Reviewer’ s report
Title: ‘Flower of the body’: Menstrual experiences and needs of young adolescent women with
cerebral palsy in Bangladesh, and their mothers providing menstrual support.
Version: 0Date: 19 Mar 2020
Reviewer: Mahon Therese
Reviewer's report:
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This paper addresses a critical gap in menstrual health research in exploring menstrual related
experiences of adolescents with disabilities and their carers. The material-discursive approach toanalysis applying feminist disability theory is relevant and provides new insights to informempowering approaches to menstrual health interventions.
The findings, conclusions and recommendations may be strengthened by drawing on other
evidence in relation to adolescent girls experiences of menstruation in Bangladesh and othercountries, and more recent research on menstrual experiences of adolescents with physical andintellectual impairments and pilot interventions to support them.
In particular, a number of studies (e.g. Morrison et al 2018 https://doi.org/10.26522/ssj.v12i2.1623
from Nepal) highlight that adolescent girls describe experiencing menarche as a social marker that
signals increased restriction on their behaviour and independence due to concerns about their risk
of becoming sexually active, being sexually assaulted or seen as ready for marriage. The authorshighlight that adolescence is a time when 'other young women are establishing their autonomy' yetthe paper does not cite evidence to show if this is actually the case for other adolescent girls inBangladesh.
Also, the recent work by Wilbur et al 2019 (Feasibility Study of a Menstrual Hygiene
Management Intervention for People with Intellectual Impairments and Their Carers in Nepal -https://doi.org/10.1080/13691058.2019.1580768) provides evidence of potentially appropriateinterventions for adolescent girls with intellectual impairments and their carers. Particularly thisstudy highlights communications tools that may be appropriate to include in the conclusions.Whilst the assertion that 'young adolescent women with CP should be included in formalmenstrual education programs' is supported by the evidence cited in this paper, other evidencesuch as that of Wilbur highlights that communication tools and approaches need to be accessibleand adapted for those with intellectual impairments and also need to address the specific menstrualrelated needs of those with intellectual or physical impairments and the role of carers. Thereforeformal menstrual education programs need to be inclusive and delivered through mechanisms thatwould reach adolescents with disabilities and their carers.
Finally, whilst the importance of accessible and inclusive, menstrual health supportive WASH
infrastructure is an essential component of menstrual health and hygiene interventions (as well asbeing a human right), the evidence cited to support the link of lack of access to negative healthoutcomes (such as urinary tract infections, scabies in the vaginal area and abnormal abdominalpain) is not strong, as the cited paper itself is referring to a number of other studies to make thisclaim that may not have sufficiently robust methodology to assess causality of menstrual practiceswith such clinical outcomes. It is important to note that there is a need for stronger evidence in thisarea. One robust paper that is based on direct research (i.e. not citing others) is Torondel et al 2018(Association between unhygienic menstrual management practices and prevalence of lower
reproductive tract infections: a hospital-based cross-sectional study in Odisha, India).
Are the methods appropriate and well described?
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YesDoes the work include the necessary controls?
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Unable to assessAre the conclusions drawn adequately supported by the data shown?
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additional statistical review?
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Not relevant to this manuscriptQuality of written English
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AcceptableDeclaration of competing interests
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