|Year : 2019 | Volume
| Issue : 2 | Page : 141-146
Assessment of menstrual hygiene among adolescent girls of East Delhi: A community-based cross-sectional research from an urban resettlement colony
Anita Shankar Acharya1, Nidhi Tiwari2, Sanjeev Kumar Rasania1, Jyoti Khandekar1, Damodar Bachani3
1 Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
2 Statistics Division, Ministry of Health and Family Welfare, Delhi, India
3 John Snow India Pvt Ltd, New Delhi, India
|Date of Submission||09-Jul-2019|
|Date of Decision||17-Jul-2019|
|Date of Acceptance||03-Oct-2019|
|Date of Web Publication||19-Dec-2019|
Anita Shankar Acharya
Department of Community Medicine, Lady Hardinge Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
Introduction: Even though menstruation is a normal physiological process, menstrual hygiene is a most neglected issue with many myths and social stigmas being associated with it. Due to unhygienic menstrual practices, young girls are vulnerable to reproductive tract infections and pelvic inflammatory diseases and other complications. Therefore, the objective of this study was to assess the knowledge, attitude, and practices of menstrual hygiene among adolescent girls.
Material and Methods: This is a descriptive cross-sectional study conducted in an urban resettlement colony of Kalyanpuri, East Delhi. One hundred and five adolescent girls participated in the study. The mean age of the participants was 14.18 ± 2.13 years. Predesigned and pretested semi-structured questionnaire was used. Institutional Ethical clearance was obtained.
Results: In this study, out of 105 girls, only 35.2% girls had knowledge about menstruation before they experienced menarche. Only 56.2% girls were aware that menstruation is a normal physiological process. Overall knowledge level about menstrual hygiene was unsatisfactory. Only 31.4% of girls were using sanitary pads during menstruation, 59.25% of the respondents had good practices. About 12.4% girls had positive attitude toward menstrual hygiene.
Conclusion: Although practices on menstrual hygiene management among adolescents were fairly satisfactory, knowledge and attitude still need to improve. Findings indicate the need of behavior change communication campaigns along with frequent reinforcement of school health education programs.
Keywords: Adolescents, Delhi, menstrual hygiene
|How to cite this article:|
Acharya AS, Tiwari N, Rasania SK, Khandekar J, Bachani D. Assessment of menstrual hygiene among adolescent girls of East Delhi: A community-based cross-sectional research from an urban resettlement colony. Indian J Community Fam Med 2019;5:141-6
|How to cite this URL:|
Acharya AS, Tiwari N, Rasania SK, Khandekar J, Bachani D. Assessment of menstrual hygiene among adolescent girls of East Delhi: A community-based cross-sectional research from an urban resettlement colony. Indian J Community Fam Med [serial online] 2019 [cited 2021 Oct 25];5:141-6. Available from: https://www.ijcfm.org/text.asp?2019/5/2/141/273528
| Introduction|| |
Adolescents structure a sizeable extent of the populace and an imperative asset of any nation. The World Health Organization (WHO) defines “Adolescents” as individuals in the 10–19 years age group. The principle physical changes amid this period incorporate the preadult's development spurt, gonadal development, development of sexual organs and attributes, and other changes in the body. Menarche is the most critical occasion in the life of a preadult young lady. It is the first menstrual period mostly happening between the ages of 12–15 years and is a vital achievement of pubescence generally for women. Menarche marks the start of a huge number of physical, physiological, and mental changes in the lives of the immature young women. Despite the fact that, the menarche is nevertheless one milestone of the development process, it is frequently, socially characterized as the marker of young lady's development and availability for marriage and sexual movement.
Menstrual cycle is a typical natural process and a key indication of regenerative (reproductive) wellbeing, yet in numerous societies it is treated as something negative, dishonorable, or filthy. The continued silence around menstruation combined with restricted access to information at home and in schools results in millions of women and girls having almost no learning about what's going on to their bodies when they bleed and how to manage it. Women's capability of managing their menstruation hygienically are influenced by many factors. The most common factors are restricted access to cheaper and hygienic materials and disposal choices, lack of personal bathroom, fresh water and soap for menstrual hygiene. Menstrual hygiene management is defined as “Women and adolescent girls using a clean menstrual management material to absorb or collect blood that can be changed in privacy as often as necessary for the duration of the menstruation period, using soap and water for washing the body as required, and having access to facilities to dispose of used menstrual management materials.” Menstrual cycle requires the accessibility of material assets to retain menstrual blood, encourage individual cleanliness and discard squander, preferably with satisfactory security.
