Awareness and practices about menstruation among adolescent girls: A cross-sectional study

Priyanka R Parmar; Shrikalp S Deshpande

doi:10.4103/cmrp.cmrp_92_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 12 | Issue : 6 | Page : 265-269

Awareness and practices about menstruation among adolescent girls: A cross-sectional study

Priyanka R Parmar¹, Shrikalp S Deshpande²
¹ Department of Pharmacology and Pharmacy Practice, Shri Sarvajanik Pharmacy College, Mehsana; Department of Pharmacy, Kadi Sarva Vishwavidhyalaya, Gandhinagar, Gujarat, India
² Department of Pharmacology and Pharmacy Practice, K. B. Institute of Pharmaceutical Education and Research, Gandhinagar, Gujarat, India

Date of Submission	13-Sep-2022
Date of Decision	14-Nov-2022
Date of Acceptance	17-Nov-2022
Date of Web Publication	29-Dec-2022

Correspondence Address:
Prof. Priyanka R Parmar
64, Anmol Sahara Township, Radhanpur Road, Mehsana - 384 002, Guajarat
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cmrp.cmrp_92_22

Abstract

Introduction: Menstruation is still a taboo in India and it is common for people across society to feel uncomfortable about the subject. It is a normal physiological process.
Objectives: The objective of this study was to assess awareness and hygiene practices amongst adolescent girls and to study the menarche age of respondents in comparison to their mother's age at menarche.
Materials and Methods: A cross-sectional, observational and prospective study was carried out in two private high schools of Mehsana city, Gujarat. Data were collected in a form of a structured questionnaire. Adolescent girls from 10 to 19 years were enrolled in the study. Ethical approval was obtained before initiating data collection. IBM SPSS version 2.0 was used for the analysis of the data.
Results: Out of a total of 454 screened, 398 adolescents were enrolled in the study with an 87.76% response rate. The mean menarche age of adolescent girls was 13.33 ± 1.18 years. Mothers 316 (78.4%) were the first source of information. Majority of study respondents (68.5%) rated menstruation as a part of the physiologic process caused by hormonal changes. About 18.6% knew the uterus as a source of bleeding. About 59.8% of adolescent girls were scared and discomforted at their menarche. Most (93.5%) were using sanitary pads as absorbent material. Half of the respondents were using water to clean their genitals. Nearly half of the respondents felt hesitation for discussing their menstrual-related problems with others. The mean menarche age of the participants was 13.33 ± 1.18 years with a minimum of 10 years and a maximum of 18 years, while their mother's age at menarche was 14.58 ± 1.27 years.
Conclusion: Menstrual hygiene education must be provided to adolescent girls. Need to solve taboos and misconception amongst adolescent girls of India.

Keywords: Adolescents, hygiene practice, knowledge, menstruation

How to cite this article:
Parmar PR, Deshpande SS. Awareness and practices about menstruation among adolescent girls: A cross-sectional study. Curr Med Res Pract 2022;12:265-9

How to cite this URL:
Parmar PR, Deshpande SS. Awareness and practices about menstruation among adolescent girls: A cross-sectional study. Curr Med Res Pract [serial online] 2022 [cited 2023 May 30];12:265-9. Available from: http://www.cmrpjournal.org/text.asp?2022/12/6/265/366176

Introduction

The menstrual cycle is characterised by variability of cycle length 26 to 35 days, menses of 5 days and a fertile phase.^[1] As per Menstrual Hygiene Management Guideline, menstruation is still a taboo in India and it is common for people across society to feel uncomfortable about the subject. Coupled with it, is the fact that there is a lack of information on the process of menstruation and the proper requirements for managing menstruation. The taboos in society prevent girls and women from articulating their needs and the problems of poor menstrual hygiene management have been largely ignored or misunderstood.

Materials and Methods

Study design and duration

A cross-sectional, observational and prospective study was carried out in two private high schools of Mehsana city, Gujarat. The study was performed between August 2021 and April 2022.

Sample size and study population

The sample size was calculated with a 95% confidence interval for P that was expected to be about 50% (0.5) with a margin of error(d) no more than 0.05, n = (1.96^2) (0.50) (10.50)/(0.5^2), n = 384. However, 398 adolescent girls participated in the study as per the inclusion criteria. Adolescent girls between the age group of 10 and 19 years who had attended their menarche were included in the study. Adolescent girls studying in standard 9^th12^th were randomly selected.

