DISSERTATION ON
A QUALITATIVE STUDY TO EXPLORE THE KNOWLEDGE, ATTITUDES AND EXPERIENCES OF
ADOLESCENT GIRLS REGARDING MENSTRUAL HYGIENE DURING MENSTRUATION AT SELECTED
COLLEGE AT CHENNAI.
M.Sc (NURSING) DEGREE EXAMINATION
BRANCH – III OBSTETRICS AND GYNAECOLOGICAL NURSING
COLLEGE OF NURSING
MADRAS MEDICAL COLLEGE, CHENNAI – 600 003
A dissertation submitted to
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY, CHENNAI – 600 032
In partial fulfilment of the requirement for the award of degree of
MASTER OF SCIENCE IN NURSING
OCTOBER 2020
DISSERTATION ON
A QUALITATIVE STUDY TO EXPLORE THE KNOWLEDGE, ATTITUDES AND EXPERIENCES OF
ADOLESCENT GIRLS REGARDING MENSTRUAL HYGIENE DURING MENSTRUATION AT SELECTED
COLLEGE AT CHENNAI.
Examination : M.Sc (Nursing) Degree Examination Examination month and year : OCTOBER 2020
Branch & Course : III–OBSTETRICS AND
GYNAECOLOGICAL NURSING
Register No : 301821256
Institution : COLLEGE OF NURSING,
MADRAS MEDICAL COLLEGE, CHENNAI – 600 003
Sd: ________________________ Sd:___________________
Internal Examiner External Examiner
Date: Date:
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY,
CHENNAI – 600 032.
CERTIFICATE
This is to certify that this dissertation titled, “A QUALITATIVE STUDY TO EXPLORE THE KNOWLEDGE, ATTITUDES AND EXPERIENCES OF ADOLESCENT GIRLS REGARDING MENSTRUAL HYGIENE DURING MENSTRUATION AT SELECTED COLLEGE AT CHENNAI”, is a bonafide work done by NIRMALA.A, M.Sc.,(Nursing) II Year student, College of Nursing, Madras Medical College, Chennai – 03, submitted to the Tamil Nadu Dr.
M.G.R. Medical University, Chennai in partial fulfillment of the requirement for the award of the degree of Master of Science in Nursing Branch-III: OBSTETRICS AND GYNAECOLOGICAL NURSING under our guidance and supervision during the academic period from 2018- 2020.
Mrs.A.Thahira Begum, M.Sc.(N), MBA., M.Phil.
Principal,
College of Nursing, Madras Medical College , Chennai- 03.
Dr.E.Theranirajan, MD., DCH., MRCPCH(UK)., FRCPCH (UK)., Dean,
Madras Medical College , Chennai- 03.
A QUALITATIVE STUDY TO EXPLORE THE KNOWLEDGE, ATTITUDES AND EXPERIENCES OF
ADOLESCENT GIRLS REGARDING MENSTRUAL HYGIENE DURING MENSTRUATION AT SELECTED
COLLEGE AT CHENNAI.
Approved by the dissertation committee on 12.11.2019
CLINICAL SPECIALITY GUIDE
Mrs.S.Thenmozhi, M.Sc(N)., _________________
Lecturer in Obstetrics and GynaecologicalNursing, College of Nursing, Madras Medical College, Chennai-03.
PRINCIPAL
Mrs.A.Thahira Begum, M.Sc(N)., M.B.A., M.Phil., _________________
Principal,
College of Nursing, Madras Medical College, Chennai -03.
DEAN
Dr.E.Theranirajan, MD., DCH.,
MRCPCH(UK)., FRCPCH(UK) _________________
Dean,
Madras Medical College, Chennai-03.
A dissertation submitted to
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY, CHENNAI – 600 032
In partial fulfilment of the requirement for the award of degree of
MASTER OF SCIENCE IN NURSING
OCTOBER 2020
ACKNOWLEDGEMENT
I praise and thank the God Almighty for showering his everlasting love and blessings to make my dream of studying in an esteemed college possible in real. He has been bestowed his blessings over me throughout my study period with a joy of spirit and enthusiasm in the completion of this dissertation successfully.
My sincere thanks to Dr.R.Jayanthi, MD., F.R.C.P.(GLASG)., Former Dean, Madras Medical College, Chennai – 03 for permitting me to conduct the study in this prestigious institution.
I extend my sincere thanks to My sincere thanks to Dr.E.Theranirajan, MD., DCH., MRCPCH(UK)., FRCPCH(UK), Dean, Madras Medical College, Chennai – 03 for permitting me to conduct the study in this prestigious institution.
I am more privileged to thank the Institutional Ethics Committee, of Madras Medical College, Chennai-03 for giving me the approval to conduct this study.
I express my heartfelt thanks to Mrs.A.Thahira Begum, M.Sc(N)., M.B.A., M.Phil., Principal, College of Nursing, Madras Medical College, Chennai -03 for her constant visionary support and untired efforts which motivated us in completion of the study successfully. Her kind of guidance is truly immeasurable. It’s my pleasure to express my heartfelt gratitude to for permitting me to conduct the study in College of Nursing, Madras Medical College, Chennai -03. I dedicate my heartfelt thanks and gratitude to our esteemed leader.
I owe my special thanks to Mr. M. Nithyanandham, M.Sc (N), Vice Principal and Mrs.K.Rajeshwari, M.Sc (N), Nursing Tutor,
permission to conduct the study in College of Nursing, Madras Medical College, Chennai -03
I dedicate my heartful thanks to our esteemed leader Dr.R.Shankar Shanmugam, M.Sc (N)., M.B.A., Ph.D., for all his motivating efforts in driving us to complete the study in a right way. His motivating words and supportive inputs helped us to take the study in an appropriate direction and complete it at the right destiny.
My great pleasure and privileges to express my gratitude to Mrs.S.Thenmozhi, M.Sc(N)., Lecturer in Obstetrics and Gynaecological Nursing Department, College of Nursing, Madras Medical College, Chennai – 03 for her constant support, calm approach, supportive guidance which helped me to complete the study peacefully and successfully.
My sincere thanks to Mrs.S.Lilly Puspam, M.Sc(N)., Reader, former HOD in Obstetrics and Gynaecological Nursing Department, College of Nursing, Madras Medical College, Chennai – 03
My sincere thanks to Mrs.R.Sumathi, M.Sc (N)., Reader, Nursing Administration Department in College of Nursing, Madras Medical College, Chennai -03 for her sincere, support and motivating efforts and facilitation as a first-year B.sc (N) Coordinator which guided us in making the study successfully.
