Muthusamy Sivakami

Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis

Objectives To assess the status of menstrual hygiene management (MHM) among adolescent girls in India to determine unmet needs. Design Systematic review and meta-analysis. We searched PubMed, The Global Health Database, Google Scholar and references for studies published from 2000 to September 2015 on girls’ MHM. Setting India. Participants Adolescent girls. Outcome measures Information on menarche awareness, type of absorbent used, disposal, hygiene, restrictions and school absenteeism was extracted from eligible materials; a quality score was applied. Meta-analysis was used to estimate pooled prevalence (PP), and meta-regression to examine the effect of setting, region and time. Results Data from 138 studies involving 193 subpopulations and 97 070 girls were extracted. In 88 studies, half of the girls reported being informed prior to menarche (PP 48%, 95% CI 43% to 53%, I2 98.6%). Commercial pad use was more common among urban (PP 67%, 57% to 76%, I2 99.3%, n=38) than rural girls (PP 32%, 25% to 38%, I2 98.6%, n=56, p<0.0001), with use increasing over time (p<0.0001). Inappropriate disposal was common (PP 23%, 16% to 31%, I2 99.0%, n=34). Menstruating girls experienced many restrictions, especially for religious activities (PP 0.77, 0.71 to 0.83, I2 99.1%, n=67). A quarter (PP 24%, 19% to 30%, I2 98.5%, n=64) reported missing school during periods. A lower prevalence of absenteeism was associated with higher commercial pad use in univariate (p=0.023) but not in multivariate analysis when adjusted for region (p=0.232, n=53). Approximately a third of girls changed their absorbents in school facilities (PP 37%, 29% to 46%, I2 97.8%, n=17). Half of the girls’ homes had a toilet (PP 51%, 36% to 67%, I2 99.4%, n=21). The quality of studies imposed limitations on analyses and the interpretation of results (mean score 3 on a scale of 0–7). Conclusions Strengthening of MHM programmes in India is needed. Education on awareness, access to hygienic absorbents and disposal of MHM items need to be addressed. Trial registration number CRD42015019197.

UTILIZATION OF MATERNAL HEALTH SERVICES AMONG INTERNAL MIGRANTS IN MUMBAI, INDIA.

This study aimed to understand access to maternal health care and the factors shaping it amongst poor migrants in Mumbai, India. A cross-sectional mixed methods approach was used. It included multistage cluster sampling and face-to-face interviews, through structured interview schedules, of 234 migrant women who had delivered in the two years previous to the date they were interviewed. Qualitative in-depth interviews of migrant women, health care providers and health officials were also conducted to understand community and provider perspectives. The results showed that access to antenatal care was poor among migrants with less than a third of them receiving basic antenatal care and a quarter delivering at home. Multivariate analysis highlighted that amongst migrant women those who stayed in Mumbai during pregnancy and delivery had better access to maternal health care than those who went back to their home towns. Poor maternal health care was also due to weaker demand for health care as a result of the lack of felt-need among migrants due to socio-cultural factors and lack of social support for, and knowledge of, health facilities in the city. Supply-side factors such as inadequate health infrastructure at primary and secondary levels, lack of specific strategies to improve access to health care for migrants and cumbersome administrative procedures that exclude migrants from certain government programmes all need to be addressed. Migrants should be integral to the urban development process and policies should aim at preventing their exclusion from basic amenities and their entitlements as citizens.

Prevalence and Factors Associated With Intimate Partner Violence Among Young Women Aged 15 to 24 Years in India: A Social-Ecological Approach

Intimate partner violence (IPV) is a critical public health issue that has reached epidemic proportions. Research investigating IPV among young women in India using large-scale population data is lacking. This study examined the prevalence and factors associated with IPV among women aged 15 to 24 years in India through a social-ecological approach. This cross-sectional study analyzed data from the National Family Health Survey, a population-based survey conducted in India from 2005 to 2006. The past-year prevalence of emotional, physical, and sexual forms of IPV, among ever-married women aged 15 to 24 years were computed. Multivariate logistic regression was conducted to evaluate the association of factors at various levels of the social-ecological framework with the past-year experience of emotional, physical, sexual, and any form of IPV. The past-year prevalence of IPV among women aged 15 to 24 years (n = 16,285) was 29%. Physical IPV was the most common, affecting 23% in the past year. The past-year prevalence of sexual IPV among women aged 15 to 24 years at 9.5% was higher than older women. Individual factors significantly associated with the past-year experience of all forms of IPV were the young age at first marriage, parental IPV, and ever had a terminated pregnancy. At the relationship level, husband’s controlling behaviors, his consumption of alcohol, and experience of violence from other family members were positively associated with all forms of IPV in the past year. Poverty and acceptance of IPV increased the women’s odds of experiencing IPV. IPV was associated with multiple factors occurring at all levels of the social-ecological framework. Actions to prevent and eliminate IPV in India demand multidisciplinary and collaborative efforts that are tailored specifically for adolescents and young women. It is imperative to protect the girls and young women from IPV; it protects the future of India.

