate the already existing stigma and shame surrounding menstruation.

“The link between sanitation infrastructure, menstrual materials, and social impact arose as one author explained how inadequate access to absorbent materials and disposal methods can perpetuate the already existing stigma and shame surrounding menstruation.27”

• cites [27] Swedish International Development Cooperation Agency Health: both a prerequisite and an outcome of sustainable development 2016 Available from: https://www.sida.se/contentassets/2d05faf3aebc4092a0ef96439c026262/18565.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

May combine two claims.

Despite the rarity of learning lessons publicly shared in humanitarian aid reports, some documentation did include recommendations of providing sex-sensitive, participatory responses for MHM, including feedback mechanisms in interventions to create a comfortable environment for women to share information.

“Despite the rarity of learning lessons publicly shared in humanitarian aid reports, some documentation did include recommendations of providing sex-sensitive, participatory responses for MHM, including feedback mechanisms in interventions to create a comfortable environment for women to share information.37,49,50”

• cites [37] Cooperative for Assistance and Relief Everywhere Rapid gender and protection assessment report: Kobane refugee population Suruç, Turkey 2014 Available from: https://reliefweb.int/report/turkey/rapid-gender-and-protection-assessment-report-kobane-refugee-population-suruc-turkey Accessed January 29, 2018Not checked yet

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• cites [49] Djibouti Red Crescent Society Djibouti/Yemen unrest 2015 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/Djibouti%20DREF%20Review%20Final%20Report.pdf Accessed January 29, 2018Not checked yet

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• cites [50] West Bengal State Inter Agency Group Report of joint rapid need assessment: south Bengal flood 2017 2017 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/jrna-report-of-south-bengal-flood-2017.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

May combine two claims.

A search for the term 'menstrual hygiene' on October 23, 2017 produced 144 English-language reports written between 1999 and 2017, with increasing frequency in more recent years.

“A search for the term “menstrual hygiene” on October 23, 2017 produced 144 English-language reports written between 1999 and 2017, with increasing frequency in more recent years.”

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

Thapa and Acharya mentioned that MH had received low priority, due to the overwhelming need for water, food, and shelter in such crisis situations.

“Thapa and Acharya22 mentioned that MH had received low priority, due to the overwhelming need for water, food, and shelter in such crisis situations.”

• cites [22] Thapa SB Acharya G Women’s health is not in focus in disaster zones: lessons from the Nepal earthquake J Fam Plann Reprod Health Care 2017 43 92 93 27940443Not checked yet

  Not checked in the free run.

May combine two claims.

Collaboration and knowledge sharing with relevant actors in a humanitarian response was found to be important, as was ensuring that staff were aware of and competent in discussing MHM needs.

“Collaboration and knowledge sharing with relevant actors in a humanitarian response was found to be important,31,47 as was ensuring that staff were aware of and competent in discussing MHM needs.8,31”

• cites [31] House S Mahon T Cavill S Menstrual hygiene matters 2012 Available from: https://washmatters.wateraid.org/publications/menstrual-hygiene-matters Accessed January 29, 2018Not checked yet

  Not checked in the free run.

• cites [47] Inter-agency Working Group on Reproductive Health in Crises Inter-agency Field Manual on Reproductive Health in Humanitarian Settings: 2010 Revision for Field Review Geneva IAWG 2010 26203479Not checked yet

  Not checked in the free run.

• cites [8] Columbia University A toolkit for integrating menstrual hygiene management (MHM) into humanitarian response: the full guide 2017 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/mhm-emergencies-toolkit-full_0.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

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

Consideration of the MHM needs of vulnerable groups (disabled, very poor, unaccompanied minors, orphans, and minority groups) among the wider female population in crisis was recommended in the most recently published guideline.

“Consideration of the MHM needs of vulnerable groups (disabled, very poor, unaccompanied minors, orphans, and minority groups) among the wider female population in crisis was recommended in the most recently published guideline.8”

• cites [8] Columbia University A toolkit for integrating menstrual hygiene management (MHM) into humanitarian response: the full guide 2017 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/mhm-emergencies-toolkit-full_0.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

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

There was one mention of ensuring MHM needs were included in budgetary planning.

