Menstrual hygiene management and its determinants among adolescent girls in low-income urban areas of Delhi, India: a community-based study

"I know your problems; take your bag and go home": a qualitative study using the social-ecological model to understand drivers of suboptimal school and social participation among secondary schoolgirls in Northwest Tanzania

BACKGROUND

School attendance and completion among girls protect them from multiple sexual and reproductive health problems. However, inadequate resources for managing menstruation remains a barrier to school participation and learning in low- and middle-income countries. With the increased global focus on closing the gender gap in education, schoolgirls' voices are important in understanding drivers of suboptimal social and school participation during menstruation. This paper explores how menstruation influences social and school participation from the perspectives of schoolgirls.

METHODS

We conducted 40 in-depth interviews with purposively-selected secondary schoolgirls aged 13-20 years in two rural and two urban schools in Northern Tanzania from 2021 to 2022. To be eligible for participation, the schoolgirls must have reported missing school during their last menstruation. We used an in-depth interview guide to elicit girls' menstrual experiences and how such experience influenced their school and social participation. We used NVivo 12 software to code data and employed thematic analysis using the social-ecological model.

RESULTS

The respondents described the drivers of suboptimal social and school participation at the individual level (negative menstrual experience, i.e. menstrual pain and constant worries of menstrual blood leaking, and individual economic constraints); interpersonal level (the fear of menstrual status disclosure, and peer's attitude); school level (inadequate emergency pad at school, lack of private place to change, and unhygienic school WASH); and societal level socio-cultural restrictions (girls are prohibited from touching plants/vegetables, engaging in household chores/religious worship, or physical contact with men during menstruation, and refusal to use conventional painkillers to relief menstrual pain).

CONCLUSIONS

The findings suggest that drivers of suboptimal social and school participation among secondary schoolgirls exist at the individual, interpersonal relationship, school, and societal levels. Multi-level evidence-based multicomponent interventions to improve menstrual health at all socio-ecological levels are warranted for optimal social and school participation among schoolgirls.

Menstrual hygiene practices, determinants, and association with reproductive tract infection in India: a large repeated cross-sectional analysis (2015-2021)

The promotion of menstrual health and hygiene globally, especially in lower-middle-income countries (LMICs), is a major public health imperative. The primary study objective was to ascertain the change in the patterns of menstrual hygiene practices and their sociodemographic determinants amongst adolescent girls and young women in India. The present study analyses data from the Indian National Family and Health Survey (NFHS), round 4 (2015-2016) and round 5 (2019-21). Women in the age group 15-24 years (n = 241,180) were interviewed regarding their menstrual hygiene practices. The proportion of women using sanitary napkins as absorbent during menstruation increased from 41.8% (NFHS-4) to 64.1% (NFHS-5), with more than six in ten adolescent girls and young women in India using sanitary pads during menses, although the socioeconomically vulnerable more likely to lack access. The higher age group (20-24 years), rural residence, lower wealth quintile, absence of schooling, absence of flush toilets, and lack of exposure to media were factors that were independently associated with the use of cloth as menstrual absorbent. Vaginal discharge was reportedly higher among women using unhygienic products, however, on adjusted analyses, no statistically significant association was observed with the type of absorbent used. The transition from cloth to sanitary pads has nearly doubled on average in the states implementing free and subsidised government pad distribution schemes during the same period.

Period poverty: Menstrual information, product selection, and disposal among urban female nursing students in Bangladesh

Period poverty, the lack of access to menstrual hygiene products, sanitation facilities, and education, remains a pressing issue in low- and middle-income countries. This study explored the emotional and practical challenges faced by nursing students, focusing on menstrual education, product accessibility, and disposal practices. A qualitative approach was adopted, involving 35 female nursing students (aged 26 ± 3.3 years) from seven government nursing colleges across three regions of Bangladesh. Data was collected from June to July 2023 through Focus Group Discussions (FGDs) and In-Depth Interviews (IDIs). Purposive sampling was employed for FGDs, while convenience was sampling used for IDIs. Thematic analysis, facilitated by MAXQDA2023 software, identified key themes and subthemes related to menstrual experiences. Three major themes emerged: (1) fear and confusion during first menstruation, (2) barriers to menstrual product accessibility, and (3) challenges in menstrual hygiene management. Many students reported fear and confusion during their first menstruation, largely due to inadequate information from female family members, especially mothers. Sanitary pads were the preferred menstrual product, but the embarrassment of buying products in front of men often made purchasing them difficult and they used old clothes. Additionally, a lack of proper disposal facilities and embarrassment in managing menstruation in public were significant concerns. This study underscores the need for comprehensive menstrual education and improved Water, Sanitation and Hygiene (WASH) infrastructure in educational institutions. Addressing these issues is critical to promoting safe and dignified menstrual management, reducing stigma, and enhancing health outcomes for menstruators.

