Do Menstrual Hygiene Management Interventions Improve Education and Psychosocial Outcomes for Women and Girls in Low and Middle Income Countries? A Systematic Review
BACKGROUND:
Unhygienic
and ineffective menstrual hygiene management has been documented across low
resource contexts and linked to negative consequences for women and girls.
OBJECTIVES:
To
summarise and critically appraise evidence for the effectiveness of
menstruation management interventions in improving women and girls' education,
work and psychosocial wellbeing in low and middle income countries.
METHODS:
Structured
systematic searches were conducted in peer-reviewed and grey literature to
identify studies evaluating education and resource provision interventions for
menstruation management. Individual and cluster randomised controlled trials
were eligible for inclusion, as were non-randomised controlled trials. Study
characteristics, outcomes and risk of bias were extracted using a piloted form.
Risk of bias was independently assessed by two researchers.
RESULTS:
Eight
studies described in ten citations were eligible for inclusion. Studies were
highly heterogeneous in design and context. Six included assessment of
education-only interventions, and three provided assessment of the provision of
different types of sanitary products (menstrual cups, disposable sanitary pads,
and reusable sanitary pads). A moderate but non-significant standardised mean
difference was found for the two studies assessing the impact of sanitary pad
provision on school attendance: 0.49 (95%CI -0.13, 1.11). Included studies were
heterogeneous with considerable risk of bias. Trials of education interventions
reported positive impacts on menstrual knowledge and practices, however, many
studies failed to assess other relevant outcomes. No trials assessed or
reported harms.
CONCLUSIONS:
There
is insufficient evidence to establish the effectiveness of menstruation
management interventions, although current results are promising. Eight trials
have been conducted, but a high risk of bias was found and clinical
heterogeneity precluded synthesis of most results. Whilst trials provided some
indication of positive results, further research is needed to establish the
role of menstruation hygiene management in education performance, employment
and other psychosocial outcomes. This review provides a concise summary of
present trials and highlights improvements for future work.
Below: Review authors’ judgements about methodological items for each included study
- 1Centre for Evidence-Based Intervention, University of Oxford, Oxford, United Kingdom.
- PLoS One. 2016 Feb 10;11(2):e0146985. doi: 10.1371/journal.pone.0146985. eCollection 2016.
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