Use of menstrual cups among school girls: longitudinal observations nested in a randomised controlled feasibility study in rural western Kenya

Anna Maria Van Eijk,Linda Mason,Jackton Omoto,Alie Eleveld,Elizabeth Nyothach,Penelope A Phillips-Howard,Clifford Oduor,Kayla F Laserson,Isaac Ngere,John Vulule,Kelly Alexander,David Obor,Kelvin Oruko,Aisha Mohammed

doi:10.1186/s12978-018-0582-8

Abstract

BackgroundA menstrual cup can be a good solution for menstrual hygiene management in economically challenged settings. As part of a pilot study we assessed uptake and maintenance of cup use among young school girls in Kenya.MethodsA total of 192 girls between 14 to 16 years were enrolled in 10 schools in Nyanza Province, Western Kenya; these schools were assigned menstrual cups as part of the cluster-randomized pilot study. Girls were provided with menstrual cups in addition to training and guidance on use, puberty education, and instructions for menstrual hygiene. During repeated individual visits with nurses, girls reported use of the menstrual cup and nurses recorded colour change of the cup.ResultsGirls were able to keep their cups in good condition, with only 12 cups (6.3%) lost (dropped in toilet, lost or destroyed). Verbally reported cup use increased from 84% in the first 3 months (n = 143) to 96% after 9 months (n = 74). Colour change of the cup, as ‘uptake’ indicator of use, was detected in 70.8% of 192 participants, with a median time of 5 months (range 1–14 months). Uptake differed by school and was significantly higher among girls who experienced menarche within the past year (adjusted risk ratio 1.29, 95% CI 1.04–1.60), and was faster among girls enrolled in the second study year (hazard ratio 3.93, 95% CI 2.09–7.38). The kappa score comparing self-report and cup colour observation was 0.044 (p = 0.028), indicating that agreement was only slightly higher than by random chance.ConclusionsObjective evidence through cup colour change suggests school girls in rural Africa can use menstrual cups, with uptake improving with peer group education and over time.Trial registrationISRCTN17486946. Retrospectively registered 09 December 2014.

Highlights

A menstrual cup can be a good solution for menstrual hygiene management in economically challenged settings
Qualitative studies note girls’ stigma if menstrual blood leaks at school, resulting in an inability to focus on lessons and withdrawal from school activities [2, 3, 10]; these studies suggest that lack of options for Menstrual hygiene management (MHM) leads to school absenteeism and drop-out [2, 10, 11]
The public health burden is typical of rural African communities [27]; past mortality among adolescents and young adults has been largely ascribed to communicable diseases and injuries [33], and maternal mortality among females

Summary

Introduction

A menstrual cup can be a good solution for menstrual hygiene management in economically challenged settings. Qualitative studies note girls’ stigma if menstrual blood leaks at school, resulting in an inability to focus on lessons and withdrawal from school activities [2, 3, 10]; these studies suggest that lack of options for MHM leads to school absenteeism and drop-out [2, 10, 11] Both qualitative and quantitative studies indicate that girls value modern menstrual products [2, 3, 12,13,14], such as branded sanitary pads; in some settings transactional sex is used to obtain these products from boys and men [2, 5, 12]. Improved MHM may be considered an essential component among a variety of interventions to strengthen girls’ sexual and reproductive health, can reduce their sexual exposures, and increase their chance of reaching their potential in school [1]

Methods

Results

Conclusion