Knowledge about menstrual hygiene directly from childhood may raise safe practices and may help in reducing the suffering of the millions of women. Menstrual hygiene and management will directly contribute to (SDG)-3 on “Ensuring healthy lives and promoting well-being for all ages,” SDG-4 on ensuring “Inclusive and equitable quality education and promote lifelong learning.”
With this foundation, the present study was attempted to assess the knowledge, attitude, and practices and source of information among the adolescent girls of a resettlement colony of East Delhi and also to identify the status of menstrual hygiene among them.
| Material and Methods|| |
The study was a descriptive cross-sectional study conducted in an urban resettlement colony, Kalyanpuri in East Delhi. This pilot study was planned under a project of ICMR-MOHFW, named “Health Accounting Scheme-Empowering people for health care through multisectoral coordination – An Operational Evaluation” which is being carried out in two blocks (intervention block 18 and 12 and control block 20). These blocks were selected by simple random sampling. These two intervention and control blocks comprised 1004 households with total population 5023. It includes 986 adolescents who were enrolled in the Health Accounts Scheme, 517 boys and 469 girls of age group 10–19. This study was done during the preintervention phase of the scheme. All participants were invited after taking proper consent from the head of households and assent from the adolescents. As it was a pilot study, a convenience sample of 109 adolescents was taken. They were invited at Urban Health Center of Kalyanpuri. The inclusion criteria were unmarried, nonpregnant, nonlactating adolescent girls of age 10–19 years who had attained menarche, and willing to participate in the study. Four adolescent girls were excluded as they had not attained menarche. Hence, a total of 105 girls who fulfilled the inclusion criteria formed the final study sample. They were given a questionnaire which was explained to them. After completing data collection, health education was given and sanitary napkins were distributed among participants. Institutional ethical clearance was taken for the Health Account Scheme study. Informed consent was also obtained from the head of the family and the adolescent girl before the study.
A predesigned, pretested, semi-structured questionnaire was used. Care was taken to ensure privacy and confidentiality. The pretested questionnaire was administered under supervision of the investigators to prevent the participants from sharing responses. The semi-structured questionnaire included topics relating to knowledge regarding menstruation, source of information regarding menstruation and hygiene practiced during menstruation. Following data collection, queries from the participants relating to menstrual and reproductive health were addressed by the investigators.
Data were entered in Microsoft Excel and analyzed after data cleaning in SPSS version 16 (IBM Inc., Chicago, Illinois, USA). Continuous data were expressed in terms of mean and standard deviation (SD), and 95% confidence interval was used. The categorical data were expressed as percentage/proportions and difference in proportions was compared using chi-square test. P < 0.05 was considered to be statistically significant.
| Results|| |
Total study participants were 105 with mean age 14.18 ± 2.13 years. Majority (86.6%) of them were Hindus, 5.7% Muslims, 3.8% Sikhs, and 3.8% Christians.
About one-fifth (20.9%) mothers of adolescent girls were illiterate, 27.6% just literate, 22.8% primary, 22.8% middle 14.2%, high school 9.5%, higher secondary 1.9%, and 2.8% girls were unaware about the details of mother's education. More than half 59% girls attained menarche in the age 12–14 years [Table 1], while 27.6% girls have attained in early age <12 years. In this study, age of menarche ranged from 10 to 16 years with the mean age of 12.2 (SD 1.26) years. Only one girl attained early menarche at the age of 10 years. The length of menstruation cycle was 28–32 days in 28.6%% girls [Table 1]. The duration of menstrual cycle ranged from 15 to 60 days. Three girls reported that their length of cycle was 15 days and 1.9% girls reported 60 days. This is not normal, and they were advised for further investigations. Blood flow for more than 5 days was reported by 14.3% girls.
|Table 1: Menstrual pattern in adolescent girls of Kalyvanpuri, East Delhi (n=105)|
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Regarding knowledge about menstruation, only 35.2% girls heard about menstruation before menarche. More than half (54.3%) girls were fearful during menarche; around one-fifth girls (21.9%) felt stressed [Table 2]. Most common reasons for fear were fear of staining cloth (70.2%) fear of following restrictions (7.0%), fear of pain (7.0%), fear of smell (7.0%), fear of getting infection (5.3%), etc.
