Drivers and challenges to use of menstrual cups among schoolgirls in rural Uganda: a qualitative study
Maria Hyttel | Camilla Faldt Thomsen | Bianca Luff | Halvor Storrusten | Viola Nilah Nyakato | Marianne Tellier
Is the menstrual cup a potential solution to address the challenges surrounding menstrual health and management (MHM) for girls and women in low-income contexts? This qualitative study assessed the drivers and challenges for acceptability of the menstrual cup (MC) among schoolgirls in rural Uganda. The study included 36 schoolgirls aged 13–17 recruited from a school-based controlled trial of MCs with 194 participants. After 4 months, 12 follow-up interviews and four focus group discussions were held with study participants After an initial learning curve the findings indicate that MCs are acceptable among schoolgirls in rural Uganda and suggest that the MC can be an acceptable, sustainable, and environmentally friendly MHM method for girls and women in similar contexts. Most (34 out of 36) participants overcame initial challenges mastering the techniques for insertion and removal and adapted to MC use. The main challenge for following the guidelines for hygienic use was finding equipment to boil the cup for disinfection. Major drivers for acceptability were creating trust in the MC and peer support as well as increased comfort, independence, and mobility due to reduced leakage compared with previous MHM methods, especially when in school.Abboud, S., Jemmott L.S. and Sommers M.S. (2015) ‘We are Arabs: the embodiment of virginity through Arab and Arab American women’s lived experiences’, Sexuality & Culture 19(4): 715–36 <http://dx.doi.org/10.1007/s12119-015-9286-1>.
Adinma, E.D. and Adinma, J.I.B. (2008) ‘Perceptions and practices on menstruation amongst Nigerian secondary school girls’, African Journal of Reproductive Health 12(1), 74–83.
Beksinska, M.E., Smit, J., Greener, R., Todd, C.S., Lee, M.T., Maphumulo, R.M. and Hoffmann, V. (2015) ‘Acceptability and performance of the menstrual cup in South Africa: a randomized crossover trial comparing the menstrual cup to tampons or sanitary pads’, Journal of Women’s Health 24(2): 151 <http://dx.doi.org/10.1089/jwh.2014.5021>.
Boosey, R., Prestwich, G. and Deave, T. (2014) ‘Menstrual hygiene management amongst schoolgirls in the Rukungiri district of Uganda and the impact on their education: a cross-sectional study’, Pan African Medical Journal 19: 1 <http://dx.doi.org/10.11604/pamj.2014.19.253.5313>.
Buckley, T. and Gottlieb, A. (1988) Blood Magic: The Anthropology of Menstruation, Berkeley, CA: University of California Press.
Crichton, J., Okal, J., Kabiru, C.W. and Zulu, E.M. (2012) ‘Emotional and psychosocial aspects of menstrual poverty in resource-poor settings: a qualitative study of the experiences of adolescent girls in an informal settlement in Nairobi’, Health Care for Women International 34(10): 891–916 <http://dx.doi.org/10.1080/07399332.2012.740112>.
Grant, M., Lloyd, C. and Mensch, B. (2013) ‘Menstruation and school absenteeism: evidence from rural Malawi’, Comparative Education Review 57(2): 260–84 <http://dx.doi.org/10.1086/669121>.
Howard, C., Rose, C., Trouton, K., Stamm, H., Marentette, D., Kirkpatrick, N., Karalic, S., Fernandez, R. and Paget, J. (2011) ‘FLOW (finding lasting options for women): multicentre randomized controlled trial comparing tampons with menstrual cups’, Canadian Family Physician Médecin de Famille Canadien 57(6): 208–15.
Hyttel, M., Rasanathan, J.J.K., Tellier, M. and Taremwa, W. (2012) ‘Use of injectable hormonal contraceptives: diverging perspectives of women and men, service providers and policymakers in Uganda’, Reproductive Health Matters 20(40): 148–157 <http://dx.doi.org/10.1016/S0968-8080(12)40654-1>.
Mason, L., Laserson, K.F., Oruko, K., Nyothach, E., Alexander, K.T., Odhiambo, F.O., Eleveld, A., Isy, E., Ngere, I., Omoto, J., Mohammed, A., Vulul, J. and Philips-Howard, P.A. (2015) ‘Adolescent schoolgirls’ experiences of menstrual cups and pads in rural western Kenya: a qualitative study’, Waterlines 34(1): 15–30 <http://dx.doi.org/10.3362/1756-3488.2015.003>.