“There was one mention of ensuring MHM needs were included in budgetary planning.53”

• cites [53] United Nations Children’s Fund Water, Sanitation, and Hygiene for Schoolchildren in Emergencies: A Guidebook for Teachers New York UNICEF 2011Not checked yet

  Not checked in the free run.

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

Considering timing and location of distribution to promote inclusion and mitigate risk for sex-based violence was also discussed.

“Considering timing and location of distribution to promote inclusion and mitigate risk for sex-based violence was also discussed.8,56”

• cites [8] Columbia University A toolkit for integrating menstrual hygiene management (MHM) into humanitarian response: the full guide 2017 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/mhm-emergencies-toolkit-full_0.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [56] Inter-agency Standing Committee Guidelines for Integrating Gender-Based Violence Interventions in Humanitarian Action: Reducing Risk, Promoting Resilience, and Aiding Recovery New York IASC 2015Not checked yet

  Not checked in the free run.

May combine two claims.

A lack of systematic documentation can be one contributing factor to the gap between policy and practice, which is likely linked to a lack of M&E of interventions.

“A lack of systematic documentation can be one contributing factor to the gap between policy and practice,4,6,24 which is likely linked to a lack of M&E of interventions.”

• cites [4] Sommer M Menstrual hygiene management in humanitarian emergencies: gaps and recommendations Waterlines 2012 31 83 104Not checked yet

  Not checked in the free run.

• cites [6] Sommer M Schmitt ML Clatworthy D Bramucci G Wheeler E Ratnayake R What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? Waterlines 2016 35 245 264Not checked yet

  Not checked in the free run.

• cites [24] Schmitt ML Clatworthy D Ratnayake R Understanding the menstrual hygiene management challenges facing displaced girls and women: findings from qualitative assessments in Myanmar and Lebanon Confl Health 2017 11 19 29046714 PMC5641996Not checked yet

  Not checked in the free run.

May combine two claims.

M&E indicators were lacking in many of the documents, although guidance notes for developing M&E plans were mentioned.

“M&E indicators were lacking in many of the documents, although guidance notes for developing M&E plans were mentioned.”

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

As stated in Sommer's 2012 literature review, it is unfortunate that these brief activity reports do not allow for much in way of learning.

“As stated in Sommer’s 2012 literature review,4 it is unfortunate that these brief activity reports do not allow for much in way of learning.”

• cites [4] Sommer M Menstrual hygiene management in humanitarian emergencies: gaps and recommendations Waterlines 2012 31 83 104Not checked yet

  Not checked in the free run.

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

Several documents mentioned adapting interventions to the context, including the phase of the emergency.

“Several documents mentioned adapting interventions to the context, including the phase of the emergency.31,47,52,55,56”

• cites [31] House S Mahon T Cavill S Menstrual hygiene matters 2012 Available from: https://washmatters.wateraid.org/publications/menstrual-hygiene-matters Accessed January 29, 2018Not checked yet

  Not checked in the free run.

• cites [47] Inter-agency Working Group on Reproductive Health in Crises Inter-agency Field Manual on Reproductive Health in Humanitarian Settings: 2010 Revision for Field Review Geneva IAWG 2010 26203479Not checked yet

  Not checked in the free run.

• cites [52] United Nations Population Fund Adolescent Sexual and Reproductive Health Toolkit of Humanitarian Settings: A Companion to the Inter-agency Field Manual on Reproductive Health in Humanitarian Settings New York UNFPA 2009Not checked yet

  Not checked in the free run.

• cites [55] Médecins Sans Frontières Gender and sanitation tool for displaced populations 2014 Available from: http://fieldresearch.msf.org/msf/bitstream/10144/336731/1/Gender+and+Sanitation+Tool+Final+Dec+8+2013+(1).pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

• cites [56] Inter-agency Standing Committee Guidelines for Integrating Gender-Based Violence Interventions in Humanitarian Action: Reducing Risk, Promoting Resilience, and Aiding Recovery New York IASC 2015Not checked yet

  Not checked in the free run.

