A cross-sectional study of the beliefs and attitudes towards menstruation of Chinese undergraduate males and females in Hong Kong

A cross-sectional study of knowledge, taboos, and attitudes towards menstruation

BACKGROUND

The level of knowledge and comprehension surrounding puberty and menstruation. It can substantially impact women's overall health. This cross-sectional study is conducted to get insights about menstrual knowledge, attitudes and taboos among college and university female students in Haryana.

METHODS

A survey was conducted to investigate the experiences of menstruation among female students from government universities and colleges. Respondents were categorized on the basis of age, education qualification, and background setting. Random sampling was used to ensure participation from six administrative zones. The chi-square test was used to determine statistical significance, and the analysis was built around the p-value.

RESULTS

The data reveals that there is no significant association between the age of the participants and their awareness of menstruation, scientific knowledge related to menstruation, or their personal relationships with mother, father, or family members. Similarly, there is no significant association between the participants' scientific knowledge and their level of education. However, there is a significant association between participants' personal relationships and level of education (p = .025). Additionally, a significant association was observed between taboos and level of education (p = .025).

CONCLUSION

Age, residential area, and educational levels do not seem to significantly impact participants' awareness and knowledge. This study highlights the influence of personal equations and education on attitudes and beliefs surrounding menstruation. The significant association between personal relationships and education underscores the importance of a supportive family. The persistence of menstrual taboos among undergraduates suggests that there is still a need for comprehensive and inclusive menstrual health education. This study also addressed the sustainable developmental goals for good health and well-being. Future studies should focus on exploring cultural factors such as religious beliefs and cultural norms in more detail to develop interventions that may help improve menstrual health outcomes among college and university students.

Muslim Women's Beliefs About Menstruation in Turkey

This study aimed to determine health, nutrition, religious beliefs, hygiene, and beliefs concerning menstruation of women aged between 18 and 49 years. This research was conducted as a descriptive study in primary health centers in one province in eastern Turkey between 2017 and 2019. The study sample consisted of 742 women. In the research, a questionnaire form that included the sociodemographic characteristics of the women and their thoughts regarding beliefs about their menstrual period was used. The biggest myth about food preparation was that 22% of the women believed that they will spoil food if they are involved in the food canning process while menstruating. The greatest menstrual beliefs about religious belief were that 96.1% of the women felt that it was wrong to have sexual intercourse while menstruating. The biggest beliefs about social life were that 26.5% of the women felt that they cannot have blood drawn while menstruating. The biggest beliefs about cleanliness were 89.8% of the women stated that it was necessary to take a bath at the end of menstruation. Generally, of all menstrual beliefs, opening pickles was highest among all groups. Notably, the second cluster, with a low value for kneading dough and shaving the genital area, showed a better cluster structure.

A Modified Menstrual Attitudes Scale: Heteronormative Attitudes, Sexism, and Attitudes Toward Menstruation in Male and Female Adults

Social shame and stigma surround menstruation, which may compromise women's health and rights in various contexts. Men's attitudes are particularly important because men often hold positions of power that influence women's experience. This study examined factors associated with menstrual attitudes, including heteronormative attitudes, sexism, and family influences. A cross-sectional Qualtrics panel survey (n = 802; aged 18-44; 50.8% female) was performed. We tested a revised menstrual attitudes scale based on items drawn from previously validated measures. Data were analyzed using a structural equation modeling framework. Factor analysis identified and confirmed a 5-factor model for menstrual attitudes. Men endorsed more negative attitudes toward menstruation than women; however, this difference was largely explained by factors other than gender in the structural equation model. After controlling for family and demographic characteristics, attitudes toward openness and secrecy surrounding menstruation were most strongly associated with gender role expectations and hostile sexism. Benevolent sexism was associated with finding menstruation debilitating, denying menstrual symptoms, and endorsing avoidance of activities during menstruation. Heteronormative and sexist attitudes were associated with more negative menstrual attitudes, while increased menstrual knowledge was associated with more positive menstrual attitudes. The difference in menstrual attitudes between males and females was explained largely by heteronormative attitudes and sexism. This suggests that attitudes toward menstruation are closely linked to social ideals about men and women.