I express my sincere gratitude to Ms.G.Mala, M.Sc(N)., Ph.D., former Nursing Tutor, Mr.K.Kannan, M.Sc (N)., Nursing Tutor, and Mrs.P.Tamil Selvi, M.Sc(N)., Nursing Tutor, College of Nursing, Madras Medical College, Chennai -03 for her valuable suggestions and in carrying out the study.
With utmost respect, I wish to thank Mrs.D.Rajeswari, M.Sc (N)., Nursing Tutor, College of Nursing, Madras Medical College, Chennai-
03, for her valuable guidance and encouragement which enabled me to accomplish this study.
I wish to express my heartfelt gratitude to all the Faculty Members of the College of Nursing, Madras Medical College, Chennai - 03 for their valuable guidance and suggestions in conducting this study.
I would like to express my special thanks to Dr.Susila, M.Sc(N)., Ph.D., Principal Billroth College of Nursing, Maduarvoyal, Chennai –95 for provoking the tool constructed for the study and for the valuable suggestions in bringing the tool in a right way. I also express my special gratitude to Mrs.A.I.Chitra, M.Sc (N).,Vice Principal, GRT College of Nursing, Tiruttani, for her valuable suggestions in bringing the tool in the right way for the study.
I owe to extend my sincere gratitude to Mr.A.Saravanan, M.A., B.Ed, Bharathi Higher Secondary School, Namakkal for editing the English tool and content and Mr.V.Narayanaswamy, M.A.,B.Ed, Block Educational Officer,Cumbum for editing the Tamil tool and content.
My special word of thanks to Mr.Ravi, M.A., MLIS., Librarian for extending his support in providing all the necessary materials needed to complete the study in an organized manner.
I owe my great sense of gratitude to Mr.Jas Ahamed Aslam, Shajee Computers, and Mr.M. Ramesh B.A., MSM Xerox for their enthusiastic help and sincere effort in typing the manuscript using valuable computer skills and also bringing this study into a printed form.
This journey would not have been possible without the meticulous support of my beloved husband R.Siddharthan, my lovable kids S.Vidhula and S.Nithila who encouraged and cooperated with me even though they are young, my loving father P. Asaithambi whose only dreams are providing me the best education and my lovable mother A.
Lakshmi who has supported me in completing my studies and my dearest brothers A.Saravanan and A.Chandresan and my lovable mother in law R.Namagiri
Thank you for encouraging me in all of my pursuits and inspiring me to follow my dreams. I always knew that you believed in me and wanted the best for me. Thank you for listening, offering me Advice, and supporting me through this entire process
I am greatly indebted to my soulmate and my other friends who helped me during the course of my study.
Finally, I extend my special thanks and gratitude to one, and all those who have been directly and indirectly helped me to complete the thesis wonderfully. Last but not the least; I extend my thanks to all the loving B.Sc (N) I Year Students who have participated in this study without their participation I couldn’t complete this study.
ABSTRACT
A qualitative study to explore the knowledge, attitudes and experiences of adolescent girls regarding menstrual hygiene during menstruation at selected college at Chennai.
INTRODUCTION
Menstruation is the essential rite of passage for women who constitute over 48 percent of our population. Lack of menstrual hygiene will lead to various problems on their health such as infection, reproductive tract problems, and it’s also one of the major cause of cervical cancer. In India, around 355 million menstruating women come under 30 percent of the countries population.
Hence the researcher thought to get a deep understanding of this section about awareness on menstruation and it concerns among adolescent which will uplift the understanding, in turn, bring out the better behavioral pattern on menstrual hygiene especially among adolescent girls.
OBJECTIVES
1) To explore the knowledge and attitude of adolescent girls pertaining to menstrual hygiene during menstruation.
2) To explore the major concerns and realities regarding menstrual hygiene among adolescent girls during menstruation.
METHODOLOGY
This study was conducted by adopting Qualitative research approach and Phenomenological design at College of Nursing ,Madras Medical college,Chennai-03.The five participants of late adolescent girls who belongs to B.Sc (N) I Year were selected by using convenience
variables and semi structured open ended questions which are based on the knowledge,attitude and concerns ,realities and experiences of adolescent girls regarding menstrual hygiene during menstruation. The data analysis was done using coding,derivation of subthemes and themes.
RESULTS
The findings of our study emerged with seven subthemes such as preparation for menarche, basic information regarding menstruation, physical health, attitudes, societal views, hygienic practices and others which are further classified as three specific themes such as individual knowledge, psychological well being, and menstrual hygienic practices and experiences.
DISCUSSION
Based on the study, it was concluded that according to the three themes which emerged such as individual knowledge, psychological well being and hygienic practices, remarkedly there is a lack of knowledge among adolescent girls before attending menarche, as they lack adequate information from their mothers who are considered as primary source of information , their attitude is also moderate due to lack of information regarding the physiological changes in adolescent girls and about menstruation and menstrual cycle. But at the time their menstrual hygiene knowledge is good to an acceptable level as they have received information from the peer group. Various educational programs will be helpful regarding menstrual education and menstrual hygiene at an early age to avoid emotional distress among adolescent girls during menarche and this will facilitate good menstrual hygienic practices.
