Uncovering the challenges to menstrual health: Knowledge, attitudes and practices of adolescent girls in government schools of Delhi

Abstract

Background: Menstrual hygiene management is a significant issue affecting the health of women around the world. Lack of knowledge and awareness about menstruation and the silence surrounding it is a risk factor for all women. Objective: The objectives of this study were to elicit the knowledge, attitudes, and practices of adolescent girls (13–15 years) regarding issues related to menstruation and to assess the barriers that prevent them from practising menstrual hygiene. Design and Setting: Cross-sectional study involving 187 adolescent girls from four government schools of Delhi. Method: Information was obtained using a mixed-methods approach, including a pretested questionnaire and focus group discussions with girls, parents and school staff. Results: Only 40% of girls were aware of menstruation prior to menarche. The majority of girls (95.7%) did not know the source of menstrual blood. About two-thirds (65.8%) of girls were unaware that the menstrual blood flow could be affected by anaemia. Approximately 17% of the girls believed a woman to be impure during menstruation. About half of the girls absented themselves from school for the first 2–3 days of their menstrual cycle. Thirty-four percent girls did not bathe at all during their menstrual period and a similar number of girls did not bathe daily while menstruating. Dysmenorrhoea was a common problem among 60% of girls. The mothers of girls were identified as the major source of information about menstruation. However, mothers believed that school teachers should also be imparting this knowledge. Teachers expressed the belief that menstrual hygiene was poor among girls. The provision of free sanitary napkins in school has improved hygiene levels. Conclusion: Strategic behaviour change interventions should be designed involving all stakeholders to ensure a sustained change in knowledge, attitude and practices so as to ensure the better health of adolescent girls.

Menstrual Hygiene Preparedness Among Schools in India: A Systematic Review and Meta-Analysis of System-and Policy-Level Actions

“…Broken lock/doors of the toilets were a matter of concern for the security of the girls in schools. These findings have been reported in 30 studies [26,33,72,77,78,95,102,105,106,. There were gaps with respect to the non-availability of emergency supplies of sanitary materials in schools [26,69,72,78,95].…”

“…Teachers felt the need to do games and activities to share information about various menstruation-related issues with girls. However, they could not conduct such activities in school because they were pre-occupied with routine duties and curriculum targets [77]. Teachers were a source of information among 7% girls (PP 7.0%, 95% Confidence Interval (CI) 5.0% to 8.0%, I 2 = 100%, n = 86) ( Figure 3).…”

“…The girls in schools threw away sanitary pads or other menstrual articles in toilets or left the soiled wrapped pads at toilet corners due to lack of dustbins or separate place for disposal. As a result, the sewage system was blocked, or toilets became dirty, a breeding place for flies and mosquitoes, and unhygienic for other toilet users and cleaners [26,77,109]. Less than two-thirds of schools in India had dustbins with a lid for disposing of pads.…”

“…This insensitive behavior might be fueled by ignorance, prevailing local myths, and cultural taboos related to menstrual blood among men [130,131]. As a result, topics such as puberty and menstruation were not included in the curriculum due to the predominance of male teachers in most of the schools [16,77]. There was a higher predominance of male teachers or administrators in schools, and they were hesitant to talk about MHM due to the gendered rooting of menstruation and cultural taboos related to it.…”

Validation of Health Education Material for Youth: A Step to Ensure Implementation Fidelity in Community-Based Interventions

“…The prime focus of the project was to enhance knowledge and bridge skill gaps among adolescents and YMW for their improved health, nutrition, and hygiene outcomes. Multiple studies highlighted inadequate knowledge, attitudes, and practices of the adolescents and YMW toward nutrition, reproductive health, and hygiene [20][21][22]. Our study affirms the notion that, despite high literacy levels, there is a lack of adequate knowledge of health education and promotion among the populations [23].…”