Indicators for National and Global Monitoring of Girls' Menstrual Health and Hygiene: Development of a Priority Shortlist

Hennegan, Julie; Caruso, Bethany A.; Zulaika, Garazi; Torondel, Belen; Haver, Jacquelyn; Phillips-Howard, Penelope A.; Valdez, Jonathan; Gruer, Caitlin; Okwaro, Neville; Mahon, Therese; Sommer, Marni

doi:10.1016/j.jadohealth.2023.07.017

Cited by 6 publications

(7 citation statements)

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“…Since this study was initiated, progress on indicators has been made [ 43 ]. Specifically, a shortlist of priority indicators for monitoring girls’ menstrual health at the national level [ 31 ] and a list of potential indicators for monitoring menstruation among those who work outside the home have been published [ 54 ]. Additionally, in 2021, the Joint Monitoring Programme for Water Supply, Sanitation, and Hygiene – custodians of monitoring data for SDG targets 6.1 and 6.2—included a set of harmonized menstrual health indicators as part of the first dedicated section on menstrual health in the regular reporting on household drinking water, sanitation, and hygiene [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several identified priorities have been acted upon, including the need to strengthen the evidence base, with over 50% of all menstrual health literature published after 2015 [ 4 ]. Other priorities have also seen progress, including the need for standardized menstrual measures [ 31 , 43 ] and definitions [ 30 , 44 , 45 ], and the need for a research consortium, which has begun to take shape under the umbrella of the Global Menstrual Collective (GMC). The GMC is a collaborative network whose aim is to bring together partners in MHH to amplify efforts and reduce duplication for mainstreaming menstrual health across health, education, gender, and water, sanitation, and hygiene (WASH).…”

Section: Introductionmentioning

confidence: 99%

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Research priorities for improving menstrual health across the life-course in low- and middle-income countries

Plesons,

Torondel,

Caruso

et al. 2023

Global Health Action

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Background Research on menstrual health is required to understand menstrual needs and generate solutions to improve health, wellbeing, and productivity. The identification of research priorities will help inform where to invest efforts and resources. Objectives To identify research priorities for menstrual health across the life-course, in consultation with a range of stakeholder groups from a variety of geographic regions, and to identify if menstrual health research priorities varied by expertise. Methods A modified version of the Child Health and Nutrition Research Initiative approach was utilized to reach consensus on a set of research priorities. Multisector stakeholders with menstrual health expertise, identified through networks and the literature, were invited to submit research questions through an online survey. Responses were consolidated, and individuals were invited to rank these questions based on novelty, potential for intervention, and importance/impact. Research priority scores were calculated and evaluated by participants’ characteristics. Results Eighty-two participants proposed 1135 research questions, which were consolidated into 94 unique research questions. The mean number of questions did not differ between low- and middle-income country (LMIC) and high-income country (HIC) participants, but significantly more questions were raised by participants with expertise in mental health and WASH. Sixty-six participants then ranked these questions. The top ten-ranked research questions included four on ‘understanding the problem’, four on ‘designing and implementing interventions’, one on ‘integrating and scaling up’, and one on ‘measurement’. Indicators for the measurement of adequate menstrual health over time was ranked the highest priority by all stakeholders. Top ten-ranked research questions differed between academics and non-academics, and between participants from HICs and LMICs, reflecting differences in needs and knowledge gaps. Conclusions A list of ranked research priorities was generated through a consultative process with stakeholders across LMICs and HICs which can inform where to invest efforts and resources.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Research priorities for improving menstrual health across the life-course in low- and middle-income countries

Plesons,

Torondel,

Caruso

et al. 2023

Global Health Action

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“…This instrument included items to describe how comfortable or clean adults and adolescents feel managing their menstruation, and covered key WASH variables [14,15]. In 2023, Hennegan et al described an indicator shortlist to monitor girl's MH and hygiene, including indicators focused on menstrual material access, stigma, health care and WASH services at school [16]. Although this instrument and instrument shortlist is useful for understanding women's and girls' needs in household and school contexts, it may not be suitable for marginalized populations if the duration of the survey application is long or focused on the household or school, particularly among unhoused or mobile populations for whom short surveys are more useful.…”

Section: Competing Interestsmentioning

confidence: 99%

“…Recent studies are developing scales to include measures of the other four components of MH focused on menstrual education, health care access, respectful environment and freedom to participate in all spheres of life during menstruation [1,16]. MH was defined in 2021 [1] and the JMP Gender in WASH short list of indicators that will be measured across countries was developed by Hennegen et al in 2023 [16]. Our data used in this MH-WASH scale was collected in 2020 and 2021 while these other scales were developed.…”

Section: Plos Onementioning

confidence: 99%

A brief instrument measuring the water, sanitation and hygiene domain of menstrual health among women who inject drugs

