Menstrual health solutions for out-of-school adolescent girls

糟糕的月经管理有害地影响了女孩和妇女的生活。在低收入国家，使用破布、纸张、纸巾和其他不卫生物品等临时材料吸收血液，无法使用卫生设施和用品，以及缺乏支持这些需求的知识和公开对话，都对女童和妇女的健康、教育和生产力产生不利影响。过去十年的实质性努力激发了国际捐助者和机构的支持，为改善女学生月经健康的研究提供资金。调查结果为地方和国家一级的政策和方案提供了信息，并承诺支持行动。研究结果表明，干预措施如何有助于改善女学生的健康和教育，这一进展现在必须扩大证据基础，以惠及失学少女。这些女孩包括辍学(通常与怀孕有关)、童养媳、孤儿和街头女孩，她们对自己的生活影响最小，属于最贫穷的群体。他们可能没有更少的资源来获得卫生材料、水和卫生设施或其他用品。因为他们不上学，所以他们不太可能了解自己的身体，不太可能了解自己的健康需求，也不太可能谈判人际关系，这使得他们面临着更高的SRH伤害风险。与在校同龄人隔离和日常生活负担可能会给这些女孩带来额外的心理健康风险，以及SRH(MSRH)的危害。对于这些女孩面临的月经健康(MH)问题，最需要哪些干预措施来改善这些女孩的MH和MSRH，以及如何在社区环境中最好地接生，都没有证据支持。我们的项目建议动员失学女孩、社区和利益攸关方进行一系列研究，以月经管理为切入点，确定女孩的需求和当前的mSRH危害，选择和评估最佳干预措施和交付机制，以建立证据并为大规模实施研究提供信息。我们将在UKRI资助的开创性研究的基础上，与我们的肯尼亚合作伙伴一起开展这项工作，该研究成功地评估了针对女学生的MH解决方案，并了解了国家政策。KEMRI研究网站在校外女孩中进行的一项社区调查将调查她们的月经需求，以及MH和MSRH挑战。通过参与性方法(焦点小组、社区‘横断面’走访、女孩月经日记)收集信息，同时对干预措施和提供机制进行系统审查，将确定哪些类型的干预措施是最佳的，以及如何最好地在社区提供这些干预措施。与研究人员、女孩和其他利益攸关方共同举办的讲习班将利用调查结果共同创建单一或多组分的一揽子评估方案。我们将评估所选干预措施的接受性、可接受性、使用和感知的益处，并确定哪些挑战和障碍会影响成功的交付。本次评估的结果将与研究人员、女孩和利益攸关方共同商议，以建议哪些干预方案/S和交付机制可以应用于大规模实施研究。由于女孩在社区中的脆弱性，我们将与利益攸关方一起推动保障制度，以确保女孩的安全。加强能力将纳入该项目，支持早期职业研究人员积累经验和专门知识。将与当地社区和利益攸关方分享调查结果，并将举办全国跨部门利益攸关方研讨会，与决策者和实施者讨论调查结果。我们将通过我们现有的MH平台传播，将研究和方案议程扩大到女学生之外，并与英国和其他机构分享研究结果，以制定针对高收入和低收入国家的时期贫困的行动。研究成果将被发表，并在会议上展示。

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.