Background: The purpose of this study is to examine the frequency of “period poverty,” or not being able to afford sanitary products, among university students, and associations with poor mental health. Methods: An online survey was conducted with a nationally-drawn sample (N = 471) of college-attending women to assess the association between period poverty and depression. Period poverty was measured via two questions designed for this study; depression was measured with the standard PHQ-9. Multivariable logistic regression was utilized for analysis. Results: Among our sample, 14.2% of women had experienced period poverty ever in the past-year; an additional 10% experienced it every month. Compared to those who had never experienced period poverty, adjusted analysis revealed that women with monthly past-year period poverty were the most likely to report moderate/severe depression (AOR = 2.34, 95% CI 1.09–4.99), followed by those who had experienced it ever in the past year (AOR = 1.83, 95% CI, 0.99–3.38). Conclusion: Many young women cannot afford menstrual health products to meet their monthly needs, and this may impact their mental well-being. Improved access to affordable menstrual products is needed to support these young women.

Endometriosis is a chronic gynecological disease that affects approximately 1 in 10 women of reproductive age. Symptoms of severe pelvic pain, infertility, fatigue, and abnormal menstruation can cause significant negative effects on an individual’s physical and mental health, including interactions with their family, friends, and health care providers. Stigma associated with endometriosis has been under-studied and is rarely discussed in current literature. Herein, this paper aims to provide a brief overview of published literature to explore and establish the plausibility of stigma as a driver of suboptimal psychosocial well-being and diagnostic delay among individuals living with endometriosis. We present the clinical characteristics and physical and mental health consequences associated with endometriosis, highlight several theoretical constructs of stigma, and review the limited studies documenting women’s lived experiences of endometriosis-related stigma. To mitigate harmful effects of this phenomenon, we recommend increasing efforts to assess the prevalence of and to characterize endometriosis-related stigma, implementing awareness campaigns, and developing interventions that combat the multidimensional negative effects of stigma on timely care, treatment, and quality of life for individuals living with endometriosis.

Social norms increasingly are the focus of intimate partner violence (IPV) prevention strategies but are among the least examined contextual factors in quantitative violence research. This study assesses the within-community, between-community, and contextual effect of a new measure of social norms (PVNS: Partner Violence Norms Scale) on women's risk of IPV. Data come from baseline surveys collected from 1435 female, married, reproductive-age participants, residing in 72 wards in three districts (Chitwan, Kapilvastu, Nawalparasi) in Nepal who were enrolled in a cluster randomized trial testing the impact of a social behavioral change communication intervention designed to prevent IPV. Results of unconditional multilevel logistic regression models indicated that there was cluster-level variability in the 12-month prevalence of physical (ICC = 0.07) and sexual (ICC = 0.05) IPV. Mean PVNS scores also varied across wards. When modeled simultaneously, PVNS scores aggregated to the ward-level and at the individual-level were associated with higher odds of physical (ORind = 1.12, CI = 1.04, 1.20; ORward = 1.40, CI = 1.15, 1.72) and sexual (ORind = 1.15, CI = 1.08, 1.24; ORward = 1.47, CI = 1.24, 1.74) IPV. The contextual effect was significant in the physical (0.23, se = 0.11, t = 2.12) and sexual (0.24, se = 0.09, t = 2.64) IPV models, suggesting that the ward-level association was larger than that at the individual-level. Adjustment for covariates slightly attenuated the ward-level association and eliminated the contextual association, suggesting that individual perceptions and the collective community phenomena were equally strong predictors of women's risk of IPV and should be taken into consideration when planning interventions. PVNS is a promising measure of social norms underpinning women's risk of IPV and warrants further psychometric testing.

