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. 2022 Jul:49:101482.
doi: 10.1016/j.eclinm.2022.101482. Epub 2022 Jun 3.

Product-access challenges to menstrual health throughout the COVID-19 pandemic among a cohort of adolescent girls and young women in Nairobi, Kenya

Shannon N Wood  1   2 , Rachel Milkovich  1 , Mary Thiongo  3 , Meagan E Byrne  1   2 , Bianca Devoto  1 , Grace Wamue-Ngare  4   5 , Michele R Decker  1   2 , Peter Gichangi  3   6   7
Affiliations

Product-access challenges to menstrual health throughout the COVID-19 pandemic among a cohort of adolescent girls and young women in Nairobi, Kenya

Shannon N Wood et al. EClinicalMedicine. 2022 Jul.

Abstract

Background: Access to menstrual hygiene products enables positive health for adolescent girls and young women (AGYW). Among AGYW in Nairobi, Kenya, this prospective mixed-methods study characterised menstrual health product-access challenges at two time points during the COVID-19 pandemic; assessed trajectories over the pandemic; and examined factors associated with product-access trajectories.

Methods: Data were collected from an AGYW cohort in August-October 2020 and March-June 2021 (n=591). The prevalence of menstrual health product-access challenges was calculated per timepoint, with trajectories characterizing product-access challenges over time. Logistic regression models examined associations with any product-access challenge throughout the pandemic; multinomial and logistic regressions further assessed factors associated with trajectories. Qualitative data contextualize results.

Findings: In 2020, 52·0% of AGYW experienced a menstrual health product-access challenge; approximately six months later, this proportion dropped to 30·3%. Product-access challenges during the pandemic were heightened for AGYW with secondary or lower education (aOR=2·40; p<0·001), living with parents (aOR=1·86; p=0·05), not the prime earner (aOR=2·27; p=0·05); and unable to meet their basic needs (aOR=2·25; p<0·001). Between timepoints, 38·0% experienced no product-access challenge and 31·7% resolved, however, 10·2% acquired a challenge and 20·1% experienced sustained challenges. Acquired product-access challenges, compared to no challenges, were concentrated among those living with parents (aOR=3·21; p=0·05); multinomial models further elucidated nuances. Qualitative data indicate deprioritization of menstrual health within household budgets as a contributor.

Interpretation: Menstrual health product-access challenges are prevalent among AGYW during the pandemic; barriers were primarily financial. Results may reflect endemic product-access gaps amplified by COVID-specific constraints. Ensuring access to menstrual products is essential to ensure AGYW's health needs.

Funding: This work was supported, in whole, by the Bill & Melinda Gates Foundation [010481].

Keywords: Adolescent girls and young women; COVID-19; Kenya; Menstrual health.

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Conflict of interest statement

No conflicts of interest to disclose.

Figures

Fig 1
Figure 1
Sankey diagram depicting changes in menstrual health product-access challenge trajectories among young women in Nairobi, Kenya from 2020 to 2021 survey waves (n=591). Sankey diagram of transitions between any menstrual health product-access challenge and no menstrual health product-access challenge between 2020 survey and 2021 survey. Red indicates continued product-access challenges at both time points. Green indicates no product-access challenge at either time point. Yellow indicates transition from either a product-access challenge to no product-access challenge or from no product-access challenge to product-access challenge between survey waves.
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