Knowledge and practices regarding the menstrual management among reproductive women residing in Belagavi

Introduction

Menstruation is generally considered as unclean in the Indian society. Isolation of the menstruating girls and restrictions being imposed on them in the family, have reinforced a negative attitude towards this phenomenon. 1 The first menstruation (menarche) occurs between 11 and 15 years with a mean of 13 years. Menstruation is still regarded as something unclean or dirty in Indian society. The reaction to menstruation depends upon awareness and knowledge about the subject. The manner in which a girl learns about menstruation and its associated changes may have an impact on her response to the event of menarche. Although menstruation is a natural process; it is linked with several misconceptions and practices, which sometimes result into adverse health outcomes. Hygiene related practices of women during menstruation are of considerable importance, especially in terms of increased vulnerability to reproductive tract infections (RTI). 2 Many studies have revealed that most of the adolescent girls had incomplete and inaccurate information about the menstrual physiology and hygiene. It also revealed that mothers, television, friends, teachers and relatives were the main sources which provided information on menstruation to the adolescent girls. Good hygienic practices such as the use of sanitary pads and adequate washing of the genital area are essential during menstruation. Women and girls of the reproductive age need access to clean and soft, absorbent sanitary products which can in the long run, protect their health.3

There are several taboos, myths and misconceptions regarding menstruation all over the world, mainly in developing countries. Among different religions, a menstruating woman is considered as 'impure' or 'polluted'. Moreover, several restrictions are imposed on the women during these days. Menstruation and its management are expected to concern women and men alike as it a key determinant of human reproduction and parenthood. Understanding about their level of knowledge and the practices which are followed by them with respect to menstruation are beneficial for planning a public health program for improving the awareness level with respect to their life processes and promoting their quality of life. Hence the present study was undertaken to assess the knowledge and the practices of menstrual hygiene among the reproductive age-group women and to assess the association of the knowledge and the practices of menstrual hygiene among the reproductive age-group women residing in the rural and urban areas of Belagavi.

Material and Methods

A Community based cross sectional study was conducted among the reproductive age-group women residing under urban and rural health centres of Belagavi city, Karnataka. The study was undertaken for a period of 6 months from February 2018 to July 2018. However, women from other rural and urban areas also attended the health centres, were included in this study. Taking 5% absolute error, the sample size was calculated as 265. On rounding off we selected a sample size of 280 women from the above-mentioned health centres for the study. A pre-designed, pre-tested and structured questionnaire was used in the study. A personal interview of the study subjects was done to collect data. After obtaining verbal consent, a rapport was established and the purpose of the study was explained to those women who came to the OPD of respective rural and urban health centres. The nature of the information which had to be furnished by the study subjects were also explained. The questionnaire included topics which were related to awareness, the sources of information, hygienic practices and the restricted activities practiced during menstruation. The socio-demographic profile including the subjects’ details, literacy, occupation and socioeconomic status were enquired and documented. The menstrual hygiene questionnaire included queries about types of absorbent used, its storage place, the use of clean or unclean napkins and the frequencies of changing and cleaning them. The information about personal hygiene included washing and bathing during menses, the practice of wearing stained clothes etc.

Result

A total of 280 women have participated in our study. The socio-demographic characteristics are summarized in Table 1. Of the 280 women participated, 32.6% were in the age group of 20-24 years. Majority of the women belong to Hindu population (70%), while 26.8% of the study population were illiterate, around 69.6% of the women were house wife. While more than half of the families of the women belong to lower socio-economic level i.e class III, IV &V (76.1%).

On the questions asked regarding knowledge about menstruation, 90.7% opined that menstruation is a physiological process, 83.6% were unaware about the cause of menstruation, while information regarding prior to menarche, 68.5% said they didn’t had any information, while those who got information, most of them are from their mother (42.9%). Usage of sanitary pads, 63.2% were aware about it. The results on the questions asked about the knowledge about menstruation are shown in Table 2.

Attitude and practice during menstruation, 50.7% told restriction is present, half of the women said ritual purification performed after menstruation, while 46.7% and 40.3% used cloth and sanitary pads respectively during menstruations. 30.3% said they used same cloth every month. Frequency of cleaning external genitalia, 49.2% washed once in a day, while 54.5% used soap and water to clean the genitalia. 77.8% told they bathed once in a day during menstruation. Disposal of absorbent material, 53.5% disposed in garbage, while 16.7% reused them (Table 3).

Discussion

A total of 280 women have participated in our study. Majority of the women are in the age group of 20-24 years (32.6%), while 26.8% of the study population were illiterate, more than half of the women were house wife (69.6%). 90.7% opined that menstruation is a physiological process, which is almost similar to the study done by Shamima Yasmin et al, in which 72.8% girls believed it to be a physiological process,2 on the contrary Khanna et al study conducted in Rajasthan showed that 70% believed that menstruation was not a natural process.4 Furthermore, in our study 83.6% didn’t knew about the cause of menstruation, while information regarding prior to menarche, 68.5% said they didn’t had any information, those who got information, most of them are from their mother (42.9%) whereas a study conducted by El-Gilany et al. in Mansoura, Egypt mass media were the main source of information about menstrual hygiene followed by mothers,5 while Deo et al study reported that 40 (42.5%) urban and 41 (55.4%) rural girls were aware about menstruation prior to attainment of menarche.6 Patel RA et al, study showed that, main source of information was mother which was 32.09% and 36.95% in urban and rural areas respectively. In urban area, teacher was also a source of information in 31.02% of girls as compared to 17.51% in rural area.7 Nair P et al also found 45.7% of the girls who had attained menarche and 29% of the pre-pubertal subjects said that they had prior knowledge about menstruation and the main source of information was mother.8 Dhingra et al found that 64% of girls were partially aware of menstruation,1 On the contrary Gupta J et al found that 68% of adolescent girls were not aware about menses.9 On Usage of sanitary pads in our study, 63.2% were aware about it but only 40.3% used it. 50.7% told that some form of restriction is present, half of the women said ritual purification performed after menstruation, while 46.7% used cloth during menstruations, among them 30.3% said they used same cloth every month. A study by Dasgupta et al in a rural community showed that majority of the girls preferred cloth pieces rather than sanitary pads as menstrual absorbent. Only 11.25% girls used sanitary pads during menstruation.10 Khanna et al study in Rajasthan, more than half of the girls used old cloth during their periods and only about 20% using readymade sanitary pads.4 On Frequency of cleaning external genitalia, 49.2% washed once in a day, while 54.5% used soap and water to clean the genitalia. 77.8% told they bathed once in a day during menstruation. Disposal of absorbent material, 53.5% disposed in garbage, while 16.7% reused them.

Conclusion

Educating girls at the beginning of menarche about the routine practice of taking a bath with warm water in the early days of menstrual period, would not only lead to the development of positive mental and social behaviours, but could also be effective in reducing hygiene problems in the community throughout their reproductive age period. In our study and as well as most of the studies identified mother as the main source of information, health professional should involve mothers in general discussions about issues related to menstruation and how to deal with them. Other sources can also be involved in discussion. As hygienic practices during menstruation are unsatisfactory, these girls should be educated about importance of hygiene during menstruation through focused group discussion and with demonstrations.

Source of Funding

No funding sources.

Conflict of Interest

None declared.

Ethical Approval

Approved by Institutional Ethics Committee.

Acknowledgement

Authors would like to thank all the participants of study and acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors, editors and publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.