|Table 2: Distribution of respondents according to their attitudes during menstruation (n=105)|
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Out of the total, only 4.8% girls had correct knowledge that menstrual blood comes from the uterus. Only 56.2% of girls had correct knowledge that menstruation is a physiological process, while only 33.3% knew about the cause of menstruation [Table 3].
|Table 3: Distribution of respondents according to their knowledge about menstruation (n=105)|
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Thirty-three (31.4%) girls used only sanitary pad as a type of absorbent [Table 4]. 49.5% girls used to change <2 absorbent/day. 73.6% of girls used to dispose their used absorbent in a dustbin) and 72.4% of girls did not miss school because of menstruation. Only half of the (51%) girls took regular bath and kept their genital area clean.
|Table 4: Distribution of respondents according to their practices during menstruation (n=105)|
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Of the various restrictions imposed during menstruation [Table 5], important ones were like not attending religious functions which was seen among majority, 82.9% of the study participants. Others restrictions were not allowed to enter kitchen or do cooking in 37.1% study participants. Mother was the source of information in more than half (54.3%) of the girls followed by school (50.5%), sister (23.8%), friends (12.5%), and TV/internet only in 8.6%, while there was no role of ASHA and Anganwadi worker in adolescent health education [Table 6].
|Table 5: Restrictions practiced during menstruation by study subjects (n=105)|
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|Table 6: Source of information about menstruation in the study subjects (n=105)|
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Mother's education and knowledge regarding menstruation before menarche was not significant (χ2 = 2.41, P > 0.05).
| Discussion|| |
Girls start to menstruate during puberty, typically between ages of 10–19 years. In the present study, maximum number (59%) of girls had attained menarche between 12 and 14 years. Pariya et al. conducted a cross-sectional study in West Bengal found similar results. Another study conducted in Aligarh found 69% of girls had attained menarche in similar age group.
According to the WHO standard, a menstrual cycle is defined as the interval from the 1st day of one bleeding episode up to and including the day before the next bleeding episode. The menstrual cycle is usually around 28 days but can vary from 21 to 35 days. In our study, 44.8% of girls had menstrual cycle in between 28 and 32 days. 54.3% had 2–5 days of menstrual flow, which was slightly lower than the findings of Mathiyalagen et al. in his study.
Menstruation is entrenched with stigma and taboos, menstruation is rarely discussed in families or schools, and menarche often arrives suddenly to girls with little or no knowledge of what is happening. In this study, only 35.2% girls were aware of menstruation before menarche. Similarly, about 24.7% of adolescent were aware before menarche in other studies. Menstruation is a natural process linked to the reproductive cycle of women and girls. It is not a sickness, but if not properly managed, it can result in health problems which can be compounded by social, cultural, and religious practices. Only 56.2% of girls were aware that menstruation is a normal physiological process. Each cycle involves the release of an egg (ovulation) which moves into the uterus through the fallopian tubes. Tissue and blood start to line the walls of the uterus for fertilization. If the egg is not fertilized, the lining of the uterus is shed through the vagina along with blood. The bleeding generally lasts between 2 and 7 days, with some lighter flow and some heavier flow days. The cycle is often irregular for the 1st year or two after menstruation begins. The menstrual cycle is regulated by a complex hormonal system with positive and negative feedback mechanisms and changes in sensitivity of peripheral tissues. In this study, 33.3% of girls were aware that menstrual cycle of female reproduction is regulated by hormones.
In this study, only 12.4% of girls had normal attitude toward menstruation. 54.3% of girls were fearful, 21.9% were stressed, and 38.1% had discomfort and even 27.6% of girls missed their school attendance during menstruation. Menstruation is normal, but attitude toward menstruation is not, this is because menstruation remains a taboo in many societies and various negative cultural attitudes and beliefs are still associated with it. In almost all cultures, menstruation is supposed to be kept secret and completely hidden from others. Young girls are taught from a younger age, and they have to manage it privately and discreetly. The lack of menstrual hygiene education and facilities greatly impacts the lives of women and girls. Menstruating women and girls are still often considered “dirty” or “impure” which may lead to forced seclusion, reduced mobility, and dietary restrictions. Furthermore, menstruating girls and women can be excluded from participation in daily social activities. Some cultural beliefs around menstruation reinforce gender inequities and have negative impact on the dignity, health, and education of women and girls.
