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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 18  |  Issue : 1  |  Page : 20-25

Experiences of Menstruation with Factors Influencing Menstrual Hygiene Practices Among Adolescent Girls Attending Outpatient Department of Secondary Care Hospital Setting: A Cross-sectional Study


1 College of Nursing, AIIMS, Bhubaneswar, Odisha, India
2 Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India

Date of Submission01-Jan-2022
Date of Acceptance02-Feb-2022
Date of Web Publication8-May-2022

Correspondence Address:
Mansi Pal
Community Health Nursing, College of Nursing, AIIMS, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AMJM.AMJM_2_22

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  Abstract 

Background: Menstruation is a physiological process as it brings changes in a young woman’s life. In this process, menarche is the most important phase in menstruation. It is the onset of first menstruation in girls. In today’s time also, menstruation is confused by different perceptions, myths, and misconceptions, which later affect their menstrual hygiene practices. Materials and Methods: The mixed method approach is adopted for the study. A qualitative approach using an in-depth interview was adopted for exploring the experiences of adolescent girls, and a quantitative approach was used for assessing factors influencing menstrual hygiene practices. Results: Adolescent girls had various experiences regarding their menarche. Seventy-four percent of girls had average menstrual hygiene practices. Several influencing factors were found and after applying binary logistic analysis four risk factors were found, which are caste, problems faced by girls during menses, frequency of changing pads, and method of disposal. Conclusion: The present study shows that girls had various experiences at the time of their menarche. They are having average menstrual hygiene practices, and there are various factors found which influence menstrual hygiene practices. Though there are several modules to maintain menstrual hygiene, still many adolescent girls lack resources such as a supply of clean water, availability of toilets, and use of sanitary pads.

Keywords: Adolescents health, experience, menstrual hygiene, menstruation


How to cite this article:
Pal M, Devi S, Taywade M. Experiences of Menstruation with Factors Influencing Menstrual Hygiene Practices Among Adolescent Girls Attending Outpatient Department of Secondary Care Hospital Setting: A Cross-sectional Study. Amrita J Med 2022;18:20-5

How to cite this URL:
Pal M, Devi S, Taywade M. Experiences of Menstruation with Factors Influencing Menstrual Hygiene Practices Among Adolescent Girls Attending Outpatient Department of Secondary Care Hospital Setting: A Cross-sectional Study. Amrita J Med [serial online] 2022 [cited 2022 Aug 11];18:20-5. Available from: https://ajmonline.org.in/text.asp?2022/18/1/20/344945




  Introduction Top


According to the World Health Organization, adolescence is a very important phase of life to bring psychological and biological growth in children. About one-fifth of India’s population is adolescents, of which 12% (300 million) of the girls are menstruating every day.[1],[2]

Menstruation is a physiological process as it brings changes in a young woman’s life, in which menarche is the most important phase. It is the onset of first menstruation in girls. Many girls’ menarches start between the ages of 10 and 16 years, with a mean age between 12 and 13 years.[3],[4] Hence, some extra care is required at this crucial time. Menstruation has always been confused by different perceptions, myths, and misconceptions. In today’s time, there is still some extent of openness toward menstruation, but some differences in attitude, experiences, and practices persist.[5] Although it is a normal physiological phenomenon, this topic is not discussed openly. Even today menstruation is still a secret topic of mother and daughter in many families.[6] Additionally, menstrual practice is still clouded by many restrictions. The various restrictions hampering daily living activities, inadequate awareness, lack of availability of resources, and social and economic conditions are affecting all menstrual hygiene practices.[7] One of the challenges is the non-availability of proper infrastructures such as the availability of washrooms and toilets. There is a lack of support from the male teachers in schools, and menstrual shaming is done by peer groups.[8]

This article aims to understand experiences of menstruation and factors influencing menstrual hygiene practices of adolescent girls in the rural setting. The objectives of the study are (1) to explore the experience of adolescent girls during menstruation and (2) to determine the factors influencing menstrual hygiene practices among adolescent girls.


  Materials and Methods Top


Study design

A mixed method design was used.

Study setting

Odisha has a population of 42 million people. The setting of the present study was outpatient department (OPD) of a secondary care hospital, Mendhasala. It is one of the public healthcare centers in Khordha, Odisha. Every day at least 5–8 adolescent girls were attending OPD.

Study duration

The study duration was 4 months (November 2019–January 2020).

Sample size, study participants, and sampling methods

Two hundred adolescent girls for quantitative data and eight adolescent girls for qualitative data were considered. For quantitative data, the estimated sample size is as per the following equation: n = Z2P(1 - P)/d2, where precision is 5 percent, prevalence 50 percent, population size 400, and 95% confidence interval. Total 200 study were enrolled for the study. For qualitative data, sample size was based on data saturation. In the present study, one interview was only taken each day. After eight interviews were taken, researchers observed that data saturation has reached. According to data saturation, eight samples were taken. Non-probability (purposive sampling) was used to recruit the adolescent girls as participants for this study. Data were taken from girls who were attending the OPDs. They were included in the study if they are willing and have experienced at least three episodes of menstruation.