TABLE OF CONTENTS
CHAPTER CONTENTS PAGE NO
I INTRODUCTION 1
1.1 Background of the study 5
1.2 Need for the study 9
1.3 Statement of the problem 12
1.4 Objectives of the study 12
1.5 Operational definitions 13
1.6 Assumptions 14
1.7 Delimitations 14
II REVIEW OF LITERATURE 15
III RESEARCH METHODOLOGY 35
3.1 Research approach 35
3.2 Research design 36
3.3 Research Variables of the study 36
3.4 Setting of Study 36
3.5 Study population 36
3.6 Target population 36
3.7 Accessible population 36
3.8 Sample 36
3.9 Criteria for sample selection 37
3.10 Sample size 37
3.11 Sampling technique 37
3.12 Development and description of tools 38
3.13 Content validity 39
3.14 Ethical consideration 39
CHAPTER CONTENTS PAGE NO
3.15 Pilot study 40
3.16 Data collection procedure 41
3.17 Plan for Data analysis 42
IV DATA ANALYSIS AND INTERPRETATION
44
V DISCUSSION 72
VI SUMMARY, IMPLICATION,
RECOMMENDATION, LIMITATION AND CONCLUSION
6.1 Summary 82
6.2 Conclusion 85
6.3 Implications 85
6.4 Limitations 87
6.5 Recommendations 87
REFERENCES APPENDICES
LIST OF TABLES
TABLE
NO. TITLE PAGE NO
4.1 DESCRIPTION OF DEMOGRAPHIC
VARIABLES 46
4.2 ANALYSIS OF THE CONTENT OF THE PARTICIPANTS AND DERIVATION OF CONCEPTS
48
4.3 DERIVATION OF THEMES AND SUBTHEMES 49 4.4 NARRATIVE ANALYSIS BASED ON
SUBTHEMES OF PARTICIPANT A 50
4.5 NARRATIVE ANALYSIS BASED ON
SUBTHEMES OF PARTICIPANT B 52
4.6 NARRATIVE ANALYSIS BASED ON
SUBTHEMES OF PARTICIPANT C 54
4.7 NARRATIVE ANALYSIS BASED ON
SUBTHEMES OF PARTICIPANT D 56
4.8 NARRATIVE ANALYSIS BASED ON
SUBTHEMES OF PARTICIPANT E 58
4.9 NARRATIONS OF PARTICIPANTS BASED ON
SUBTHEMES REGARDING KNOWLEDGE. 60
4.10 NARRATIONS OF PARTICIPANTS BASED ON SUBTHEMES REGARDING ATTITUDE.
63 4.11 NARRATIONS OF PARTICIPANTS BASED ON
SUBTHEMES REGARDING REGARDING CONCERNS, REALITIES AND EXPERIENCES
65
LIST OF FIGURES
FIGURE
NO. TITLE
1.1 GLOBAL BURDEN OF DISEASE REGARDING THE MORTALITY RATES DUE TO UNSAFE WASH.
1.2 INDIAN SCENARIO OF MENSTRUATING WOMEN AND USE OF SANITARY NAPKINS
1.3 TAMIL NADU SCENARIO OF MENSTRUATION AWARENESS AMONG WOMEN
1.4 USE OF VARIOUS FORMS ABSORBENTS DURING MENSTRUATION AT CHENNAI
3.1 SCHEMATIC REPRESENTATION OF THE RESEARCH METHODOLOGY
4.1 BASED ON THE SUBTHEMES AND RESEARCH QUESTIONS
4.2 PICTORIAL REPRESENTATION OF THEMES
LIST OF APPENDICES
S.NO CONTENTS
1. Certificate of approval from the institutional ethics committee 2. Permission letter from COLLEGE OF NURSING
3. Certificate of content validity
4. Informed consent - English and Tamil 5. Certificate of English Editing
6. Certificate of Tamil Editing
7. Tool for Data Collection - English and Tamil 8. Transcribed File –Tamil and English
9. Photos
LIST OF ABBREVIATION
ABBREVIATION EXPANSION
TAB TABLE
FIG FIGURE
MH MENSTRUAL HYGIENE
WASH WATER,SANITATION AND HYGIENE
NGO NON GOVERNMENTAL ORGANISATION
UNICEF UNITED NATIONS INTERNATIONAL
CHILDRENS EMERGENCY FUND
NFHS NATIONAL FAMILY HEALTH SURVEY
MHM MENSTRUAL HYGIENE MANAGEMENT
FGD FOCUS GROUP DISCUSSIONS
LMIC LOW MIDDLE INCOME COUNTRIES
CHAPTER-I INTRODUCTION
“ When a women sheds the blood of life each moon at menstruation a man can only shed the blood of death through warfare and killing.”
– Katha Pollitt.
Adolescence is the Latin word that means to grow up and it is the stage of development of transition between childhood and adulthood.
The age group of adolescents is between 10 -19 years as per the world health organization. The adolescence period is of intensive growth and has changed all their aspects of life like physical, mental, social, and emotional health. Adolescence is a period of storm and stress of human life. The behaviors developed during the adolescent period produce long-lasting effects for individual and public health in various ways. As we all tell, the future of a nation lies in the hands of the youth who are majorly in this age group.
The adolescent period can be classified into three stages such as early adolescence, mid-adolescence, and late adolescence. In this transitional period, the child reaches a degree of maturation, this is the time where they discover the physical changes in their body. Physical growth is one of the biggest changes in adolescence period. Every adolescent will undergo various hormonal and physical changes which are a challenging task for both the genders. In our country, there is a lack of awareness among the adolescent regarding these changes that occurs in them.
Adolescent health is very important to make them grow and develop with good health. For this purpose the adolescent girls need information in accessing knowledge which includes age-appropriate comprehensive sexual education, menstrual cycle, menstruation
health services that are acceptable, equitable, appropriate an d effective and enhance the safe and supportive environment.
The major hormonal and physiological development that occurs in adolescent girls in their lifetime is the beginning of their menarche.
After that many girls face problems of irregular menstruation, excessive bleeding, and dysmenorrhea, interrupting their educational performance and social lives. Various physical, psychological and social responses arise among them as a result of menarche and menstrual changes that occur to them. More awareness about menstruation from childhood may intensify safe practices and may aid in alleviating the sufferings from millions of women.
Menstruation is the essential rite of passage for women who constitute over 48 percent of our population. In India still, the stig ma, prejudice, and ignorance attached to menstruation are indeed baffling.
Based on societal ignorance in the developing world, shame surrounding menstruation and its direct barrier to girls' education remains a hushed conversation. Even nowadays educated parents feel shy about talking about menstruation to their children.
Adolescent girls in India form a susceptible population, where the female child is abandoned from getting all facilities in their life such as education, health, etc. Indian society still considers menstruation as something unclean or dirty. The response to menstruation is determined by the knowledge and awareness about the same. However, a girl acquires knowledge about menstruation and its related changes may affect her reaction to the event of menarche. In our country there are various boons and misconceptions which exist still in menarche and menstrual practices, which in turn result in adolescent girls till remaining unaware of the scientific realities and hygienic practices, which lead to negative impacts in their life. All over in India, about one
hundred and thirteen million adolescent girls are at high risk of dropping out of school due to the stigma regarding menstrual health. Further, there was a minimal conversation regarding menarche and menstrual health hygiene either at school or home due to the taboo many girls believe that bodies are purging evil spirits or that are injured once a month this is a shame-filled reality. Most of the mothers are also unaware of the bodily changes occurring in the female before puberty.
At least a few months before getting her first period a girl may have more clear vaginal discharge, hair growth in the pubic, and axilla region.
The normal premenstrual symptoms were not discussed with the girl such as breast tenderness, bloating of the abdomen, abdominal cramps, leg pain, etc which will vary from person to person.
