"I stretch them out as long as possible:" U.S. women's experiences of menstrual product insecurity during the COVID-19 pandemic.

BACKGROUND: A growing body of evidence highlights how the COVID-19 pandemic has exacerbated gender inequalities in the US. This resulted in women being more vulnerable to economic insecurity and decreases in their overall well-being. One relevant issue that has been less explored is that of women's menstrual health experiences, including how inconsistent access to menstrual products may negatively impact their daily lives. METHODS: This qualitative study, conducted from March through May 2021, utilized in-depth interviews that were nested within a national prospective cohort study. The interviews (n = 25) were conducted with a sub-sample of cis-gender women living across the US who had reported challenges accessing products during the first year of the pandemic. The interviews sought to understand the barriers that contributed to experiencing menstrual product insecurity, and related coping mechanisms. Malterud's 'systematic text condensation', an inductive thematic analysis method, was utilized to analyze the qualitative transcripts. RESULTS: Respondents came from 17 different states across the U.S. Three key themes were identified: financial and physical barriers existed to consistent menstrual product access; a range of coping strategies in response to menstrual product insecurity, including dependence on makeshift and poorer quality materials; and heightened experiences of menstrual-related anxiety and shame, especially regarding the disclosure of their menstruating status to others as a result of inadequate menstrual leak protection. CONCLUSIONS: Addressing menstrual product insecurity is a critical step for ensuring that all people who menstruate can attain their most basic menstrual health needs. Key recommendations for mitigating the impact of menstrual product insecurity require national and state-level policy reform, such as the inclusion of menstrual products in existing safety net basic needs programs, and the reframing of menstrual products as essential items. Improved education and advocacy are needed to combat menstrual stigma.

Menstrual health and management during the COVID-19 syndemic in the Barcelona area (Spain): A qualitative study.

BACKGROUND: Available evidence suggests that menstrual health and management have been impaired during the COVID-19 syndemic. However, research in this area is scarce, and it is failing to voice the experiences of women and people who menstruate regarding their menstrual experiences. OBJECTIVES: This study aimed to explore the experiences of menstrual health and menstrual management among women and people who menstruate in the Barcelona area (Spain) during the COVID-19 syndemic. DESIGN: This is a qualitative study, conducted taking a critical feminist approach, is embedded in the 'Equity and Menstrual Health in Spain' project. METHODS: It includes photo-elicitation individual interviews with 34 women and people who menstruate in the area of Barcelona (Spain). Data were collected in person and through telephone calls between December 2020 and February 2021. Analyses were performed using Thematic Analysis. RESULTS: Main findings navigated through the menstrual changes experienced by some participants, especially women living with long COVID-19, and the barriers to access healthcare and menstrual products during COVID-19. While some participants experienced menstrual poverty, this did not appear to be exacerbated during COVID-19. Instead, access to menstrual products was compromised based on products' availability and mobility restrictions. Menstrual management and self-care were generally easier, given that menstrual experiences were almost exclusively relegated to private spaces during lockdown periods. CONCLUSIONS: Our findings highlight the need to further research and policy efforts towards promoting menstrual health and equity, considering social determinants of health, and taking intersectional and gender-based approaches. These strategies should be further encouraged in social and health crises such as the COVID-19 syndemic.

The pit latrine paradox in low-income settings: A sanitation technology of choice or a pollution hotspot?

