Menstrual Health Experiences of People with Intellectual Disabilities and Their Caregivers during Vanuatu’s Humanitarian Responses: A Qualitative Study
Abstract
:1. Introduction
1.1. Menstrual Health for People with Disabilities
1.2. Menstrual Health for Women and Girls with Disabilities during Emergencies
1.3. Inclusion of People with Disabilities in Humanitarian Responses Delivered in Vanuatu
1.4. Study Aim and Research Questions
2. Materials and Methods
2.1. Study Site
2.2. Study Population and Sampling
2.3. Data Collection Methods
- Showed the young person that the doll was wearing a used menstrual material by taking it out of the doll’s underwear. Passed it to the young person and observed her reaction to it (e.g., awareness, unperturbed, disgust)
- Asked the young person where the doll should put the used menstrual material and observe her response (e.g., put it in the bin, in the laundry, on the floor, throw it in the bushes)
- Asked the young person what the doll should do next and then showed her a clean menstrual material. We observed her reactions throughout, including if she indicated that the doll should put the clean menstrual material in her underwear, get dressed, and wash her hands
2.4. Data Analyses
2.5. Informed Consent Process
2.6. Research Team
3. Results
3.1. Participation and Safeguarding
“Sometimes, she messes on her clothing; that’s why I don’t want her to go out of the house when she menstruates. She can go out when the menstruation is over. If she happens to go out when she menstruates and messes on her clothes, I am embarrassed when people come to tell me.”(Female caregiver)
“She removed [her menstrual material] and just threw it down. When her brothers saw it, they called out to the woman and said, “Come and pick up this little girl’s dirty [menstrual] cloths.” Because she didn’t know what to do because I wasn’t there. She pulled it out then threw it down and walked around.”(Female caregiver)
“When she menstruates, I stay with her at home. I cannot leave her alone at home. I have to be with her all the time until her menstruation is over.”(Female caregiver)
“Since I have a daughter whose situation is like this, it makes life difficult for me. I don’t sell every day because I need to be with her if she has a problem or if she is sick [menstruating].”(Female caregiver)
“I call my boss and ask to take leave for three days—I explain to him that my daughter is like this, and then he agrees. I stay home until her period is finished, and then I go back to work.”(Female caregiver)
3.2. Decisions during Emergencies
“Sometimes we would hear that when she’s here [alone], men would come and play with her.”(Female caregiver)
“We couldn’t go elsewhere because nobody likes her.....We do not go to other people’s houses. […] The three of us didn’t go anywhere. We took shelter inside our kitchen. The wind blew out part of the kitchen.”(Female caregiver)
“Even though they don’t have a house anymore or it is damaged, these victims will not want to move into the evacuation centres. […] I have seen at the evacuation centre who needed privacy […]. Carers are also ashamed because they are with these young girls who need to use the toilets and are menstruating.”(Key informant)
“They had houses which were totally damaged, they had no food, and their places were muddy. They could not go anywhere, so they had to evacuate to some churches and classrooms, but then there was no privacy.”(Key informant)
“I don’t know how because these are church buildings and church compounds, but to find a way to be able to accommodate people with intellectual issues and have privacy for themselves and their carer. [….] Because when this is not made available […] even though they don’t have a house anymore or it is damaged, these victims will not want to move into the evacuation centres.”(Key informant)
3.3. Resilience to Disasters
“You had asked a question of how we are earning an income, and we said it was through kava, but in reality, we hardly have time to plant kava now that her situation is deteriorating. […..] We need to rebuild, but we cannot do that because everything is money.”(Female caregiver)
3.4. Hygiene Kit Content
“They have included everything we needed. We were so happy with the things we received. […] I feel so fortunate because I don’t have to buy pads anymore. We have received free pads.”(Female caregiver)
- P:
- Before the cyclone, [incontinence] wasn’t too much but after the cyclone…
- I:
- She misses going to the toilet more than before the cyclone came?