Menstrual education is frequently taught with sex education in developed countries. Girls always prefer their mothers to be the primary source of information about menstruation and puberty. But information is often shared among friends and peers which may promote a positive outlook on puberty. The importance of menstrual education in a society determines the growth of people and their understanding regarding the menstrual cycle and its management. Where menstruation is taboo, girls tend to conceal the fact that they may be menstruating and struggle to ensure that they give no sign of menstruation and negligence will lead to improper menstrual hygiene. Effective educational programs are essential to provide children and adolescents for providing clear and accurate information regarding menstruation and menstrual hygienic practices.
Menstrual Hygiene Management (MHM) is outlined as concept of women and adolescent girls of maintaining a clean menstrual management material which was used to absorb or collect blood that has to be changed in privacy whenever necessary according to their
washing the body part as required, and has adequate access to facilities to dispose of the menstrual management materials‟.
Menstrual Hygiene Day was celebrated on May 28 every year as the annual awareness day. This day was celebrated every year which helps to break the silence and stigma regarding menstruation and build adequate awareness about the important role of menstrual hygiene management thus by enabling girls to reach their complete potential.
The important vision behind MH Day represents every woman and girl can manage her menstruation hygienically “ in safety, privacy, and dignity wherever they are”.
Menstrual hygiene in India is still a long way to go. In our country the awareness, education, and access to safe products related to menstruation are still at a very preliminary phase. The menstruation once again emphasized globally how deeply entrenched social norms regarding menstruation restrict girls' freedom and affect their both physical and mental health. The important aspect of menstrual hygienic practices is the use of safe or clean hygienic materials to capture or absorb menstrual blood. The other health problems related to inadequate or improper menstrual hygiene is anemia, infection, prolonged or short menstrual periods, and diseases of reproductive tracts and also affects the mental health and will lead to psychological problems such as anxiety, embarrassment, guilt, and shame.
These problems in India are preventable which are related to menstrual hygiene but are majorly due to lack of awareness and low socio-economic status in maintaining menstrual hygiene. Around more than 60,000 cases of cervical cancer deaths are reported every year from India and two-third of cases are due to poor menstrual hygienic practices.
1.1 BACKGROUND OF STUDY
About 80% of women in the world experience menstrual pain at some times in their life. Every woman suffers from periods of pain right from her teenage until their menopause periods. Most adolescents experience some discomfort during menstruation, especially on the first day. But in 5% to 10% of adolescent girls, the pain is severe enough to disrupt their daily routine life. Around 40% of adolescent girls suffer from menstrual pain along with certain premenstrual symptoms such as bloating, breast tenderness, a swollen stomach, lack of concentration, mood swings, irritable mood tiredness, and clumsiness.
GLOBAL SCENARIO
GLOBAL BURDEN OF DISEASE REGARDING THE MORTALITY RATES DUE TO UNSAFE WASH.
Fig-1.1: Shows the global burden of disease regarding the mortality rates due to unsafe wash.
Based on the study conducted by world bank (2016) globally around five hundred million women are lacking inadequate facilities for menstrual hygiene management. Insufficient water, sanitation, and hygiene facilities (WASH), particularly in most of the public places like
obstacles in a women‟s life. There has been a lack of separate toilets with doors that cannot be safely closed and the lack of adequate facilities to dispose of sanitary napkins and sufficient water for washing their hands to maintain their menstrual hygiene adequately. Certain evidence-based information shows that girls' absenteeism in schools is as a result of lack of menstrual hygiene management which directly implicates economic costs in their lives and the country (world bank 2016).
NATIONAL LEVEL
Indian Scenario Of Menstruating Women And Use Of Sanitary Napkins
Fig-2: Indian Scenario Of Menstruating Women And Use Of Sanitary Napkins
In India, around 355 million menstruating women come under 30 percent of the countries population. Even nowadays in India menstruation is a gender disparity. Certain myths are still prevalent and most of the girls are forced to drop out of schools at an early stage or retained at home every month during their menstruation. According to 2014, NGO Dasra report on title spot they found nearly 23 million school drop out girls annually are due to lack of menstrual hygiene management facilities which are due to lack of awareness and inadequate water supply and nonavailability of napkins. The report of this study also came up with some exciting numbers of that around 70%
of menstruating girls' mothers think that menstruation is dirty and 71%
of adolescent girls remain unaware of menstruation until attaining menarche.
According to the UNICEF report which pointed out that in Tamil Nadu, stated that 79 percent of girls are unaware of menstrual hygiene practices. Although the percentage was 66% in Uttar Pradesh 5 6% in Rajasthan and 51% in West Bengal and vice versa ( women for Swachh India 2018)
According to the National Family Health Survey (NFHS) 2015 -16 report, around 57.6% of women in India are using sanitary napkins. This includes 48.5% of women in rural areas and 77.5% of women in urban areas. The report also said that there is an acute lack of information about female reproductive health and sanitation-related issues among adolescent girls in rural areas.
STATE LEVEL
Tamil Nadu Scenario Of Menstruation Awareness among Women
Fig-1.3: Tamil Nadu Scenario Of Menstruation Awareness among Women
According to the Scoping Study on Menstrual Hygiene Management- PNP/NNP in November 2018 it indicates the UNICEF report which pointed out that in Tamil Nadu, 79 percent of girls are unaware of menstrual hygiene practices, celebrations are held for a girl who attains puberty as a practice. Friends and relatives are invited, and presents are given to the girl to mark this special occasion.
Nevertheless, before the commencement of the celebration, the girl is put through ritual seclusion where she is asked to sit on a wooden plank, in the corner of her house, veranda, or cowshed, for a period of 9 to 13 days from the moment her period commences. Sometimes, a hut is ma de with fresh leaves, either inside or outside the house, where she is asked to remain during the entire course of her menstrual period. During this time, she is given special food to eat. Whenever she goes to the toilet, she is advised to carry neem leaves or anything made of iron to ward off evil spirits. Many times, the girl is told about the social taboos and restrictions that accompany puberty. However, it is pertinent to note that the girl is rarely told about the different kinds of sanitary products available, the need for maintaining menstrual hygiene, or the ill effects of bad menstrual hygiene.
Use Of Various Forms Absorbents During Menstruation At Chennai
Fig1.4: Use Of Various Forms Absorbents During Menstruation At Chennai
At a study conducted by Tanvi Nitin (2017) among 100 girls in urban slum areas at Chennai reported that 76% of the adolescent girls did not know menses before menarche and the major source of information was mother in 84% of adolescent girls and only 16% of the girls commented that bleeding was initiated from their uterus. Mostly 60% of girls used sanitary pad and the rest used cloth pieces and 22%
of girls used water and no soap for hand washing during their menstruation. Also, there is a lot of multiple restrictions being practiced.