Pit latrines are widely promoted to improve sanitation in low-income settings, but their pollution and health risks receive cursory attention. The present narrative review presents the pit latrine paradox; (1) the pit latrine is considered a sanitation technology of choice to safeguard human health, and (2) conversely, pit latrines are pollution and health risk hotspots. Evidence shows that the pit latrine is a 'catch-all' receptacle for household disposal of hazardous waste, including; (1) medical wastes (COVID-19 PPE, pharmaceuticals, placenta, used condoms), (2) pesticides and pesticide containers, (3) menstrual hygiene wastes (e.g., sanitary pads), and (4) electronic wastes (batteries). Pit latrines serve as hotspot reservoirs that receive, harbour, and then transmit the following into the environment; (1) conventional contaminants (nitrates, phosphates, pesticides), (2) emerging contaminants (pharmaceuticals and personal care products, antibiotic resistance), and (3) indicator organisms, and human bacterial and viral pathogens, and disease vectors (rodents, houseflies, bats). As greenhouse gas emission hotspots, pit latrines contribute 3.3 to 9.4 Tg/year of methane, but this could be an under-estimation. Contaminants in pit latrines may migrate into surface water, and groundwater systems serving as drinking water sources and pose human health risks. In turn, this culminates into the pit latrine-groundwater-human continuum or connectivity, mediated via water and contaminant migration. Human health risks of pit latrines, a critique of current evidence, and current and emerging mitigation measures are presented, including isolation distance, hydraulic liners/ barriers, ecological sanitation, and the concept of a circular bioeconomy. Finally, future research directions on the epidemiology and fate of contaminants in pit latrines are presented. The pit latrine paradox is not meant to downplay pit latrines' role or promote open defaecation. Rather, it seeks to stimulate discussion and research to refine the technology to enhance its functionality while mitigating pollution and health risks.

A mixed-methods study measuring the effectiveness of a menstrual health intervention on menstrual health knowledge, perceptions and practices among young women in Zimbabwe.

OBJECTIVES: While integral to women's physical and mental well-being, achieving good menstrual health (MH) remains a challenge for many women. This study investigated the effectiveness of a comprehensive MH intervention on menstrual knowledge, perceptions and practices among women aged 16-24 years in Harare, Zimbabwe. DESIGN: A mixed-methods prospective cohort study with pre-post evaluation of an MH intervention. SETTING: Two intervention clusters in Harare, Zimbabwe. PARTICIPANTS: Overall, 303 female participants were recruited, of whom 189 (62.4%) were seen at midline (median follow-up 7.0; IQR 5.8-7.7 months) and 184 (60.7%) were seen at endline (median follow-up 12.4; IQR 11.9-13.8 months). Cohort follow-up was greatly affected by COVID-19 pandemic and associated restrictions. INTERVENTION: The MH intervention provided MH education and support, analgesics, and a choice of menstrual products in a community-based setting to improve MH outcomes among young women in Zimbabwe. PRIMARY AND SECONDARY OUTCOMES: Effectiveness of a comprehensive MH intervention on improving MH knowledge, perceptions, and practices among young women over time. Quantitative questionnaire data were collected at baseline, midline, and endline. At endline, thematic analysis of four focus group discussions was used to further explore participants' menstrual product use and experiences of the intervention. RESULTS: At midline, more participants had correct/positive responses for MH knowledge (adjusted OR (aOR)=12.14; 95% CI: 6.8 to 21.8), perceptions (aOR=2.85; 95% CI: 1.6 to 5.1) and practices for reusable pads (aOR=4.68; 95% CI: 2.3 to 9.6) than at baseline. Results were similar comparing endline with baseline for all MH outcomes. Qualitative findings showed that sociocultural norms, stigma and taboos around menstruation, and environmental factors such as limited access to water, sanitation and hygiene facilities affected the effect of the intervention on MH outcomes. CONCLUSIONS: The intervention improved MH knowledge, perceptions and practices among young women in Zimbabwe, and the comprehensive nature of the intervention was key to this. MH interventions should address interpersonal, environmental and societal factors. TRIAL REGISTRATION NUMBER: NCT03719521.

Menstrual Changes after COVID-19 Infection and COVID-19 Vaccination.

