Product-access challenges to menstrual health throughout the COVID-19 pandemic among a cohort of adolescent girls and young women in Nairobi, Kenya
Authors & affiliation
Shannon N. Wood, Rachel Milkovich, Mary Thiongo, Meagan E. Byrne, Bianca Devoto, Grace Wamue-Ngare, Michele R. Decker, Peter Gichangi
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 time points, 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. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.