'It's like a burden on the head': Redefining Adequate Menstrual Hygiene Management Throughout Women's Life Course in Odisha, India Open Access

MacRae, Elizabeth (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/r781wg07h?locale=en


There has been growing recognition of menstrual hygiene management (MHM) as a significant public health issue. However, research has predominately focused on the experiences of adolescent girls in school settings. This focus neglects the experiences of women and girls beyond the educational setting and in varying life stages. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India, critique the current definition of adequate MHM as put forth by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP), and propose an amended definition of MHM that captures the range of needs and concerns reported by women in rural Odisha, India. Focus group discussions and in-depth interviews were conducted on women’s experiences of menstruation across four life stages (unmarried women, recently married women, married women, and older women) in rural Odisha, India and thematic analysis was used to identify menstruation-related challenges and needs. We found women voiced needs that aligned with those articulated in the JMP definition: access to clean materials, privacy for changing materials, soap and water for bathing, and disposal facilities for materials. However, we also found the menstruation-related needs in the JMP definition need modification: beyond access to clean materials, women require comfortable and reliable materials; the need for soap and water extends beyond bathing; privacy is needed for the spectrum of menstruation-related practices; and access to disposal facilities needs to be prioritized. Additionally, we identified needs that extend beyond the existing definition: pain management, social support, and information. Given the limited scope of the current MHM framework, we proposed a revised definition of adequate MHM that more comprehensively captures the needs of women in this population. This definition may prove useful for future research, creating measures of assessment, or guiding interventions and program priorities.

Table of Contents

Table of Contents


Chapter I: Introduction 1

Problem Statement 1

Purpose Statement 1

Research Question and Objectives 2

Significance Statement 2

Definitions of Terms 3


Chapter II: Literature Review 4

Global Issue of Menstrual Hygiene Management 4

Impacts of Menstruation 5

Taboo and Restrictions 5

Physical Impacts 6

Psychosocial Impacts 6

Educational Impacts 7

Requirements for Menstrual Hygiene Management 8

Menstrual Management Materials 8

Water, Cleaning, and Disposal Facilities 9

Information and Social Support 9

Menstrual Hygiene Management Throughout the Life Course 10

Strengths and Limitations of Literature 11

Study Relevance 13


Chapter III: Manuscript 14

Introduction 17

Methods 20

Study Design 20

Setting 20

Participants 21

Data Collection and Preparation 22

Data Management and Analysis 23

Ethics 23

Results 24

Participant Characteristics 24

Qualitative Findings 27

Discussion 40

Findings Consistent with JMP Definition 40

Modifications to JMP Definition 41

Additions to JMP Definition 43

Strengths and Limitations 44

Conclusion 45


Chapter IV: Conclusion and Recommendations 46

Public Health Implications 46

Recommendations for Future Research 49


References 50


Appendices 55

Appendix A: Free-list Interview Tool 55

Appendix B: Focus Group Discussion Guide (Unmarried Women) 63

Appendix C: Focus Group Discussion Guide (Married Women) 68

Appendix D: Demographic Tool 73


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