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Young Adolescent Girls' Knowledge of Menstruation and Puberty

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Young Adolescent Girls' Knowledge of Menstruation and Puberty Young adolescent girls' knowledge of menstruation and puberty A rapid evidence review Professor Ernestina Coast and Dr. Samantha R. Lattof December 2018 Disclaimer This document is an output of the Gender and Adolescence: Global Evidence (GAGE) programme which is funded by UK aid from the UK government. However, views expressed and information contained within do not necessarily reflect the UK government’s official policies and are not endorsed by the UK government, which accepts no responsibility for such views or information or for any reliance placed on them. Table of contents Glossary V Acronyms VII Executive summary i Summary of evidence i Key findings i Evidence gaps ii 1 Background 1 1.1 Puberty and menstruation 1 1.2 Why should programming and research focus on early adolescents? 2 1.3 Sociocultural norms on menstruation and menstrual hygiene 2 1.4 Puberty knowledge, information and education 3 2 Aim, objectives and research question 4 3 Methods 5 3.1 Rapid evidence review 5 3.2 Inclusion and exclusion criteria 5 3.3 Searching and screening strategy 5 3.4 Data extraction, analysis and quality assessment 6 4 Results 8 4.1 Included studies 8 4.2 Relevant studies 8 4.3 Outcome 1: Knowledge of menstruation 8 4.4 Outcome 2: Menstrual hygiene practices 14 4.5 Outcome 3: Knowledge of puberty 17 4.6 Outcome 4: Attitudes, myths and/or perceptions about menstruation 19 4.7 Outcome 5: Experiences of menstruation/puberty 21 4.8 Outcome 6: Sources of information about menstruation/puberty 23 4.9 Included studies that evaluate interventions across any outcomes 25 4.10 Relevant studies that evaluate interventions across any outcomes 32 4.11 Relevant systematic reviews 43 5 Discussion 47 5.1 Relevant systematic reviews 49 6 References 50 Young adolescent girls' knowledge of menstruation and puberty 7 Annexes 54 Appendix A: Search terms, their combinations and database application 54 Appendix B: Results of search term tests 55 Appendix C: Data extraction tables for included studies (n=15) 56 Appendix D: Data extraction tables for relevant excluded studies (n=44) 68 Figures Figure 1: Search and screening results 6 Tables Table 1: PICOTS criteria for inclusion 5 Table 2: Summary table of included studies 9 Table 3: Summary table of relevant excluded studies 10 Table 4: Summary table of included studies 22 Table 5: Included studies that evaluated an intervention 26 Table 6: Relevant studies that evaluated an intervention 33 Table 7: Relevant systematic reviews identified by the search 44 Glossary Absorbent irregular for the first year or two after menstruation begins A product or material used to absorb menstrual flow; may (House, Mahon et al. 2012). be disposable (e.g. sanitary napkin) or re-usable (e.g. cloth, menstrual cup) Menstrual flow The amount of blood and other matter discharged from Amenorrhea the uterus during menstruation; often described as light, The absence of periods moderate, or heavy Axillary hair Menstrual hygiene management Hair in the underarm area Includes: access to clean absorbents; facilities to change, clean or dispose of absorbents as needed; access to soap Catamenia and water for cleaning the body; access to soap and water Blood and other matter discharged from the uterus at for cleaning absorbents (Sommer and Sahin 2013) menstruation Menstrual hygiene management: hardware interventions Dysmenorrhea/Dysmenorrhoea/ Dysmenorrheic Interventions designed to address material deprivations Painful menses in women with normal pelvic anatomy; pain such as the provision of absorbents, or improved Water, during periods Sanitation and Hygiene (WASH) facilities (Hennegan and Montgomery 2016) Irregular cycles (menstrual irregularities) Unpredictable long and short cycles with varying degrees Menstrual hygiene management: software interventions of blood loss. Interventions that address deficits in knowledge of menstruation and management by providing education Menarche (menarcheal) (Hennegan and Montgomery 2016) First menstruation Menstrual hygiene products Menorrhagia Personal care products (e.g. sanitary napkin, tampon) used Excessive, very heavy and prolonged bleeding; can lead to by people who are menstruating to absorb menstrual flow anaemia and be fatal if untreated Menstruation Menses The shedding of the uterine lining occurring on a regular See menstruation basis in reproductive-aged females in monthly menstrual cycles Menstrual cycle Usually around 28 days but can vary from 21 to 35 days. Oligomenorrhea Each cycle involves the release of an egg (ovulation) that Light or infrequent periods (menstrual cycles of 35-90 moves into the uterus through the fallopian tubes. Tissue days) and blood start to line the