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

House et al considered the phases of an emergency in the level of community consultation required before acting, with less in acute phases and increased understanding and revision of programs occurring during stabilization phases.

“House et al31 considered the phases of an emergency in the level of community consultation required before acting, with less in acute phases and increased understanding and revision of programs occurring during stabilization phases.”

• cites [31] House S Mahon T Cavill S Menstrual hygiene matters 2012 Available from: https://washmatters.wateraid.org/publications/menstrual-hygiene-matters Accessed January 29, 2018Not checked yet

  Not checked in the free run.

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

Hardware interventions focused on the provision of MH materials and the availability of female-friendly WASH facilities, including at schools and health facilities.

“Hardware interventions focused on the provision of MH materials8,31,36,47,52,53,57 and the availability of female-friendly WASH facilities, including at schools and health facilities.31,36,47,53,55,56”

• cites [8] Columbia University A toolkit for integrating menstrual hygiene management (MHM) into humanitarian response: the full guide 2017 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/mhm-emergencies-toolkit-full_0.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [31] House S Mahon T Cavill S Menstrual hygiene matters 2012 Available from: https://washmatters.wateraid.org/publications/menstrual-hygiene-matters Accessed January 29, 2018Not checked yet

  Not checked in the free run.

• cites [36] Sphere Project Humanitarian Charter and Minimum Standards in Disaster Response 3rd ed Rugby, UK Practical Action Publishing 2011Not checked yet

  Not checked in the free run.

• cites [47] Inter-agency Working Group on Reproductive Health in Crises Inter-agency Field Manual on Reproductive Health in Humanitarian Settings: 2010 Revision for Field Review Geneva IAWG 2010 26203479Not checked yet

  Not checked in the free run.

• cites [52] United Nations Population Fund Adolescent Sexual and Reproductive Health Toolkit of Humanitarian Settings: A Companion to the Inter-agency Field Manual on Reproductive Health in Humanitarian Settings New York UNFPA 2009Not checked yet

  Not checked in the free run.

• cites [53] United Nations Children’s Fund Water, Sanitation, and Hygiene for Schoolchildren in Emergencies: A Guidebook for Teachers New York UNICEF 2011Not checked yet

  Not checked in the free run.

• cites [57] Global Camp Coordination and Camp Management Cluster Camp Management Toolkit Geneva International Organization for Migration 2015Not checked yet

  Not checked in the free run.

May combine two claims.

A study examining reproductive health funding showed increases in the previous 12 years, although that which has been dedicated to MHM was not possible to distinguish, due to the overlap among health, WASH, and nonfood item (NFI) sectors.

“A study16 examining reproductive health funding showed increases in the previous 12 years, although that which has been dedicated to MHM was not possible to distinguish, due to the overlap among health, WASH, and nonfood item (NFI) sectors.”

• cites [16] Tanabe M Schaus K Rastogi S Krause S Patel P Tracking humanitarian funding for reproductive health: a systematic analysis of health and protection proposals from 2002–2013 Confl Health 2015 9 S2 25798188 PMC4331814Not checked yet

  Not checked in the free run.

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

Qualitative indicators examined user satisfaction with sanitation facilities, perceptions of levels of participation in programming, and barriers to participation in such groups.

“Qualitative indicators examined user satisfaction with sanitation facilities,8,36 perceptions of levels of participation in programming, and barriers to participation in such groups.56”

• cites [8] Columbia University A toolkit for integrating menstrual hygiene management (MHM) into humanitarian response: the full guide 2017 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/mhm-emergencies-toolkit-full_0.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [36] Sphere Project Humanitarian Charter and Minimum Standards in Disaster Response 3rd ed Rugby, UK Practical Action Publishing 2011Not checked yet

  Not checked in the free run.

• cites [56] Inter-agency Standing Committee Guidelines for Integrating Gender-Based Violence Interventions in Humanitarian Action: Reducing Risk, Promoting Resilience, and Aiding Recovery New York IASC 2015Not checked yet

  Not checked in the free run.

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

Though not an empirical representation of progress, the increase in documentation presented does show that MHM is becoming a more frequently reportable topic.