Data collection and preparation

Adolescent girls were enrolled, and informed consent and assent were obtained. After that a set of questions were asked to them about menstrual hygiene practices (checklist), factors influencing menstrual hygiene practice (semi-structured questionnaire), and to explore their experiences of menstruation (in-depth interview).

Menstrual hygiene practice checklist: Participants responded according to the practices they follow during their menstruation. It comprised 16 items. Each item needs to be answered and scored as always (2), sometimes (1), or never (0). Items 2, 4, and 5 were only applicable for cloth users. Reverse scoring was also done for question numbers 6, 7, and 15. The menstrual hygiene practices were categorized as good, average, or bad on the basis of scores. Total soring was separate for cloth users and sanitary pad users. For cloth users, score division was 0–9 (bad practice), 10–22 (average practice), and 23–32 (good practice) and scoring for sanitary pad users was 0–8 (bad practice), 9–18 (average practice), and 19–26 (good practice).

Factors influencing menstrual hygiene practices: It comprised four subheadings: (a) socio-demographic data, (b) knowledge about menstruation, (c) problems faced during menstruation, and (d) assessment of menstrual health practices.

Experience of menstruation: The tool was developed to explore the experiences of menstruation of adolescent girls who will meet the inclusion criteria. It comprised eight open-ended questions as follows: first menstrual experience, restriction, school experience, male behavior, family support, regular menstrual health, society-related questions, and the introduction of the session and thanks giving session. It was a validated tool with a reliability coefficient of 0.96.


  Results Top


Demographic characteristics of study participants

A total of 200 adolescent girls were enrolled in the study. The mean age of girls is 17.1 with a standard deviation of 2.24. The menarche age of girls is 13.2 with a standard deviation of 1.5 [Table 1].
Table 1: Demographic characteristics of study participants

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Experiences of menstruation of study participants

To explore the experiences of menstruation of adolescent girls, 5 themes and 13 subthemes emerged after the thematic analysis. The first theme is menstrual feeling, which includes subtheme experience of fear and anxiety and lack of awareness regarding menstruation. The second theme is restrictions which include subtheme isolation, limited activities, and body hygiene practices. The third theme is menstruation and males, which includes subthemes such as feeling shy to talk and a change in behavior with the male. The fourth theme is school experience during menstruation which includes subtheme fear of embarrassment, school absence, and secret topics between girls and teachers. The last theme is a societal burden which includes subtheme celebration, social burden, and misconceptions [Table 2].
Table 2: Experience of menstruation of study participants

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Menstrual hygiene practices among study participants

Average menstrual hygiene practice was followed by adolescent girls among both sanitary pad user and cloth user [Table 3].
Table 3: Menstrual hygiene practices among study participants

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Factors influencing menstrual hygiene practices among study participants

Factors influencing menstrual hygiene practices: The χ2 value between the menstrual practices and score of menstrual hygiene practices shows significant association with 15 factors [Table 4].
Table 4: Factors influencing menstrual hygiene practices among study partipants

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Relationship between menarche age and menstrual hygiene score

The r value showed that the relationship is a weak correlation (r= −0.023) between menarche age and menstrual hygiene practice and is not significant at the 0.05 level of significance (P = 0.744) [Table 5].
Table 5: Relationship between menarche age and menstrual hygiene score, n = 200

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Binary logistic analysis

It revealed that girls from tribal caste, girls who faced weakness at the time of menstruation, girls who changed pads less than two times a day, and girls who threw pads in open had more risk of having average menstrual hygiene practice [Table 6].
Table 6: Binary logistic analysis between menstrual hygiene practice and its influencing factors, n = 200

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  Discussion Top


The main objective of the study was to explore the experiences of menstruation and to assess factors influencing menstrual hygiene practices. The study was limited to adolescent girls who were attending the outpatient department of secondary care hospital in the rural setting. Despite the fact that adolescent girls have started experiencing menstruation, it was observed that girls had some experiences of menarche and followed some practices during their menstruation which was unhealthy. During the study, girls revealed about their menarche time and their practices followed during menstruation. All the girls were selected from a rural area. Most of the girls belonged to the Hindu religion and were from below poverty line.[9] This study mainly highlights the experiences of adolescent girls who faced a lot of restrictions during their menarche, which lead to their unhygienic practices.[10],[11] There were various kinds of restrictions during their menarche such as the first 7 days girls were isolated from others. They used to stay in one room for those days and were imposed to follow other various restrictions which include not coming out of the house, not looking at the faces of males, bathing with cow dung, cannot eat non-veg foods, restricted to drinking less water, etc. Among these restrictions, a lot were known but few were very surprising and were followed only in the name of traditions. These restrictions have somehow a negative memory on girls. They used to feel irritated, angry, lonely, cursed, and helpless.[12],[13] They feel this is tradition and it will go along with them, and they cannot deny it. Their mothers followed this then, and in future, their daughters will also follow. Apart from the experiences, this study also includes adolescent girls menstrual hygiene practices. Most of the adolescent girls had average hygiene practices and none of them had bad practices. Various factors were found which influenced their menstrual hygiene. Among these factors, there was an association found among menstrual hygiene practices of girls with menarche age, religion, and caste.[14],[15],[16] It was found that mothers were the main source of information. Also, in the present study, significant association was found among information received, source of information, and menstrual hygiene. In other studies, the majority of girls used clothes as absorbent.[7] Among them, the majority of girls changed the absorbent and cleaned genitalia less than four times a day. A similar study showed that girls change sanitary pads only twice a day.[15] In the present study, the majority of girls threw pads in the river. The reason was that they had to hide about their menstruation from males in the family to save them from embarrassment.