Background: Several factors such as stress, depression, infection, and vaccination influenced the menstrual cycle in women during the coronavirus disease 2019 (COVID-19) pandemic. We investigated whether there were changes in the menstrual cycle in women after COVID-19 vaccination or infection and, if so, the nature of the change. Methods: This study was designed as a descriptive, cross-sectional study. A face-to-face survey was conducted among menstruating women aged 18-50 years from May 31 to July 31, 2022. Women were inquired about their first three menstrual cycles that occurred after COVID-19 infection or vaccination. Results: Of 241 women with COVID-19 infection, 86 (35.7%) mentioned that they experienced various changes in their menstrual patterns in the first three cycles after infection. Of 537 participants who received various COVID-19 vaccines, 82 (15.1%) stated that they experienced changes in their menstrual patterns after vaccination. The incidence of postvaccination menstrual change was higher in women who received Pfizer-BioNTech and Sinovac (CoronaVac) vaccines. Only 10.9% of women who reported a change in their menstrual pattern after vaccination or infection consulted a physician. Conclusion: COVID-19 infection and vaccination can affect the menstrual cycle in women. It is important to be aware of the menstrual changes after COVID-19 infection and vaccination and to warn and inform women about this issue.

COVID-Related Distress Is Associated with Increased Menstrual Pain and Symptoms in Adult Women.

The COVID-19 pandemic resulted in heightened stress for many individuals, with women reporting more stress than men. Although a large body of evidence has demonstrated that stress, in general, can impact the menstrual cycle, it is not yet clear if COVID-specific stress would impact women's menstrual health. The current study explored the relationship between COVID-related stress and distress and menstrual variables (menstrual pain, number and severity of menstrual symptoms, and menstrual pain interference) in a sample of reproductive-age adult women. Seven-hundred fifteen women completed the initial survey and were re-contacted to complete the same survey three months later. Of those recontacted, 223 completed the follow-up survey. Results indicated that COVID-related stress and distress was associated with higher levels of menstrual pain, more frequent and more severe menstrual symptoms, and greater menstrual pain interference, even after accounting for age, hormonal use, bodily pain, and pain catastrophizing. Our findings suggest that women experience unique vulnerabilities that directly impact their health and functioning, and both research and clinical care should address these symptoms through careful assessment and treatment of menstrual pain and symptoms, particularly during and after periods of high stress and distress.

The COVID-19 vaccine did not affect the basal immune response and menstruation in female athletes.

The COVID-19 pandemic restricted the regular training and competition program of athletes. Vaccines against COVID-19 are known to be beneficial for the disease; however, the unknown side effects of vaccines and postvaccination reactions have made some athletes hesitant to get vaccinated. We investigated the changes in inflammatory responses and menstrual cycles of female athletes before and after vaccination. Twenty female athletes were enrolled in this study. Blood was collected from each subject before the first COVID-19 vaccination and after the first and second vaccinations. Laboratory data, including white blood cell, neutrophil, lymphocyte, and platelet counts, and inflammatory markers, including NLR (neutrophil-to-lymphocyte ratio), PLR (platelet lymphocyte ratio), RPR (red cell distribution width to platelet ratio), SII (systemic immune-inflammation index), and NeuPla (neutrophil-platelet ratio), were analyzed statistically. The menstrual changes before and after vaccination and the side effects were collected by questionnaires. No significant changes in the laboratory data were found after the first and second shots when compared to those at prevaccination: white blood cell, neutrophil, lymphocyte, platelet, NLR, PLR, SII, RPR, and NeuPla (p > 0.05). In addition, there were no significant changes in the menstruation cycle or days of the menstrual period (p > 0.05). All side effects after vaccination were mild and subsided in 2 days. The blood cell counts, inflammatory markers, and menstruation of female athletes were not affected by COVID-19 vaccines.

COVID-19 vaccination and menstruation.

COVID-19 vaccination causes small changes to menstruation that quickly resolve.

COVID-19-associated mental health impact on menstruation physiology: A survey study among medical students in Jordan.

