Menstrual inequity in Spain: a cross-sectional study

Abstract Background Menstrual inequity has an impact on (menstrual) health outcomes and emotional wellbeing. It is also a significant barrier to achieve social and gender equity. The aim of this study was to assess menstrual inequity and its associations with sociodemographic factors, among women and people who menstruate (PWM) aged 18-55 in Spain. Methods A cross-sectional online survey-based study was conducted in Spain in March-July 2021. Data were analysed through descriptive statistical analyses and multivariate logistic regression models. Results 22,823 women and PWM participated (Mean age=33.2, SD = 8.7). Over half had accessed healthcare services for menstruation (61.9%) and had partial/no menstrual education pre-menarche (58.4%). Lifetime menstrual poverty was 22.2-39.9%. Main risk factors for menstrual poverty were identifying as non-binary (aOR: 1.67, 95% CI, 1.32-2.11), being born in non-European or Latin American countries (aOR: 2.74, 95% CI, 1.77-4.24), and not having a permit to reside in Spain (aOR: 4.27, 95% CI, 1.94-9.38). In turn, menstrual poverty protective factors were having completed university education (aOR: 0.61, 95% CI, 0.44-0.84) and not experiencing financial hardship in the last 12 months (aOR: 0.06, 95% CI, 0.06-0.07). Besides, 75.2% of participants indicated having overused menstrual products because of not having access to adequate menstrual management facilities. Menstrual-related discrimination was reported by 44.0% of women and PWM. Menstrual discrimination risk was higher among non-binary menstruators (aOR: 1.88, 95% CI, 1.52-2.33). Menstrual-related work (20.3%) and educational (62.7%) absenteeism was reported. Conclusions Our study suggests that menstrual inequity in Spain is widespread, especially among those more socioeconomically deprived, vulnerable migrant populations and non-binary and trans menstruators. Findings from this study are being useful to inform future research and menstrual (health) policies. Key messages • Menstrual inequity especially impacts socioeconomically deprived, gender nonconforming menstruators and vulnerable migrant populations in Spain. • Menstrual inequity research is crucial to address social inequities of health and develop menstrual policies.


Background:
Menstrual inequity has an impact on (menstrual) health outcomes and emotional wellbeing. It is also a significant barrier to achieve social and gender equity. The aim of this study was to assess menstrual inequity and its associations with sociodemographic factors, among women and people who menstruate (PWM) aged 18-55 in Spain.

Conclusions:
Our study suggests that menstrual inequity in Spain is widespread, especially among those more socioeconomically deprived, vulnerable migrant populations and non-binary and trans menstruators. Findings from this study are being useful to inform future research and menstrual (health) policies. Key messages: Menstrual inequity especially impacts socioeconomically deprived, gender nonconforming menstruators and vulnerable migrant populations in Spain. Menstrual inequity research is crucial to address social inequities of health and develop menstrual policies.
Abstract citation ID: ckac129.308 Associations between area-and individual-level community belonging and self-rated health

Background:
Previous studies point to the importance of individuals' sense of community belonging to multiple measures of health and well-being. However, the extent to which collective sense of belonging within neighbourhoods might influence individual health has not been characterized. The objectives of this study are to describe variations in self-rated health by a novel arealevel measure of community belonging and determine the impact of including these measures in models of individuallevel community belonging and self-rated health.

Methods:
We conducted a cross-sectional study of respondents of the 2020 Canadian Community Health Survey (CCHS) living in census tracts. These data were merged with novel small area estimates of community belonging derived by Statistics Canada from the CCHS 2016-2019. Multinomial logistic regression models were used to analyse associations of individual-and area-level community belonging, and self-rated health. We adjusted for sex, age, recent immigrant status, visible minority status, province, marital status, presence of children in the household, smoking status, presence of chronic conditions, income, and employment status. All results were generated using survey weights and bootstraps representing a subpopulation of 21 million people.

Results:
A greater proportion of CCHS respondents living in neighbourhoods with the strongest collective sense of community belonging reported being in good, very good, or excellent health. Models indicate that living in a neighbourhood with low collective sense of community belonging is associated with higher odds of reporting being in poor or fair health (OR = 1.44, 95% CI 1.15-1.81) even after adjusting for other factors, including individual-level sense of community belonging, which also remained independently associated with self-rated health.

Conclusions:
Both area-and individual-level sense of community belonging are independently associated with self-rated health.

Key messages:
The collective sense of belonging within neighbourhoods may influence health outcomes.
Measures of area-level and individual-level community belonging may capture different aspects of social connections with respect to health.