Instrument preparation and data collection

Data were collected in a form of a structured questionnaire. A case record form was prepared to collect information from the participants. In addition to demographic information, 19 questions were used to assess overall knowledge and 8 questions for hygiene practice. This questionnaire was constructed based on different searched literature.^{[2],[3],[4],[5],[6]} Each question had multiple options with a blend of positive and negative answers. Questionnaire was initially prepared in English, and then translated in the vernacular language Gujarati and back to English to find its consistency. After getting approval from an expert opinion, it was subjected to a pilot study in 65 randomly selected subjects whose data were not included in the final data. Minor modifications were done in questionnaire after the completion of the pilot study. Final data collection was initiated after the pilot study; subjects were randomly enrolled in the study as per inclusion criteria. Personal interview was the method used to retrieve information from each subject. Before initiating the interview, an informed consent form was signed by the subject having an age of more than 16 years. Consents from the parents were collected when the age of the subject was less than 16 years.

Ethical considerations

Ethical approval was obtained before data collection by submitting all relevant documents for the study to the local Independent Ethics Committee located at Mehsana city. This study was conducted in accordance with good clinical practice guidelines.

Data analysis

After data collection, IBM SPSS version 2.0 (IBM SPSS Software, Ahmedabad, Gujarat, India) was used for the analysis of the data. As per the objectives of the study, descriptive analysis was conducted. Results were described in tables and graphs.

Results

Out of total of 454 school girls screened, 398 adolescent girls were enrolled in the study with an 87.76% response rate. The mean age was 15.83 ± 1.124 years with a minimum of 13 years and a maximum of 19 years. Majority of the respondents had an age of 16 years (145, 36%), followed by 17 years (105, 26.38%) and 15 years (72, 17.9%). The mean menarche age of the participants was 13.33 ± 1.18 years with a minimum of 10 years and a maximum of 18 years, while their mother's age at menarche was 14.58 ± 1.27 years [Table 1].

Table 1: Demographic characteristics of respondents

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Mothers (316, 78.4%) were the first source who told adolescents about menarche as compared to other family members, friends and teachers. Respondents were using social media (206, 51.11%) and books (120, 29.8%) as other sources of information. Most of the respondents agreed (329, 81.6%) that they had been properly trained before menarche. About half of the study participants (180, 44.7%) knew about physiological changes, religious beliefs and absorbent materials [Table 2]. Some respondents (89, 22.1%) were not having such information. Most of (324, 80%) the respondents attended school sessions conducted by the teacher about menstruation.

Table 2: Source of information of respondents

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Knowledge assessment of participants regarding menstruation was done. A large number of study respondents (276, 68.5%) rated menstruation as a part of physiologic process caused by hormonal changes (280, 69.47%), while (127, 31.90%) respondents had no idea about menstruation and its cause (123, 30.90%). The respondents rated the vagina (129, 32.1%), abdomen (3, 0.7%) and bladder (90, 22.3%) as menstrual blood discharged organs. Only few (75, 18.6%) suggested the uterus as a menstrual blood discharge organ, as shown in [Table 3].

Table 3: Knowledge assessment, belief and reaction of respondents

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Belief and habits of respondents are also represented in [Table 3]. Two hundred and thirty-two (57.6%) respondents suggested menstrual blood is unhygienic. Few (48, 11.9%) participants were not knowing about the use of absorbents. A large number (353, 87.6%) had a concern about eating nutritious food during the menstrual cycle. Nearly half of the respondents were avoiding the consumption of certain food during menstruation. Most of the respondents (233, 57.8%) rated the same intake of eating habits as usual.

Reactions of the respondents are elaborated in [Table 3]. Some (179, 44.97%) adolescent girls were normal and happy, while other (224, 56.28%) respondents were scared and emotionally disturbed. Nearly half (222, 55.1%) of the respondents were not hesitant to discuss their menstrual problems with others. Few respondents (142, 35.2%) were not consulting a doctor if they faced any problem related to menstruation.

Menstrual hygiene practice of respondents is mentioned in [Table 4]. Most girls 377 (93.5%) were using sanitary pads as absorbent material. Nearly half of the respondents 200 (49.6%) were using only water to clean their genitals, while 203 (51.4%) were using soap, antiseptic liquid and pH water. A large number of respondents 178 (44.16%) were visiting the medical store to buy sanitary items. More than half of the respondents 239 (59.3%) were changing the absorbent during school.

Table 4: Menstrual hygiene practices of respondents

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Nearly, 338 (84.9%) respondents agreed that one pad should ideally be used for 4 to 8 h as described in [Table 4].

[Table 4] represents the handling of absorbent material. Most of the respondents 381 (95.72%) were appropriately discarding used sanitary items in dustbins (338, 83.9%). Few respondents 118 (29.64%) were complained of developing rashes due to the use of sanitary items.

Discussion

The age of menarche in our study was observed 13.33 ± 1.18 years, which is in line with the 8 studies from India and Pakistan, the reported age of 12 to 15 years in these studies.^{[4],[5],[7],[8],[9],[10],[11],[12]} Premenarcheal awareness was found by asking about the source of information and type of information respondents had before their menarche. Recent study has similar results with different studies performed in different states of India.^[13] Mothers were the first source of information, followed by sisters, friends and teachers as proven by Choudhary and Gupta.^[4] Few studies suggested teachers as the least source of information.^[3] Same was revealed in meta-analysis done by Sharma et al. that amongst 74 studies.^[2] Social media was the other source of information for the respondents to retrieve information, followed by books and television. Recent study investigated nearly half of the respondents have an idea about physiological changes, religious changes and the use of absorbent at the beginning of the menarche.