- P:
- Yes
“…with the rain, it is not enough. When it rains, six is not enough. I’d wash these ones, but the others would not be dry yet.”(Female caregiver)
“I think that where there is a hygiene kit, you know, one pack of menstrual pads to a family. That is not enough.”(Key informant)
“Wouldn’t it be great if we could have a team doing pre-positioning […] and having the products on-site. Because we know there’s gonna be some sort of natural disaster, whether it be a tsunami, earthquake or cyclone. It’s going to happen in Vanuatu.”(Key informant)
3.5. Menstrual Health Interventions in Non-Humanitarian Settings
“What I see is happening is […]: “here’s your hygiene kit; we move on to the next village now”. So, and you know it’s a really sensitive topic, so clearly someone needs to take charge in that village to be responsible for education and the dispersal of the education that goes alongside the kit. And so often a reusable product is possibly a new product, and there is no knowledge about how do you use it.”(Key informant)
“The importance of when a new product is issued in a hygiene kit, that it is vital that the people distributing have got the knowledge [about] how to use it. The anecdotal information I had is that there were children running around with reusable menstrual pads on their arms as wings, playing.”(Key informant)
“I think the briefing card was too detailed. It was too wordy, and when I read it and tried to transfer it down to a level where they could understand, it was too much in a short time.”(Key informant)
“Women and girls that have a disability in peacetime still face many challenges in managing menstrual health. They do not feel comfortable speaking about it. […] They will feel shy, or they will fear talking about their needs, so they really isolate themselves.”(Key informant)
“If we have that specific initiative available [for people with disabilities] during peacetime, we are working with them, we understand them, we are creating a relationship. […] Because when it comes to disaster, and we are making quick decisions, it’s very easy to overlook the need of persons with disabilities.”(Key informant)
3.6. The Importance of WASH Services for Menstrual Health
“It is all right to give them calico, but we need to think of water before we give because if we give and there is no water, that is a big problem.”(Key informant)
“It was really hard, we tried really hard. Sometimes we take a truck to the sea [to bathe]. […] So if you have money, you must have money because it costs to take the truck down to the sea.”(Female caregiver)
3.7. Menstrual Health Caregiving Roles and Impacts
“Since they cut mummy’s leg and daddy is now sick and down in bed, I have no choice but to help her because I love her so much. That’s why I have to take care of her because if my wife did it, she would complain.”(Male caregiver)
- I:
- Excuse me, I just want to ask a question: Does her father help to take care of her?
- P:
- Yes, sometimes, if I’m out, her father will help her change [her menstrual material] when she has her period.
- I:
- Her father? He helps?
- P:
- Yes
“Whenever there is community work, my husband would bring cooked food to share with the others during mealtimes. However, none would want to eat the food he brings with him [because he supports her during menstruation].”(Female caregiver)
“I tell him that he should make it his duty to take care of her since he was the one who assisted in making sure that she was alive. If he hadn’t done that, we would not be burdened in taking care of her now.”(Female caregiver)
“I’m doing this because children such as these bring blessings, lots of blessings that support those of us who are able-bodied.”(Female caregiver)
3.8. Observation of Young People
“When I brought out the doll, she smiled widely, and her eyes brightened. The doll really got her attention.”(Field notes)
“The doll was the one that made her sit up straight and be more focused during the rest of the interview. She [young person] didn’t want to touch the used pad but pointed to the bucket to indicate where the used pad should go.”(Field notes)
4. Discussion
Study Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Hennegan, J.; Winkler, I.T.; Bobel, C.; Keiser, D.; Hampton, J.; Larsson, G.; Chandra-Mouli, V.; Plesons, M.; Mahon, T. Menstrual health: A definition for policy, practice, and research. Sex. Reprod. Health Matters 2021, 29, 31–38. [Google Scholar] [CrossRef] [PubMed]
