Periods, Poverty and School

Yesterday, the BBC published an article regarding girls in the UK missing school as they are unable to afford sanitary pads or tampons. Whilst shocking, it is hardly surprising. Homeless charities and food banks have been appealing for years for people to donate sanitary items to them and recently this need was highlighted in a scene in the film “I, Daniel Blake” where the young mum shoplifts sanitary towels and deodorant whilst buying some food shopping. This isn’t quite as in depth, and contains more personal/anecdotal information than my last couple of posts but this has struck a serious cord with me and the result is this blog post.

I’ve only done a quick search but cannot find any research which points at the economic and social cost of missing school (and/ or work) due to not being able to afford sanitary towels (if anyone can find anything UK based then please to let me know). However, a report from the USA in 2014 found that improving attendance is an essential strategy for reducing achievement gaps and that those missing 3 or more days of school in the month prior to a test scored  more than a full grade level lower than their counterparts on the National Assessment of Educational Progress achievement scale. Given the average female has a period every 28 days, lasting between 3 and 7 days, it’s easy to see how missing school due to not being able to afford protection could be extremely detrimental to education; further exacerbating existing inequalities due to poverty.

Now some of you may think that this isn’t a big deal and folk should just get on with it without protection – “just shove some loo roll in your pants”, “wear black trousers” or “just buy a moon cup then you don’t need to buy stuff each month” are some of the things I’ve seen and heard in relation to this.

(WARNING: what comes next may be considered too much information for some but I think it’s important that we understand the reality.)

  • Shoving loo roll in your knickers is generally the short term solution when you’ve been caught by surprise by a period; when you’re out and don’t have anything in your handbag. It feels gross, it doesn’t work very well (it rolls up or to one side and it doesn’t stop you from leaking for very long) and it just isn’t a long term solution.
  • Black trousers doesn’t stop you bleeding through onto seats or it dribbling down your leg. For anyone to think it’s reasonable for a young woman, or any woman, to have to deal with that if it’s not her choice (some folk do like free bleeding)is baffling to me and I’m not sure how many ways I can say you’re wrong. As a 21 year old I was absolutely mortified when I had bled onto a seat (told you TMI, you were warned!) and I can’t imagine how 13 year old I would’ve reacted. Particularly if it had been at school surrounded by my peers – 25 year old me is getting palpitations considering it.
  • Thirdly, the moon cup. I entirely agree that long term it’s cheaper than buying sanitary towels/tampons and arguably better for the environment too but by suggesting this you fail to understand poverty. These things cost around £15 and upwards from what I can find and if you cannot afford the £2.00+ for a pack of sanitary pads (and one pack may or may not last you the duration of your period) then £15 is out of the question.  This doesn’t even consider whether a person feels comfortable with the insertion etc which is a personal choice and differs from person to person.

I saw this article and it saddened me but I wasn’t surprised.  I was saddened because I know how I’ve felt when I’ve been caught without anything in my house or in my bag. I can’t imagine how these girls must feel knowing that they don’t just have to make it to shops or to their house before they’ll feel comfortable again. That it’s going to be days before they’re comfortable and they’re going to have to catch up on work when they do go back. I think this BBC article has raised that there is a fairly urgent need for research into the cost (economic, personal and social) of this on people and in the meantime, if you’re in a position to do so, why not see if your local school/youth club/food bank would take a donation? We hand out free condoms but it’s rare to be able to access sanitary products without cost.  That we are in this position makes me sad, it also makes me incredibly angry.  Young girls are losing out on their education, not because of the associated pain or symptoms of this natural process, but simply as they cannot afford to control it in a way which makes them feel comfortable, that’s incredibly unjust and further perpetuates the inequalities of living in poverty.

MSc Project – the Pros and the Cons

I completed my research project on food insecurity and long term conditions  between January 2016 and July 2016. The way it worked for my MSc involved being given a list of project outlines (you could also propose your own) by different supervisors to pick from. I met with a couple of different supervisors about different projects on the list as there were a few which appealed to me and I wanted to find out more about. I ended up selecting a qualitative study which required primary data collection.

I went with the project I did as it was the one that appealed to me most and it seated within my background and interests (social inequalities/health inequalities).  I’d been really intrigued by some of the lectures I’d had in my qualitative reasearch module as so was keen to try this style of research.Overall I really enjoyed my project.  Yes there were some “I’m hiding under this desk and not coming out moments” (ask poor Heidi who had to sit behind me – she is doing a PhD looking at participant recruitment to clincal trials which you can find information about here) but these were mostly due to paperwork approvals taking longer than expected and me watching the time I had to complete my project tick past. On the whole I found it to be enjoyable, useful and informative.