Building Partnership to Improve Migrants’ Access to Healthcare in Mumbai

Objectives An intervention to improve migrants’ access to healthcare was piloted in Mumbai with purpose of informing health policy and planning. This paper aims to describe the process of building partnership for improving migrants’ access to healthcare of the pilot intervention, including the role played by different stakeholders and the contextual factors affecting the intervention. Methods The process evaluation was based on Baranowski and Stables’ framework. Observations in community and conversations with stakeholders as recorded in daily diaries, minutes of pre-intervention workshops, and stakeholder meetings served as data sources. Data were coded using the framework and descriptive summaries of evaluation components were prepared. Results Recruitment of stakeholders was easier than sustaining their interest. Community representatives led the intervention assisted by government officials. They planned community-level interventions to improve access to healthcare that involved predominantly information, education, and communication activities for which pre-existing formal and informal social networks and community events were used. Although the intervention reached migrants living with families, single male migrants neither participated nor did the intervention reach them consistently. Contextual factors such as culture differences between migrants and native population and illegality in the nature of the settlement, resulting in the exclusion from services, were the barriers. Conclusion Inclusive multi-stakeholder partnership, including migrants themselves and using both formal and informal networks in community is a feasible strategy for health education and has potential to improve the migrants’ access to healthcare. However, there are challenges to the partnership process and new strategies to overcome these challenges need to be tested such as peer-led models for involvement of single male migrants. For sustaining such efforts and mainstreaming migrants, addressing contextual factors and having formal mechanisms for their inclusion are equally important.

Menopause: Midlife Experiences of Low Socio-economic Strata Women in Haryana

This paper reports the findings of a cross-sectional study undertaken to understand the differences in terms of age at menopause, perception about menopause and menopausal symptom experience of women in Haryana. The study reveals that rural women have early onset of menopause as compared to urban women. Women had their own culturally shaped perceptions about menopausal changes which differ between urban and rural areas. In both the areas, women report to suffer from a multitude of symptoms with a higher percentage of urban women identifying suffering from psychological symptoms.

Lost in transition: menstrual experiences of intellectually disabled school-going adolescents in Delhi, India

Issues around reproductive health of intellectually disabled adolescents have received limited attention in India. This study aimed to bring to light these issues to inform policy and practice surrounding reproductive health among intellectually disabled adolescents. The objectives of this study were to understand the problems encountered by intellectually disabled adolescents and their primary caretakers during management of the adolescent’s menstrual cycle, and to explore the strategies adopted to overcome them. Using qualitative methodology, in-depth interviews were carried out with 23 primary caretakers (all mothers) of adolescent girls in the age group of 11–19 years with IQ of 20–50 were interviewed using in-depth interviews. The mothers of adolescents were selected using purposive sampling and grounded theory methodology was followed for data analysis. The adolescents faced a whole range of issues; from not being able to change sanitary napkins due to physical constraints, to not being able to comm...

Living conditions of internal labour migrants: a nationwide study in 13 Indian cities

In India, rural impoverishment and livelihood opportunities in cities result in rural-urban migration. However, migrants face myriad of challenges at destination. This paper reports living conditions of internal labour migrants living in 13 Indian cities. Quantitative data were collected from migrants, who have migrated to the city within the last ten years but not less than 30 days. Majority of migrants live in non-notified slums in katcha or semi-pucca or squatter houses. About 38% of migrants do not have access to sanitary latrine and depend on open defecation. Only 59% of households had metered electricity connection. Only 23% possess ration card while 57% have voter identification cards. Thus, migrants are deprived of basic amenities and are marginalised to access several social entitlements. Since migrants are an inalienable part of the cities, the governments should recognise them as a vulnerable group that needs targeted interventions.

Menarche and Menstruation in Rural Adolescent Girls in Maharashtra, India A Qualitative Study

Background: Menarche and menstrual experiences play a critical role in adolescent girls’ life. These not only significantly influence their sexual and reproductive health but also possess much social and educational impact. This study qualitatively explores the perceptions, practices and experiences related to menarche and menstruation among rural Indian adolescent girls which has been less studied in the past literature. Methods: A convenience sampling method was used to select 32 adolescent girls (eight girls who did not reach menarche and 24 girls who attained menarche) from rural Maharashtra in India. Information about the perceptions, practices and experiences of menarche and menstruation among the participants was obtained through focus group discussions and was analyzed using thematic analysis. Findings: Most of the participants, especially girls without menarche lacked adequate knowledge about menstruation and its processes. All communications regarding menstruation were between friends, whereas mothers were found to be playing a limited role. Some of the girls were using sanitary pads, while most girls still use old cloths. Financial concerns and difficulty in obtaining sanitary pads were major obstructions for their use. Lack of awareness and appropriate care for menstrual morbidities were reported among these girls, which put impact on their educational attainment. Conclusions: Suitable strategy needs to be developed for providing correct knowledge about menstruation among adolescent girls, such as inclusion of adolescent friendly services in school curriculum and training of mothers and teachers to provide friendly counselling to the girls. Further, menstrual pad vending machines could be installed in schools and colleges, for easy access of sanitary pads at subsidized rate. Special care and support during menstruation can prevent several adverse events from occurring in adolescent girls’ lives.