walls of the uterus for fertilisation. If the egg is not fertilised, the lining of the uterus is shed Period through the the vagina along with blood. The bleeding See menstruation generally lasts between two and seven days, with some lighter flow and some heavier flow days. The cycle is often Young adolescent girls' knowledge of menstruation and puberty Periodicity changes lead to the development of sperm (spermache) The interval between periods and the first ejaculation (semenarche). Polymenorrhea Pubescent Frequent periods or short cycles (less than 21 days) Reaching (or having reached) puberty Premenstrual syndrome (PMS) Sanitary hygiene products Consistent and severe pattern of emotional and physical See menstrual hygiene products symptoms, such as pain, bloating and mood changes that occur in the latter part of the menstrual cycle Secondary sex characteristics Sex characteristics that appear during puberty in response Puberty to the release of hormones (e.g. development of breasts in A time of rapid physical, psychological and cognitive girls, growth of testes in boys) changes. Hormonal changes lead females to experience their first menstruation (menarche). For males, hormonal Acronyms ASHAs Accredited social health activists FGDs Focus group discussions HICs High-income countries KP Kishori Panchayat LMICs Low- and middle-income countries MeSH Medical subject headings MHM Menstrual hygiene management PICOTS Population, intervention (condition), comparison/control, outcome, time, setting PMS Premenstrual syndrome PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses RAs Research assistants RCT Randomised controlled trial RER Rapid evidence review RH Reproductive health SRH Sexual and reproductive health SSKY Saloni Swasth Kishori Yojna STDs Sexually transmitted diseases TIAB Title and abstract WASH Water, sanitation and hygiene WoS Web of Science Young adolescent girls' knowledge of menstruation and puberty Executive summary This rapid evidence review (RER) was commissioned to use a community-based sample and one study explicitly answer the research question: includes in- and out-of-school adolescents. Six of the How and what do girls aged 10-14 years know about included studies report on interventions. puberty and menstruation in LMICs? Relevant studies are included in the results, as they are This review of the evidence represents an opportunity likely to contain information that is highly salient for this for learning. It is the first attempt that the authors are RER. Nearly half of these studies come from two countries aware of to conduct a systematic description of the (12 from India and seven from Nigeria), and 21 studies are evidence – across a range of evidence types – relating from Asia. Within geographic regions, the studies are highly to young (10-14years) adolescent females. There is an clustered by country. In sub-Saharan Africa, Nigeria (n=7) understanding that significant proportions of girls in and Ethiopia (n=4) have significantly more studies than LMICs attain menarche without any understanding of other countries. Of the 12 relevant studies that report on what is happening to them or how to manage it. To date, an intervention, 10 studies used a pre-post test design. however, there has not been a systematic synthesis of the Knowledge of menstruation is once again the most evidence about girls’ experience of knowledge (content, commonly reported outcome measure (n=28), followed by source, timing) about puberty, including menstruation. This sources of information about menstruation/puberty (n=26) review provides a base for future research. A key challenge and menstrual hygiene practices (n=24). Knowledge of for LMIC societies, policy-makers and programme puberty is the least frequently reported outcome (n=7), managers is how to best support adolescent girls through illustrating a striking emphasis on menstruation (and MHM) adolescence, from pre-adolescence to early adulthood. compared to puberty. The RER identifies gaps that future evidence must address Some studies (typically school-based) looked at in order to develop a better evidence base for decision- interventions while others were descriptive. Some makers. distinguished between ‘hardware’ interventions (designed to The RER systematically examines work published address material deprivations by providing sanitary pads or in English between 2006 and 2016 using a systematic absorptive cloths, for example) and ‘software’ interventions approach to the evidence search in order to maximise (educating girls about what to expect during puberty and replicability, transparency and the potential for future menstruation and how to manage menstruation). updating and expansion. The systematic search generated 7,758 items, of which 15 met the inclusion criteria. An Key findings additional 44 studies were identified as relevant,
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