Managing menstruation in the workplace: an overlooked issue in low- and middle-income countries.

The potential menstrual hygiene management barriers faced by adolescent girls and women in workplace environments in low- and middle-income countries has been under addressed in research, programming and policy. Despite global efforts to reduce poverty among women in such contexts, there has been insufficient attention to the water and sanitation related barriers, specifically in relation to managing monthly menstruation, that may hinder girls' and women's contributions to the workplace, and their health and wellbeing. There is an urgent need to document the specific social and environmental barriers they may be facing in relation to menstrual management, to conduct a costing of the implications of inadequate supportive workplace environments for menstrual hygiene management, and to understand the implications for girls' and women's health and wellbeing. This will provide essential evidence for guiding national policy makers, the private sector, donors and activists focused on advancing girls' and women's rights

Beyond menstrual hygiene: addressing vaginal bleeding throughout the life course in low and middle-income countries.

Girls and women experience numerous types of vaginal bleeding. These include healthy reproductive processes, such as menstruation and bleeding after childbirth, but also bleeding related to health conditions, such as fibroids or cancer. In most societies, the management of menstruation is handled covertly, something girls are often instructed about at menarche. The management of other vaginal bleeding is often similarly discreet, although behaviours are not well documented. In many societies, cultural taboos frequently hinder open discussion around vaginal bleeding, restricting information and early access to healthcare. Additionally, the limited availability of clean, accessible water and sanitation facilities in many low and middle-income countries augments the challenges girls and women face in conducting daily activities while managing vaginal bleeding, including participating in school or work, going to the market or fetching water. This paper aims to highlight the key vaginal bleeding experiences throughout a woman's life course and the intersection of these bleeding experiences with their access to adequate water and sanitation facilities, information and education sources, and supplies. The aim is to address the silence around girls and women's vaginal bleeding and their related social, physical and clinical management needs across the life course; and highlight critical gaps that require attention in research, practice and policy around this neglected topic of health and gender equality

A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools

Summary Points: There is an absence of guidance, facilities, and materials for schoolgirls to manage their menstruation in low- and middle-income countries (LMICs). Formative evidence has raised awareness that poor menstrual hygiene management (MHM) contributes to inequity, increasing exposure to transactional sex to obtain sanitary items, with some evidence of an effect on school indicators and with repercussions for sexual, reproductive, and general health throughout the life course. Despite increasing evidence and interest in taking action to improve school conditions for girls, there has not been a systematic mapping of MHM priorities or coordination of relevant sectors and disciplines to catalyze change, with a need to develop country-level expertise. Columbia University and the United Nations Children's Fund (UNICEF) convened members of academia, nongovernmental organizations, the UN, donor agencies, the private sector, and social entrepreneurial groups in October 2014 (“MHM in Ten”) to identify key public health issues requiring prioritization, coordination, and investment by 2024. Five key priorities were identified to guide global, national, and local action

Indicators for National and Global Monitoring of Girls' Menstrual Health and Hygiene: Development of a Priority Shortlist

Purpose Despite the importance of menstrual health and hygiene (MHH) for adolescent girls' health, education, and gender equality, few countries monitor MHH. MHH needs remain underprioritized, and progress achieved through policies, programs, or investments go unmeasured. This article reports the systematic development of an indicator shortlist to monitor adolescent girls' MHH at the national and global levels across low- and middle-income countries. Methods A core group of MHH researchers and practitioners collaborated with stakeholders from three countries with demonstrated commitment to monitoring MHH (Bangladesh, Kenya, and the Philippines), measures experts, and a global advisory group. The approach included the following: (1) define domains for monitoring MHH; (2) review and map existing indicators and measures; (3) iteratively shortlist indicators through appraising quality, feasibility, and stakeholder input; and (4) refine the shortlist and develop guidance for use. Results The shortlist comprises 21 indicators across seven domains covering menstrual materials, water, sanitation, and hygiene facilities, knowledge, discomforts and disorders, supportive social environments, menstrual health impacts, and policies. Indicators are accompanied by measures that have been tested or are expected to provide reliable data, alongside justification for their selection and guidance for use. Discussion The shortlisted indicators reflect the multisectoral collaboration necessary for ensuring girls' MHH. Uptake requires integration into monitoring systems at national and global levels. Future work remains to evaluate the performance of the indicators over time and to support their widespread use. Governments and stakeholders can use these indicators to track the progress of programs and policies, monitor unmet MHH needs, identify disparities, and set targets for improvement

Geography graduates’ professional socialisation and identity development through service learning.

