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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 18
| Issue : 1 | Page : 20-25 |
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Experiences of Menstruation with Factors Influencing Menstrual Hygiene Practices Among Adolescent Girls Attending Outpatient Department of Secondary Care Hospital Setting: A Cross-sectional Study
Mansi Pal1, Shyama Devi1, Manish Taywade2
1 College of Nursing, AIIMS, Bhubaneswar, Odisha, India
2 Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
| Date of Submission | 01-Jan-2022 |
| Date of Acceptance | 02-Feb-2022 |
| Date of Web Publication | 8-May-2022 |
Correspondence Address:
Mansi Pal
Community Health Nursing, College of Nursing, AIIMS, Bhubaneswar, Odisha
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/AMJM.AMJM_2_22
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 | |  |
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 | | |
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 | | |
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].
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].
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].
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
Click here to view |
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
Click here to view |
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 | | |
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 | | |
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 | | |
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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