BACKGROUND: The coronavirus disease 2019 pandemic has been an extraordinarily stressful situation in recent years. Stress is a physiological reaction to negative stimuli that is regulated by different neuroendocrine pathways. The female reproductive function is maintained by the menstrual cycle, which is negatively affected by hyperstimulation of stress signals. OBJECTIVES: This study evaluates the effect of the coronavirus disease 2019 outbreak on menstrual function and mental health, exploring the relationship between them. DESIGN: The current study uses a cross-sectional, survey-based design. METHODS: During this cross-sectional study, an online self-completion questionnaire was conducted among a sample of 385 Jordanian female medical students during the pandemic. The survey compared menstrual characteristics, depression, anxiety, and stress 10 months after the coronavirus disease 2019 pandemic with 10 months prior. Paired t-test, McNemar's test, Pearson's correlation, and multiple linear regression model were employed to analyze data using SPSS software. RESULTS: The mean age of female medical student respondents was 19.89 years. Data showed that the menstrual cycle length significantly increased during the coronavirus disease 2019 pandemic compared with 10 months prior (32.23 days versus 30.02 days, p = 0.019). The average number of heavy bleeding days also increased during the coronavirus disease 2019 pandemic (2.82 days versus 2.42 days, p = 0.002). The proportion of females with heavy bleeding amount was more than doubled during the pandemic of coronavirus disease 2019 compared with before (27.3% versus 10.4%, p = 0.000). Unpleasant menstrual signs such as nausea and/or vomiting, breast pain, and urinary urgency were significantly increased during the pandemic (p = 0.000, p = 0.008, and p = 0.024, respectively). During coronavirus disease 2019, a positive association between total Depression, Anxiety, and Stress Scale-21 Questionnaire score and heavy bleeding was identified (p < 0.05). The findings also indicated that mental disorders and the incidence of amenorrhea, nausea and/or vomiting, and urinary urgency were positively correlated during the coronavirus disease 2019 pandemic. The multiple regression analysis revealed associations between several menstrual characteristics such as amenorrhea and severity of bleeding with coronavirus disease 2019-related depression, anxiety, and stress. CONCLUSION: This study revealed that the stress related to the pandemic of coronavirus disease 2019 could affect the female menstrual cycle and hence the quality of women's life. Therefore, this study could serve as a baseline for planning and introducing stress mitigation interventions in crisis situations to improve the physiological and mental well-being of females and improve their quality of life.

Effect of COVID-19 vaccine on menstrual experience among females in six Arab countries: A cross sectional study.

BACKGROUND: There have been varying reports on the potential occurrence and severity of changes to menstruation including the median cycle length, days of bleeding, bleeding heaviness, and menstrual pain, following receipt of COVID-19 vaccinations. We aimed to assess potential postvaccination menstrual changes in women residing in the Middle East. METHODS: We implemented a cross-sectional online survey-based study. Data about the participants' demographic characteristics, menstruation experience, and vaccination status were collected and analyzed among six Arab countries. RESULTS: Among 4942 menstruating females included in this study, females who had received one or more doses of COVID-19 vaccination reported a higher frequency of back pain, nausea, tiredness, pelvic pain with periods, unprescribed analgesics use, and passage of loose stools. They also reported higher scores describing average and worst menstrual pain. Fully vaccinated females reported heavier flow and more days of bleeding. CONCLUSION: Our findings indicate that COVID-19 vaccine may have an effect on menstruation in terms of menstrual pain and bleeding heaviness. The evidence needs to be further investigated in longitudinal studies.

Association between COVID-19 vaccines and the menstrual cycle in young Japanese women.