Factors Associated with Exclusive Use of Hygienic Methods during Menstruation among Adolescent Girls (15-19 Years) in Urban India: Evidence from NFHS-5

Background

Menstrual hygiene is a critical public health concern for adolescent girls in urban India. However, there is a paucity of research on this subject, particularly on a national scale. To the best of our knowledge, this study diverges from previous research, as the majority of prior investigations in India have centered on rural locales, married individuals, and those aged between 15 and 24 years. Thus, this study aims to fill this gap by investigating the factors associated with the exclusive use of hygienic methods during menstruation among urban adolescent girls (15-19 years) in India.

Method

A total of 25136 samples were included in this analysis from the National Family Health Survey 5 (NFHS-5). The Binary logistic regression model has been administered to determine the associated factors of the exclusive use of hygienic methods among adolescent girls.

Results

The results of the multivariate model revealed significant positive associations between higher education levels and usage of menstrual hygiene management products (AOR: 1.860; 95 % CI: 1.418-2.439), (AOR: 2.110; 95 % CI: 1.553-2.867). Additionally, individuals in higher wealth quintiles were more likely to use MHM products, with the richest quintile showing the highest likelihood (AOR: 5.310; 95 % CI: 4.494-6.275). Attendance at cultural events such as cinema or theater was positively associated with MHM product utilization (AOR: 1.338; 95 % CI: 1.181-1.517).Conversely, Lack of access to sanitation facilities was inversely associated with MHM product utilization (AOR: 0.742; 95 % CI: 0.628-0.877). Muslim girls had lower odds than Hindus (AOR: 0.576; 95 % CI: 0.520-0.637). Substantial regional variations were evident, with the Western (AOR: 0.879; 95 % CI: 0.759-1.019), Eastern (AOR: 0.747; 95 % CI: 0.654-0.854), Central (AOR: 0.349; 95 % CI: 0.313-0.388), and North-eastern regions (AOR: 0.597; 95 % CI: 0.490-0.727) displaying diminished odds of MHM product usage relative to the southern region. General caste had higher odds compared to scheduled caste (AOR: 1.255, 95 % CI: 1.103-1.429), while other backward caste had lower odds (AOR: 0.858, 95 % CI: 0.771-0.955).

Conclusion

These findings underscore the importance of addressing inequalities in access to menstrual hygiene products among urban adolescent girls in India. Targeted interventions and educational programs are essential to ensure equitable access and promote overall health and well-being.

Perceived difficulties in maintaining menstrual hygiene practices among indigenous adolescents during seasonal water scarcity periods in Bandarban hill district of Bangladesh: A cross-sectional study

BACKGROUND

Access to clean water is important for menstrual hygiene practices, an important aspect of health for adolescent girls. In Bangladesh, adolescent girls represent poor menstrual hygiene practices, whereas the practice is worse among vulnerable population groups living in areas experiencing seasonal water scarcity. This study portrays perceived difficulties in menstrual hygiene practices among indigenous adolescent girls during the period of seasonal water scarcity in Bandarban Hill District, Bangladesh.

METHOD

Data was collected from 242 indigenous adolescent girls through interviews during the period of water scarcity. Backward stepwise regression model was used to identify factors associated with perceived difficulty in maintaining menstrual hygiene (PD) practices.

RESULT

The study participants, mainly living in hard-to-reach areas, reported difficulty in getting adequate water during the water scarcity period, and the quality of water was reported to be poor. PD due to water scarcity was found to be significantly associated with water source degradation (β = 0.247, < 0.001), the need for boiling/purifying water before use for menstrual hygiene (β = 0.203, p = 0.005), and experience of water availability when it was necessary to maintain their optimal menstrual hygiene practice (β = 0.449, p < 0.001), time required to collect water (β = 0.209, p < 0.001), taking a bath every day (β = -0.228, p < 0.001), and frequency of washing genitals per day (β = - 0.094, p = 0.040).

CONCLUSION

Indigenous adolescents perceive difficulty in menstrual hygiene practices during the period of water scarcity. Further research could be carried out to observe to what extent the seasonal water scarcity could be attributable to worsen the menstrual hygiene practices and to identify the need for addressing the problems.

Menstrual Hygiene Problems and Challenges Faced by Adolescent Females in Rural Areas: A Narrative Review

Menstruation is a vital sign of reproductive health and development. Menstrual hygiene practices are consequently a significant public health issue. However, menstrual practices are still tainted by taboos and other sociocultural constraints, which adversely affect health since adolescent females in rural areas are unaware of the scientific facts regarding menstrual hygiene practices. The Indian government has recognized the significance of menstrual hygiene and developed and implemented several programs and schemes for menstrual hygiene management (MHM). But due to a lack of, little, or inaccurate knowledge and cultural practices and socio-economic status, adolescent females face many obstacles and suffer from health issues. A comprehensive literature and data search was done using key databases such as PubMed and Google Scholar and other sources such as the Ministry of Health and Family Welfare (MoHFW), the United Nations International Children's Emergency Fund (UNICEF), the World Health Organization (WHO), and Google to identify the relevant articles and reviewed publications using full-text search. A total of 40 articles out of 1,461 were selected for review after the screening and elimination of repeated articles. The objective of this literature review is to assess the awareness and knowledge of the importance of menstruation, the understanding of safe menstruation practices, the significance of properly disposing of menstrual products, and the knowledge of how to guard against reproductive system infection and its consequences and also to identify the problems and challenges faced by adolescent females during their menstrual hygiene practices or management. The core of many health issues is misinformation, myths, erroneous beliefs, lack of awareness, and incomplete or incorrect knowledge about menstruation. Therefore, it is essential to teach adolescent females about hygienic behavior and safe menstrual practices.

Menstrual hygiene practices among adolescent women in rural India: a cross-sectional study

Background

Exclusive use of hygienic methods (sanitary napkins, locally prepared napkins, tampons, and menstrual cups) to prevent the visibility of bloodstains during menstruation is still considerably low among adolescent women in rural India. However, no prior research has explored the prevalence and determinants of exclusive hygienic methods among rural Indian adolescent women. To address this gap, this study examines the factors affecting adolescent women’s exclusive use of hygienic methods in rural India. Additionally, this study explores state- and district-level geographical disparities in the exclusive use of hygienic methods among adolescent women in rural India.

Methods

Information on 95,551 adolescent women from rural India from the latest round of National Family Health Survey (NFHS-5) was analyzed. Bivariate statistics and multilevel logistic regression analysis were used to assess the Individual- and community-level factors associated with exclusive use of hygienic methods among adolescent women in rural India. Choropleth maps were used to discern the geographical disparities in the exclusive use of hygienic methods.

Results

In rural India, only 42% of adolescent women exclusively used hygienic methods, with substantial geographic disparities at the state and district levels. At the state level, the exclusive use of hygienic methods varied from 23% in Uttar Pradesh to 85% in Tamil Nadu. Even greater variation was observed at the district level. There was a clear north-south divide in the exclusive use of hygienic methods among adolescent women in rural India. The results of multilevel logistic regression indicated a considerable amount of variation in the exclusive use of hygienic methods at community level which further reduced when controlled for individual and community-level factors. Rural Indian adolescent women with higher education (AOR:3.20, 95% CI: 2.81–3.64), from general category (AOR: 1.14, 95% CI: 1.07–1.21), with medium mass media exposure (AOR: 1.43, 95% CI: 1.35–1.51), and from richest wealth quintile (AOR: 3.98, 95% CI: 3.69–4.30) were more likely to use hygienic methods exclusively.

Conclusion

Wide differential across biodemographic and socioeconomic groups, and substantial geographic disparities at state- and district-level in the exclusive use of hygienic methods suggests a need to adopt context-specific interventions for adolescent women in rural India. Distribution of subsidized or free menstrual hygiene methods to disadvantaged adolescent women, and in the low-prevalence districts may increase the level of exclusive use of hygienic methods remarkably.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14622-7.