Stoilova Dani, Cai Rebecca, Aguilar-Gomez Sandra, Batzer Naomi Heller, Nyanza Elias Charles, Benshaul-Tolonen Anja
Department of Economics, Barnard College, Columbia University, New York City, NY, United States of America.
Columbia University, New York City, NY, United States of America.
PLOS Glob Public Health. 2022 Mar 14;2(3):e0000110. doi: 10.1371/journal.pgph.0000110. eCollection 2022.
Menstrual hygiene management is an important determinant for girls' educational outcomes. We develop a method of cross-sectional analysis that quantifies the relative importance of four distinct mechanisms: material, biological, social and informational constraints and consider four main schooling outcomes: absenteeism, early departure, concentration and participation. We use survey data from 524 female students enrolled in four co-educational secondary schools in Northern Tanzania. Average age at first period is 14.2 years (standard deviation = 1.1, range 9-19). Information is the least binding constraint: 90-95% of girls report they received information about menstruation and how to manage it. In contrast, biological constraints are hindering: (i) the distribution of menstrual cramps and pain is bifurcated: most girls report very light or very strong pain (rather than moderate) with considerable educational impacts for girls in the latter group, (ii) irregular cycles (62%) and difficulty predicting the cycle (60%) lead to stress and uncertainty. Socio-cultural constraints are binding as 84% would feel shame if male peers knew their menstrual status, and 58% fear being teased over periods. Material constraints include prohibitive costs: girls spending between 12-70% of the daily national poverty line (6,247 TSH per day) on pads during their period. However, we discern no statistically significant relationship between access to pads and absenteeism. In contrast, biological and socio-cultural constraints as well as lack of sanitary infrastructure have significant effects on absenteeism. The results have several implications. First, sanitary pad interventions should consider participation and concentration as main outcomes, in addition to absenteeism. Second, biological (menstrual cramps and pain) and socio-cultural (fear, stigma) constraints are drivers of menstruation-related absenteeism and participation in the classroom and need to be evaluated in trials. We suggest exploring analgesic use, alternative pain-management techniques, menstrual cycle tracking technologies, and social programming in future trials.
经期卫生管理是影响女孩教育成果的一个重要因素。我们开发了一种横断面分析方法，该方法量化了四种不同机制的相对重要性：物质、生物、社会和信息限制，并考虑了四个主要的学业成果：缺勤、早退、注意力集中程度和参与度。我们使用了来自坦桑尼亚北部四所男女同校中学的524名女学生的调查数据。初潮的平均年龄为14.2岁（标准差=1.1，范围9 - 19岁）。信息限制是最不具约束力的：90 - 95%的女孩表示她们收到了有关月经及其管理方法的信息。相比之下，生物限制具有阻碍作用：（i）痛经和疼痛的分布呈两极分化：大多数女孩报告疼痛非常轻微或非常强烈（而非中度），后一组女孩受到了相当大的教育影响，（ii）月经周期不规律（62%）以及难以预测周期（60%）会导致压力和不确定性。社会文化限制具有约束力，因为84%的女孩如果男性同龄人知道她们的月经状况会感到羞耻，58%的女孩担心经期会被嘲笑。物质限制包括高昂的成本：女孩在经期购买卫生巾的花费占每日国家贫困线（每天6247坦桑尼亚先令）的12 - 70%。然而，我们并未发现获得卫生巾与缺勤之间存在统计学上的显著关系。相比之下，生物和社会文化限制以及卫生基础设施的缺乏对缺勤有显著影响。这些结果有几个方面的意义。首先，卫生巾干预措施除了考虑缺勤外，还应将参与度和注意力集中程度作为主要成果。其次，生物（痛经和疼痛）和社会文化（恐惧、污名）限制是与月经相关的缺勤和课堂参与的驱动因素，需要在试验中进行评估。我们建议在未来的试验中探索止痛药的使用、替代疼痛管理技术、月经周期跟踪技术以及社会项目。