Calderón-Villarreal,

Avelar Portillo,

Abramovitz

et al. 2024

PLoS ONE

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Background Domains of adequate menstrual health (MH) include access to water, sanitation, and hygiene (WASH). People who menstruate with social disadvantages—such as homelessness or drug injection practices–often face barriers to WASH access. However, validated instruments to measure MH are limited among marginalized populations, and available instruments involve lengthy surveys. We developed and evaluated psychometric properties of a novel ‘MH WASH Domain Scale-12’ among people who menstruate and who inject drugs in the Tijuana–San Diego region and identified correlates of MH access using this scale. Methods We constructed a MH-scale based on access to twelve WASH-related items: (1) menstrual products, (2) body hygiene (bathing per week), (3) water sources for bathing, (4) improved, (5) non-shared, (6) available, (7) private, (8) nearby, (9) and safe sanitation facilities, (10) availability of soap, (11) water source for handwashing, and (12) handwashing facilities with soap/water. Variables were dichotomized and summed, with scores ranging from 0–12 points and higher scores indicating better MH access. We assessed the scale’s reliability and construct and content validity using data from a binational cross-sectional study. The sample included people who inject drugs (PWID) who had ever menstruated in their lifetime and were 18+ during 2020–2021. MH-WASH items were described, and the scale was further used as an outcome variable to identify correlates. Results Among 125 (124 cis-female and 1 trans-male) PWID that reported menstruating, our ‘MH WASH Domain Scale-12’ was reliable (Cronbach’s alpha = 0.81, McDonald’s Omega total = 0.83) and valid. We identified two sub-domains: Factor-1 included items describing ‘WASH availability’ and Factor-2 contained items related to ‘WASH security’—encompassing physical and biological safety. Scale scores were significantly lower among participants experiencing unsheltered homelessness compared to participants experiencing sheltered homelessness or living in permanent housing. Conclusion We constructed and validated a novel and reliable scale to measure MH-related WASH access that can be used to assess MH among marginalized populations in English- and Spanish-speaking contexts. Using this scale we identified disparities in MH-WASH access among PWID and who menstruate in the US-Mexico border region.

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“…Second, single items from the MPNS have been included as part of recommended indicators for national and global monitoring of menstrual health and hygiene. [17,18] We prioritised retaining these in shorter forms to enable comparability of data collected using the scale with national data. Third, we decided apriori to retain items in the MPNS that capture experiences separately relating to the home and school environments.…”

Section: The Present Studymentioning

confidence: 99%

The Menstrual Practice Needs Scale Short Form (MPNS-SF) and Rapid (MPNS-R): Development in Khulna, Bangladesh, and validation in cross-sectional surveys from Bangladesh and Uganda

Hennegan,

Hasan,

Jalil

et al. 2024

Preprint

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Objectives. Develop and validate short and rapid forms of the 36-item Menstrual Practice Needs Scale (MPNS-36). Design. Item reduction prioritised content validity and was informed by cognitive interviews with schoolgirls in Bangladesh, performance of scale items in past research, and stakeholder feedback. The original MPNS-36 was revalidated, and short and rapid forms tested in a cross-sectional survey. This was followed by further tests of dimensionality, internal consistency, and validity in multiple cross-sectional surveys. Setting and participants. Short form (MPNS-SF) and rapid form (MPNS-R) measures were developed in a survey of 313 menstruating girls (mean age=13.51) in Khulna, Bangladesh. They were further tested in the baseline survey of the Adolescent Menstrual Experiences and Health Cohort, in Khulna, Bangladesh (891 menstruating girls, mean age=12.40); and the dataset from the MPNS-36 development in Soroti, Uganda (538 menstruating girls, mean age=14.49). Results. The 18-item short form reflects the six original subscales, with the four core subscales demonstrating good fit in all three samples (Khulna pilot: RMSEA=0.064 90%CI 0.043-0.084, CFI=.94, TLI=.92. Cohort baseline: RMSEA=0.050 90%CI 0.039-0.062, CFI=.96, TLI=.95. Uganda: RMSEA=0.039 90%CI 0.028-0.050, CFI=.95, TLI=.94). The 9-item rapid form captures diverse needs. A two-factor structure was the most appropriate but fell short of adequate fit (Khulna pilot: RMSEA=0.092 90%CI 0.000-0.158, CFI=.93, TLI=.89). Hypothesised associations between the MPNS scores and other constructs were comparable between the MPNS-36 and MPNS-SF in all populations, and replicated, with attenuation, in the MPNS-R. Internal consistency remained acceptable. Conclusions. The MPNS-SF offers a reliable and valid measure of adolescent girls' menstrual hygiene experience while reducing participant burden, to support implementation and improve measurement in menstrual health research. The MPNS-R provides a brief measure with poorer structural validity, suited to including menstrual health within broader water, sanitation and hygiene or sexual and reproductive health research.

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Indicators for National and Global Monitoring of Girls' Menstrual Health and Hygiene: Development of a Priority Shortlist

Cited by 6 publications

References 39 publications

Research priorities for improving menstrual health across the life-course in low- and middle-income countries

Research priorities for improving menstrual health across the life-course in low- and middle-income countries

A brief instrument measuring the water, sanitation and hygiene domain of menstrual health among women who inject drugs

The Menstrual Practice Needs Scale Short Form (MPNS-SF) and Rapid (MPNS-R): Development in Khulna, Bangladesh, and validation in cross-sectional surveys from Bangladesh and Uganda

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