Oche, M., Umar, A.S., Gana, G.J. and Ango, J.T. (2012) ‘Menstrual health: the unmet needs of adolescent girls in Sokoto, Nigeria’, Scientific Research and Essays 7(3): 410–8.
Oster, E. and Thornton, R. (2011) ‘Menstruation, sanitary products and school attendance: evidence from a randomized evaluation’, American Economic Journal: Applied Economics 3: 91–100 <http://dx.doi.org/10.1257/app.3.1.91>.
Oster, E. and Thornton, R. (2012) ‘Determinants of technology adoption: peer effects in menstrual cup up-take’, Journal of the European Economic Association 10: 1263–93 <http://dx.doi.org/10.1111/j.1542-4774.2012.01090.x>.
Ruby Cup (no date) ‘Why you should switch to Menstrual Cups’ [website] <www.ruby-cup.com/menstrual-cups/> [accessed 8 August 2016].
Sommer, M. (2009) ‘Ideologies on sexuality, menstruation and risk: girls’ experiences of puberty and schooling in northern Tanzania’, Culture, Health and Sexuality 11(4): 383 <http://dx.doi.org/10.1080/13691050902722372>.
Sommer, M. (2010) ‘Where the education system and women’s bodies collide: the social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence 33(4): 521 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008>.
Sommer, M. (2013) ‘Structural factors influencing menstruating school girls’ health and well-being in Tanzania’, Compare: A Journal of Comparative and International Education 43(3): 323 <http://dx.doi.org/10.1080/03057925.2012.693280>.
Tegegne, T.K. and Sisay, M.M. (2014) ‘Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia’, BMC Public Health 14: 1118 <http://dx.doi.org/10.1186/1471-2458-14-1118>.
Trinies, V., Caruso, B.A., Sogoré, A., Toubkiss, J. and Freeman, M.C. (2015) ‘Uncovering the challenges to menstrual hygiene management in schools in Mali’, Waterlines 34(1): 31 <http://dx.doi.org/10.3362/1756-3488.2015.004>.
Abboud, S., Jemmott L.S. and Sommers M.S. (2015) ‘We are Arabs: the embodiment of virginity through Arab and Arab American women’s lived experiences’, Sexuality & Culture 19(4): 715–36 <http://dx.doi.org/10.1007/s12119-015-9286-1>.
Adinma, E.D. and Adinma, J.I.B. (2008) ‘Perceptions and practices on menstruation amongst Nigerian secondary school girls’, African Journal of Reproductive Health 12(1), 74–83.
Beksinska, M.E., Smit, J., Greener, R., Todd, C.S., Lee, M.T., Maphumulo, R.M. and Hoffmann, V. (2015) ‘Acceptability and performance of the menstrual cup in South Africa: a randomized crossover trial comparing the menstrual cup to tampons or sanitary pads’, Journal of Women’s Health 24(2): 151 <http://dx.doi.org/10.1089/jwh.2014.5021>.
Boosey, R., Prestwich, G. and Deave, T. (2014) ‘Menstrual hygiene management amongst schoolgirls in the Rukungiri district of Uganda and the impact on their education: a cross-sectional study’, Pan African Medical Journal 19: 1 <http://dx.doi.org/10.11604/pamj.2014.19.253.5313>.
Buckley, T. and Gottlieb, A. (1988) Blood Magic: The Anthropology of Menstruation, Berkeley, CA: University of California Press.
Crichton, J., Okal, J., Kabiru, C.W. and Zulu, E.M. (2012) ‘Emotional and psychosocial aspects of menstrual poverty in resource-poor settings: a qualitative study of the experiences of adolescent girls in an informal settlement in Nairobi’, Health Care for Women International 34(10): 891–916 <http://dx.doi.org/10.1080/07399332.2012.740112>.
Grant, M., Lloyd, C. and Mensch, B. (2013) ‘Menstruation and school absenteeism: evidence from rural Malawi’, Comparative Education Review 57(2): 260–84 <http://dx.doi.org/10.1086/669121>.
Howard, C., Rose, C., Trouton, K., Stamm, H., Marentette, D., Kirkpatrick, N., Karalic, S., Fernandez, R. and Paget, J. (2011) ‘FLOW (finding lasting options for women): multicentre randomized controlled trial comparing tampons with menstrual cups’, Canadian Family Physician Médecin de Famille Canadien 57(6): 208–15.