1.2 NEED FOR THE STUDY
Menstruation is a natural process, it has often been seen as secrecy in many parts of India. Menstrual hygiene becomes an important aspect in the life of an adolescent girl once she attains puberty and has been associated with varying characteristics. Being it is a demanding process and a reported significant source of morbidity too, hence it becomes prime importance to study the attitude and experiences of adolescent girls during menstrual hygiene.
In our country, girls do not consistently have access to education on puberty till attaining her menarche. Mostly 71 % of girls do not know about menarche and menstrual hygiene. Most of the girls ask their mothers for information and support but 70% of mothers consider that it as dirty talking regarding menstruation and feel shame on it.
According to a report on a landscape analysis regarding menstrual health in India, it is known that in our country due to economic issues girls do not have consistent access to Menstrual Hygiene Management products. Mostly 88% of women and girls in India use homemade alternatives such as clothes rags, hay, sand, etc which are not safe and leak-proof which leads to infection and shame among women and girls. A certain amount of girls lack access to sanitation facilities throughout the country. In our country, 63 million
national efforts have taken place to improve sanitation, increasing awareness, and seeking community support to manage menstruation privately but still its an ongoing process.
According to an article published in April 2020 in times group regarding menstruation “ the shame, superstition beliefs relating to culture and matter of secrecy affects the menstrual hygiene”. Also stating that 80 % of adolescent girls were taken by surprise, panic, and afraid after they got their first menses.
According to a study conducted by Muthusamy Sivakami(2019) it was showed that inadequate menstrual hygiene can lead to vario us health effects such as the increased risk of reproductive and urinary tract infections which will contribute to the negative attitudes among women towards menstruation which will produce a considerable burden on physical and psychological health in young girls.
Kristen Kurlander (2019) conducted a study to explore the common barriers among women in maintaining menstrual hygiene across the barriers to the global and domestic level as a literature review. He has concluded that menstrual hygiene is one of the human rights that need attention from the health care workers especially nurses.
Nurses should stress the importance of menstrual hygiene as it affects reproductive health which is also a specific role for the nurses.
According to a study conducted by Mansi Tiwari (2018) regarding menstrual practices in rural India indicates the hygienic practices rely on basic sanitation facilities, availability of napkins, the mindset of people regarding menstruation which is considered as something dirty and unclean and therefore various initiatives are necessary to rectify the problems regarding menstrual hygiene.
Neha Goyal, (2018) conducted a cross-sectional study in Haldwani among 574 adolescent girls (10-19 years) in four selected government and private schools. According to this study, the mean age of the girls is 14.95 years and the mean age of their menarche was 12.94 years. Most of the girls 441 (76.82%) had regular cycles of 21-35 days and that 95 (16.55%) girls had irregular menstrual periods. The statistical significance was the same in rural and urban areas related to the regularity in the menstrual cycle and the duration of flow in the majority 300 (52.26%) of girls was about 2-4 days which was followed by 5-7 days in 222 (38.68%) of girls.
According to a study conducted by Anjali Mahajan (2017) among school-going adolescent girls in Himachal Pradesh, it's ruled out that about 29%of girls have adequate knowledge,71% of girls do not have adequate knowledge regarding menstrual hygiene and its closely related to lack of information, superstitious beliefs, and cultural practices and education of the mother. The practice scores reveal that 19% has poor practice,69% has fair practice and 12% had a good practice.
For assessing the menstrual hygiene completely the nurses can determine the needs of the adolescent by verbal interviews and physical examination to promote and restore health and prevent illness and alleviate suffering. As menstrual hygiene is a growing human rights issue that needs the attention of health professionals and nurses, in particular, should pay attention to the issues of menstrual hygiene and also reproductive health due to poor menstrual hygiene which affects the health and wellbeing of the adolescent girls.
Nurses always play a bridge role between the people and the health care system. Regarding the individual role, nurses have the responsibility to advocate for the health and well being of the individual
which she performs through a thorough assessment of the physical and psychological states of the individual.
After going through various studies the researcher thinks that menstrual hygiene is one of the most important features of women‟s life right from the menarche till menopause. As lack of menstrual hygiene will lead to various impacts on their health such as infection, reproductive tract problems, and certainly various studies indicate it‟s also a major cause of cervical cancer. Also, the researcher felt that the deep understanding of this section about awareness of menstruation and the impact of menstrual health among adolescent girls' will enhance the knowledge on the menstrual cycle, menstrual hygiene practices.
The present need of this study is to ascertain the prevalence of menstrual problems among late adolescent Indian girls, their knowledge, attitude and experiences and practices of menstrual hygiene and its impact on their performance, hygienic practices, and treatment approaches and the researcher selected the late adolescent to have a view of how far they received information during their early adolescent period to derive at a conclusion of the need for menstrual hygiene.
1.3 STATEMENT OF THE PROBLEM
A qualitative study to explore the knowledge, attitudes and experiences of adolescent girls regarding menstrual hygiene during menstruation at selected college at Chennai.
1.4 OBJECTIVES
1) To explore the knowledge and attitude of adolescent girls pertaining to menstrual hygiene during menstruation.
2) To explore the major concerns and realities regarding menstrual hygiene among adolescent girls during menstruation.
1.5 OPERATIONAL DEFINITION
KnowledgeKnowledge refers to the basic existing knowledge on menstruation, menarche, and level of awareness regarding menstrual hygienic practices among adolescent girls.
Attitude
Attitude means how the adolescent girls feel towards their menstrual cycle, myths, concepts regarding menstrual hygienic practices during menstruation.
Experiences
Experiences refer to the socio-cultural beliefs and taboos regarding menstrual hygiene that the adolescent girls are adopting and practicing during menstruation.
Menstruation
Menstruation is the regular natural change that occurs in the female reproductive system in every female after attaining menarche in the late adolescent period.
Menstrual Hygiene
Menstrual hygiene is the measure adopted by the adolescent girls' such materials used as absorbents, time of changing the absorbents, and maintaining hygienic practices during menstruation.
Adolescent Girls
Adolescent girls refer to the age group of 17-19 years who come under the late adolescence.
1.6 ASSUMPTIONS
The adolescent girls may be having moderate knowledge regarding menstruation and menstrual hygiene.
The adolescent girls may have a negative attitude towards menstruation and menstrual hygiene.
The adolescent girls may practice inadequate menstrual hygiene.
1.7 DELIMITATION
The samples are limited to 5 late-adolescent girls.
The data collection periode is limited for a period of four weeks.