INTRODUCTION: Although several studies have investigated the association between coronavirus disease 2019 (COVID-19) vaccines and the menstrual cycle, available data are limited. Therefore, this study investigated the effect of COVID-19 vaccines on the menstrual cycle and the effect of the menstrual cycle phase on the vaccine side effects during vaccine administration in Japan. METHODS: A self-administered questionnaire was used to collect data on the date of vaccination; type of vaccine; type, grade, and duration of the side effects; regularity of menstruation; normal length of the menstrual cycle; and the day one date of menstruation around vaccination. The survey was conducted from October 2021 to March 2022. RESULTS: The difference between the predicted and actual menstrual cycle length was 1.9 ± 3.0, 1.6 ± 2.8 (p = 0.557), and 2.5 ± 3.8 (p = 0.219) days before vaccination and after the first and second dose of the vaccine, respectively. In participants who received vaccinations twice within a single menstrual cycle, this difference was 1.3 ± 3.5 and 3.9 ± 3.3 (p = 0.045) days before and after vaccination, respectively. The grade and proportion of the side effects after the second dose of the vaccine was highest during the menstrual period and lowest during the ovulation period, with a significant effect on headache and chills. CONCLUSION: COVID-19 vaccines tended to prolong the menstrual cycle. The side effects of the COVID-19 vaccine tended to be at a maximum when vaccination occurred during the menstrual period and minimal during the ovulation period.

The effect of COVID-19 vaccination on the menstrual pattern and mental health of the medical students: A mixed-methods study from a low and middle-income country.

OBJECTIVE: To assess the effect of COVID-19 vaccination on menstrual patterns and mental health of medical students and to explore the students' perspective regarding this effect. MATERIALS AND METHODS: This mixed-method study was conducted on the medical and dental students of the private and public sector institutions of Peshawar from September 2021 to March 2022. A Menstrual symptom questionnaire (MSQ) and hospital anxiety and depression scale (HADS) were used. This was followed by qualitative interviews with the students who faced problems in their menstruation after the COVID-19 vaccination. RESULTS: A total of 953 students were included, with a mean age of 20.67±1. 56 years. More than half (n = 512, 53.7%) experienced menstrual cycle abnormalities post-vaccination. The majority having disturbances in their menstrual cycle had significantly higher levels of anxiety (p = 0.000). Results on the menstrual symptom questionnaire, anxiety, and depression subtype of HADS showed a negative and statistically significant relationship with changes after COVID-19 vaccination (p<0.05). In the qualitative interviews, 10 (58.8%) students each had problems with frequency and flow, followed by 7 (41.2%) students, who had dysmenorrhea. Seven (41.2%) consulted a gynecologist for management. The majority (n = 14, 82.4%) stated that these issues had an adverse impact on their mental health and almost half (n = 8, 47.1%) suggested consulting a gynecologist while facing such situations. CONCLUSION: This study showed the impact of the COVID-19 vaccine on women`s menstrual patterns and subsequent mental health status. Although the majority of the students experienced menstrual cycle abnormalities and subsequent mental health adversities post COVID-19 vaccination but these were temporary and self-limiting and were attributed to the psychological impact of the vaccination. Therefore, it is imperative to alert health care professionals about possible side effects and prior counseling is expected to play an important role in this context.

Incarceration, menstruation and COVID-19: a viewpoint of the exacerbated inequalities and health disparities in South African correctional facilities.

PURPOSE: The menstrual health and menstrual hygiene management (MHM) of incarcerated women remains relatively low on the agenda of public health interventions globally, widening the inequitable access of incarcerated women to safe and readily available menstrual health products (MHP). The COVID-19 pandemic has adversely impacted on the MHM gains made in various development sectors in the global North and South, through its amplification of vulnerability for already at-risk populations. This is especially significant to developing countries such as South Africa where the incarcerated female population are an often-forgotten minority. DESIGN/METHODOLOGY/APPROACH: This viewpoint highlights the ignominious silence of research and policy attention within the South African carceral context in addressing MHM. The ethical and political implications of such silences are unpacked by reviewing international and local literature that confront issues of inequality and equitable access to MHP and MHM resources within incarcerated contexts. FINDINGS: Structural inequalities in various contexts around the world have exacerbated COVID-19 and MHM. Within the prison context in South Africa, women face multiple layers of discrimination and punishment that draw attention to the historical discourses of correctional facilities as a site of surveillance and discipline. RESEARCH LIMITATIONS/IMPLICATIONS: This study acknowledges that while this viewpoint is essential in rising awareness about gaps in literature, it is not empirical in nature. PRACTICAL IMPLICATIONS: The authors believe that this viewpoint is essential in raising critical awareness on MHM in carceral facilities in South Africa. The authors hope to use this publication as the theoretical argument to pursue empirical research on MHM within carceral facilities in South Africa. The authors hope that this publication would provide the context for international and local funders, to assist in the empirical research, which aims to roll out sustainable MHP to incarcerated women in South Africa. SOCIAL IMPLICATIONS: The authors believe that this viewpoint is the starting point in accelerating the roll out of sustainable MHP to incarcerated females in South Africa. These are females who are on the periphery of society that are in need of practical interventions. Publishing this viewpoint would provide the team with the credibility to apply for international and national funding to roll out sustainable solutions. ORIGINALITY/VALUE: It is hoped that the gaps in literature and nodes for social and human rights activism highlighted within this viewpoint establish the need for further participatory research, human rights advocacy and informed civic engagement to ensure the voices of these women and their basic human rights are upheld.