In hindsight picking a primary data collection study within the time frame was ambitious and perhaps added more stress but would I do it again? Absolutely yes. Here are the Pros and Cons from my point of view:

Pros
– Having to learn about how to apply for ethical approvals and research passports and such like was a massive learning curve but it stands me in good stead for knowing how to navigate these systems in future and the timescales I can expect

-Not having a budget for transcription meant I learnt how to do transcribing. My typing skills improved quite dramatically and I probably still have much of it memorised (great way to learn your data), I found this made analysis much easier

-Doing something new really made it feel like the research was “mine”. I was really invested in it and really cared (Still do!) about the research and progressing the evidence within the area of food insecurity

-I went to a few different training sessions such as study documentation and applying for ethics which enabled me to keep my research folder up to scratch and again has given me the skills for future projects

Cons
– Requiring various approvals left me very pushed for time. I’d advise anyone with this type of tight time frame to get ahead of the game. My protocol was ready by the end of January but really the beginning of January would have been much better.

-TRANSCRIPTION IS THE DEVIL. It takes so long and I found it massively tedious. It also takes about 3x longer than you expect it to and words start to look funny after you’ve typed them out so many times. I understood quite quickly “the look” people gave me when I said I was doing transcription myself.

-Trying to recruit was fairly painful. My focus was on health professionals who are notoriously hard to recruit due to time constraints and in turn my recruitment window was shortened by the aforementioned approvals.

There are probably a lot more pros and cons, I’ll add to this list as they come back to me. Have you completed a project and have any to add? Does anyone have any to add on a secondary data project? I’d love to hear them!

MSc Project – Food Insecurity and Long Term Conditions

Between September 2015 and August 2016 I completed my MSc in Public Health Research at the University of Aberdeen (now the Master of Public Health).

The first few months involved classes, course work and exams – I learnt a lot and it has provided me with a really solid grounding for a career in research – but where the fun really began was in the 6 month project phase.

I chose a primary data study (where the researcher collects the data for their study rather than use existing data) which looked at health professionals’ experiences of and perspectives on food insecurity and long term conditions. I was supervised by Dr Flora Douglas and Professor Vikki Entwistle. I’ll do another blog post about the positives/negatives, from my point of view, about my choice but for now I’ll talk about food insecurity and our findings.

For those of you with less time/shorter attention spans/hatred of rambling. Or if you want to read some quotes gathered in the study please feel free to read my study summary available here: health-professionals-and-food-insecurity-summary 


What is food insecurity? 
You might have heard of food poverty rather than food insecurity. They’re quite similar but basically food insecurity focuses on the range of experiences that people can have rather than focusing exclusively on the manifestation of hunger.

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A commonly used UK definition of food insecurity was coined by Elizabeth Dowler and colleagues in 2001 and is the one which we used in this study:

“The inability to acquire or consume an adequate quality or sufficient quantity of food in socially acceptable ways, or the uncertainty that one will be able to do so”
(Dowler,2001)

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We don’t currently measure food insecurity in the UK so at the moment food banks are often used as a proxy. This isn’t ideal as not everyone who is food insecure will access a food bank; based on a Canadian study only around a 5th of all those who are food insecure access a food bank. However it’s enough to indicate that food insecurity has been increasing sharply in the last few years.

So now you know a bit about the background on food insecurity I’ll briefly discuss long term conditions.

What are long term conditions?
In this study we used the Scottish Government’s definition of a long term condition:

 “a condition that lasts a year or longer, impacts on a person’s life, and may require ongoing care and support.”

In Scotland alone over 2 million people live with at least one long term condition. International evidence (again I’ll mention that we don’t routinely collect data on food insecurity so we’re reliant on international evidence to inform us) suggests that households living with a long term condition are more vulnerable to experiencing food insecurity than those without (Tarasuk et al, 2013; Seligman et al, 2010). In addition to this  children from food insecure households are more likely to go on to develop chronic mental health and respiratory diseases such as depression and asthma (Kirkpatrick et al, 2010; McIntyre et al, 2013). Those who do experience food insecurity and have a long term condition such as diabetes or heart disease have been found to be less able to manage any such condition.(Department of Health, 2012; Gucciardi et al 2014; Seligman et al, 2014; Vorozis & Tarasuk, 2013) This lack of ability to manage long term conditions as a result of being food insecure, independent of other social determinants of health (ie. even when you take into account other factors like employment status), has been found to lead to increased health care utilisation and costs in a universal health care system in Canada. (Tarasuk et al, 2015).

So back to the UK… we can infer that food insecurity is increasing from the food back statistics, we can also see that those with long term conditions might have more difficulty managing their conditions if they are experiencing food insecurity as well as be more likely to experience food insecurity – where do the health professionals come in?

Well, firstly health professionals are likely to engage with those living with long term conditions with around 80% of the GP consultations occurring annually in Scotland being related to long term conditions(Audit Scotland, 2007). However, it is not only GPs who work with individuals with long term conditions. The range of services provided by the NHS means a number of health professionals are likely have contact with individuals with long term conditions for example, clinicians, nurses and Allied Health Professionals.

Secondly, the limited evidence there is available suggests that health and social care professionals increasingly act, or are expected to act, as informal referring agents to food banks in Scotland and elsewhere in the UK (Douglas et a, 2015b; Sosenko et al 2013).

