Acceptability, uptake, and effectiveness of a menstrual health intervention among young women in Zimbabwe

Menstrual health (MH) is fundamental to women’s mental, physical, and reproductive health and well-being. Yet, many women face barriers and challenges in managing their menstruation safely and with dignity, especially in low- and middle-income countries. Past and existing MH interventions tend to be implemented independently from other sexual and reproductive health (SRH) services, focus on school-going girls, access to water, sanitation and hygiene facilities, and the provision solely of either MH education or MH products. This thesis aims to bridge the evidence gap by investigating the acceptability, uptake and effectiveness of a community-based MH intervention providing a choice of MH products with MH education and support, among school-going and non-school-going young women aged 16-24 years. The study was nested within a community-based SRH intervention among youth aged 16-24 years in Zimbabwe called CHIEDZA. CHIEDZA routine intervention data from 27725 female CHIEDZA clients was used to quantitatively assess uptake of MH services, MH product choice and patterns of use over time. Pre- and post-intervention survey data from a prospective cohort of 300 participants was used to investigate the effectiveness of the MH intervention on MH knowledge, perceptions, and practices. MH intervention acceptability and the facilitators and barriers to product choice were investigated through thematic analysis of qualitative focus group discussions and in-depth interviews with healthcare providers and young women. Results are presented in four peer-reviewed papers that addressed each of the study objectives. Objective 1 was to understand existing knowledge levels, perceptions, and practices around MH among women aged 16–24 years in Zimbabwe and to design and pilot a complex MH intervention within CHIEDZA. Objective 2 was to investigate MH product choice, continued use or discontinuation of products, and patterns of use over time within the MH intervention. Objective 3 was to assess the effect of the MH intervention on MH knowledge, perceptions, and practices over time. Finally, objective 4 was to describe the acceptability of the MH intervention. Overall, this thesis demonstrates how a community-based MH intervention was acceptable and effective in improving MH knowledge, perceptions, and practices among women aged 16-24 years in Zimbabwe. Key to intervention acceptability was the choice of menstrual products provided, accompanied by analgesics and MH education and support. MH integration within SRH services was also central in facilitating acceptable female service engagement. Findings further highlight the existing severe unmet need for MH products and information and the contextual sociocultural factors that are central to informing the menstrual experiences of women.