Menstrual health solutions for out-of-school adolescent girls

月经管理不善对女孩和妇女的生活产生有害影响。在低收入国家，使用抹布、纸、纸巾和其他不卫生物品等临时材料吸收血液，无法获得卫生设施和用品，以及缺乏支持这些需求的知识和公开对话，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，以资助改善女学生月经健康的研究。调查结果为地方和国家一级的政策和规划以及支持行动的承诺提供了信息。研究结果说明了干预措施如何有助于改善女学生的健康和学业。这一进展现在必须扩大证据基础，使之覆盖到失学少女。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，她们对自己的生活没有什么决定权，属于最贫穷的群体。他们获得卫生材料、水和卫生设施或其他物资的资源可能更少。由于她们不上学，她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，也不太可能就关系进行谈判，从而使她们面临更高的性健康和生殖健康危害风险。与学校同龄人的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，以及性健康与生殖健康（mSRH）危害。这些女孩面临哪些月经健康问题，最需要哪些干预措施来改善这些女孩的月经健康和她们的生殖健康，以及如何在社区环境中最好地提供这些干预措施，目前尚无证据基础。我们的项目建议让失学女孩、社区和利益相关者参与开展一系列研究，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提供机制，建立证据并为大规模实施研究提供信息。我们将与我们的肯尼亚合作伙伴一起开展这项工作，我们的开创性研究由英国资助，成功地评估了女学生的MH解决方案，并为国家政策提供了信息。在KEMRI研究站点对失学女孩进行的社区调查将调查她们的月经需求以及卫生保健和mSRH面临的挑战。通过参与性方法（焦点小组、社区“样带”散步、女孩月经日志）收集信息，同时对干预措施和实施机制进行系统审查，将确定哪种干预措施是最佳的，以及如何在社区中以最佳方式实施。由研究人员、女孩和其他利益攸关方参加的讲习班将利用研究结果共同创建单组件或多组件一揽子评估方案。我们将评估所选干预措施的吸收、可接受性、使用和感知效益，并确定影响成功实施的挑战和障碍。评估结果将与研究人员、女童和利益攸关方共同审议，以建议哪些一揽子干预措施和实施机制可用于大规模实施研究。由于女童在社区中的脆弱性，我们将与利益攸关方共同促进保障制度，以确保女童的安全。能力加强将被纳入该项目，支持早期职业研究人员积累经验和专业知识。调查结果将与当地社区和利益攸关方分享，并将举行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。我们将在现有的妇幼保健平台上传播，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，以制定针对高收入国家和低收入国家经期贫困的行动。研究成果将在会议上发表和展示。

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.