Menstrual product preference and factors associated with use of freely-distributed reusable products among secondary students in Uganda: a longitudinal study

INTRODUCTION: Access to menstrual products is a key factor for improving menstrual health, but there is limited research on the facilitators and barriers to their uptake and use. We describe menstrual product use, and factors associated with use of freely-distributed reusable pads and menstrual cups among female students in Ugandan secondary schools. METHODS: We analysed one-year follow-up data nested within a cluster-randomised trial evaluating the effectiveness of a multi-component menstrual health intervention among female students in 60 schools. The intervention included provision of five reusable pads and an optional menstrual cup, with training. We used random-effects logistic regression to identify factors associated with reported use of each product type at last menstrual period (LMP) at endline. We conducted focus group discussions and in-depth interviews among students and caregivers to explore product preferences, using thematic analysis. RESULTS: We analysed data from 2622 post-menarche participants present at both baseline and endline (mean age 15.6 years). Of these, 1683 (64.2%) used more than one type of menstrual product at LMP and 2203 (84.0%) used disposable pads at LMP, at endline. Among 1221/1302 (93.8%) intervention arm participants who received menstrual pads, and 613 (47.1%) who received a menstrual cup, 845 (69.2%) and 156 (25.4%) respectively reported using these products at LMP at endline. Reusable pad use was associated with older age, lower socioeconomic status, being a day scholar, prior use of reusable pads, and having higher menstrual self-efficacy at baseline. Use of a menstrual cup was associated with older age and being of non-Muganda ethnicity. Qualitative findings showed that knowledge, perceptions, affordability, prior familiarity, ease of use, comfort, peer influence, social stigma, and access to private washing facilities played key roles in product preference among the students. CONCLUSION: In this setting, participants used more than one product during a single menstrual period and preferred disposable pads when provided with free reusable products, due to challenges including washing and drying, social stigma, and discomfort. Provision of menstrual products needs to address both uptake and sustained use by considering individual preferences, cultural acceptability, sustainability, comfort, and environmental factors. TRIAL REGISTRATION: ISRCTN 45461276; 16/09/2021.