Given that Health Professionals are working with people who have long term conditions AND they are potentially being asked to make referrals to food banks we wanted to explore: (a) what they understood about household food insecurity in general terms, (the extent to which they knew about it, or understood about it to be a problem in Scotland); and (b) their experiences of supporting people who were affected by one or more long term conditions and (possibly) food insecure.

What did we find out?

We spoke with 20 primary and secondary care health professionals in a combination of interviews and discussion groups between April and July 2016. We found that:

  • Most were aware that some of their patients were, or could be affected by food insecurity, but they lacked confidence that they could always recognise it in particular patients and were unsure how to raise the issue to find out.
  • Some knew some patients who definitely had difficulty managing their health condition(s) due to food insecurity and considered more likely to have poorer health outcomes as a result. The particular implications of food insecurity could depend on the conditions. For example, health professionals working with people with diabetes were concerned about diet quality whilst those supporting patients with respiratory conditions such as COPD were more concerned with dietary quantity.
  • All thought they had a role to play in relation to food insecurity. Typically this involved needing to be aware of food insecurity as a potential problem and signposting people to potential sources of help.
  • Health professionals seemed to have varying degrees of uncertainty about what they could and should be doing in relation to food insecure patients given their clinical roles, priorities, and time constraints.
  • Some believed it was necessary to modify standard dietary advice to make it realistic for people they believed to be food insecure. However, this created tension and uncertainty about deviating from evidence based clinical guidelines for condition management.

From these findings we concluded that our study provided a preliminary insight into questions about the impact of food insecurity on long term condition management in Scotland. Without denying the need to address the root causes of food insecurity, the study suggests we need to get a better and broader (national) picture of how it affects and is addressed in clinical health care practice. Work is also needed to identify how best to support health professionals work effectively and appropriately with people whose ability to manage their long term conditions is impaired by food insecurity. Finally, we need generate a much better picture and understanding of the impact of food poverty on chronic condition management from the perspective of people who are directly affected by both chronic and acute food poverty health in Scotland.

So that’s  quick run down of some of the background to, and the findings of, my MSc project.If you have any questions/comments please feel free to direct them to me here or on twitter

References

Audit Scotland (2007) Managing Long Term Conditions. Available from: http://www.audit-scotland.gov.uk/docs/health/2007/nr_070816_managing_long_term.pdf

Department of Health (2012) Chronic disease management. A compendium of information Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216528/dh_134486.pdf

Dowler E, Turner S, with Dobson B. (2001) Poverty bites: food, health and poor families. London: Child Poverty Action Group.

Douglas F, Sapko J, Kiezebrink K and Kyle J (2015a) Resourcefulness, Desperation, Shame, Gratitude and Powerlessness: Common Themes Emerging from A Study of Foodbank Use in Northeast Scotland. Public Health 2(3): 297-317

Douglas F, Ejebu O-Z, Garcia A, MacKenzie F, Whybrow S, McKenzie L, Ludbrook A and Dowler E. The Nature and Extent of Food Poverty (2015b) Available from: http://www.healthscotland.com/uploads/documents/25717-The%20nature%20and%20extent%20of%20food%20poverty%20insecurity%20in%20Scotland.pdf

FAO  (2013) Food and Agriculture Organization of the United Nations The Food Insecurity Experience Scale. Available from: http://www.fao.org/3/a-as583e.pdf

Gucciardi, E., Vahabi, M., Cockwell, D., Norris, N., Del Monte, JP. (2014),Farnum, C. The Intersection Between Food Insecurity and Diabetes: A Review. Curr Nutr Rep 3: 324.

Kirkpatrick SI, McIntyre L, Potestio M. Child hunger and longterm adverse consequences for health. Arch Pediatr Adolesc Med 2010;164:754-62. 8.

Loopstra R and Tarasuk V (2015) Food Bank Usage Is a Poor Indicator of Food Insecurity: Insights from Canada. Social Policy and Society 2015 Jul:443-455

McIntyre L, Williams J, Lavorato D, et al. (2013) Depression and suicide ideation in late adolescence and early adulthood are an outcome of child hunger. J Affect Disord 2013;150:123-9

Seligman HK, Laraia BA, Kushel MB (2010) Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr 2010;140:304-310.

Seligman HK, Bolger AF, Guzman D, Lopez A, Bibbins-Domingo K. (2014)  Exhaustion of food budgets at month’s end and hospital admissions for hypoglycemia. Health Affairs. 2014 Jan 1;33(1):116–123.

Tarasuk, V., Mitchell, A., McLaren L., and McIntyre L (2013) Chronic physical and mental health conditions among adults may increase vulnerability to household food insecurity. J Nutr. 2013 Nov;143(11):1785-93

Tarasuk V, Cheng J, deOliveira C, Dachner N, Gundersen C, Kurdyak P (2015) Association between household food insecurity and annual health care costs CMAJ 187/14/E429

Vorozis NT & Tarasuk VS (2013) Household food insufficiency is associated with poorer health. J Nutr. 2013 Jan;133(1):120-126

(PS. referencing this just brought back horrible flashbacks to desperate 5am referencing the day of hand in after dreaming about ones I’d missed…You better appreciate them!)