“Though not an empirical representation of progress, the increase in documentation presented does show that MHM is becoming a more frequently reportable topic.”

May combine two claims.

Thirteen reports discussed sanitation-infrastructure interventions, while only one mentioned the customary practices of the beneficiary community.

“Thirteen reports discussed sanitation-infrastructure interventions, while only one mentioned the customary practices of the beneficiary community.”

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

Contrary to House et al, Médecins Sans Frontières suggested that community consultation can and should occur in the first and second phases of an emergency, starting with technically appropriate sanitation-facility designs and adjusting these based on assessment findings for the specific beneficiary population.

“Contrary to this, Médecins Sans Frontières55 suggested that community consultation can and should occur in the first and second phases of an emergency, starting with technically appropriate sanitation-facility designs and adjusting these based on assessment findings for the specific beneficiary population.”

• cites [55] Médecins Sans Frontières Gender and sanitation tool for displaced populations 2014 Available from: http://fieldresearch.msf.org/msf/bitstream/10144/336731/1/Gender+and+Sanitation+Tool+Final+Dec+8+2013+(1).pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

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

Depending on the guideline reviewed, more or less emphasis was placed on software interventions.

“Depending on the guideline reviewed, more or less emphasis was placed on software interventions.”

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

Several guidelines recommended facilitating female-only groups for education sessions.

“Several guidelines recommended facilitating female-only groups for education sessions.8,31,53”

• cites [8] Columbia University A toolkit for integrating menstrual hygiene management (MHM) into humanitarian response: the full guide 2017 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/mhm-emergencies-toolkit-full_0.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [31] House S Mahon T Cavill S Menstrual hygiene matters 2012 Available from: https://washmatters.wateraid.org/publications/menstrual-hygiene-matters Accessed January 29, 2018Not checked yet

  Not checked in the free run.

• cites [53] United Nations Children’s Fund Water, Sanitation, and Hygiene for Schoolchildren in Emergencies: A Guidebook for Teachers New York UNICEF 2011Not checked yet

  Not checked in the free run.

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

Several recommendations were made to support the success of hardware interventions, including that at minimum during the acute emergency phase, basic information on MH, including how to use products distributed and sanitation systems, be provided.

“Several recommendations were made to support the success of hardware interventions, such as suggestions that at minimum during the acute emergency phase, basic information on MH, including how to use products distributed and sanitation systems, be provided.8,31,36,52”

• cites [8] Columbia University A toolkit for integrating menstrual hygiene management (MHM) into humanitarian response: the full guide 2017 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/mhm-emergencies-toolkit-full_0.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [31] House S Mahon T Cavill S Menstrual hygiene matters 2012 Available from: https://washmatters.wateraid.org/publications/menstrual-hygiene-matters Accessed January 29, 2018Not checked yet

  Not checked in the free run.

• cites [36] Sphere Project Humanitarian Charter and Minimum Standards in Disaster Response 3rd ed Rugby, UK Practical Action Publishing 2011Not checked yet

  Not checked in the free run.

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

Indicators set out in the most recent toolkit for MHM in emergencies provided space for program adaptation through considering female reports of receiving adequate and sufficient materials to meet their specific needs.

“Indicators set out in the most recent toolkit for MHM in emergencies8 provided space for program adaptation through considering female reports of receiving adequate and sufficient materials to meet their specific needs.”

• cites [8] Columbia University A toolkit for integrating menstrual hygiene management (MHM) into humanitarian response: the full guide 2017 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/mhm-emergencies-toolkit-full_0.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

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

In the last few years, global attention to integrate MHM into humanitarian response guidelines has increased.

“In the last few years, global attention to integrate MHM into humanitarian response guidelines has increased.”

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

The importance of "women-friendly" sanitation facilities that can offer a comfortable space for the female population to deal with their menstruation was highly recognized.

“The importance of “women-friendly” sanitation facilities that can offer a comfortable space for the female population to deal with their menstruation was also highly recognized.”

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

Some papers suggested the importance of working within families or creating counseling services, psychological support groups, and women's self-help groups, which could have a big impact on the well-being of girls and women in times of natural disasters.