Hyttel, M., Rasanathan, J.J.K., Tellier, M. and Taremwa, W. (2012) ‘Use of injectable hormonal contraceptives: diverging perspectives of women and men, service providers and policymakers in Uganda’, Reproductive Health Matters 20(40): 148–157 <http://dx.doi.org/10.1016/S0968-8080(12)40654-1>.
Mason, L., Laserson, K.F., Oruko, K., Nyothach, E., Alexander, K.T., Odhiambo, F.O., Eleveld, A., Isy, E., Ngere, I., Omoto, J., Mohammed, A., Vulul, J. and Philips-Howard, P.A. (2015) ‘Adolescent schoolgirls’ experiences of menstrual cups and pads in rural western Kenya: a qualitative study’, Waterlines 34(1): 15–30 <http://dx.doi.org/10.3362/1756-3488.2015.003>.
Oche, M., Umar, A.S., Gana, G.J. and Ango, J.T. (2012) ‘Menstrual health: the unmet needs of adolescent girls in Sokoto, Nigeria’, Scientific Research and Essays 7(3): 410–8.
Oster, E. and Thornton, R. (2011) ‘Menstruation, sanitary products and school attendance: evidence from a randomized evaluation’, American Economic Journal: Applied Economics 3: 91–100 <http://dx.doi.org/10.1257/app.3.1.91>.
Oster, E. and Thornton, R. (2012) ‘Determinants of technology adoption: peer effects in menstrual cup up-take’, Journal of the European Economic Association 10: 1263–93 <http://dx.doi.org/10.1111/j.1542-4774.2012.01090.x>.
Ruby Cup (no date) ‘Why you should switch to Menstrual Cups’ [website] <www.ruby-cup.com/menstrual-cups/> [accessed 8 August 2016].
Sommer, M. (2009) ‘Ideologies on sexuality, menstruation and risk: girls’ experiences of puberty and schooling in northern Tanzania’, Culture, Health and Sexuality 11(4): 383 <http://dx.doi.org/10.1080/13691050902722372>.
Sommer, M. (2010) ‘Where the education system and women’s bodies collide: the social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence 33(4): 521 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008>.
Sommer, M. (2013) ‘Structural factors influencing menstruating school girls’ health and well-being in Tanzania’, Compare: A Journal of Comparative and International Education 43(3): 323 <http://dx.doi.org/10.1080/03057925.2012.693280>.
Tegegne, T.K. and Sisay, M.M. (2014) ‘Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia’, BMC Public Health 14: 1118 <http://dx.doi.org/10.1186/1471-2458-14-1118>.
Trinies, V., Caruso, B.A., Sogoré, A., Toubkiss, J. and Freeman, M.C. (2015) ‘Uncovering the challenges to menstrual hygiene management in schools in Mali’, Waterlines 34(1): 31 <http://dx.doi.org/10.3362/1756-3488.2015.004>.
Abboud, S., Jemmott L.S. and Sommers M.S. (2015) ‘We are Arabs: the embodiment of virginity through Arab and Arab American women’s lived experiences’, Sexuality & Culture 19(4): 715–36 <http://dx.doi.org/10.1007/s12119-015-9286-1>.
Adinma, E.D. and Adinma, J.I.B. (2008) ‘Perceptions and practices on menstruation amongst Nigerian secondary school girls’, African Journal of Reproductive Health 12(1), 74–83.
Beksinska, M.E., Smit, J., Greener, R., Todd, C.S., Lee, M.T., Maphumulo, R.M. and Hoffmann, V. (2015) ‘Acceptability and performance of the menstrual cup in South Africa: a randomized crossover trial comparing the menstrual cup to tampons or sanitary pads’, Journal of Women’s Health 24(2): 151 <http://dx.doi.org/10.1089/jwh.2014.5021>.
Boosey, R., Prestwich, G. and Deave, T. (2014) ‘Menstrual hygiene management amongst schoolgirls in the Rukungiri district of Uganda and the impact on their education: a cross-sectional study’, Pan African Medical Journal 19: 1 <http://dx.doi.org/10.11604/pamj.2014.19.253.5313>.
Buckley, T. and Gottlieb, A. (1988) Blood Magic: The Anthropology of Menstruation, Berkeley, CA: University of California Press.
Crichton, J., Okal, J., Kabiru, C.W. and Zulu, E.M. (2012) ‘Emotional and psychosocial aspects of menstrual poverty in resource-poor settings: a qualitative study of the experiences of adolescent girls in an informal settlement in Nairobi’, Health Care for Women International 34(10): 891–916 <http://dx.doi.org/10.1080/07399332.2012.740112>.