- Hennegan, J.; Shannon, A.K.; Rubli, J.; Schwab, K.J.; Melendez-Torres, G.J. Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PLOS Med. 2019, 16, e1002803. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wea, L.D.; Hepilita, Y.; Fachry, M.E. The experiences of visually impaired teenage girls on menstrual hygiene management: A qualitative study. Enferm. Clin. 2020, 30 (Suppl. 2), 222–225. [Google Scholar] [CrossRef]
- Dündar, T.; Özsoy, S. Menstrual hygiene management among visually impaired women. Br. J. Vis. Impair. 2020, 38, 347–362. [Google Scholar] [CrossRef]
- Márquez-González, H.; Valdez-Martinez, E.; Bedolla, M. Hysterectomy for the Management of Menstrual Hygiene in Women With Intellectual Disability. A Systematic Review Focusing on Standards and Ethical Considerations for Developing Countries. Front. Public Health 2018, 6, 338. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wilbur, J.; Torondel, B.; Hameed, S.; Mahon, T.; Kuper, H. Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people. PLoS ONE 2019, 14, e0210974. [Google Scholar] [CrossRef]
- Wilbur, J.; Morrison, C.; Iakavai, J.; Shem, J.; Poilapa, R.; Bambery, L.; Baker, S.; Tanguay, J.; Sheppard, P.; Banks, L.M.; et al. “The weather is not good”: Exploring the menstrual health experiences of menstruators with and without disabilities in Vanuatu. Lancet Reg. Health-West. Pac. 2021, 18, 100325. [Google Scholar] [CrossRef]
- Wilbur, J.; Kayastha, S.; Mahon, T.; Torondel, B.; Hameed, S.; Sigdel, A.; Gyawali, A.; Kuper, H. Qualitative study exploring the barriers to menstrual hygiene management faced by adolescents and young people with a disability, and their carers in the Kavrepalanchok district, Nepal. BMC Public Health 2021, 21, 476. [Google Scholar] [CrossRef]
- Harvey, K.; Mano, P.; Lakshminarayana, I.; Gupta, S. G480(P) Menstruation matters: The impact of menstruation on girls and young women with severe learning difficulties and their families. Arch. Dis. Child. 2019, 104 (Suppl. 2), A193. [Google Scholar] [CrossRef]
- Wilbur, J.; Scherer, N.; Mactaggart, I.; Shrestha, G.; Mahon, T.; Torondel, B.; Kuper, H. Are Nepal’s water, sanitation and hygiene and menstrual hygiene policies and supporting documents inclusive of disability? A policy analysis. Int. J. Equity Health 2021, 20, 157. [Google Scholar] [CrossRef]
- Sommer, M. Menstrual hygiene management in humanitarian emergencies: Gaps and recommendations. Waterlines 2012, 31, 83–104. [Google Scholar] [CrossRef] [Green Version]
- Sommer, M.; Schmitt, M.L.; Clatworthy, D.; Bramucci, G.; Wheeler, E.; Ratnayake, R. What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? A global review. Waterlines 2016, 35, 245–264. [Google Scholar] [CrossRef]
- Sphere. The Sphere Handbook. Humanitarian Charter and Minimum Standards in Humanitarian Response. 2018. Available online: https://spherestandards.org/handbook-2018/ (accessed on 22 September 2022).
- Sommer, M.; Schmitt, M.L.; Clatworthy, D. A Toolkit for Integrating Menstrual Hygiene Management (MHM) into Humanitarian Response; Columbia University, Mailman School of Public Health and International Rescue Committee: New York, NY, USA, 2017. [Google Scholar]
- Wilbur, J.; Clemens, F.; Sweet, E.; Banks, L.M.; Morrison, C. The inclusion of disability within efforts to address menstrual health during humanitarian emergencies: A systematised review. Front. Water 2022, 4, 158. [Google Scholar] [CrossRef]
- Wilbur, J.; Mactaggart, I.; Mahon, T.; Torondel, B.; Hameed, S.; Kuper, H. The Bishesta campaign: A menstrual hygiene management intervention for people with intellectual impairments and their carers. Waterlines 2021, 40, 209–224. [Google Scholar] [CrossRef]
- Wilbur, J.; Mahon, T.; Torondel, B.; Hameed, S.; Kuper, H. Feasibility Study of a Menstrual Hygiene Management Intervention for People with Intellectual Impairments and Their Carers in Nepal. Int. J. Environ. Res. Public Health 2019, 16, 3750. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Thapa, P.; Sivakami, M. Lost in transition: Menstrual experiences of intellectually disabled school-going adolescents in Delhi, India. Waterlines 2017, 36, 317–338. [Google Scholar] [CrossRef]
- Altundağ, S.; Çalbayram, N. Teaching menstrual care skills to intellectually disabled female students. J. Clin. Nurs. 2016, 25, 1962–1968. [Google Scholar] [CrossRef]
- United Nations Development Programme. Human Development Index. Available online: http://hdr.undp.org/en/content/human-development-index-hdi2021 (accessed on 31 October 2022).
- Statista. Countries with the Highest Disaster Risk Worldwide in 2021. 2021. Available online: https://www.statista.com/statistics/1270469/disaster-risk-index-most-affected-countries/ (accessed on 15 July 2022).