Strength and limitation of the study

The key strength of this study is its reliance on two methods, qualitative and quantitative. This study includes rural adolescent girls. The sample size was adequate. The limitation is the single center and purposive sampling used. Hence, generalization of the study cannot be done. Also, due to methodological limitations, triangulation is not possible.


  Conclusion Top


The present study shows that girls had various experiences at the time of their menarche. They are having average menstrual hygiene practices, and there are various factors that influence menstrual hygiene practices. Although there are several modules to maintain menstrual hygiene, still many or adolescent girls lack resources such as a supply of clean water, availability of toilets, and use of sanitary pads. In order to improve menstrual hygiene among adolescent girls for a long time, it should collaborate with various policies and guidelines.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sarkar I, Dobe M, Dasgupta A, Basu R, Shahbabu B. Determinants of menstrual hygiene among school going adolescent girls in a rural area of West Bengal. J Family Med Prim Care 2017;6:583-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Adolescence | Definition, Characteristics, & Stages | Britannica [Internet]. Available from: https://www.britannica.com/science/adolescence. [Last accessed 2021 Jun 13].  Back to cited text no. 2
    
3.
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;2018:1730964.  Back to cited text no. 3
    
4.
Hennegan J, Shannon AK, Rubli J, Schwab KJ, Melendez-Torres GJ. Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PLoS Med 2019;16:e1002803.  Back to cited text no. 4
    
5.
Karthiga V, Boratne AV, Datta SS, Joice S, Abraham SB, Purty AJ. Menstrual problems and pattern of consultation among adolescent school girls in Pondicherry.Indian J of Med Spec 2011;2.  Back to cited text no. 5
    
6.
Thakur H, Aronsson A, Bansode S, Stalsby Lundborg C, Dalvie S, Faxelid E. Knowledge, practices, and restrictions related to menstruation among young women from low socioeconomic community in Mumbai, India. Front Public Health 2014;2:72.  Back to cited text no. 6
    
7.
Mumtaz Z, Sivananthajothy P, Bhatti A, Sommer M. “How can we leave the traditions of our Baab Daada” socio-cultural structures and values driving menstrual hygiene management challenges in schools in Pakistan. J Adolesc 2019;76:152-61.  Back to cited text no. 7
    
8.
Caruso BA, Portela G, McManus S, Clasen T. Assessing women’s menstruation concerns and experiences in rural India: Development and validation of a menstrual insecurity measure. Int J Environ Res Public Health 2020;17:3468. doi: 10.3390/ijerph17103468. PMID: 32429238; PMCID: PMC7277189.  Back to cited text no. 8
    
9.
Torondel B, Sinha S, Mohanty JR, Swain T, Sahoo P, Panda B, et al. Association between unhygienic menstrual management practices and prevalence of lower reproductive tract infections: A hospital-based cross-sectional study in Odisha, India. BMC Infect Dis 2018;18:473.  Back to cited text no. 9
    
10.
Bhusal CK. Practice of menstrual hygiene and associated factors among adolescent school girls in Dang District, Nepal. Adv Prev Med 2020;2020:1292070.  Back to cited text no. 10
    
11.
Suhasini K, Chandra M. Factors influencing menstrual hygiene practice among late adolescent girls in an urban area of Belgaum. Ann Commun Health 2017;4:20-4.  Back to cited text no. 11
    
12.
Omidvar S, Begum K. Factors influencing hygienic practices during menses among girls from south India—A cross sectional study. Int J Collab Res Int Med Public Health 2010;12:411-23.  Back to cited text no. 12
    
13.
Mason L, Nyothach E, Alexander K, Odhiambo FO, Eleveld A, Vulule J, et al. “We keep it secret so no one should know”—A qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural Western Kenya. PLoS One 2013;8:e79132.  Back to cited text no. 13
    
14.
MacRae ER, Clasen T, Dasmohapatra M, Caruso BA. “It’s like a burden on the head”: Redefining adequate menstrual hygiene management throughout women’s varied life stages in Odisha, India. PLoS One 2019;14:e0220114.  Back to cited text no. 14
    
15.
Goel P, Kumar R, Meena GS, Garg S. Association of sociodemographic characteristics with KAP regarding menstrual hygiene among women in an urban area in Delhi. Trop J Obstet Gynaecol 2018;35:158-64.  Back to cited text no. 15
  [Full text]  
16.
Sivakami M, Maria van Eijk A, Thakur H, Kakade N, Patil C, Shinde S, et al. Effect of menstruation on girls and their schooling, and facilitators of menstrual hygiene management in schools: Surveys in government schools in three states in India, 2015. J Glob Health 2019;9:010408.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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