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Knowledge, Awareness and Health Seeking Behaviour regarding Menstrual hygiene practices among reproductive age females in rural district of Gaya, Bihar

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Introduction

Maintaining proper menstrual hygiene is essential for women’s health and overall well-being, encompassing practices and products used during menstruation to ensure cleanliness, comfort, and dignity. Proper menstrual hygiene management involves the use of sanitary products like pads, tampons, or menstrual cups, coupled with good hygiene practices such as regular changing and disposal of used materials. It also includes education about menstrual health, breaking stigma, and ensuring access to affordable and sustainable menstrual products for all menstruators. Effective menstrual hygiene not only promotes physical health but also contributes to women’s empowerment and societal equality by addressing cultural taboos and promoting confidence and participation in daily activities without disruption.

Adolescent women are often inexperienced in MHM (Singh et al., 2022). They lack adequate and correct knowledge about their bodies, especially the reproductive system and its working, given the social prohibitions on discussing these issues. They also lack the disposable income to buy hygienic menstrual products. Inability to manage menstrual hygiene can have serious consequences for their physical, mental, and emotional health, as well as their social development and educational attainment Therefore, managing menstrual health and hygiene among adolescent women is a major public health concern for policymakers in low-income and middle-income countries, including India.

India hosts about one-fifth of the world’s population of adolescent women. Unfortunately, most of them, especially those living in rural areas, typically face many restrictions that limit their agency and autonomy. During menstruation, these restrictions become much more severe, preventing them from participating in many aspects of social life, worshipping, bathing cooking, and sexual activity. Millions of adolescent girls in India drop out of school every year due to restrictions on mobility, a lack of restrooms and disposal facilities in schools, and fear or shame caused by the odour and stains of menstrual blood. The situation is further worsened by the widespread ignorance around puberty and menstruation, the lack of access to menstrual hygiene products, and the absence of adequate water, sanitation, and hygiene facilities, leading to poor menstrual hygiene practices. Menstruation is a biological and physiological phenomenon in girls’ or women’s lives. It is part of the reproductive cycle of women, which takes place for the first time (known as puberty or menarche), mostly at the age of 12–13 years, and ceases around the age of 45–49 year (menopause).

During this age range, on average, women get menstruation once in 28 days, in which they will experience shedding of blood (from the vagina) for about 1–7 days. Thus it is estimated, on average, women undergo the experience of menstruating for about six to seven years. In the Indian context, though the age at menarche used to be celebrated as function in the case of an adult or young girl, it is surrounded by several taboos, myths, and misconceptions, and thereby, the menstruation period is treated as impure. These, in turn, lead to not keeping up appropriate menstrual health. But following applicable healthy practices or cleanliness of the body in general and external genitals in particular during menstruation (widely known as menstrual hygiene) is essential among women not only from the point of personal hygiene but also keeping up sexual and reproductive health. Menstrual hygienic practices include using a material for absorbing blood during menstruation and cleaning of genitals and include a variety of other aspects such as disposing of absorbed material, bathing practices, etc. Research evidence in India has established that absence of or sticking to poor menstrual hygienic practices would cause specifically menstrual and gynaecological problems or reproductive problems at large.

In rural India, only 42% of adolescent women exclusively used hygienic methods, with substantial geographic disparities at the state and district levels(Singh et al., 2022). At the state level, the exclusive use of hygienic methods varied from 23% in Uttar Pradesh to 85% in Tamil Nadu[1]. 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.

According to WHO (2022), calls for three actions. Firstly, to recognize and frame menstruation as a health issue, not a hygiene issue – a health issue with physical, psychological, and social dimensions, and one that needs to be addressed in the perspective of a life course – from before menarche to after menopause. Secondly, to recognize that menstrual health means that women and girls and other people who menstruate, have access to information and education about it; to the menstrual products they need; water, sanitation, and disposal facilities; to competent and empathic care when needed; to live, study and work in an environment in which menstruation is seen as positive and healthy not something to be ashamed of; and to fully participate in work and social activities. Thirdly, to ensure that these activities are included in the relevant sectoral work plans and budgets, and their performance is measured.

WHO recognizes that several sectors have equally important roles to play in promoting and safeguarding Menstrual Health and is committed to stepping up its efforts to encourage health policymakers and programme managers to engage with these sectors to promote the rights of women, girls and other people who menstruate and meet their comprehensive menstrual health needs, especially in humanitarian contexts. WHO is also committed to breaking the silence and stigma associated with menstruation and to make schools, health facilities and other workplaces (including WHO’s workplaces), menstruation responsive

Governments are beginning to act, but they need to do much more.

Activists – including young people – and nongovernmental organizations have done much to place menstrual health on the agenda. A growing number of governments are taking action. Some governments have removed taxes on menstrual products. Others have focused on the challenges faced by school-going adolescents in obtaining menstrual products. Still others have put in place strategies to provide menstrual products to populations in difficult circumstances e.g., those who are homeless or those who are incarcerated. Finally, a handful of countries have put in place laws and policies for medical leave when one is experiencing pain, discomfort and other symptoms and signs related to menstruation. These are useful steps, but governments could and should do more than improve access to menstrual products. They should make schools, workplaces and public institutions supportive of managing menstruation with comfort and dignity.

Problem statement:

Menstrual-related problems are widespread among adolescent girls in India.Different types of menstrual abnormalities are found in different populations, suggesting socio-cultural and regional variation. 64% of girls have at least one menstrual-related issue. In the age group of 10–19 years, poor menstrual hygiene and lack of self-care are critical drivers of morbidity and other problems. Some of the issues are urinary tract infections (UTI), scabies in the vaginal area, atypical abdominal pain, absence from school, and pregnancy complications. Studies report that out of an estimated 113 million adolescent girls in India, around 68 million adolescent girls attend roughly 1.4 million schools. Poor MHM practices and cultural taboos are viewed to be barriers to their school attendance. Menstrual abnormalities and disorders are frequently linked to physical, mental, social, psychological, and reproductive issues, affecting adolescents’ daily lives and their families live through various psychosocial problems such as anxiety

Objectives:

Methodology

Statistical analysis plan

All information collected will be entered in MS Excel and analysed using SPSS version 22. Categorial variables will be expressed as proportions and percentages. Continuous variables will be expressed as mean (standard deviation) / median(interquartile range). The chi-square test/Fischer exact test will be used to assess the association between categorical variables. p-value of < 0.05 will be considered statistically significant.

Expected Outcome:

Poor menstrual hygiene in rural villages can lead to several negative outcomes:

Addressing these issues requires comprehensive strategies that include improving access to affordable and hygienic menstrual products, educating communities about menstrual health and hygiene, ensuring access to clean water and sanitation facilities, and challenging social taboos and stigma surrounding menstruation.

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