- ReliefWeb. Business Network Brief-Vanuatu (June 2021). Available online: https://reliefweb.int/report/vanuatu/business-network-brief-vanuatu-june-2021 (accessed on 15 July 2022).
- Australian Government Department of Foreign Affairs and Trade. Tropical Cyclone Harold, Australia’s Response to Tropical Cyclone Harold. Available online: https://www.dfat.gov.au/crisis-hub/tropical-cyclone-harold (accessed on 15 July 2022).
- Rovins, J.; Stewart, C.; Brown, N. Learning from Population Displacement in the Pacific: Case Study of the 2017–2018 Eruption of the Ambae Volcano, Vanuatu. 2020. Available online: https://www.preventionweb.net/publication/learning-population-displacement-pacific-case-study-2017-2018-eruption-ambae-volcano (accessed on 15 July 2022).
- Government of the Republic of Vanuatu, National Disaster Management Office. National Disaster Management Office. Available online: https://ndmo.gov.vu (accessed on 22 September 2022).
- Baker, S.; Brown, T.; Caleb, N.; Lakavai, J.; Marella, M.; Morris, K. Disability Inclusion in Disaster Risk Reduction: Experiences of People with Disabilities in Vanuatu during and after Tropical Cyclone Pam and Recommendations for Humanitarian Agencies. 2017. Available online: https://www.preventionweb.net/publication/disability-inclusion-disaster-risk-reduction-experiences-people-disabilities-vanuatu (accessed on 29 September 2022).
- Huggett, C.; Munro, A.K. Period Poverty in the Pacific: Exploring Opportunities and Barriers to Progress Menstrual health. 2022. Available online: www.wateraid.org (accessed on 22 September 2022).
- Downing, S.G.; Benjimen, S.; Natoli, L.; Bell, V. Menstrual hygiene management in disasters: The concerns, needs, and preferences of women and girls in Vanuatu. Waterlines 2021, 40, 144–159. [Google Scholar] [CrossRef]
- Shelter Cluster Vanuatu. Ambae Mass Evacuation 2017: Response Review. 2017. Available online: https://reliefweb.int/report/vanuatu/shelter-cluster-vanuatu-ambae-mass-evacuation-2017-response-review (accessed on 26 August 2022).
- Washington Group on Disability Statistics. Recommended Short Set of Questions; Washington Group on Disability Statistics: Washington, DC, USA, 2010. [Google Scholar]
- Patton, M.Q. Qualitative Research & Evaluation Methods: Thousand Oaks; Sage Publications: Thousand Oaks, CA, USA, 2002. [Google Scholar]
- Bhakta, A.; Annan, G.; Esseku, Y.Y.; Esseku, H.; Fisher, J.; Lartey, B.; Reed, B. Finding Hidden Knowledge in WASH: Effective Methods for Exploring the Needs of Perimenopausal Women in Ghana 39th WEDC International Conference; WEDC: Kumasi, Ghana, 2016. [Google Scholar]
- Ansari, Z. Understanding the Coping Mechanisms Employed by People with Disabilities and Their Families to Manage Incontinence in Pakistan; LSHTM: London, UK, 2017. [Google Scholar]
- Wilbur, J.; Morrison, C.; Bambery, L.; Tanguay, J.; Baker, S.; Sheppard, P.; Mactaggart, I. “I’m scared to talk about it”: Exploring experiences of incontinence for people with and without disabilities in Vanuatu, using mixed methods. Lancet Reg. Health-West. Pac. 2021, 14, 100237. [Google Scholar] [CrossRef]
- Bhakta, A. Uncovering WASH Realities through PhotoVoice, SLH Learning Paper 9; Institute of Development Studies: Brighton, UK, 2020; Available online: https://opendocs.ids.ac.uk/opendocs/bitstream/handle/20.500.12413/15395/SLH_Learning_Paper_9_PhotoVoice.pdf?sequence=6 (accessed on 12 August 2022).