Period poverty: The perceptions and experiences of impoverished women living in an inner-city area of Northwest England.

BACKGROUND: The menstrual needs of girls and women are important to health, education, and well-being. Unmet need and harm from poor menstrual health in low-and- middle-income countries have been documented, but with little empirical research undertaken in high income countries. Continuing austerity in the UK suggests menstruators are likely more vulnerable to 'period poverty' than previously, with the COVID-19 pandemic assumed to exacerbate the situation. AIM: To explore the menstrual experiences and perceptions of women in the UK who are living under circumstances of deprivation, alongside views of staff working in organisations supporting these women, to understand whether women's menstrual needs are met. METHODS: A qualitative study was conducted in an inner-city in NW England. Three focus group discussions and 14 in-depth interviews were conducted across three study sites supporting impoverished women. Data was analysed thematically. RESULTS: Themes were: reflections on menstruation; affordability of products; access to public facilities; organisational support; potential solutions. Many women perceived menstruation as a burden in three aspects: physical discomfort and pain; psychological anxiety; and shame and stigma. Managing menstruation was difficult due to cost relative to low incomes, with food, heating and lighting prioritised, leaving women improvising with materials or wearing products for longer than desired. Most suggested that products should be free, often remarking if men required similar items this would happen. Most women were unaware supporting organisations provided free products. Staff felt the small range of products offered did not meet client needs and were ill-prepared to have conversations on products and clients' menstrual needs. CONCLUSION: Impoverished women lack the necessary resources to manage their menses well which negatively impacts their health and brings stress, embarrassment, and shame. Support, including access to free products, is needed at both local and national level to help impoverished women manage their menstrual hygiene.

Premenstrual and menstrual changes reported after COVID-19 vaccination: The EVA project.

BACKGROUND: Menstrual disorders were not reported as a possible secondary effect in any of the clinical trials for the SARS-CoV-2 vaccines. AIM: To describe the prevalence of perceived premenstrual and menstrual changes after COVID-19 vaccine administration. DESIGN: Cross-sectional study. METHODS: A total of 14,153 women (mean age 31.5 ± 9.3 years old) who had received the full course of vaccination at least three months earlier were included in this cross-sectional study. Data including the type of vaccine administered, perceived changes in the amount and duration of menstrual bleeding, presence of clots, cycle length, and premenstrual symptoms were collected through a retrospective online survey from June to September 2021. RESULTS: Of the women who participated in this study, 3136 reported no menstrual changes and 11,017 (78% of the study sample) reported experiencing menstrual cycle changes after vaccination. In summary, women who reported menstrual changes after vaccination were older (overall p < 0.001) and slightly more smokers (p = 0.05) than women who did not report any changes. The most prevalent changes in relation to premenstrual symptoms were increased fatigue (43%), abdominal bloating (37%), irritability (29%), sadness (28%), and headaches (28%). The most predominant menstrual changes were more menstrual bleeding (43%), more menstrual pain (41%), delayed menstruation (38%), fewer days of menstrual bleeding (34.5%), and shorter cycle length (32%). CONCLUSION: Women vaccinated against COVID-19 usually perceive mild menstrual and premenstrual changes. Future studies are warranted to clarify the physiological mechanisms behind these widely reported changes.