Grant, M., Lloyd, C. and Mensch, B. (2013) ‘Menstruation and school absenteeism: evidence from rural Malawi’, Comparative Education Review 57(2): 260–84 <http://dx.doi.org/10.1086/669121>.
Howard, C., Rose, C., Trouton, K., Stamm, H., Marentette, D., Kirkpatrick, N., Karalic, S., Fernandez, R. and Paget, J. (2011) ‘FLOW (finding lasting options for women): multicentre randomized controlled trial comparing tampons with menstrual cups’, Canadian Family Physician Médecin de Famille Canadien 57(6): 208–15.
Hyttel, M., Rasanathan, J.J.K., Tellier, M. and Taremwa, W. (2012) ‘Use of injectable hormonal contraceptives: diverging perspectives of women and men, service providers and policymakers in Uganda’, Reproductive Health Matters 20(40): 148–157 <http://dx.doi.org/10.1016/S0968-8080(12)40654-1>.
Mason, L., Laserson, K.F., Oruko, K., Nyothach, E., Alexander, K.T., Odhiambo, F.O., Eleveld, A., Isy, E., Ngere, I., Omoto, J., Mohammed, A., Vulul, J. and Philips-Howard, P.A. (2015) ‘Adolescent schoolgirls’ experiences of menstrual cups and pads in rural western Kenya: a qualitative study’, Waterlines 34(1): 15–30 <http://dx.doi.org/10.3362/1756-3488.2015.003>.
Oche, M., Umar, A.S., Gana, G.J. and Ango, J.T. (2012) ‘Menstrual health: the unmet needs of adolescent girls in Sokoto, Nigeria’, Scientific Research and Essays 7(3): 410–8.
Oster, E. and Thornton, R. (2011) ‘Menstruation, sanitary products and school attendance: evidence from a randomized evaluation’, American Economic Journal: Applied Economics 3: 91–100 <http://dx.doi.org/10.1257/app.3.1.91>.
Oster, E. and Thornton, R. (2012) ‘Determinants of technology adoption: peer effects in menstrual cup up-take’, Journal of the European Economic Association 10: 1263–93 <http://dx.doi.org/10.1111/j.1542-4774.2012.01090.x>.
Ruby Cup (no date) ‘Why you should switch to Menstrual Cups’ [website] <www.ruby-cup.com/menstrual-cups/> [accessed 8 August 2016].
Sommer, M. (2009) ‘Ideologies on sexuality, menstruation and risk: girls’ experiences of puberty and schooling in northern Tanzania’, Culture, Health and Sexuality 11(4): 383 <http://dx.doi.org/10.1080/13691050902722372>.
Sommer, M. (2010) ‘Where the education system and women’s bodies collide: the social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence 33(4): 521 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008>.
Sommer, M. (2013) ‘Structural factors influencing menstruating school girls’ health and well-being in Tanzania’, Compare: A Journal of Comparative and International Education 43(3): 323 <http://dx.doi.org/10.1080/03057925.2012.693280>.
Tegegne, T.K. and Sisay, M.M. (2014) ‘Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia’, BMC Public Health 14: 1118 <http://dx.doi.org/10.1186/1471-2458-14-1118>.
Trinies, V., Caruso, B.A., Sogoré, A., Toubkiss, J. and Freeman, M.C. (2015) ‘Uncovering the challenges to menstrual hygiene management in schools in Mali’, Waterlines 34(1): 31 <http://dx.doi.org/10.3362/1756-3488.2015.004>.
Abboud, S., Jemmott L.S. and Sommers M.S. (2015) ‘We are Arabs: the embodiment of virginity through Arab and Arab American women’s lived experiences’, Sexuality & Culture 19(4): 715–36 <http://dx.doi.org/10.1007/s12119-015-9286-1>.
Adinma, E.D. and Adinma, J.I.B. (2008) ‘Perceptions and practices on menstruation amongst Nigerian secondary school girls’, African Journal of Reproductive Health 12(1), 74–83.
Beksinska, M.E., Smit, J., Greener, R., Todd, C.S., Lee, M.T., Maphumulo, R.M. and Hoffmann, V. (2015) ‘Acceptability and performance of the menstrual cup in South Africa: a randomized crossover trial comparing the menstrual cup to tampons or sanitary pads’, Journal of Women’s Health 24(2): 151 <http://dx.doi.org/10.1089/jwh.2014.5021>.
