Stress, Menstruation and School Attendance: Effects of Water Security on Adolescent Girls in South Gondar, Ethiopia 公开
Fehr, Alexandra Elizabeth Thomp (2011)
Abstract
Stress, Menstruation and School Attendance: Effects of Water
Security on Adolescent
Girls in South Gondar, Ethiopia
By Alexandra Fehr
Background: Water, sanitation and hygiene (WASH) issues are
a growing concern
globally and disproportionately affect women and girls in
low-resource settings. Many of
the physical health outcomes of poor WASH have been studied, but
little attention has
been garnered to mental health. This is especially true among
adolescents, an oft-
neglected group in public health research. Initial research on the
topic has shown that
water insecurity, much like food insecurity, is significantly
associated with poor mental
health among women.
Objective: The objective of this study is to determine to
what extent water insecurity,
particularly water collection, menstrual management and school
hygiene, affect stress and
school attendance among adolescent girls, aged 13-18. This study
took place in South
Gondar, Ethiopia during the summer of 2010.
Methods: This study was conducted using a survey,
free-listing and ranking activities, in
addition to focus group discussions. A variety of qualitative and
quantitative analysis
methods, including consensus analysis, were used.
Results: 38% and 43% of participants had missed school due
to water collection and
menstruation, respectively. School hygiene was found to be in a
poor state, with 90% of
post-menarcheal girls stating their school did not have a place to
maintain hygiene while
menstruating. Consensus analysis, however, showed that among the
items causing stress
and school absence, menstruation was ranked eighth for stress and
ninth for school
absence.
Discussion: This study has several implications. First, it
further demonstrates the need
for WASH interventions and studies to include mental health
outcomes in addition to
physical ones. Second, it sheds light on the complications of
adolescent life, especially in
regard to barriers to health, well-being and school attendance.
Thirdly, by analyzing this
study's results and the already established associations between
different components of
WASH and health, this study proposes a theoretical model for which
water insecurity
leads to gender disparities in health.
Table of Contents
Table of Contents
Chapter 1: Introduction - 1
Chapter 2: Literature Review - 4
2.1: Contextual Level - 7
2.1.a: Drought - 7
2.1.b: Poverty - 8
2.1.c: Poor WASH Infrastructure - 9
2.1.d: Institutionalized Gender Inequality - 12
2.2: Individual Behavioral Level - 14
2.2.a: Universal Individual Behavioral Factors - 14
2.2.b: Female-Specific Individual Behavioral Factors - 14
2.2.b.i: Water Collection - 15
2.2.b.ii: Menstruation and Menstrual Management - 16
2.2.b.iii: Decreased Educational Opportunities - 19
2.2.b.iv: Early Marriage and Early Pregnancy - 22
2.3: Population Level - 24
2.4: Cultural Consensus - 28
Chapter 3: Manuscript - 30
3.1: Introduction - 30
3.2: Methods - 33
3.3: Results - 36
3.4: Discussion - 43
3.5: Conclusion - 47
Chapter 4: Discussion - 48
References - 57
Appendix - 57
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