Period teasing, stigma and knowledge: A survey of adolescent boys and girls in Northern Tanzania

Emerging evidence suggests that menstruation-related teasing is a common experience among adolescent girls with ramifications on their school participation, yet empirical evidence on the prevalence and determinants of period teasing in schools remain scarce. Menstrual hygiene research and policies almost exclusively focus on girls and women, leading to a dearth of knowledge of male attitudes. We conducted the first quantitative survey of period teasing in schools in sub-Saharan Africa, focusing on 432 male and 524 female students in four co-educational secondary schools in northern Tanzania. Period teasing is prevalent; 13% of girls have experienced period teasing, and more than 80% fear being teased, especially by male classmates. Girls’ fears are associated with insufficient menstrual hygiene management resources and practices. Girls cope by reducing school attendance, participation, and concentration in the classroom during periods. Boys engage in period teasing because they perceive periods as embarrassing, especially visible markers of periods (odor or stains). Social norms, such as peer behavior and home restrictions on menstruating women, are associated with more teasing. Boys believe it is strongly inappropriate for girls to reveal period status or to discuss periods with males, including male teachers. In contrast, boys are well informed about basic biological facts of menstruation (scoring 60% on a knowledge quiz, not statistically different from the girls) and have received information from school curricula and health workers. Lack of suitable menstrual hygiene practices and restrictive social norms is correlated with period teasing, which hinders gender equality in educational opportunities. Providing narrowly bio-medical focused education about menstruation may not be enough to reduce period teasing in contexts with period stigma.

How do people in China think about causes of their back pain? A predominantly qualitative cross-sectional survey

Background

Low back pain (LBP) is the second highest cause of health burden in China. Delayed recovery, poor clinical outcomes and persistence of LBP are associated with negative pain beliefs about LBP. Chinese philosophies are nested into the daily life of people in China, which is likely to influence pain beliefs. However, there is lack of knowledge about people’s discourses regarding their LBP in China. The primary aim of this study was to explore the discourses underlying the beliefs of people in China about what causes their persistent or recurrent LBP. The secondary aim was to investigate the sources of these pain beliefs.

Methods

People (n = 152) from South Central, East and North Mainland China with LBP completed an online survey about what they believed caused their persistent or recurrent LBP and where these understandings came from. Potential causes of persistent or recurrent LBP were explored qualitatively using discourse analysis. The sources of these discourses were assessed by descriptive statistics with conventional content analysis.

Results

Five discourses were identified to underpin participants’ beliefs about what caused their persistent or recurrent LBP, namely: (1) biomedical problems (66.4%), (2) unbalanced lifestyle (48.7%), (3) menstruation and ‘kidney’ status (9.2%), (4) the ‘Five Elements’ imbalance (7.9%), and (5) energy status (5.9%). Most participants responded that their pain beliefs were based on information derived from healthcare professionals (59.2%), followed by the internet (24.3%) and family (23.0%).

Conclusions

People from moderately and well-developed parts of Mainland China think predominantly in line with a Western biomedical viewpoint about their LBP. Traditional Chinese medicine related pain beliefs mainly to the concept of ‘balance’ were evident on contemporary Chinese society’s understandings of LBP. These cultural beliefs could be relevant to consider in LBP management and involve healthcare professionals, family and patient in this process.

Understanding menstruation: Influence of gender and ideological factors. A study of young people's social representations

This research investigates social representations of menstruation. It analyses firstly how young Spanish people understand menstruation in their everyday lives. And secondly, it explores how gender and ideological factors (liberal vs. conservative; feminist vs. non-feminist) impact on the meaning of menstruation and its implications for acceptance of this process. A free association exercise elicited by the word “menstruation” was answered by 250 people and the content was examined by lexical analysis. The results divided social representations of menstruation into two levels: firstly, a traditionalist level that is clearly linked to a negative stigmatized discourse about menstruation; and, secondly, a progressive level where two different discourses emerge, one representing liberal men and the other representing feminist women. The results show that only the feminist conception of menstruation provides an empowered and emotionally positive representation. The concept of menstruation is concluded to emerge from various sources of information, values and social conventions that are somewhat removed from its scientific meaning. The representation of menstruation is therefore understood to be situated within a social, ideological and emotional context. Accordingly, health education campaigns should frame their discourse about menstruation within a feminist perspective as their point of departure, thereby increasing their effectiveness.

