BACKGROUND Disposal and washing facilities and services for menstrual materials are often designed based upon technical specifications rather than an in-depth understanding of what drives peoples' choices of practices. OBJECTIVES AND DATA SOURCES This systematic review identified and summarised the main behavioural drivers pertaining to the choice of disposal and washing practices of menstrual materials through the thematic content analysis and study appraisal of 82 publications (80 studies) on menstrual health and hygiene published since 1999, reporting the outcomes of primary research across 26 countries. RESULTS Disposal and washing behaviours are primarily driven by the physical state of sanitation facilities; however, this is intrinsically linked to taboos surrounding and knowledge of menstruation. IMPLICATIONS Using reasons given for disposal and washing practices by menstruators or those who know them well, or inferred by authors of the reviewed studies, we identify the key considerations needed to design facilities and services which best suit the desired behaviours of both planners and those who menstruate. INCLUSIVITY The term menstruators is used throughout to encompass all those mentioned in the studies reviewed (girls and women); although no studies explicitly stated including non-binary or transgender participants, this review uses inclusive language that represents the spectrum of genders that may experience menstruation. REGISTRATION The review protocol is registered on PROSPERO: 42019140029.

Drivers of menstrual material disposal and washing practices: A systematic review.

Background: Menstrual hygiene management has become a globally recognized public health issue. As evidenced by the National Family Health Survey-4 (NFHS-4), among the states in India, Bihar accounts for the lowest use of hygienic methods of menstrual protection among youth. Further, the use in rural areas of Bihar is substantially lower than in urban areas. Objectives: Therefore, using NFHS-4 data, this study endeavors to explore the socioeconomic and demographic factors in explaining the rural-urban gap in the use of hygienic methods of menstrual protection among youth in Bihar. Methodology: A logistic regression model is used to identify the socioeconomic and demographic determinants of the use of hygienic methods, and Fairlie's decomposition technique is employed to compute the rural-urban difference in the use, and then to decompose these differentials into their separate underlying factors. Results: Findings from logistic regression analysis reveal that women's education, household wealth, media exposure, use of toilet facility, and awareness of sexually transmitted infections (STIs) are the significant determinants influencing the use of hygienic methods of menstrual protection. Results from decomposition analysis indicate that while use of improved toilet facility and mass media exposure among youth reduce the rural-urban gap, the unequal distribution of women's educational qualification, wealth index, marital status, and awareness of STIs has tended to widen the gap. Conclusion: The findings suggest promotion of menstrual hygiene practices, enhancement of menstrual hygiene knowledge, opportunities for women's education, better sanitation practices, exposure of mass media, and economic incentives among youth in rural Bihar.

What Explains the Rural-Urban Gap in the Use of Hygienic Methods of Menstrual Protection among Youth in the East Indian State of Bihar?

Abstract In this paper, we present the results of a qualitative study by a non-profit organisation implementing a community-based urban adolescent development programme. The study highlights the sexual and reproductive health and rights (SRHR) situation of marginalised young women in a developed state of India. Our findings, based on in-depth interviews with young women and frontline health providers, show that structural factors, such as economic and social stratifiers, gender norms and cultural beliefs, result in further marginalisation of young women. In turn, marginalisation adversely affects the realisation of SRHR through discriminatory practices around menstruation and lack of control in matters related to sexuality, contraception, pregnancy and safe abortion. Rights to the highest standards of sexual and reproductive health (SRH) care are compromised. Health system factors like providers’ attitudes and knowledge, commodity supplies, and indifference to ensuring delivery of contraceptives and other services often result in unplanned pregnancies and affect the quality of young women’s SRH care. Whatever information and support adolescents and young women get is from local community-based organisations. We conclude that structural determinants and violations of fundamental rights to education, equal opportunities and participation constitute a significant barrier to the enjoyment of SRHR by the marginalised young women in the study. Unless these are addressed, government policies and programmes to promote young people’s SRHR will not benefit young women from disadvantaged communities. Partnership and complementarity between government programmes, adolescents and health rights civil society organisations are recommended to promote rights-based, equitable adolescent and youth-friendly services to this vulnerable population.

Social and economic marginalisation and sexual and reproductive health and rights of urban poor young women: a qualitative study from Vadodara, Gujarat, India

The field of artificial intelligence (AI) has evolved considerably in the last 60 years. While there are now many AI applications that have been deployed in high-income country contexts, use of AI in resource-poor settings remains relatively nascent. With a few notable exceptions, there are limited examples of AI being used in such settings. However, there are signs that this is changing. Several high-profile meetings have been convened in recent years to discuss the development and deployment of AI applications to reduce poverty and deliver a broad range of critical public services. The authors provide a general overview of AI and how it can be used to improve global health outcomes in resource-poor settings. They also describe some of the current ethical debates around patient safety and privacy. The research paper specifically highlights the challenges related to women menstrual hygiene and suggests AI technology for improving the menstrual hygiene and healthcare services in resource-poor settings for women. Many health system hurdles in such settings could be overcome with the use of AI and other complementary emerging technologies. Further research and investments in the development of AI tools tailored to resource-poor settings will accelerate the realization of the full potential of AI for improving global health in resource-poor contexts.

Artificial Intelligence Based System: Improving the Women Menstrual Hygiene

Background The exclusive use of hygienic materials during menstruation (sanitary napkins, locally made napkins, tampons, and menstrual cups) among urban women in India has been increasing over time. However, little is known about the wealth-based disparity in the exclusive use of hygienic materials during menstruation among these women. This study, therefore, measures wealth-based inequality in the exclusive use of hygienic materials during menstruation among urban women in India. Furthermore, the measured inequality is decomposed to unravel its contributing factors. Data and methods Using data from the National Family Health Survey-5 (2019–21), we calculated the Erreygers normalized concentration index (CI) for India and each of its states to measure wealth-based inequality in the exclusive use of hygienic materials during menstruation among women in urban India. Further, we decomposed the Erreygers CI to estimate the relative contribution of covariates to wealth-based inequality in the exclusive use of hygienic materials during menstruation. The analysis included 54,561 urban women aged 15–24 from 28 states and eight union territories of India. Results The Erreygers CI value of 0.302 indicated a pro-rich inequality in the exclusive use of hygienic materials among urban women in India. While all the states and UTs showed pro-rich inequality, the CI varied considerably across the country. Among the bigger states, the inequality was highest in Madhya Pradesh (CI: 0.45), Assam (CI: 0.44), Bihar (CI: 0.41), and West Bengal (CI: 0.37) and the lowest in the south Indian states of Tamil Nadu (CI: 0.10), Andhra Pradesh (CI: 0.15), Telangana (CI: 0.15), and Kerala (CI: 0.20). Erreygers decomposition revealed that wealth-based inequality in women’s education and mass media exposure contributed almost 80% of the wealth-based inequality in the exclusive use of hygienic materials during menstruation among urban women in India. Conclusion Substantial pro-rich inequality in the exclusive use of hygienic materials suggests that the policies and program initiatives should prioritize reaching out to poor women to increase the overall rate of exclusive use of hygienic materials during menstruation in urban India.

https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0277095&type=printable

Wealth-based inequality in the exclusive use of hygienic materials during menstruation among young women in urban India

For the first time since Independence, India’s urban population has registered a higher increase than the rural population. Increasing urbanbiased economic activity and job creation are leading to ...

https://journals.sagepub.com/doi/pdf/10.1177/0971521518811174

Vasudha Chakravarthy

Papers

Does Menstrual Hygiene Management in Urban Slums Need a Different Lens? Challenges Faced by Women and Girls in Jaipur and Delhi: