Publications by authors named "Caitlin Gruer"

6 Publications

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How addressing menstrual health and hygiene may enable progress across the Sustainable Development Goals.

Glob Health Action 2021 01;14(1):1920315

Multiple Institutions; End of Manuscript and Appendix B; Monitoring Menstrual Health and Hygiene Management, Green Paper.

There is increasing global attention to the importance of menstrual health and hygiene (MHH) for the lives of those who menstruate and gender equality. Yet, the global development community, which focuses on issues ranging from gender to climate change to health, is overdue to draw attention to how addressing MHH may enable progress in attaining the Sustainable Development Goals (SDGs). To address this gap, we undertook a collective exercise to hypothesize the linkages between MHH and the 17 SDGs, and to identify how MHH contributes to priority outcome measures within key sectoral areas of relevance to menstruating girls in low- and middle-income countries. These areas included Education, Gender, Health (Sexual and Reproductive Health; Psychosocial Wellbeing), and Water, Sanitation and Hygiene (WASH). These efforts were undertaken from February - March 2019 by global monitoring experts, together with select representatives from research institutions, non-governmental organizations, and governments ( = 26 measures task force members). Through this paper we highlight the findings of our activities. First, we outline the existing or potential linkages between MHH and all of the SDGs. Second, we report the identified priority outcomes related to MHH for key sectors to monitor. By identifying the potential contribution of MHH towards achieving the SDGs and highlighting the ways in which MHH can be monitored within these goals, we aim to advance recognition of the fundamental role of MHH in the development efforts of countries around the world.
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http://dx.doi.org/10.1080/16549716.2021.1920315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253211PMC
January 2021

Public restrooms, periods, and people experiencing homelessness: An assessment of public toilets in high needs areas of Manhattan, New York.

PLoS One 2021 23;16(6):e0252946. Epub 2021 Jun 23.

Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America.

Access to safe, clean water and sanitation is globally recognized as essential for public health. Public toilets should be accessible to all members of a society, without social or physical barriers preventing usage. A public toilet facility's design and upkeep should offer privacy and safety, ensure cleanliness, provide required sanitation-related resources, and be gender equitable, including enabling comfortable and safe management of menstruation. Menstrual hygiene management (MHM) refers to the need to ensure that girls, women and all people who menstruate have access to clean menstrual products, privacy to change the materials as often as needed, soap and water for washing the body as required, and access to facilities to dispose of used materials. Challenges around menstruation faced by people experiencing homelessness, which tend to be greater than those facing the general population, include inadequate toilet and bathing facilities, affordability issues around menstrual products, and menstrual stigma. Public toilets are a vital resource for managing menstruation, particularly for vulnerable populations without reliable access to private, safe, and clean spaces and menstrual products. This mixed-methods study sought to: 1) understand the lived experiences of MHM among people experiencing homelessness in New York City with respect to public toilets; 2) describe general and MHM-related characteristics of public toilets in high need areas of Manhattan and analyze their interrelationships; and 3) examine the associations among neighborhood-level demographics and the public toilet characteristics in those areas. Qualitative methods included key informant interviews (n = 15) and in-depth interviews (n = 22) with people with experience living on the street or in shelters, which were analyzed using Malterud's 'systematic text condensation' for thematic cross-case analysis. Quantitative methods included audits and analyses of public toilet facilities (n = 25) using traditional statistics (e.g., Spearman's correlations) and spatial analyses (e.g., proximity buffers). Qualitative findings suggest cleanliness, access to restrooms, and availability of resources are critical issues for the participants or prospective users. Quantitative analyses revealed insufficiently provided, maintained, and resourced public toilets for managing menstruation in high-needs areas. Findings also suggest that toilets with more MHM-related resource availability, such as menstrual products and toilet stall disposal bins, were more difficult to access. Neighborhood-level characteristics showed a potential environmental injustice, as areas characterized by higher socioeconomic status are associated with more access to MHM-specific resources in public restrooms, as well as better overall quality.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252946PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221515PMC
June 2021

Seeking menstrual products: a qualitative exploration of the unmet menstrual needs of individuals experiencing homelessness in New York City.

Reprod Health 2021 Apr 13;18(1):77. Epub 2021 Apr 13.

Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA.

Background: There has been increasing recognition that certain vulnerable populations in the United States of America struggle to meet their menstruation-related needs, including people experiencing homelessness. Media and policy attention on this subject has focused on the provision of free menstrual products to vulnerable populations, including a New York City legislative bill, which guarantees access to menstrual products for Department of Homeless Services shelter residents (Intros 1123-A).