Heavy menstrual bleeding among women aged 18-50 years living in Beijing, China: prevalence, risk factors, and impact on daily life

Background

Heavy menstrual bleeding (HMB) has been shown to have a profound negative impact on women’s quality of life and lead to increases in health care costs; however, data on HMB among Chinese population is still rather limited. The present study therefore aimed to determine the current prevalence and risk factors of subjectively experienced HMB in a community sample of Chinese reproductive-age women, and to evaluate its effect on daily life.

Methods

We conducted a questionnaire survey in 2356 women aged 18–50 years living in Beijing, China, from October 2014–July 2015. A multivariate logistic regression model was used to identify risk factors for HMB.

Results

Overall, 429 women experienced HMB, giving a prevalence of 18.2%. Risk factors associated with HMB included uterine fibroids (adjusted odds ratio [OR] =2.12, 95% confidence interval [CI] = 1.42–3.16, P < 0.001) and multiple abortions (≥3) (adjusted OR = 3.44, 95% CI = 1.82–6.49, P < 0.001). Moreover, women in the younger age groups (≤24 and 25–29 years) showed higher risks for HMB, and those who drink regularly were more likely to report heavy periods compared with never drinkers (adjusted OR = 2.78, 95% CI = 1.20–6.46, P = 0.017). In general, women experiencing HMB felt more practical discomforts and limited life activities while only 81 (18.9%) of them had sought health care for their heavy bleeding.

Conclusions

HMB was highly prevalent among Chinese women and those reporting heavy periods suffered from greater menstrual interference with daily lives. More information and health education programs are urgently needed to raise awareness of the consequences of HMB, encourage women to seek medical assistance and thus improve their quality of life.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0726-1) contains supplementary material, which is available to authorized users.

Male perception about the inconveniences associated with monthly bleeding for their partner - an international survey

OBJECTIVE

To assess men's perceptions about monthly bleeding and associated inconveniences for their partner, as well as men's attitudes regarding the desired menstruation frequency for their partner and knowledge about hormonal contraceptives.

METHODS

A 15 min quantitative online survey was conducted among 5044 men aged 18-45 years, who had been in a relationship for more than 6 months, across 13 European countries (Austria, Belgium, Czech Republic, France, Germany, Hungary, Italy, Latvia, The Netherlands, Poland, Portugal, Spain and Switzerland). Responses were compared to those obtained in a similar study among European women.

RESULTS

Most men perceived that their partner considered her menstrual flow as moderate, lasting an average of 5.2 d, slightly longer than previously reported by women. Almost all men reported that their partners experience menstruation-related symptoms. However, prevalence of mood-related symptoms was perceived to be more frequent and physical symptoms less frequent, relative to women's self-reported symptoms. Given the option, 71% of men would choose longer intervals between their partner's periods. Maintaining the couple's sex life, social life and relationship quality were key factors cited in their preference. Overall, 42% of respondents stated that women taking hormonal contraceptives needed to have monthly periods.

CONCLUSIONS

Men's perception regarding their partner's periods was generally consistent with that previously reported by women. Most men would prefer less frequent bleeding episodes for their partners. Although, the present data suggest that couples are discussing periods, knowledge about contraception could be improved. Health care professionals should intensify counselling to better inform both partners about their contraceptive options.

'We do not know': a qualitative study exploring boys perceptions of menstruation in India

BACKGROUND

In low-middle income countries and other areas of poverty, menstrual hygiene management (MHM) can be problematic for women and girls. Issues include lack of knowledge about menstruation and MHM, and stigma around menstruation, also access to affordable and absorbent materials; privacy to change; adequate washing, cleaning and drying facilities; as well as appropriate and accessible disposal facilities. In order to effect change and tackle these issues, particularly in patriarchal societies, males may need to become advocates for MHM alongside women. However, little is known about their knowledge and attitudes towards menstruation, which may need addressing before they can assist in acting as advocates for change. The present study was undertaken to explore knowledge and attitudes about menstruation among adolescent boys across India, in order to gauge their potential to support their 'sisters'.

METHODS

The study was undertaken across three states in India, chosen a priori to represent the cultural and socio-economic diversity. Qualitative data using focus group discussions with 85 boys aged 13-17 years, from 8 schools, was gathered. Data were analysed using thematic analysis.

RESULTS

The results were organised into three main themes, reflecting the key research questions: boys' knowledge of menstruation, source of knowledge, and attitudes towards menstruation and menstruating girls. Knowledge comprised three aspects; biological function which were generally poorly understood; cultural rites which were recognized by all; and girls' behaviour and demeanour, which were noted to be withdrawn. Some boys learnt about puberty and menstruation as part of the curriculum but had concerns this was not in-depth, or was missed out altogether. Most gathered knowledge from informal sources, from overhearing conversations or observing cultural rituals. Few boys openly displayed a negative attitude, although a minority voiced the idea that menstruation is a 'disease'. Boys were mostly sympathetic to their menstruating sisters and wanted to support them.

CONCLUSIONS

These findings provide some optimism that males can become advocates in moving forward the MHM agenda. The reasons for this are twofold: boys were keen for knowledge about menstruation, searching information out despite societal norms being for them to remain ignorant, they were also largely sympathetic to their menstruating sisters and fellow classmates and understanding of the issues surrounding the need for good MHM.

Promoting the menstrual health of adolescent girls in China

In China, nurses have limited presence in schools, thus, adolescent girls often lack accurate information about menstrual health, which may lead to incorrect and unhealthy menstrual-related behavior. This study investigated the effects of a culturally and developmentally tailored nursing intervention on the menstrual health of adolescent girls in China. Following institutional review board approval, adolescent girls aged 12-15 were recruited from two schools. A quasi-experimental, pretest-posttest design examined the effects of five interactive education sessions on menstrual health. The final sample included 116 adolescent girls. Significant improvement was observed in the intervention group regarding menstrual knowledge, confidence in performing menstrual healthcare behavior, and dysmenorrhea related self-care behavior. A nurse-managed education program improved adolescent girls' menstrual knowledge, promoted a more positive attitude, encouraged confidence, and improved pain relief practice. We recommend that professional nurses globally advocate for school nursing and routine menstrual health education for adolescent girls.

Self-Care Strategies among Chinese Adolescent Girls with Dysmenorrhea: A Qualitative Study

Little is known about how Chinese adolescent girls manage dysmenorrhea. This study aims to explore self-care strategies among Chinese adolescent girls with dysmenorrhea. The study uses a mixed methods design with two phases: a cross-sectional survey in phase I and semistructured interviews in phase II. This paper reports phase II. In line with the phase I findings, 28 adolescent girls with different characteristics (high or low levels of self-care behavior and pain intensity, who did or did not self-medicate, and who had or had not received menstrual education) were recruited for interviews. Content analysis was used for data analysis. Four categories emerged from the data: lifestyle changes, symptom management, communicating dysmenorrhea with others, and seeking medical advice. Girls selected their diets carefully and reduced physical activity during menstruation to avoid aggravating symptoms. Heat therapy commonly was employed for symptom management. A few girls self-medicated to obtain immediate relief from pain, but the majority expressed reservations about using medication because they worried about dependence and side effects. Some girls communicated dysmenorrhea with their family and friends, but the majority did not seek medical advice. The present study showed that girls employed various self-care strategies for dysmenorrhea, including some strategies stemming from traditional Chinese medicine. The findings revealed menstrual etiquette among Chinese adolescent girls with dysmenorrhea, and demonstrated that self-medication was not part of most girls' self-care. Understanding the self-care strategies of these girls is important, as it can help nurses develop a culturally-specific intervention to promote self-care among adolescent girls with dysmenorrhea.

Chhaupadi Culture and Reproductive Health of Women in Nepal

Different sociocultural barriers concerning women's health are still prevalent. Chhaupadi culture in Nepal is that threat wherein menstruating women have to live outside of the home in a shed-like dwelling. Our study aims to determine the factors of reproductive health problems related to Chhaupadi. A cross-sectional study was performed with women of menstrual age (N = 672) in Kailali and Bardiya districts of Nepal. Data were collected with stratified sampling and analyzed using SPSS. Reproductive health problems were observed according to the World Health Organization reproductive health protocol. Regression analysis was performed to show the association between relevant variables. Results reveal that one fifth (21%) of households used Chhaupadi. Condition of livelihood, water facility, and access during menstruation and precisely the Chhaupadi stay was associated (P < .001) with the reproductive health problems of women. The study concludes that Chhaupadi is a major threat for women's health. Further research on appropriate strategies against Chhaupadi and menstrual hygiene should be undertaken.