“There was lots of agreement about incorporating part of this training and education within the school system,61 but some papers also suggested the importance to work within families17 or the creation of counseling services, psychological support groups, and women’s self-help groups, which could have a big impact on the well-being of girls and women in times of natural disasters.22”

• cites [17] Benner M Townsend J Kaloi W Reproductive health and quality of life of young Burmese refugees in Thailand Confl Health 2010 4 5 20338037 PMC2907534Not checked yet

  Not checked in the free run.

• cites [22] Thapa SB Acharya G Women’s health is not in focus in disaster zones: lessons from the Nepal earthquake J Fam Plann Reprod Health Care 2017 43 92 93 27940443Not checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Cultural taboos regarding discussing MHM with beneficiaries may impact the comfort of staff.

“However, it has been noted that cultural taboos regarding discussing MHM with beneficiaries may impact the comfort of staff; therefore, more effort should be made to prepare and train competent staff in this area.”

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

An article published by Thomson Reuters Foundation describes the challenges that refugee women face in managing menstruation.

“An article published by Thomson Reuters Foundation62 describes the challenges that refugee women face in managing menstruation.”

• cites [62] Pujol-Mazzini A For refugee women, periods a dangerous, shameful time 2017 Available from: http://news.trust.org/item/20170308150652-db2y1 Accessed January 29, 2018Not checked yet

  Not checked in the free run.

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

Special attention to MHM-product distribution and construction and adaptation of "women-friendly" WASH facilities has been given.

“Special attention to MHM-product distribution and construction and adaptation of “women-friendly” WASH facilities has been given.”

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

The Columbia University and International Rescue Committee document collated all information on assessment, best practices, and M&E indicators.

“As a document dedicated to filling the identified gaps, the authors collated all information on assessment, best practices, and M&E indicators.”

• cites [8] Columbia University A toolkit for integrating menstrual hygiene management (MHM) into humanitarian response: the full guide 2017 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/mhm-emergencies-toolkit-full_0.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

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

Until recently, House et al. had presented the most comprehensive document on MHM in emergencies.

“Until recently, House et al31 had presented the most comprehensive document on MHM in emergencies, with “knowledge and practice on MH programming from around the world to encourage the development of comprehensive and context specific approaches to MH.””

• cites [31] House S Mahon T Cavill S Menstrual hygiene matters 2012 Available from: https://washmatters.wateraid.org/publications/menstrual-hygiene-matters Accessed January 29, 2018Not checked yet

  Not checked in the free run.

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

In Zimbabwe, hypothetical acceptability was examined through a qualitative study.

“In Zimbabwe,59 hypothetical acceptability was examined through a qualitative study.”

• cites [59] Averbach S Sahin-Hodoglugil N Musara P Chipato T van der Straten A Duet for menstrual protection: a feasibility study in Zimbabwe Contraception 2009 79 463 468 19442783Not checked yet

  Not checked in the free run.

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

Nine of the peer-reviewed papers were original research studies and seven were literature reviews.

“Nine of the peer-reviewed papers were original research studies and seven literature reviews.”

May combine two claims.

Despite progress, many gaps still exist, such as agreement about which indicators can be used to monitor and evaluate MHM interventions.

“Despite the progress seen in the last few years, many gaps still exist, such as agreement about which indicators can be used to monitor and evaluate MHM interventions, lack of clarity about how to identify key components of an MHM response in different emergency settings, which actors should be integrated, and clear guidelines to assess context and beneficiaries’ needs.”

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

Dignity kits often include both reusable items, such as clothing, buckets, and shoes, as well as disposal materials, such as sanitary pads.

“Dignity kits often include both reusable items, such as clothing, buckets, and shoes, as well as disposal materials, such as sanitary pads.”

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

Many other factors associated with these experiences have also been reported in these contexts, including barriers to access of safe and private sanitation facilities, lack of support by international agencies, and stress when having to adapt to new menstrual management practices.

“Many other factors associated with these experiences have also been reported in these contexts (barriers to access of safe and private sanitation facilities, lack of support by international agencies, stress when having to adapt to new menstrual management practices).”

