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A comparative study of menarche and menstruation knowledge and experiences of girls aged 16-19 years old in low-resource settings of the Philippines and the United Kingdom
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Evans, Rebecca Ruth Lane (2023) A comparative study of menarche and menstruation knowledge and experiences of girls aged 16-19 years old in low-resource settings of the Philippines and the United Kingdom. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b3985899~S1
Abstract
It is known that menstruation is a challenge to schoolgirls that can affect both attendance and participation. This research seeks to understand the factors that affect the quality of the menstrual experience of schoolgirls so that more supportive policies can be designed.
This was a mixed-methods study which recruited menstruators between the ages of 16 and 19 in the Philippines (a Low-and-Middle Income Country (LMIC)) and in the United Kingdom (UK) (a High-Income Country (HIC)) using Facebook Advertising. Respondents completed an on-line survey in Qualtrics. 11 Likert-style questions were used to produce a Menstrual Knowledge score and 14 Likert-style questions were used to produce a Menstrual Experiences score. Regression analysis looked for associations between the menstrual experience and demography. A small group of respondents from each country took part in an asynchronous epistolary Focus Group Discussion via social media. Qualitative data were imported into Nvivo for Thematic Analysis.
706 menstruators were recruited (Philippines n = 308 and UK n = 398). For the focus groups, n = 12 and n = 8 respectively. Using P<0.5, predictors of knowledge in the Philippines were perceived income, improved sanitation, a waste-collection service and state-schooling Predictors of experience were absolute income (food security) and improved sanitation. Predictors of knowledge in the UK were perceived income, urban setting and state-schooling. Predictors of experience were perceived income, urban setting and age. There was a significant difference between the Philippines and the UK in knowledge score but no difference between experience score (P<0.001). There was a significant difference between the two countries in how girls feel when they are menstruating (P<0.01). Girls in the UK felt more negative about menstruation than those in the Philippines. Girls in both countries frequently described suffering from dysmenorrhea which affected their participation. They also reported anxiety about leaking which affected their concentration.
This study confirmed that access to menstrual products and adequate Water, Sanitation and Hygiene (WASH) facilities is a fundamental requirement for girls to manage their menstruation at school. Limited access to resources in the Philippines affected girls’ menstrual experiences, and a few were forced to go home from school to deal with the bleeding. This study also revealed that despite UK schools providing products and a good standard of facilities, this alone did not improve girls’ experience of menstruation; girls in the UK did not rate their menstrual experience any better than those in the Philippines.
Debilitating dysmenorrhea was very commonly experienced. In the Philippines, girls got support from their peers and their teachers and could leave the classroom temporarily to change or rest if necessary. In the UK, girls complained about school policies that did not let them out of the classroom. They routinely took painkillers, and some took the contraceptive pill, in order to be able to cope. The menstrual stigma requiring them to ‘put up and shut up’ led to anxiety and negative feelings around menstruation. These findings concur with what has been called ‘the Menstrual Mandate’ in HICs in which girls are expected to conceal their menstruation from others (Bobel, 2019).
This research found that girls in LMIC need access to painkillers as well as pads and infrastructure to enable them to participate in school activities, but in both LMIC and HIC, policies that remove the menstrual stigma, educate about dysmenorrhea and menstrual disorders, and promote Menstrual Health more widely need to be developed. The results of the literature review into menstrual education interventions suggested that interactive interventions that promote discussion are the most effective for improving menstrual literacy.
Item Type: | Thesis (PhD) | ||||
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Subjects: | Q Science > QP Physiology | ||||
Library of Congress Subject Headings (LCSH): | Menarche -- Philippines, Menarche -- Great Britain, Menstrual cycle -- Social aspects -- Philippines, Menstrual cycle -- Social aspects -- Great Britain, Menstruation disorders, Adolescent gynecology, Menstruation, Teenage girls -- Health and hygiene -- Great Britain, Teenage girls -- Health and hygiene -- Philippines | ||||
Official Date: | February 2023 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Griffiths, Frances, Harris, Bronwyn | ||||
Extent: | 351 pages : illustrations, charts | ||||
Language: | eng |
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