Menstrual health solutions for out-of-school adolescent girls

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Poor menstrual management deleteriously impacts girls' and women's lives. In low-income countries, the use of makeshift materials such as rags, paper, tissues and other unhygienic items to absorb blood, an inability to access sanitation facilities and supplies, and the lack of knowledge and open dialogue to support these needs detrimentally impact girls' and women's health, education, and productivity. Substantive efforts in the past decade have galvanised international donor and agency support to fund research to improve the menstrual health of schoolgirls. Findings have informed policy and programmes at local and national level, and pledges to support action. Research findings have illustrated how interventions contribute towards improvements in schoolgirls' health and schooling.This progress must now expand the evidence base to reach out-of-school adolescent girls. These girls comprise school dropouts (often pregnancy related), child brides, orphans and streetgirls, who have the least agency over their lives and are among the poorest. They are likely to have fewer resources to access hygienic materials, water and sanitation facilities, or other supplies. Because they do not attend school they are less likely to have knowledge about their bodies or understand their health needs or negotiate relationships, placing them at heightened risk of SRH harms. Isolation away from their in-school peers and burdens of daily living may place additional mental health risks to these girls, as well as SRH (mSRH) harms. No evidence-base exists on what menstrual health (MH) problems these girls face, which interventions are most needed to improve these girls MH and mSRH, and how to best deliver them in community settings. Our project proposes to engage out-of-school girls, communities, and stakeholders to conduct a series of studies, using menstrual management as an entry point, to identify girls needs and current mSRH harms, select and evaluate optimal interventions and delivery mechanisms, to build evidence and inform large-scale implementation studies. We will conduct this with our Kenyan partners following on from our pioneering UKRI-funded research that successfully evaluated MH solutions for schoolgirls and informed national policy. A community survey in out-of-school girls in the KEMRI research site will investigate their menstrual needs, and MH and mSRH challenges. Information gathering through participatory methods (focus groups, community 'transect' walks, girls' menstrual journals), in parallel with a systematic review of interventions and delivery mechanisms, will determine what types of interventions are optimal, and how best they can be delivered in the community. Workshops with researchers, girls and other stakeholders will use findings to co-create single or multi-component packages for evaluation. We will evaluate uptake, acceptability, use, and perceived benefits of the selected interventions and identify what challenges and barriers affect successful delivery. Outcomes from this evaluation will be jointly deliberated with researchers, girls, and stakeholders, to recommend which intervention package/s and delivery mechanisms can be applied in large-scale implementation studies. Due to girls vulnerability in the community, we will promote safeguarding systems with stakeholders to ensure girls' safety. Capacity strengthening will be integrated within the project, supporting early career researchers to build experience and expertise. Findings will be shared with the local community and stakeholders, and a national cross-sector stakeholder workshop will be held to discuss findings with decision-makers and implementers. We will disseminate across our existing MH platforms to expand the research and programme agenda beyond schoolgirls and share findings with UK and other agencies to develop action for period poverty in high as well as low-income countries. Research will be published and presented at conferences.