May combine two claims.

Two systematic reviews concluded that there was good evidence that educational interventions can improve MHM practices and reduce social restrictions.

“Two systematic reviews assessing the association of the social effects of MHM concluded that there was good evidence that educational interventions can improve MHM practices and reduce social restrictions, but they also concluded that there is a lack of strong evidence and that the studies included presented a high risk of bias, mainly due to outcome assessment.9,40”

• cites [9] Sumpter C Torondel B A systematic review of the health and social effects of menstrual hygiene management PLoS One 2013 8 e62004 23637945 PMC3637379Not checked yet

  Not checked in the free run.

• cites [40] Hennegan J Montgomery P Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low and middle income countries? A systematic review PLoS One 2016 11 e0146985 26862750 PMC4749306Not checked yet

  Not checked in the free run.

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

The potential introduction of new menstrual products in emergency settings was suggested in some of the literature.

“The potential introduction of new menstrual products in emergency settings was suggested in some of the literature; however, no studies about new products were found with a focus on humanitarian contexts.”

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

The Columbia University and International Rescue Committee document's information was supported by case studies and developed as a cross-sector tool for use by various sectors involved in MHM responses.

“The information was supported by case studies and developed as a cross-sector tool for use by the various sectors involved in MHM responses.”

• cites [8] Columbia University A toolkit for integrating menstrual hygiene management (MHM) into humanitarian response: the full guide 2017 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/mhm-emergencies-toolkit-full_0.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

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

Of the 51 articles, 16 were peer-reviewed papers and 35 were gray literature.

“16 articles were peer-reviewed papers and 35 gray literature.”

May combine two claims.

In Kenya, a mixed-method study collected baseline data and compared this to data 4 months after introducing menstrual cups.

“In Kenya,58 a mixed-method study collected baseline data and compared this to data 4 months after introducing menstrual cups.”

• cites [58] African Population and Health Research Center Attitudes Towards, and Acceptability of, Menstrual Cups as a Method for Managing Menstruation: Experiences of Women and Schoolgirls in Nairobi, Kenya Nairobi APHRC 2010Not checked yet

  Not checked in the free run.

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

From the gray literature, four were master's theses, 11 guidelines, and 20 NGO reports.

“From the gray literature, four were master’s theses, 11 guidelines, and 20 NGO reports (communications, policy briefs, evaluations, and case studies).”

May combine two claims.

Narratives from displaced populations state that they received sufficient items on arrival, but maintenance was inadequate to meet needs.

“This is supported by narratives from displaced populations that state that they received sufficient items on arrival, but maintenance was inadequate to meet needs.49”

• cites [49] Djibouti Red Crescent Society Djibouti/Yemen unrest 2015 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/Djibouti%20DREF%20Review%20Final%20Report.pdf Accessed January 29, 2018Not checked yet

  Not checked in the free run.

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

A review highlighted the need for systematic approaches or guidelines to issues of inclusiveness in the emergency context.

“A review13 also highlighted the need for systematic approaches or guidelines to issues of inclusiveness in the emergency context.”

• cites [13] Brown J Cavill S Cumming O Jeandron A Water, sanitation, and hygiene in emergencies: summary review and recommendations for future research Waterlines 2012 31 11 29Not checked yet

  Not checked in the free run.

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

Sommer et al outlined three essential components of the holistic response required to improve MHM among women and girls in emergency settings: access to appropriate menstrual material and additional supportive material for storage, washing, and drying; adequate infrastructure for water, sanitation, changing areas, and waste-disposal mechanisms; and menstrual health education and promotion.

“Sommer et al6 outlined the components of the holistic response required to improve MHM among women and girls in emergency settings, which included three essential components: access to appropriate menstrual material and additional supportive material for storage, washing, and drying; adequate infrastructure for water, sanitation, changing areas, and waste-disposal mechanisms; and menstrual health”

• cites [6] Sommer M Schmitt ML Clatworthy D Bramucci G Wheeler E Ratnayake R What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? Waterlines 2016 35 245 264Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S1 (asserted), S2 (checkable). May combine two claims.