CHAPTER-II
REVIEW OF LITERATURE
A review of literature is a systematic and logical arrangement of information that is carefully selected from scientific writings. The ultimate purpose of a good review of literature is to find out the best available shreds of evidence from various updated sources and organize them scientifically within the framework of the current research project.
According to Florence king, she explained that “Gradually my whole concept of time changed until I thought of a month as having twenty-five days of humanness and five other days when I might just as well have been an animal in a steel trap.”
In this study, the review of literature were classified under the following sections
SECTION A: Reviews related to physiological changes during menstruation.
SECTION B: Reviews related to menstrual problems among adolescent girls.
SECTION C: Reviews related To Knowledge, Attitude, And Practice on menstruation and menstrual hygiene.
SECTION D: Reviews related To Menstrual Health.
SECTION E: Reviews related To Programmes on Menstrual Hygiene Of Adolescent Girls
SECTION A: REVIEWS RELATED TO PHYSIOLOGICAL CHANGES DURING MENSTRUATION
Niru Shamsun (2018) conducted a study among female nursing students in Dhaka city to assess the knowledge and practice of menstrual
63.2% of the respondents were 20 years and below and most of them of about 74.5% were unmarried and of about 60.4% of them were studying diploma in nursing and the rest of the participants (38.6%) were B.Sc.
nursing students.About 72.6% of the participant's mothers had an education status of above higher secondary level and most of the participants (61.3%) were from nuclear family and half (51.9%) of the participants mentioned that menstruation is only the uterine bleeding and the majority (67.0%) of the participants were surprised during their menarche. Most of the participant's sources of information about menstruation before menarche were their sister (95.3%), followed by their friend (92.5%), rest being their mother (67.9%) and the rest mentioned the teacher (62.3%). Mostly 76.5% of the participants mentioned that their mode of disposal of absorbents was dustbin and most of them (68.9%) and they used water and soap to clean their genital area during menstruation. It was concluded that there is a need for more awareness regarding the information on good menstrual hygiene practices.
Manisha G (2017) conducted an exploratory study among 150 school going adolescent girls at Pune to assess the stress experiences during menstruation and the results of the study showed that 46.6% of girls have moderate /average stress,43.3% of girls have mild/low level of stress and 10% of them are having severe /high level of stress due to physiological and psychological experiences during menstruation. It was concluded that stress hampers the routine activities of adolescent girls and hence they are a need for awareness programs to manage the stress during menstruation.
Evans Paul et al., (2016) conducted a cross-sectional study involving 293 undergraduate students in Northern Ghana to assess the relationship between knowledge on menstruation and safe menstrual practices. The participant's knowledge on menstruation was an average
of 57.3% but regarding their menstrual hygiene practice which was good to about 80.2% and their mean age was p = 0.005 and their course of study was p = 0.008 which have been significantly influenced by the participant's knowledge on menstruation with older students as well as the medical and midwifery students who are being most knowledgeable. The Muslim rather than Christian female students have been practicing better menstrual hygiene (p = 0.0001). The average knowledge score on menstruation showed the deficit of knowledge on the anatomy and physiology of the female reproductive system among the students and hence by increasing their knowledge on menstruation shows a positive and effective relationship on the practice of good menstrual hygiene.
Aarohi M (2015) conducted a cross-sectional study among 400 adolescent girls at Rajkot district to assess the awareness and practices of menstrual hygiene and the results implicated that the mean of the girls was 14.90+/- 2.90 years and the majority of the girls are educated only up to 9 to 11 standard and among the participants about 73.25%
girls were using clothes and only 26.75% are using sanitary napkins.
The physiology of menstruation was known to 5.7% of the girls only and the source of bleeding was known to 24% of girls Physiology of menstruation was known to only 5.7% of school-going girls. About 99%
of girls were practicing cleaning their genitals with water and infection - related awareness was present among 56.25% of girls and hence the girls are lacking knowledge regarding the physiology of menstruation and infections due to poor menstrual hygienic practices. So adequate knowledge should be provided to them.
SECTION B: REVIEWS RELATED TO MENSTRUAL PROBLEMS AMONG ADOLESCENT GIRLS
Julie Hennegan et al., (2019) undertook a systematic search in 76
selected to identify qualitative studies of women's and girls' experiences on menstruation in low- and middle-income countries. By the synthesis in the study, they identified overarching themes and their relation ships to develop a directional model of menstrual experience. The socio - cultural theme includes menstrual stigma and gender inequality, influencing experiences by limiting knowledge about menstruation and limiting social support, and shaping internal and external enforced behavioral expectations. In this study they have also showed inadequate physical infrastructure to support menstruation, as well as an economic environment in access to affordable menstrual materials. Based on this study the menstrual experience included multiple themes such as menstrual practices, perceptions of practices and environments, confidence, shame and distress, and containment of bleeding and odo ur.
These themes are interlinked and contribute to negative impacts on the women and these impacts included harm to physical and psychological health as well as education and social engagement.
Priya Jain et al ., (2018) conducted a study among 50 adolescent girls (12-19 yrs) and the aim was to collect the insight from experiences of adolescent girls in psychological and physical challenges which they come out from social restriction, taboos and beliefs and practices related to menstruation. The findings of the study was based five major themes which the adolescent girls reported affecting their well-being, identity, and their life outcomes. According to the first theme, it denotes that first menstruation follows bizarre experiences and menarche gave them bizarre and unusual experiences. The second theme was that regarding restrictions during menstruation and the majority of the girl verbalized that they have to face many restrictions in their social and religious lives. Based on the third theme which implies that menstruation produces negative impacts on their well-being. The fourth theme was that social awareness regarding menstruation may have the chance to
lessen the negative outcomes. Based on the fifth theme, it was denoted that there is a multitude of myths that are associated with menstruation.
Thus, according to these study findings which revealed that the adolescent girls exhibited little knowledge about menstruation before their menarche and internal physical process of menstruation as well as they faced adverse psychosocial and physical problems in their lifetime during menstruation. The negative feelings during menstruation like panic experiences, inhibitions in social or day to day life, the prohibition to take part in religious activities and cooking food were also conveyed by them and the major concern rely on developing coping strategies and benefit the prevention.