Methods: This qualitative study explored the challenges people experiencing homelessness in New York City face in accessing menstrual products. Data collection was conducted from June to August 2019 and included: Semi-structured key informant interviews with staff from relevant government agencies and homeless service providers (n = 15), and semi-structured in-depth interviews with individuals with experience living on the street and in shelters (n = 22). Data were analysed using thematic analysis.

Results: Key themes that emerged included: (1) insufficient and inconsistent access to menstrual products; (2) systemic challenges to providing menstrual products; and (3) creative solutions to promote access to menstrual products. Both shelter- and street-living individuals reported significant barriers to accessing menstrual products. While both populations struggle, those in shelters were more likely to be able to purchase menstrual products or access free products at their shelter, while those living on the streets were more likely to have to resort to panhandling, theft, or using makeshift materials in place of menstrual products. Across both populations, individuals described barriers to accessing free products at shelters and service providers, primarily due to distribution systems that rely on gatekeepers to provide a few pads or tampons at a time, sometimes of inadequate quality and only upon request. Shelters and service providers also described challenges providing these products, including inconsistent supply.

Conclusion: These findings highlight the critical importance of expanding and improving initiatives seeking to provide access to menstrual products for vulnerable populations. Despite policy level efforts to support menstrual product access, individuals experiencing homelessness in New York City, whether living in shelters or on the street, are often not able to access the menstrual products that they need to manage their monthly menstrual flow.
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http://dx.doi.org/10.1186/s12978-021-01133-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042836PMC
April 2021

Menstruation and homelessness: Challenges faced living in shelters and on the street in New York City.

Health Place 2020 11 25;66:102431. Epub 2020 Sep 25.

Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 W. 168th Street, Room 537, New York, NY 10032, USA.

A growing literature attests to menstrual management difficulties of girls, women and other people who menstruate. Largely ignored are the menstruation-management needs of people experiencing homelessness. We explored these realities in New York City through in-depth interviews with individuals living on the street and in shelters (n = 22), key informant interviews with staff at government agencies, shelters and service provider organizations (n = 15), and field audits of public toilets. This paper explores both pragmatic difficulties presented by inadequate access to toilets, bathing spaces, and laundering services, and pervasive menstrual stigma. Amplifying the difficulties was near-constant pressure "to pass," as someone who was not homeless in order to enable increased access to toilets, and as someone who was not menstruating, in order to engage in the activities of daily living. Our findings highlight the need for improved quality and accessibility of bathrooms for sheltered and street-dwelling homeless, and expedited access to bathing and laundering. Such actions are essential given the steady increase in homelessness in NYC and - under the long shadow of COVID - especially timely.
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http://dx.doi.org/10.1016/j.healthplace.2020.102431DOI Listing
November 2020

The Extent to Which Menstruation-Related Issues Are Included in Graduate-Level Public Health Curricula.

Front Public Health 2020 28;8:442. Epub 2020 Aug 28.

Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States.

Menstruation is increasingly recognized as an issue in domestic and global public health. Public health graduates of U.S. schools of public health must have adequate competencies to address menstruation and its implications for health and well-being in their future endeavors in research, practice and policy. This study sought to understand the extent to which U.S. schools currently integrate menstruation-related content (menstrual health, menstrual hygiene, etc.) and related competencies into their curricula. We reviewed the course directories of the top 20 US schools of public health as ranked in 2018. Courses were selected based on inclusion of menstruation and adolescent health-related search terms. Syllabi were subsequently obtained and analyzed for inclusion of specific menstruation-related terms. Syllabi including these terms were further analyzed to determine the level of inclusion of menstruation-related topics in relation to public health competencies, and the area of specialization. Of an estimated 5,000 courses assessed, 28 included menstruation-related topics. Most frequently, this inclusion was minimal (e.g., a single reading or assignment), and was limited in scope. Content was typically found within global health, environmental health, and maternal and child health. Given growing attention to menstruation domestically and globally, and the limited current inclusion of this issue in US schools of public health curricula, graduates may not be receiving adequate training on a critically important topic of relevance within population health. Schools should consider reviewing their curricula to assess whether there are opportunities to integrate menstruation-related content in relation to the relevant public health competencies.
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http://dx.doi.org/10.3389/fpubh.2020.00442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491256PMC
May 2021

Neglect of menarche and menstruation in the USA.

Lancet 2019 06 6;393(10188):2302. Epub 2019 Jun 6.

Liverpool School of Tropical Medicine, Liverpool, UK.

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http://dx.doi.org/10.1016/S0140-6736(19)30300-9DOI Listing
June 2019
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