Similar results were suggested by author Michael et al.^[5] Majority of the respondents were trained properly before their age of menarche and attended a school session to understand menarche delivered by the teacher, these findings were opposite to the study performed in Balochistan.^[5]

Knowledge assessment was found appropriate amongst our respondents. Few authors have concluded similar results.^{[10],[11],[14]} Half of the adolescent girls from slum areas of Mumbai had low knowledge about menarche compared to respondents from other areas of Mumbai.^[7],[15] Around 70% of respondents knew it is a part of the physiological process due to hormonal changes. A study from Nagpur has indicated that the majority of adolescent girls were unaware about the cause and reason for menstruation.^[12] Nearly, 25% of the respondents were unaware about menstruation as a physiological process. Some respondents rated menstruation as a type of female disease and curse of God. About 27.1% of the participants rated menstruation as a curse of God.^[5] About 18.6% were correct for the source of bleeding, remaining 81.4% of respondents answered bladder, vagina and abdomen as discharged organs. Aarohi et al. concluded only 24% of the girls knew the uterus as a source of bleeding.^[11] Shah et al. reported that knowledge regarding pubertal changes, menstrual blood source, route of menstrual blood and urine was found to be low in their population.^[16] Nearly, 80% of respondents knew how to use absorbent material during menstruation.

Around 60% of respondents were scared and felt discomfort at their first menarche in the line of similar study performed in Rajasthan where girls reacted abnormally due to menarche.^[4] Majority of the respondents were convinced to eat nutritious food without avoiding specific food during menstruation. Few respondents were avoiding some specific food items such as jaggery, brinjal, papaya, and junk food which is spicy, hot and oily. Very less respondents rated less eating habits as compared to routine eating habits. Most of the respondents believed menstrual blood is unhygienic. About 21.6% of adolescent girls from Gandhinagar rated menstruation as blood toxins.^[9] Respondents had sufficient knowledge about the ideal use of sanitary pads. About half of the respondents felt hesitation for discussing their menstrual-related problems with others. About 35.2% of respondents were not consulting a doctor for their problems.

Almost all the respondents were using commercially available sanitary pads as an absorbent material. It was common for different studies conducted.^[17] Respondents from Bhavnagar used old plain cloth as a menstrual absorbent.^[10] Kansal et al. revealed only 30% of total adolescent girls used sanitary pads.^[18] A study from Ethiopia has reported that 68% of the respondents had poor knowledge and amongst them, 60% had poor menstrual hygienic practices.^[19] Half of the respondents were using only water to clean their genitals which is similar with the study of Aarohi, et al.^[11] Subhas, 1 et al. concluded from their study that only 33.85% of participants practiced proper cleaning of genitals.^[12] Majority of the adolescent bought sanitary pads from medical and general stores. Almost all respondents practiced safe disposal of used absorbent material and only 1.4% did inappropriate disposal in toilets or drainage. About 12.9% were burying the used absorbent item. Twenty-three percentage of the girls threw the absorbent in open spaces and girls were avoiding changing of absorbent in school.^[3] In the current study, 60% of respondents changed absorbent materials in schools, which indicates that toilets and water facilities are available at schools, which is higher than previously reported by other researchers. It was found that out of the total, approximately 7.2% of the practices about changing absorbent materials per day were incorrect. Similar study revealed the frequency of changing sanitary pads was 2-3 times by most of participants.^[20] Twenty-five percentage of the respondents had rashes because of absorbent.

Rastogi et al. studied different approaches to overcome the gap of knowledge about menstrual hygiene amongst adolescent girls with different interventions of variety of methods such as discussion, lecture, demonstration using audiovideo materials and provision of resources such as menstrual cups, sanitary pads and soap to spread awareness on menstrual hygiene.^[21] Awareness was provided amongst adolescent girls about the anatomy and physiology of the menstrual cycle, consumption of nutritional diet, use and handling of sanitary items and relevant information on this sensitive subject. This study helps adolescent girls of society for the improvisation of menstrual hygiene practices. In the future, more studies need to be done at different regions for the betterment of the menstrual hygiene practice.

Conclusion

Menstrual hygiene education should be provided to adolescent girls. Need to solve taboos and misconceptions amongst adolescent girls of India.

Acknowledgements

The authors want to acknowledge the school authorities for the smooth conduction of this clinical study.

Financial support and sponsorship

This research was not funded by any authority or organisation.

Conflicts of interest

There are no conflicts of interest.

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