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

Full article at:   http://goo.gl/fH2C4K

By:  Hennegan J1, Montgomery P1.

• 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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Lack of Support for Relation between Woman's Masculinity Preference, Estradiol Level & Mating Context

It has been proposed that women's preferences for male facial sexual dimorphism are positively correlated with conception probability and differ between short- and long-term mating contexts. In this study, we tested this assumption by analyzing relationships between estradiol levels to the women's preferences of male faces that were manipulated to vary in masculinity. Estradiol was measured in daily saliva samples throughout the entire menstrual cycle collected by Polish women with regular menstrual cycles. 

In our analyses, we included the three most commonly used definitions of the fertile window in the literature. After computing the overall masculinity preference of each participant and measuring hormone levels, we found that

1. the timing of ovulation varied greatly among women (between -11 and -17 days from the onset of the next menses, counting backwards), 
2. there was no relationship between daily, measured during the day of the test (N=83) or average for the cycle (N=115) estradiol levels and masculinity preferences, 
3. there were no differences in masculinity preferences between women in low- and high-conception probability phases of the cycle, and 
4. there were no differences in masculinity preferences between short- and long-term mating contexts. 

Our results do not support the idea that women's preferences for a potential sexual partner's facial masculinity fluctuate throughout the cycle.

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By: Marcinkowska UM1, Ellison PT2, Galbarczyk A3, Milkowska K3, Pawlowski B4, Thune I5, Jasienska G6.

• 1Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, 20 Grzegorzecka St., 31-531 Krakow, Poland. Electronic address: ummarcinkowska@gmail.com.
• 2Department of Human Evolutionary Biology, Harvard University, 11 Divinity Av., Cambridge, MA 02138, USA.
• 3Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, 20 Grzegorzecka St., 31-531 Krakow, Poland.
• 4Department of Human Biology, University of Wrocław, Kuźnicza 35, Wrocław, Poland.
• 5Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway.
• 6Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, 20 Grzegorzecka St., 31-531 Krakow, Poland; Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT 06511-3707, USA.  

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