Clinical, Epidemiologic and Ethical Aspects of Hysterectomy in Young Females With Intellectual Disability: A Multi-Centre Study of Public Hospitals in Mexico City.

Background: Non-therapeutic hysterectomy has been performed to this day in Mexican women with intellectual disabilities (IDs), but the rationale for performing the procedure has been rarely submitted to clinical ethics committees. The objectives of the present research were to determine the frequency of hysterectomy and the clinical and epidemiologic characteristics that associated to the indication of hysterectomy in girls and young females with IDs and to analyse the emerging ethical issues related to the procedure. Materials and Methods: A medical chart review was conducted to identify female patients aged ≤ 25 years who had IDs based on anatomical pathologies and hospital records and underwent hysterectomy between January 2014 and December 2019 in nine high-concentration hospitals in Mexico City. Data were collected using a questionnaire developed ex professo and validated through a pilot study and analysed using the Statistical Package for the Social Sciences (SPSS) 21.0 software. Results: Information of 234 female patients with or without ID who were ≤ 25 years of age was reported by the departments of anatomical pathology and paediatrics. Of the patients, 184 (79%) were excluded because the information reported was found to be erroneous or incomplete during the medical records review. Most of the 50 emales included in the study had moderate ID (n = 23, 46%) followed by those with severe ID (n = 17, 34%). The mean age at hysterectomy was 15 ± 2.9 years. Prophylactic-total abdominal hysterectomy was the most frequently performed (n = 42, 84%). A concurrence was observed between the parental and medical reasons justifying hysterectomy. The most frequent reasons were fertility control (parents vs. physicians: 46 vs. 42%), management of menstrual hygiene (28 vs. 30%) and risk of sexual abuse (6 vs. 6%). Conclusion: This study showed that performing non-therapeutic hysterectomy is subject to the clinical judgement of physicians according to their perception of the patient's quality of life. Therefore, the ethical quality of the decision to perform the procedure in girls and young females resides in the ethical value of its consequences.

Reusable sanitary napkins in rural India: a remote quality improvement project for adolescent girls promoting menstrual hygiene health during the COVID-19 pandemic.

Medical and public health research supports an ongoing need for health promotion in meeting menstrual hygiene needs, including menstrual hygiene management (MHM) education and the adoption of reusable sanitary napkins. This quality improvement project focuses on menstruation education for adolescent girls in rural Tamil Nadu, India and the promotion of reusable sanitary napkins. Results indicate a significant improvement in MHM knowledge, confidence in managing menstruation, adoption of reusable sanitary napkins, and a decrease in missed school days. These findings support global recommendations for health promotion in India.

Access to period products during the first nation-wide lockdown in Australia: Results from an online survey.

In early 2020, Australia experienced a nation-wide lockdown to help stop the spread of COVID-19. While many aspects of normal life were put on hold, others, like menstruation, did not stop. We examined the impact of the lockdown on the ability of people to access their usual period products. We conducted an online survey open for 2.5 weeks during the lockdown. Here, we report on responses from participants who identified as female, who were of reproductive age, and who answered questions regarding their ability to access their usual products. We fitted univariable and multivariable logistic regression models to explore factors associated with difficulty accessing period products and utilized a conventional content analysis for the free-text qualitative data. Of the 410 participants, nearly one-third reported difficulties accessing their usual period products during lockdown. Women under 25 years were more likely to experience difficulty accessing products. Free-text comments revealed the ways in which women handled this, often purchasing whatever was available regardless of whether it was a product that met their needs or not. Periods do not stop in a pandemic, and it is vital that people are able to access the products they require to manage their periods hygienically and comfortably.