- White, S.; Kuper, H.; Itimu-Phiri, A.; Holm, R.; Biran, A. A Qualitative Study of Barriers to Accessing Water, Sanitation and Hygiene for Disabled People in Malawi. PLoS ONE 2016, 11, e0155043. [Google Scholar] [CrossRef]
- O’Connor, C.; Joffe, H. Intercoder Reliability in Qualitative Research: Debates and Practical Guidelines. Int. J. Qual. Methods 2020, 19, 1609406919899220. [Google Scholar] [CrossRef]
- World Health Organization (WHO); United Nations Children’s Fund (UNICEF). Progress on Household Drinking Water, Sanitation and Hygiene 2000–2020: Five Years into the SDGs; World Health Organization: Geneva, Switzerland, 2021.
- Kyrkou, M. Health issues and quality of life in women with intellectual disability. J. Intellect. Disabil. Res. 2005, 49, 770–772. [Google Scholar] [CrossRef]
- Mactaggart, I.; Baker, S.; Bambery, L.; Iakavai, J.; Kim, M.J.; Morrison, C.; Poilapa, R.; Shem, J.; Sheppard, P.; Tanguay, J.; et al. Water, women and disability: Using mixed-methods to support inclusive WASH programme design in Vanuatu. Lancet Reg. Health-West. Pac. 2021, 8, 100109. [Google Scholar] [CrossRef]
- Izutsu, T. Disability-Inclusive Disaster Risk Reduction and Humanitarian Action: An Urgent Global Imperative; The University of Tokyo: Tokyo, Japan, 2019. [Google Scholar]
- Bond Disability and Development Group; Climate Action Network UK. Disability Inclusion in UK Climate Action; Bond: London, UK, 2016. [Google Scholar]
- GLAD Network-Global Action on Disability. 3 Steps towards Disability-Inclusive Climate Action. Available online: https://gladnetwork.net/sites/default/files/GLAD%20Infographic_Accessible.pdf (accessed on 31 September 2022).
- Chou, Y.C.; Lu, Z.Y. Caring for a daughter with intellectual disabilities in managing menstruation: A mother’s perspective. J. Intellect. Dev. Disabil. 2012, 37, 1–10. [Google Scholar] [CrossRef]
- Chou, Y.-C.; Lu, Z.-Y. Deciding about sterilisation: Perspectives from women with an intellectual disability and their families in Taiwan. J. Intellect. Disabil. Res. 2010, 55, 63–74. [Google Scholar] [CrossRef]
- Murphy, J.; Gray, C.; Cox, S. Talking Mats: The effectiveness of a low technology communication framework to help people with dementia express their views. J. Assist. Technol. 2007, 1, 30–34. [Google Scholar] [CrossRef]
- Lewis, A.; Newton, H.; Vials, S. Realising child voice: The development of Cue Cards. Support Learn. 2008, 23, 26–31. [Google Scholar] [CrossRef]
Young Person | Caregiver | Key Informant | |||
---|---|---|---|---|---|
Characteristics | N= | Characteristics | N= | Characteristics | N= |
Age group | Gender | Organisation type | |||
15–18 | 5 | Female | 15 | International government organisation | 2 |
19–31 | 12 | Male | 2 | Non-government Organisation | 4 |
Impairment type | Location | Disability organisation | 3 | ||
Visual | 0 | Urban | 8 | Private sector | 1 |
Hearing | 0 | Rural | 9 | Location | |
Mobility | 3 | Espirito Santo | 2 | ||
Cognition | 17 | Efate (Port Vila) | 4 | ||
Communication | 9 | New Zealand | 1 | ||
Multiple 1 | 10 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Wilbur, J.; Poilapa, R.; Morrison, C. Menstrual Health Experiences of People with Intellectual Disabilities and Their Caregivers during Vanuatu’s Humanitarian Responses: A Qualitative Study. Int. J. Environ. Res. Public Health 2022, 19, 14540. https://doi.org/10.3390/ijerph192114540
Wilbur J, Poilapa R, Morrison C. Menstrual Health Experiences of People with Intellectual Disabilities and Their Caregivers during Vanuatu’s Humanitarian Responses: A Qualitative Study. International Journal of Environmental Research and Public Health. 2022; 19(21):14540. https://doi.org/10.3390/ijerph192114540
Chicago/Turabian StyleWilbur, Jane, Relvie Poilapa, and Chloe Morrison. 2022. "Menstrual Health Experiences of People with Intellectual Disabilities and Their Caregivers during Vanuatu’s Humanitarian Responses: A Qualitative Study" International Journal of Environmental Research and Public Health 19, no. 21: 14540. https://doi.org/10.3390/ijerph192114540