 This paper explores, at university level, the value of a service learning approach to teaching and learning rural geography to develop students’ awareness of a professional identity. Drawing on theories of service learning as experiential learning, and the construction of professional identities in practice-based contexts, it explores how the service learning (practice-and inquiry-based) process can enhance students’ capacities to identify themselves as rural geography professionals. In particular, the paper explores how service learning contributes to raising students’ awareness via reflective exercises about the contribution of their geographical knowledge and skills to local development problem-solving.  The paper uses a case study example of a service learning module run as part of a Master’s in Rural Sustainability programme. The evidence accrues from ten of these Master’s students working with two locally-based development organisations situated in a rural market town and their efforts to devise and assess a project’s feasibility to contribute to the town’s development needs.  Overall, the paper adds to the knowledge of how professional identity is formed through practice and, how this can be facilitated via certain practice-based strategies via the service learning experience.  It concludes by reflecting on the effectiveness of this project-based approach, and on the implications of enhancing this aspect of graduates’ development vis-à-vis their future employability as rural geography professionals

Ruralization: The opening of rural areas to renew rural generations, jobs and farms: D3.1 Assessment Framework

The RURALIZATION project aims to look at ways to overcome rural decline issues that support rural regeneration and generational renewal. The empirical focus of the project is to develop, assess and disseminate novel instruments, strategies and policies that cater for rural regeneration. This is done specifically in relation to the future dreams of rural youth, facilitating rural newcomers and new entrants into farming and by addressing the issue of access to land. RURALIZATION will also carry out a trend analysis to uncover relevant trends for rural regions. This knowledge base will culminate in generating effective policy tools. Through this RURALIZATION aims to contribute to the development of a new rural frontier that provides exciting opportunities to new rural generations for social and economic sustainability and to realise their dreams in a rural context

Girls’ Menstrual Management in Five Districts of Nepal: Implications for Policy and Practice

Discriminatory practices related to menstruation affect the social, mental and physical wellbeing of girls in many low-and middle-income countries. We conducted mixed methods research in five districts of Nepal to explore how menstruation affected girls’ ability to fully participate in school and community life. We conducted 860 structured interviews, 26 group interviews and 10 focus group discussions with schoolgirls in rural areas,14 semi-structured interviews with girls’ mothers, and 10 interviews with health teachers. Girls in all districts experienced social, material and information barriers to confident menstrual management. Menstrual blood was believed to carry diseases, and girls’ movement was restricted to contain ritual pollution and protect them from illness, spirit possession, and sexual experiences. Taboos prevented girls from worshipping in temples or in their home, and some girls were not allowed to enter the kitchen, or sleep in their home while menstruating. Teachers and parents felt unprepared to answer questions about menstruation and focused on the maintenance of restrictions. Teachers and students were embarrassed discussing menstruation in school and classes were not question-driven or skills-based. Gender disaggregated teaching of menstruation and engagement of health facility staff may have positive effects. Community participatory approaches that engage girls, their families and the wider community are necessary to address harmful cultural practices. Cross-sectoral approaches to provide clean, private, safe spaces for girls and increased availability of preferred materials could enable confident menstrual management

Menstrual health: a definition for policy, practice, and research

The term menstrual health has seen increased use across advocacy, programming, policy, and research, but has lacked a consistent, self-contained definition. As a rapidly growing field of research and practice a comprehensive definition is needed to (1) ensure menstrual health is prioritised as a unified objective in global health, development, national policy, and funding frameworks, (2) elucidate the breadth of menstrual health, even where different needs may be prioritised in different sectors, and (3) facilitate a shared vocabulary through which stakeholders can communicate across silos to share learning. To achieve these aims, we present a definition of menstrual health developed by the Terminology Action Group of the Global Menstrual Collective. We describe the definition development process, drawing on existing research and terminology, related definitions of health, and consultation with a broad set of stakeholders. Further, we provide elaboration, based on current evidence, to support interpretation of the definition

Presenting problem/conditions that result in people with an intellectual disability being admitted to acute hospitals in Ireland: An analysis of NQAIS data from 2016-2020

The wide range of health conditions and complex needs experienced by people with intellectual disability (ID) means that they are more likely to utilise acute care services in comparison with the general population. ID accounts for 1% to 3% of the world’s population and has an onset before the age of 18 years (22 years from an American perspective according to the American Association on Intellectual and Developmental Disabilities (AAIDD) 2021). ID is characterised by lifelong limitations in cognitive and adaptive functioning and experiences of social and environmental restrictions which create barriers to effective participation in daily life. With increased childhood survival rates and improved diagnostic, screening and identification, this percentage has the potential to increase in the coming decades