The More You Know, the Less You Stress: Menstrual Health Literacy in Schools Reduces Menstruation-Related Stress and Increases Self-Efficacy for Very Young Adolescent Girls in Mexico

Abstract

Improving the menstrual health literacy of girls and boys is a key strategy within a holistic framework of Save the Children's school health and comprehensive sexuality education programming. As menstrual health is an emerging area of study and programming, Save the Children continues to learn and adjust its interventions using program evaluations and rigorous monitoring. This paper will examine program-monitoring data from three cohorts, representing 47 public schools in Mexico City, Puebla, and Mérida, Mexico. The study focuses on female students in 5th and 6th grade who participated in We See Equal, a school-based program centered on gender equality and puberty education, between September 2018 and December 2019. This study used a cross-sectional quantitative cohort approach to document changes in girls' experiences and perceptions around managing menstruation in school. The analysis compares girls' knowledge and experiences before and after participation in We See Equal to understand how knowledge changes over the program and how those changes may contribute to menstruation-related school engagement, stress, and self-efficacy (MENSES) outcomes. Multivariate regression models explored relationships between MENSES outcomes, knowledge and socioeconomic status (SES). Overall, results show that the more knowledge girls acquired, the higher their self-efficacy score and the lower their stress score, however, certain MHH knowledge was more predictive of MENSES outcomes and varied by SES. Among girls from lower SES, we observed significant relationships between knowing what their period was prior to menarche and the three MENSES outcomes. Decreases in menstruation-related stress were driven by items related to the practical knowledge of how to dispose of sanitary pads and reduced feelings of nervousness on days they had their period at school. Increases in self-efficacy were primarily driven by girls' confidence in their ability to track their period from month to month, feelings that they could still do well on an exam if they had their period at school, and security that they could ask a friend to lend them a pad if they needed one. Implications for future menstrual health literacy programming and targeting populations for menstrual health education, as well as priorities for future research will be discussed.

Menstrual hygiene access and practices in Latin America: scoping review

“…The scope of scientific production on access and practices of menstrual hygiene was analyzed and organized by observation of recurrence, that is, by similarity of content, emerging three categories: 1) Access to dignified conditions for MHM ( 26 , 28 - 30 , 38 ) ; 2) Need for access to information ( 14 , 28 - 33 , 36 - 37 , 39 ) ; and 3) Practices for MHM ( 27 , 31 , 34 - 35 ) . The summary of the results identified by the studies in this review is presented in Figure 3 .…”

“…The findings of studies on access to information showed that adolescent girls who talked to their mothers ( 26 , 30 ) and who received information in schools ( 38 ) were considered more likely to feel prepared to experience menstruation. They were also those who related menstruation to a positive experience ( 26 ) .…”

Towards a Common Understanding of Gender-Responsive Monitoring and Evaluation for Health Programs and Interventions: Evidence from a Scoping Review

“…Of the 31 articles that met the inclusion criteria, 26 (84%) were direct evaluations of interventions , four (13%) were systematic literature reviews of gender focused methods and evaluation tools [34][35][36][37], and one was a review of a large multi-site program [38]. Fourteen of the 26 (45%) evaluations were conducted in Sub-Saharan Africa [9][10][11][12]16,[21][22][23][24]26,28,[31][32][33] while the remaining articles focused on specific locations were split between North America (n=4) [17,18,27,29], the Middle East (n=4) [8,13,15,30], and India (n=4) [14,19,20,25].…”

“…The most prevalent RMANCAH focus area was sexual health (n=16, 52%) [13,[18][19][20][21][22][23][25][26][27][28]30,32,33,37,38], largely concerning the issues of gender-based violence (GBV) and intimate partner violence (IPV) (n=8) [13,19,23,26,30,33,35,37] and HIV/AIDS prevention (n=8) [19,22,25,28,32,33,37,38]. Seven articles focused on maternal and neonatal health interventions [9,11,12,15,16,26,29], ten evaluated adolescent or child health and nutrition programs [8,12,[15][16][17][18]20,22,27,…”

“…Sixteen of 31 studies (52%) were purely quantitative [8][9][10][11][12][13][17][18][19]21,23,25,28,29,31,32], while an additional six studies used qualitative methods as part of a mixed-methods design [14,15,20,22,30,38]. Surveys were the most common instrument used to collect data through randomized control trials (n=5) [8,12,18,21,28], cluster randomized control trials (n=6) [9,19,23,25,29,31], cross-sectional cohort studies (n=3) [11,17,32], and controlled cohort studies (n=1) [10]. In the eight mixed-methods and six qualitative-only evaluations [16,21,24,26,27,33], the most popular methods employed were in-depth interviewing (n=7) [14,16,20,…”