Day 1 Of Research Paper Analysis!

“Systematic review of menstrual health and hygiene in Nepal employing a social ecological model”

Preface: 

There are numerous socio-cultural factors that have caused an inadequate infrastructure for period management for menstruators in Nepal:

1. Education

2. Healthcare

3. Communication

4. Religion

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Socio-ecological Influences

Methodology: 

1. Extract causational factors contributing to poor menstrual hygiene across databases (n = 6)

1. Medline

2. CINAHL

3. Web of Science

4. PsychInfo

5. Nepal Journals Online

6. Kathmandu University Medical Journal

2. 20 peer-reviewed publications were ultimately incorporated in the systematic analysis (n = 25)

1. n = 9 (knowledge, attitude, and practices regarding menstruation)

2. n = 7 (reproductive health)

3. n = 3 (cultural restrictions)

4. n = 1 (educational restriction & partner violence)

1. n = 18 (descriptive)

2. n = 2 (interventional)

Note: Prisma diagrams are generally used to display systematic review breakdowns. 

Key Word: Socio-Ecological Model (SEM): public health metric that enables identification of vafriables impacting health (interpersonal, community, and policy) 

Results: The following factors were elucidated as contributing to poor systemic menstrual health measures:

• Lack of Education

• Lack of Proper WASH Facilities

• Poor sex education

• Culturally restrictive practices

Diving into the Analysis!

Now, let’s dive into the analysis. 

Religious Factors: 

Nepal is a predominantly Hindu country. In the traditional context of the Hindu religion, menstruation is considered an impurity, restricting many girls from participating in community activities. These include entering prayer rooms, temples and kitchens, interacting with males, and attaining an education. Oftentimes, gender discrimination remains the social norm in the name of religion, as women are not considered in equal standing to their male counterparts. 

Economic Standing: 

There are a plethora of socio-cultural factors that contribute to an impecunious infrastructure for education and health. Lack of access to information about menstruation and sanitation and lack of appropriate incineration facilities exacerbates the crisis further. 

Chhaupadi:  

Chhaupadi is a neglectful tradition in which women are banished to outdoor sheds during their menstrual cycles; during this time, they are essentially banished from participation within the household as they are considered impure. Although criminalized in 2017, this practice remains heavily pursued, despite locals believing that stopping this tradition would be offensive to the Gods and bring misfortune. 

Understand the challenges, barriers and facilitators to optimizing menstrual health and hygiene: 

SEM Factors: As the SEM has been shown to be a robust framework for examining menstrual health, among other public health problems, in developing countries, variables impacting access to safe, sanitary conditions that enable proper management of menstrual cycles, without external taboos.

The following provides a brief summary of factors identified in multiple levels of the SEM elucidated in the systemic review:

1. Interpersonal Level: ethnicity, education level of husbands, family members as assistance for beginning menstruation, cultural restrictions, and domestic violence

2. Community Level: educational systems, WASH facilities in schools, menstruation in the mass media, role of non-governmental organizations (NGOs) in providing menstrual hygiene management, transportation

3. Policy Level: Ultimately, there were no papers incorporated in the systemic review that elucidated the impact of policy on menstrual health and hygiene. 

Personal Takeaways & Future Directions: 

All in all, menstruation remains a challenge for women simply due to the lack of awareness of the true nature of periods and the inconceivable number of falsehoods and taboos surrounding the subject. This not only has adverse ramifications on the ability to deal with periods itself, but also overarching implications on reproductive health and education. High-quality interventions are imperative for efficacious interventions on menstrual health in Nepal.  

Source: https://pubmed.ncbi.nlm.nih.gov/35773696/