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Research article
Qualitative study exploring the barriers to menstrual hygiene management faced by adolescents and young people with a disability, and their carers in the Kavrepalanchok district, Nepal
Jane Wilbur
London School of Hygiene and Tropical Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5329-1337
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Menstrual hygiene management (MHM) is a recognised public health, social and educational issue, which must be achieved to allow the realisation of human rights. People with disabilities are likely to experience layers of discrimination when they are menstruating, but little evidence exists.
Methods: The study aims to investigate barriers to MHM that people with disabilities and their carers, face in the Kavrepalanchok, Nepal, using qualitative methods. Twenty people with disabilities, aged 15-24, who menstruate and experience ‘a lot of difficulty’ or more across one or more of the Washington Group functional domains were included, as well as 13 carers who provide menstrual support to these individuals. Purposeful sampling was applied to select participants. Different approaches were used to investigating barriers to MHM and triangulate data: in-depth interviews, observation, PhotoVoice and ranking. We analysed data thematically, using Nvivo 11.
Results: Barriers to MHM experienced by people with disabilities differ according to the impairment. Inaccessible WASH facilities were a major challenge for people with mobility, self-care and visual impairments. People with intellectual impairments had difficulty accessing MHM information and their carers despaired when they showed their menstrual blood to others, which could result in abuse. No support mechanisms existed for carers for MHM, who overwhelmed and isolated. Menstrual discomfort was a major challenge; these were managed with home remedies, or not at all. Most participants followed menstrual restrictions, which were widespread and expected, for fear of being cursed if they did not. As disability is often viewed as a curse, this demonstrates the layers of discrimination faced.
Conclusion: Issues related to MHM for people with disabilities is more complex than for others in the population due to the additional disability discrimination and impairment experienced. Research exploring these issues must be conducted in different settings, and MHM interventions, tailored for impairment type and carers requirements, must be developed. Attention to, and resourcing for disability inclusive MHM must be prioritised to ensure ‘no one is left behind’.
Keywords
disability, carers, menstruation, menstrual hygiene management, rights, Nepal
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Posted 17 Dec, 2020
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Received 13 Dec, 2020
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On 08 Dec, 2020
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On 05 Dec, 2020
Editor invited
On 05 Dec, 2020
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Review #2 received
Received 23 Nov, 2020
Reviewer #2 agreed
On 10 Nov, 2020
Review #1 received
Received 23 Oct, 2020
Editor assigned
On 06 Oct, 2020
Reviewers invited
Invitations sent on 06 Oct, 2020
Reviewer #1 agreed
On 06 Oct, 2020
Submission checks complete
On 05 Oct, 2020
Editor invited
On 05 Oct, 2020
No comments provided
Editorial decision: Major revision
On 03 Aug, 2020
Review #2 received
Received 27 Jul, 2020
Review #1 received
Received 12 Jun, 2020
Reviewer #2 agreed
On 10 Jun, 2020
Reviewer #1 agreed
On 08 Jun, 2020
Reviewers invited
Invitations sent on 05 Jun, 2020
Editor assigned
On 30 Apr, 2020
Submission checks complete
On 29 Apr, 2020
Editor invited
On 29 Apr, 2020
First submitted
On 28 Apr, 2020
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This preprint is under consideration at BMC Public Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Qualitative study exploring the barriers to menstrual hygiene management faced by adolescents and young people with a disability, and their carers in the Kavrepalanchok district, Nepal
Jane Wilbur
London School of Hygiene and Tropical Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5329-1337
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 17 Dec, 2020
No community comments so far
Review #1 received
Received 13 Dec, 2020
Reviewers invited
Invitations sent on 08 Dec, 2020
Reviewer #1 agreed
On 08 Dec, 2020
Editor assigned
On 05 Dec, 2020
Submission checks complete
On 05 Dec, 2020
Editor invited
On 05 Dec, 2020
No comments provided
Review #2 received
Received 23 Nov, 2020
Reviewer #2 agreed
On 10 Nov, 2020
Review #1 received
Received 23 Oct, 2020
Editor assigned
On 06 Oct, 2020
Reviewers invited
Invitations sent on 06 Oct, 2020
Reviewer #1 agreed
On 06 Oct, 2020
Submission checks complete
On 05 Oct, 2020
Editor invited
On 05 Oct, 2020
No comments provided
Editorial decision: Major revision
On 03 Aug, 2020
Review #2 received
Received 27 Jul, 2020
Review #1 received
Received 12 Jun, 2020
Reviewer #2 agreed
On 10 Jun, 2020
Reviewer #1 agreed
On 08 Jun, 2020
Reviewers invited
Invitations sent on 05 Jun, 2020
Editor assigned
On 30 Apr, 2020
Submission checks complete
On 29 Apr, 2020
Editor invited
On 29 Apr, 2020
First submitted
On 28 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Menstrual hygiene management (MHM) is a recognised public health, social and educational issue, which must be achieved to allow the realisation of human rights. People with disabilities are likely to experience layers of discrimination when they are menstruating, but little evidence exists.
Methods: The study aims to investigate barriers to MHM that people with disabilities and their carers, face in the Kavrepalanchok, Nepal, using qualitative methods. Twenty people with disabilities, aged 15-24, who menstruate and experience ‘a lot of difficulty’ or more across one or more of the Washington Group functional domains were included, as well as 13 carers who provide menstrual support to these individuals. Purposeful sampling was applied to select participants. Different approaches were used to investigating barriers to MHM and triangulate data: in-depth interviews, observation, PhotoVoice and ranking. We analysed data thematically, using Nvivo 11.
Results: Barriers to MHM experienced by people with disabilities differ according to the impairment. Inaccessible WASH facilities were a major challenge for people with mobility, self-care and visual impairments. People with intellectual impairments had difficulty accessing MHM information and their carers despaired when they showed their menstrual blood to others, which could result in abuse. No support mechanisms existed for carers for MHM, who overwhelmed and isolated. Menstrual discomfort was a major challenge; these were managed with home remedies, or not at all. Most participants followed menstrual restrictions, which were widespread and expected, for fear of being cursed if they did not. As disability is often viewed as a curse, this demonstrates the layers of discrimination faced.
Conclusion: Issues related to MHM for people with disabilities is more complex than for others in the population due to the additional disability discrimination and impairment experienced. Research exploring these issues must be conducted in different settings, and MHM interventions, tailored for impairment type and carers requirements, must be developed. Attention to, and resourcing for disability inclusive MHM must be prioritised to ensure ‘no one is left behind’.