Boosey, R., Prestwich, G. and Deave, T. (2014) ‘Menstrual hygiene management amongst schoolgirls in the Rukungiri district of Uganda and the impact on their education: a cross-sectional study’, Pan African Medical Journal 19: 1 <http://dx.doi.org/10.11604/pamj.2014.19.253.5313>.
Buckley, T. and Gottlieb, A. (1988) Blood Magic: The Anthropology of Menstruation, Berkeley, CA: University of California Press.
Crichton, J., Okal, J., Kabiru, C.W. and Zulu, E.M. (2012) ‘Emotional and psychosocial aspects of menstrual poverty in resource-poor settings: a qualitative study of the experiences of adolescent girls in an informal settlement in Nairobi’, Health Care for Women International 34(10): 891–916 <http://dx.doi.org/10.1080/07399332.2012.740112>.
Grant, M., Lloyd, C. and Mensch, B. (2013) ‘Menstruation and school absenteeism: evidence from rural Malawi’, Comparative Education Review 57(2): 260–84 <http://dx.doi.org/10.1086/669121>.
Howard, C., Rose, C., Trouton, K., Stamm, H., Marentette, D., Kirkpatrick, N., Karalic, S., Fernandez, R. and Paget, J. (2011) ‘FLOW (finding lasting options for women): multicentre randomized controlled trial comparing tampons with menstrual cups’, Canadian Family Physician Médecin de Famille Canadien 57(6): 208–15.
Hyttel, M., Rasanathan, J.J.K., Tellier, M. and Taremwa, W. (2012) ‘Use of injectable hormonal contraceptives: diverging perspectives of women and men, service providers and policymakers in Uganda’, Reproductive Health Matters 20(40): 148–157 <http://dx.doi.org/10.1016/S0968-8080(12)40654-1>.
Mason, L., Laserson, K.F., Oruko, K., Nyothach, E., Alexander, K.T., Odhiambo, F.O., Eleveld, A., Isy, E., Ngere, I., Omoto, J., Mohammed, A., Vulul, J. and Philips-Howard, P.A. (2015) ‘Adolescent schoolgirls’ experiences of menstrual cups and pads in rural western Kenya: a qualitative study’, Waterlines 34(1): 15–30 <http://dx.doi.org/10.3362/1756-3488.2015.003>.
Oche, M., Umar, A.S., Gana, G.J. and Ango, J.T. (2012) ‘Menstrual health: the unmet needs of adolescent girls in Sokoto, Nigeria’, Scientific Research and Essays 7(3): 410–8.
Oster, E. and Thornton, R. (2011) ‘Menstruation, sanitary products and school attendance: evidence from a randomized evaluation’, American Economic Journal: Applied Economics 3: 91–100 <http://dx.doi.org/10.1257/app.3.1.91>.
Oster, E. and Thornton, R. (2012) ‘Determinants of technology adoption: peer effects in menstrual cup up-take’, Journal of the European Economic Association 10: 1263–93 <http://dx.doi.org/10.1111/j.1542-4774.2012.01090.x>.
Ruby Cup (no date) ‘Why you should switch to Menstrual Cups’ [website] <www.ruby-cup.com/menstrual-cups/> [accessed 8 August 2016].
Sommer, M. (2009) ‘Ideologies on sexuality, menstruation and risk: girls’ experiences of puberty and schooling in northern Tanzania’, Culture, Health and Sexuality 11(4): 383 <http://dx.doi.org/10.1080/13691050902722372>.
Sommer, M. (2010) ‘Where the education system and women’s bodies collide: the social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence 33(4): 521 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008>.
Sommer, M. (2013) ‘Structural factors influencing menstruating school girls’ health and well-being in Tanzania’, Compare: A Journal of Comparative and International Education 43(3): 323 <http://dx.doi.org/10.1080/03057925.2012.693280>.
Tegegne, T.K. and Sisay, M.M. (2014) ‘Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia’, BMC Public Health 14: 1118 <http://dx.doi.org/10.1186/1471-2458-14-1118>.
Trinies, V., Caruso, B.A., Sogoré, A., Toubkiss, J. and Freeman, M.C. (2015) ‘Uncovering the challenges to menstrual hygiene management in schools in Mali’, Waterlines 34(1): 31 <http://dx.doi.org/10.3362/1756-3488.2015.004>.
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