Women's and girls' experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis
Women's and girls' experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis
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DOI：
10.1371/journal.pmed.1002803
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发表时间：
2019-05-01
期刊：
影响因子：
15.8
通讯作者：
Melendez-Torres, G. J.
中科院分区：
文献类型：
--
作者：
Hennegan, Julie;Shannon, Alexandra K.;Melendez-Torres, G. J.
关注妇女和女孩的月经需求对全球健康和性别平等至关重要。这种被忽视的经验的重要性已经阐明了越来越多的机构的定性研究，我们系统地审查和synthesized.Methods和调查结果我们进行了系统的搜索，以确定定性研究的妇女和女孩的经验，月经在低收入和中等收入国家（LMICs）。在筛选的6，892篇引文中，纳入了87篇引文中报告的76项研究。研究收集了来自35个国家的6 000多名参与者的经验。其中包括来自撒哈拉以南非洲的45项研究（来自肯尼亚[n = 7]、乌干达[n = 6]和埃塞俄比亚[n = 5]的研究数量最多），21项来自南亚（包括印度[n = 12]和尼泊尔[n = 5]），8名来自东亚和太平洋，5名来自拉丁美洲和加勒比，5名来自中东和北非，以及来自欧洲和中亚的1项研究。通过综合，我们确定了总体主题及其关系，以开发月经经验的方向模型。该模型映射了月经经历的远端和近端前因，以及这种经历对健康和福祉的影响。社会文化背景，包括月经耻辱和性别规范，通过限制有关月经的知识，限制社会支持，塑造内在和外部强制的行为期望来影响经验。资源的限制导致支持月经的物质基础设施不足，以及经济环境限制获得负担得起的月经用品。月经经验包括多个主题：月经的做法，做法和环境的看法，信心，羞耻和痛苦，并遏制出血和气味。这些经验的组成部分相互关联，对妇女和女孩的生活产生了负面影响。影响包括对身心健康以及教育和社会参与的伤害。我们的评论受到现有研究的限制。研究质量各不相同，18项研究被评为高可信度，35项中等可信度，23项低可信度。在低质量的研究中，抽样和分析往往不可信。研究集中在青春期女孩的经验是最强烈的代表，我们实现了早期饱和这一群体。反映了全球月经健康研究的重点，有一个缺乏的研究集中在成年妇女和那些从某些地理区域。结论通过合成现存的定性研究月经经验，我们强调一致的挑战，并制定了一个综合模型的月经经验。这一模式假设了可由未来研究检验的方向性途径，并可作为方案和政策制定的框架，突出了干预措施可改善妇女和女孩健康和福祉的重要前提和途径。
Background Attention to women's and girls' menstrual needs is critical for global health and gender equality. The importance of this neglected experience has been elucidated by a growing body of qualitative research, which we systematically reviewed and synthesised.Methods and findings We undertook systematic searching to identify qualitative studies of women's and girls' experiences of menstruation in low- and middle-income countries (LMICs). Of 6,892 citations screened, 76 studies reported in 87 citations were included. Studies captured the experiences of over 6,000 participants from 35 countries. This included 45 studies from sub-Saharan Africa (with the greatest number of studies from Kenya [n = 7], Uganda [n = 6], and Ethiopia [n = 5]), 21 from South Asia (including India [n = 12] and Nepal [n = 5]), 8 from East Asia and the Pacific, 5 from Latin America and the Caribbean, 5 from the Middle East and North Africa, and 1 study from Europe and Central Asia. Through synthesis, we identified overarching themes and their relationships to develop a directional model of menstrual experience. This model maps distal and proximal antecedents of menstrual experience through to the impacts of this experience on health and well-being. The sociocultural context, including menstrual stigma and gender norms, influenced experiences by limiting knowledge about menstruation, limiting social support, and shaping internalised and externally enforced behavioural expectations. Resource limitations underlay inadequate physical infrastructure to support menstruation, as well as an economic environment restricting access to affordable menstrual materials. Menstrual experience included multiple themes: menstrual practices, perceptions of practices and environments, confidence, shame and distress, and containment of bleeding and odour. These components of experience were interlinked and contributed to negative impacts on women's and girls' lives. Impacts included harms to physical and psychological health as well as education and social engagement. Our review is limited by the available studies. Study quality was varied, with 18 studies rated as high, 35 medium, and 23 low trustworthiness. Sampling and analysis tended to be untrustworthy in lower-quality studies. Studies focused on the experiences of adolescent girls were most strongly represented, and we achieved early saturation for this group. Reflecting the focus of menstrual health research globally, there was an absence of studies focused on adult women and those from certain geographical areas.Conclusions Through synthesis of extant qualitative studies of menstrual experience, we highlight consistent challenges and developed an integrated model of menstrual experience. This model hypothesises directional pathways that could be tested by future studies and may serve as a framework for program and policy development by highlighting critical antecedents and pathways through which interventions could improve women's and girls' health and well-being.