Yasmin Mohamed et al., (2018) conducted a study among 307 adolescent girls, women, and men by focus group discussion and interviews in Papua new guinea, Solomon Islands, and Fiji. This study aims to present evidence on menstruation-related beliefs contributing to restrictive practices prevalent in the areas. They analyzed using an inductive thematic approach and the participants describe a range of attitudes and beliefs that restrict the behavior of menstruating women and girls. The themes included the belief that menstrual blood is „dirty‟
and when menstruating, girls and women can bring „bad luck‟ to men and usually secrecy and shame which are associated with menstruation and the beliefs regarding menstruation and about the impact of its certain influencing behaviors on menstruation and health. Most of the restrictive practices in menstruation are prevalent in PNG and SI than Fiji and more common in rural compared with urban areas but some of the restrictions like avoidance of household chores were considered desirable by women themselves. Many participants identified certain restrictions like not being able to attend church. Health Education initiatives for women and girls are needed to address discriminatory attitudes and beliefs that contribute majorly to context to unwanted
restrictions and to support enabling attitudes and beliefs regarding menstruation.
Linda Mason et al., (2017) conducted a qualitative study across three states in India among 85 boys aged 13-17 yrs from 8 schools as a focus group discussion and chosen a concept to represent the cultural and socioeconomic diversity. The study results were organized into three main themes based on the boy's knowledge of menstruation, source of knowledge, and attitudes towards menstruation and menstruating girls. The Knowledge aspect of boys comprised three aspects of biological function which were generally poorly understood. Most of the boys gathered knowledge from informal sources, from overhearing conversations among the people or observing cultural rituals. But a few boys openly showed a negative attitude, although it is a minority voiced the idea that menstruation is a „disease‟ and they avoid that. Most of the boys were sympathetic to their menstruating sisters and wanted to support them.
Alexandra J Hawkey et al., (2016) conducted a study among 82 participants of migrant and refugee women resettled in Sydney, Australia, and Vancouver, Canada. He conducted semi-structured individual interviews among seventy-eight women and 15 focus group discussions. The main aim of this study was to explore the Experiences and Constructions of Menarche and Menstruation Among Migrant and Refugee Women.They have analyzed the data using thematic decomposition and identifying the overall theme “cycles of shame” and two core themes. In the aspect of becoming a woman, participants told menarche as a marker of womanhood which is closely linked to marriage and childbearing. In terms of the unspeakable part, women conveyed negative facts of menstruation, as it is shameful, something to be concealed, and polluting. Finally based on the study the migrant and refugee women‟s experiences of menarche and menstruation which is
essential for culturally safe medical practice, health promotion, and health education related to menstruation and menstrual hygienic practices.
Linda Mason et al., (2015) conducted a study in Siaya County in rural western Kenya and a sample of 120 adolescent girls aged 14 –16 years were taken and 11 focus group discussions are done and were analyzed thematically. From the data gathered from six FGDs with parents and community members, he came out with the themes like lack of preparation for menarche, maturation, and sexual vulnerability, and considered menstruation as an illness and secrecy and most of them consider as fear and shame of leaking out and coping with inadequate alternatives and the stage of paying for pads with sex and other problems with menstrual hygiene. Most of the girls were unprepared and had poor reproductive knowledge but had implemented practical methods to cope with menstrual difficulties, often alone. There is only sparse or inaccurate parental and school support of menstrual needs.
Girls‟ physical changes prompt boys and adults to target an d girls are getting ready for marriage. Most of the Girls admitted others rather than themselves were absent from school during menstruation, due to physical symptoms or inadequate sanitary protection and they expressed them in terms of difficulty in engaging in class due to fear of leakage and smelling and teasing by their colleagues. Sanitary pads are good but prolonged use causing chafing due to time constraints. They used improvised alternatives which include the rags and grass, which were prone to leak, caused soreness.
Alicia Botello Hermosa et al., (2015) conducted a qualitative study among 24rural and urban women of different age groups ranging from young (18-25,26-35), middle-aged (36-65 years), and elderly (>65 yrs) in Seville, Spain using grounded theory. They have conducted a
of the study implicated that they have more fear related to the use of water during menstruation thinking as it might be harmful to there health. Till nowadays there are ancient misconceptions despite health education campaigns the lack of women s knowledge about reproductive health is more.
Marni Sommer et al ., (2015) conducted a qualitative study as a comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia, and Ethiopia considering the similarities regarding the culture in bringing out negative attitudes towards menstruation and the limited provision of health information and insufficient facilities within schools are common. The findings of the study showed that there is a significant difference regarding menstrual myths, parent and child dynamics, sources of guidance, and student to teacher relations. It was found there is a critical knowledge gap around menstruation and girls' education which should be taken into consideration to improve positive attitude regarding menarche and specific measures to manage menstrual hygiene.
Ida Emelie Brantalid et al., (2015) conducted a qualitative study using a narrative approach among 12 women between the age group of 18 and 48 years in Sweden to describe the women‟s experiences of menstruation in their lifespan. By using the thematic analysis, it was found that menstruation which is a complex phenomenon binds the women together and the menstruation is considered as a private matter and the menstrual bleeding should not be revealed to anyone as a matter of fact. But overtime menstruation becomes a natural part of women's life and gender identity and the health professionals pla y a major role in supporting women to deal with menstruation.
Deepanjali Behera (2015) conducted a study qualitatively using convenience sampling to select 32 adolescent girls among which eight
girls did not attend menarche and 24 girls attended menarche f rom rural Maharashtra in India. The main aim of this study was to explore the perceptions, practices, and experiences of rural Indian adolescent girls related to menarche and menstruation. They have conducted focus group discussions among the participants, and analysis is done by thematic analysis. In this study, most of the participants, especially girls who have not attended menarche lacked adequate knowledge about menstruation and its processes and their source of information was only through their friends whereas mothers played only a limited role in that.
The financial concerns are the major reason for their sanitary napkins usage and only some of the girls used sanitary napkins whereas others used old clothes. The major concern was that lack of awareness and appropriate care during menstruation will lead to menstrual morbidities which has a greater impact on their educational goal attainment.
Ashok Pandey (2015) conducted a focus group discussion among adolescent girls in the age group of 12-18 years in two private and public schools at Samakhushi, Kathmandu valley. From this study, we come to know that young adolescent girls describe the onset of menarche as a shocking or fearful event. Mostly the information provided was regarding the use of cloth, the restrictions in participating in rituals, and the behavior towards males and the aspect of the polluting touch and the equality polluting potential of the menstrual cloth. The socio-cultural beliefs which were mostly imposed by their mothers are on the concept of pollution that they should practice during menstruation and according to Hindu culture women are not allowed to pray or fast nor is she allowed touching the holy book and temple and the girls are considered pure only after purification after the five days of menstruation and if unknowingly they touch anything before that her mother will sprinkle holy water over that. Most of the parents considered that as a sin of sending their girls to schools during their
menstruation time and its ok of them failing in exams at a later stage so the girls are not allowed to go to school. Mostly girls bath daily during their menstruation and some bath on their third day. Considering the school absenteeism the infrastructure of the toilet plays an important role in case if the lock is lacking in public schools they usually go in turns of pairs and want to wait for each other which will lead to reluctance in them and waiting will lead to the chance of infection. The FGD findings related to sanitary napkins most of the time they cannot afford to buy sanitary napkins so they use napkins when going out and at home, they use old clothes and they use one cloth for a minimum two to three cycles. However, girls told the reuse of cloth will depend on the amount of bleeding, and if it's heavy they won't reuse the clothes. Safety sanitary pads are only frequently used in school times.
