Country of origin disparities in sub-optimal menstrual hygiene management and intersecting reproductive health concerns: a pilot study from the Dominican Republic

Madison Douglas^*Kelly DresselZoe KusinitzSupriya D. MehtaStephanie Crane

• Office of Global Health, Rush University Medical Center, Chicago, United States

Introduction Due to long-standing systemic xenophobia in the Dominican Republic (DR), women of Haitian descent are underrepresented in national health data. This study examined menstrual hygiene management (MHM) and other reproductive health concerns in a migrant-dense community to inform future health studies and potential interventions. Methods An anonymous cross-sectional survey was offered in a low-income community near Santo Domingo over two, one-week periods from October 2023 to April 2024. Eligible participants were at least 14 years old. Reproductive health-related factors were assessed among participants who had menstruated in the last 12 months. Multivariable adjusted modified Poisson regression was used to identify factors associated with sub-optimal MHM, defined by lack of water and/or soap, privacy, or safe menstrual products. Results Among 148 participants who menstruated in the past 12 months, over half (53.0%) reported that menstrual materials were unaffordable sometimes (43.5%) or always (9.5%), and more than one-third (38.1%) reported menses interfering with regular duties. Overall, 21.6% had sub-optimal MHM; although 94% of women reported using disposable pads to manage menses, 14.2% were also using cloth (n=19) or underwear/diapers (n=2). Other factors contributing to sub-optimal MHM were lack of privacy (4.1%) and lack of soap (8.7%). In analyses adjusted for age, educational attainment, employment status, and menstrual product affordability, Haitian-born women were more likely to have sub-optimal MHM (aPR=7.25; 95% CI 4.23 - 12.4). Compared to women with optimal MHM, women with sub-optimal MHM were more likely to report “Poor” general health (46.9% vs. 19.8%, p=0.004) and menses interfering with regular duties (56.3% vs. 32.8%, p=0.015), and were less likely to report reliable contraceptive use (43.3% vs. 68.5%, p=0.011) and prenatal care at last pregnancy (79.3% vs. 95.3%, p=0.005). Haitian-born women were also more likely to have intersecting sub-optimal MHM and contraceptive gap or lack of prior prenatal care (20.4% vs. 2.2%, p=0.001). Conclusions Sub-optimal MHM and its association with other reproductive health concerns was common in this migrant-dense community, notably appearing more frequently among Haitian-born women. Our preliminary findings suggest opportunities for future research and context-appropriate approaches addressing structural barriers to menstrual and reproductive health—particularly for migrant populations.