Abstract

Adequate menstrual hygiene management (MHM) requires access to water and sanitation and can be challenging for many women and girls living in resource-poor settings. Inadequate MHM has been associated with urogenital infections. The aim of this study is to assess the impact of a combined household-level piped water and sanitation intervention on MHM practices and urogenital infection symptoms (UGS) among women living in rural communities of Odisha (India). This study was nested within a pair-matched cohort study designed to assess impact of the Gram Vikas MANTRA program, which provided household-level piped water, bathing areas and latrine to all households in intervention villages, on diarrheal disease (primary outcome). The program did not specifically promote menstrual hygiene practices. Forty-five intervention villages were randomly selected from a list of those where implementation was previously completed at least five years before and matched to 45 control villages. Data for the main study was collected in four rounds from June 2015 to October 2016. For the MHM sub study, household surveys were administered in round four to randomly selected women aged 18 or older among study households from the 90 villages, to assess self-reported MHM practicesand urogenital infections symptoms. MHM practices were deemed adequate if they met some of the criteria developed on the basis of international monitoring that the GV program could modify (adequate frequency of absorbent change, washing the body with soap and privacy for managing menstruation). Multilevel mixed-effects logistic regression with a random effect distribution at the level of the pair and village was used to estimate the effect of the intervention on adequate MHM practices (primary outcome) and reported UGS (secondary outcome). A total of 1045 women (517 from intervention and 528 from control) were included in the study. Women who lived in the villages receiving the intervention, were more likely to report adequate MHM practices than those in control villages (Adjusted OR (AOR) 3.54, 95% Confidence Interval (CI): 1.86–6.78). 14.51% and 15.53% of women living in the control and intervention villages reported having at least one UGS. There was no evidence of an intervention effect on reported UGS (AOR = 0.97, 95%CI: 0.64–1.46). While household latrines or bathing areas with access to piped water improve the environment that enable MHM practices related to privacy, the provision of such facilities alone had only a moderate impact in adequate MHM and did not have an effect on self-reported UGS. More targeted inventions that include behavior change strategies and that address other barriers may be necessary to improve MHM practices.

Highlights

  • Every day, more than 300 million girls and women between the ages of 15 and 49 are menstruating(George, 2013)

  • A total of 1045 women were included in this study, 528 were from control villages and 517 were from intervention villages

  • Women living in the intervention villages were similar to women living in the control villages in regard to most sociodemographic variables

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Summary

Introduction

More than 300 million girls and women between the ages of 15 and 49 are menstruating(George, 2013). As of 2015, 2.3 billion people lacked even basic sanitation services, with 860 million using unim­ proved facilities and another 890 million practicing open defeca­ tion—with a high proportion residing in India(World Health Organization, 2019). Due to this situation, government of India has made big investments in different sanitation campaigns during the last decade (World Bank, 2010) being the main focus toilet construction, with fewer resources availed for sustained coverage and use and without much attention to women needs (Garn et al, 2017). Several studies conducted in rural India have emphasized that the lack of adequate sanitation at home influences women’s experiences of safety and privacy(Caruso et al, 2015; Hulland et al, 2015; Sahoo et al, 2015; Sclar et al, 2018), and may impact mental health(Caruso et al, 2017, 2018)

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