Abstract: Exploring the Intersection of Economic Empowerment, Cultural Practices, and Menstrual Hygiene Management's Influence on Self-Esteem Among Adolescent Girls in Southwestern Uganda (Society for Social Work and Research 29th Annual Conference)

Schedule:

Sunday, January 19, 2025

Ravenna B, Level 3 (Sheraton Grand Seattle)

* noted as presenting author

Flavia Namuwonge, MBA, Doctoral Student, Washington University in St. Louis, MO

Vicent Ssentumbwe, MPH, Student, Washington University in St. Louis, St. Louis, MO

Samuel Kizito, MD, MS, Research fellow, Washington University in St. Louis, St Louis, MO

Phionah Namatovu, Research Coordinator, International Center for Child Health and Development (ICHAD), Uganda

Nhial Tutlam, PhD, Assistant Professor, Washington University in Saint Louis

Proscovia Nabunya, MSW, PhD, Assistant Professor, Washington University in Saint Louis, St. Louis, MO

Fred Ssewamala, PhD, Professor, Washington University in Saint Louis, Saint Louis, MO

Background

Sub-Saharan African (SSA) countries, including Uganda, reports a considerable number of adolescent girls who are disproportionally affected by inadequate menstrual hygiene management (MHM) facilities and supplies. The inadequate supplies coupled with the cultural and traditional practices in several SSA undermine the dignity and rights of adolescent girls and has implications for their education, health, and overall well-being including self-esteem. Using data from a National Institutes of Health-funded 3-arm Cluster Randomized Control Trial titled Suubi4Her (N=1260; 14–17-year-old school-going girls at recruitment), and applying the self-efficacy and asset theories, we address questions regarding economic empowerment and self-esteem among adolescent girls during menstruation. Specifically, we examine how cultural attitudes and knowledge of menstrual hygiene management might interact with economic empowerment to influence the self-esteem of menstruating girls in Southwestern Uganda

Methods

School-going adolescent girls from 47 public secondary schools in southwestern Uganda were assigned to three study arms: control receiving usual care comprising of sexual and reproductive health curriculum (n=16 schools, n= 408 students); and two active treatment arms: Economic Empowerment using incentivized youth development accounts (YDA) (n=16 schools, n=471 students), and YDA+ a family strengthening interventions that uses Multiple Family Group Meetings (MFG) to address adolescent girls and family health and wellbeing (n=15 schools, n=381 students). We used mixed effect models to assess the impact of economic empowerment on self-esteem, measured by the Rosenberg Self-Esteem Scale and the moderation effect of menstrual hygiene knowledge, measured by a nine-item scale and cultural attitudes, measured by school attendance during menstruation periods.

Results

At baseline there were no statistically significant difference across the study three arms. However, at 24 months following intervention delivery, we located statistically significant main effects for time (c²(2) = 102.07, p <0.001) and intervention-time interaction effects (c²(4) =12.99, p=0.011). Pairwise group comparisons at the different assessment time points, showed significantly higher self-esteem in the YDA+MFG group compared to the control at time point 3 (24-months follow-up) (b=1.282 (0.084, 2.480), p=0.36).

Conclusions

The findings of this study underscore the importance of economic empowerment, financial stability, and family support through Multiple Family Interventions in enhancing the well-being of adolescents and helping them deal with menstrual hygiene management.