Many women experience restrictions on cooking work activities, sexual intercourse, bathing, worshipping, and eating certain foods. These restrictions are due to the overall perception of the people regarding menstruation as they consider it dirty and polluting. In this study, similar restrictions were found to be practiced.
A report by Plan India indicates that only 12% of Indian women out of 355 million menstruating women use sanitary pads, >88% of women resort to stunning options such as unsanitized cloths or rugs, ashes, and husk sand (Sinha K). The biggest barrier to using a sanitary napkin is affordability. Around 70% of women in India cannot afford them. In our study, 33.14% of girls were using only disposable sanitary pads as absorbent material during menstruation, and 41% used both sanitary pads and cloth where as 27.6% of girls used only cloth. In the current study, the use of sanitary napkins was affected by the free availability of sanitary napkins in government school of Delhi.
Another issue that needs to be addressed is the disposal of materials used to soak menstrual blood. In our study, 76% of girls usually discarded the used material in community dustbins. Such a practice is detrimental to the environment and better techniques of disposing of the products used are needed. Incinerators can be installed in school and in community.
There are few limitations in our study. Our results were based on self-reporting by the study respondents. Hence, there could be underreporting by them. Another limitation could be generalizability of the results due to convenience sampling used in this study.
| Conclusion|| |
To conclude, the present study has underscored the necessity of adolescent girls to have adequate and precise knowledge about menstruation before menarche. They should also be taught about its relationship with their reproductive health. The overall knowledge about menstruation and menstrual hygiene of the adolescent girls of resettlement colony was found to unsatisfactory although the practices were noted to be fairly satisfactory. Most restrictions were laid down by the force of the family showing a poor attitude in the management of menstruation.
The girls should be made aware of the facts of menstruation and proper hygienic practices through mass media, school curriculum and school teacher, health personnel and above all, and well-informed parents. There should be monthly telecounseling sessions at all schools and Anganwadi centers, regular counseling session for mothers of adolescent girls should be arranged at school and Anganwadi centers because mother and school are the main source of information for adolescent girls. Health camps in schools need to be conducted to treat the girls suffering from reproductive tract morbidities.
This study was financially supported by the Indian Council of Medical Research, task force grant number no. 5/7/1/208-RHN, IRIS number 2008-0826, A to C. We are grateful for valuable guidance from late Prof., Dr. Deoki Nandan, Dr. Saumya Swaminathan, Dr. Balram Bhargava Dr. V. M. Katoch, Dr. R. S. Sharma, and Dr. Neeta Kumar.
Financial support and sponsorship
This study was financially supported by the Indian Council of Medical Research, task force grant number no. 5/7/1/208-RHN, IRIS number 2008-0826, A to C.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sommer, Marni, Cherenack E, Blake S, Sahin M, Burgers L. WASH in Schools Empowers Girls' Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference 2014. New York: United Nations Children's Fund and Columbia University; 2015. Available from: https://https://www.unicef.org/wash/schools/files/MHM_vConf_2014.pdf.
[Last accessed on 2019 Jul 21].
Tiwary AR. Role of menstrual hygiene in sustainable development goals. Int J Health Sci Res 2018;8:377-87.
Prajapati J, Patel R. Menstrual hygiene among adolescent girls: A cross sectional study in Urban community of Gandhinagar. J Med Res 2015;1:122-5.
Mathiyalagen P, Peramasamy B, Vasudevan K, Basu M, Cherian J, Sundar B. A descriptive cross-sectional study on menstrual hygiene and perceived reproductive morbidity among adolescent girls in a union territory, India. J Family Med Prim Care 2017;6:360-5.
] [Full text]
House S, Mahon T, Cavill S. Menstrual Hygiene Matters A Resource for Improving Menstrual Hygiene Around the World. Vol. 1. Water Aid; 2012. p. 34. Available from https://www.susana.org/_resources/documents/default/3-2210-21-1426498269.pdf. [Last accessed on 2019 May 16].
Kaur R, Kaur K, Kaur R. Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries. J Environ Public Health 2018;2018:9.
Sinha K. 70% can't Afford Sanitary Napkins: Female Hygiene in Dismal State; Survey. The Times India (New Delhi edition); 23 January, 2011. Available from: https://www.pressreader.com/
. [Last accessed on 2019 May 17].
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]