Rigorous evaluations of health sector interventions addressing intimate partner violence (IPV) in low- and middle-income countries are lacking. We aimed to assess whether an enhanced nurse-delivered intervention would reduce IPV and improve levels of safety planning behaviors, use of community resources, reproductive coercion, and mental quality of life. We randomized 42 public health clinics in Mexico City to treatment or control arms. In treatment clinics, women received the nurse-delivered session (IPV screening, supportive referrals, health/safety risk assessments) at baseline (T1), and a booster counselling session after 3 months (T2). In control clinics, women received screening and a referral card from nurses. Surveys were conducted at T1, T2, and T3 (15 months from baseline). Our main outcome was past-year physical and sexual IPV. Intent-to-treat analyses were conducted via three-level random intercepts models to evaluate the interaction term for treatment status by time. Between April and October 2013, 950 women (480 in control clinics, 470 in treatment clinics) with recent IPV experiences enrolled in the study. While reductions in IPV were observed for both women enrolled in treatment (OR, 0.40; 95% CI, 0.28–0.55; P < 0.01) and control (OR, 0.51; 95% CI, 0.36–0.72; P < 0.01) clinics at T3 (July to December 2014), no significant treatment effects were observed (OR, 0.78; 95% CI, 0.49–1.24; P = 0.30). At T2 (July to December 2013), women in treatment clinics reported significant improvements, compared to women in control clinics, in mental quality of life (β, 1.45; 95% CI, 0.14–2.75; P = 0.03) and safety planning behaviors (β, 0.41; 95% CI, 0.02–0.79; P = 0.04). While reductions in IPV levels were seen among women in both treatment and control clinics, the enhanced nurse intervention was no more effective in reducing IPV. The enhanced nursing intervention may offer short-term improvements in addressing safety planning and mental quality of life. Nurses can play a supportive role in assisting women with IPV experiences. Clinicaltrials.gov ( NCT01661504 ). Registration Date: August 2, 2012

Objective: To examine patterns of conflict-related violence and intimate partner violence (IPV) and their associations with emotional distress among Congolese refugee women living in Rwanda.Design: Cross-sectional study.Setting: Two Congolese refugee camps in Rwanda.Participants: 548 ever-married Congolese refugee women of reproductive age (15–49 years) residing in Rwanda.Primary outcome measure: Our primary outcome was emotional distress as measured using the Self-Report Questionnaire-20 (SRQ-20). For analysis, we considered participants with scores greater than 10 to be experiencing emotional distress and participants with scores of 10 or less not to be experiencing emotional distress.Results: Almost half of women (49%) reported experiencing physical, emotional or sexual violence during the conflict, and less than 10% of women reported experiencing of any type of violence after fleeing the conflict. Lifetime IPV was reported by approximately 22% of women. Latent class analysis derived four distinct classes of violence experiences, including theLow All Violenceclass, theHigh Violence During Conflictclass, theHigh IPVclass and theHigh Violence During and After Conflictclass. In multivariate regression models, latent class was strongly associated with emotional distress. Compared with women in theLow All Violenceclass, women in theHigh Violence During and After Conflictclass and women in theHigh Violence During Conflicthad 2.7 times (95% CI 1.11 to 6.74) and 2.3 times (95% CI 1.30 to 4.07) the odds of experiencing emotional distress in the past 4 weeks, respectively. Furthermore, women in theHigh IPVclass had a 4.7 times (95% CI 2.53 to 8.59) greater odds of experiencing emotional distress compared with women in theLow All Violenceclass.Conclusions: Experiences of IPV do not consistently correlate with experiences of conflict-related violence, and women who experience high levels of IPV may have the greatest likelihood for poor mental health in conflict-affected settings.

Introduction Emerging research has linked women’s sanitation and menstrual hygiene experiences with increased vulnerability to violence outside the home. Few studies, however, have investigated the relationship between menstruation and violence perpetrated by family members. This type of violence may be linked specifically to restrictions placed on women during menstruation, which are common in some regions of Nepal owing to shared power differentials that disfavour women, and societal norms that stigmatise menstruation. Objective To record the prevalence of menstrual restrictions experienced by married women and examine potential associations between intimate partner violence (IPV) in the past year and menstrual restrictions imposed by husbands and/or in-laws among women in three districts of Nepal: Nawalparasi, Kapilvastu and Chitwan. Methods Baseline data from a larger randomised control trial aiming to reduce IPV in three districts of the Terai region of Nepal (n=1800) were used to assess the prevalence of menstrual restrictions and the association with IPV. Results Nearlythree out of four women (72.3%) reported experiencing high menstrual restriction, or two or more types of menstrual restriction. When controlling for demographic variables and IPV, no type of IPV was associated with high menstrual restrictions. Conclusion The experience of menstrual restriction was widespread in this sample of women in Nepal. Future research should seek to identify how best to capture menstrual stigma and deviations around such norms. The global health and development community should prioritise integration with existing water and sanitation programmes to reduce stigma and ensure the well-being of menstruating women and girls. Trial registration number NCT02942433.