MHM goes beyond water, sanitation, and hygiene (WASH) responses, and a cross-sector approach must be taken to ensure that humanitarian actions meet women's MH needs in emergency contexts.

“It has been argued6 that MHM goes beyond water, sanitation, and hygiene (WASH) responses, and that a cross-sector approach must be taken to ensure that humanitarian actions meet women’s MH needs in emergency contexts.”

• cites [6] Sommer M Schmitt ML Clatworthy D Bramucci G Wheeler E Ratnayake R What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? Waterlines 2016 35 245 264Not checked yet

  Not checked in the free run.

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

The overarching goal of MHM interventions is to ensure that menstruating females are able to manage this healthy biological process in a sustainable, hygienic, and dignified manner.

“The overarching goal of MHM interventions is to ensure that menstruating females are able to manage this healthy biological process in a sustainable, hygienic, and dignified manner.1,7”

• cites [1] WHO/UNICEF Joint Monitoring Program for Water Supply and Sanitation Consultation on draft long list of goal, target and indicator options for future monitoring of water, sanitation and hygiene 2012 Available from: http://www.rural-water-supply.net/en/resources/details/378 Accessed January 28, 2018Not checked yet

  Not checked in the free run.

• cites [7] Biran A Curtis V Gautam OP Background paper on measuring WASH and food hygiene practices: definition of goals to be tackling post-2015 by the Joint Monitoring Programme Available from: https://www.ircwash.org/resources/background-paper-measuring-wash-and-food-hygiene-practices-definition-goals-be-tackled Accessed January 28, 2018Not checked yet

  Not checked in the free run.

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

Continuous consultation with female beneficiaries during the intervention design and implementation phases overarch this holistic approach.

“Continuous consultation with female beneficiaries during the intervention design and implementation phases overarch this holistic approach.8”

• cites [8] Columbia University A toolkit for integrating menstrual hygiene management (MHM) into humanitarian response: the full guide 2017 Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/mhm-emergencies-toolkit-full_0.pdf Accessed January 28, 2018Not checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

The most recent literature review by Sommer et al identified a lack of existing peer-reviewed evidence examining effective MHM approaches in emergencies.

“The most recent literature review by Sommer et al6 identified a lack of existing peer-reviewed evidence examining effective MHM approaches in emergencies.”

• cites [6] Sommer M Schmitt ML Clatworthy D Bramucci G Wheeler E Ratnayake R What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? Waterlines 2016 35 245 264Not checked yet

  Not checked in the free run.

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

In order to deliver efficient and effective interventions, there is a need for clear guidelines that capture beneficiaries' needs in differing contexts, with consideration of cultural practices, requirements for designing appropriate interventions, delivery systems, and monitoring and evaluation (M&E) tools.

“In order to deliver efficient and effective interventions, there is a need for clear guidelines that capture beneficiaries’ needs in differing contexts, with consideration of cultural practices, requirements for designing appropriate interventions, delivery systems, and monitoring and evaluation (M&E) tools.”

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

Specifying the quantity of menstrual products to provide to females of menstruating age in guidelines can be useful as a reference.

“Specifying the quantity of menstrual products to provide to females of menstruating age in guidelines can be useful as a reference, although considering the diversity of practices among various populations, as well as within populations,11 these specifications can also undermine the importance of consulting beneficiaries to understand their specific needs.”

• cites [11] Sommer M Kjellen M Pensulo C Girls’ and women’s unmet needs for menstrual hygiene management (MHM): the interactions between MHM and sanitation systems in low-income countries J Water Sanit Hyg Dev 2013 3 283 297Not checked yet

  Not checked in the free run.

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

The lack of studies conducted in humanitarian contexts can be justified when considering the urgency of life-saving needs.

“The lack of studies conducted in humanitarian contexts can be justified when considering the urgency of life-saving needs.”

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

There is much still to be done to build the evidence base that will feed guidelines and programs to improve MHM among girls and women in emergency contexts.

“In conclusion, there is much still to be done to build the evidence base that will feed guidelines and programs to improve MHM among girls and women in emergency contexts.”