SECTION C: REVIEWS RELATED TO KNOWLEDGE, ATTITUDE, AND PRACTICE DURING MENSTRUATION.
Alharbi KK (2018) conducted a cross-sectional study among 500 students in prince noura university in Saudi Arabia to assess the knowledge, readiness, and myths regarding menstruation and the results were the participant's main source of information was their mothers 60%, whereas only 4% considered doctors and nurses as a source of information. The study revealed that the knowledge, attitude, and readiness of participants about menstruation were really poor. The majority of the participants(73.4%) were not able to correctly recognize why girls get their period. Hence it concluded the importance of increasing awareness and giving accurate information using the scientific source in schools, colleges, or health team members.
Soheila Rabiepoor et al ., (2017) conducted a descriptive cross- sectional study among350 female students in the Urmia city by using multistage sampling in urban areas who were selected using multistage sampling of urban areas. The average age of students and their average
age of menarche are 15.96 and 12.29 respectively. The study showed that by increasing the knowledge and attitude we can improve the positive feelings about menstruation, acceptance of menstruation, and acceptance of menstruation.
Ram Naresh Yadav et al ., (2017) conducted a cross-sectional study with a self-structured questionnaire among 276 students of the seventh and eighth grades of about 11 schools. According to this study, about 67.4% of girls had fair knowledge and 26.4% had good knowledge of menstrual hygiene management. Among 141 adolescent girls, only 56 were maintaining good menstrual hygiene practices and half of them had a positive attitude regarding menstrual hygiene practices.
Anjali Mahajan et al., (2017) conducted a descriptive cross- sectional study using convenience sampling among 9th to 12th standard girls in a government girls school in Shimla, Himachal Pradesh, and selected 100 adolescents, girls. The study results show that about 29%
and 71% had adequate and inadequate knowledge regarding menstrual hygiene respectively. The study also shows that 19%,69%, and 12% o f girls had a poor, fair, and good score on menstrual hygiene practices. It also revealed that there is a positive correlation between knowledge and practices of menstrual hygiene.
Navya Sri Sreenivasa et al., (2017) conducted a Cross-Sectional Study with a probability proportionate sampling technique among 400 adolescent girls. The mean age of the adolescent girls are 14.16 and the study results showed that about 66.25% of students had information regarding menstruation before menarche and their mothers are the source of information and 80% of the girls believed menstruation as a bothering event and the majority of them use napkins for their menstruation.
Vincenzo De Sanctis et al ., (2016) conducted a literature review regarding dysmenorrhea among adolescents and young adults in different countries. Dysmenorrhea is a major gynecological problem in adolescents. Despite its high prevalence rate and its negative effects, most of the girls do not seek medical advice and consume medication of their own. Appropriate management and counseling are necessary to cope with the impacts of dysmenorrhoea among adolescents.
Jing Jing Su et al., (2016) conducted a study in promoting the menstrual health of adolescent girls in china among 112 adolescent girls.
Initially, the knowledge, attitudes, and practices of adolescent girls are assessed and a tailored nursing intervention was given which has a greater on improving the positive attitude among girls towards menstruation and confidence regarding their menstrual behavior and coping strategies to relieve pain and stress during that period.
Aruna Marati Savanthe et al .,(2015) conducted a cross-sectional study among 1160 adolescent girls. Only about 24.7% of girls are aware of their menstruation before menarche and 48% of them have dysmenorrhea and among them, their mothers are the source of information. Most of the girls have certain cultural beliefs and followed certain restrictions. As a whole 78.9% of girls used sanitary napkins and 25.6% of girls were using both cloth and napkin.
Muthusamy Sivakami et al .,(2015) conducted a survey in three states of India regarding the effects of menstruation on girls and their schooling and regarding the facilitators of menstrual hygiene. It was explored that most of the girls suffered from absenteeism to schools, not only that they also suffered from their depletion of school life. The girls also lack adequate knowledge of menstruation before menarche and lack of facilities which leads to a major drawback in maintaining menstrual
hygiene. Most of the girls also faced certain barriers during menstruation.
Shivaleela P Upashe et al., (2015) conducted a cross-sectional study in Nekemte Town, Western Ethiopia among 828 high school students using a multistage sampling technique. According to this study, 60.9% of girls had good knowledge and 39.9% of girls have good practice regarding menstrual hygiene. The study results suggest that there is a positive association between good knowledge of menstruation and the educational status of the mother and having tv or radio. And the study also finds a significant relationship between the good practice of menstrual hygiene and the educational status of the mother and earning permanent pocket money from parents.
Arpan Shailesh Yagnik (2015) conducted a quantitative study using a structured questionnaire among 475 samples of men and women using a multistage cluster sampling technique in Ahmedabad city in India. In this study its found that the knowledge, attitude, and cognitive involvement in menstruation were high among the participants whereas the behavioral involvement and menstrual practices are low among them.
Vinod Ramdasji Wasnik et al., (2015) conducted a prospective observational study among schoolgoing 435 adolescent girls in rural population of India in gujarat. In this study 17.9 % of girls reported premenstrual symptoms, 81.3% of girls had abdominal pain during menstruation, 33.5% of girls use sanitary pads and 41.8% of girls use old clothes. These are some of the patterns and problems of scho ol- going adolescent girls in rural areas in India.
SECTION D: REVIEWS RELATED TO MENSTRUAL HEALTH:
Suneela Garg (2020) conducted a study in exploring the myths in menstruation in India and the ways combating it among the school going girls in Delhi. Due to this most of the girls are school dropout when they start menstruating and lack of sanitation facilities are also a major reason. In combating these issues the women empowerment is the major way to make their decisions, health education and mass campaigns are necessary for implementing good menstrual hygienic practices and eliminating the taboos.
Kristen Kurlander (2019) conducted a study to explore the common barriers among women in maintaining menstrual hygiene across the barriers to the global and domestic level as a literature review. He has concluded that menstrual hygiene is one of the human rights that need attention from the health care workers especially nurses.
Nurses should stress the importance of menstrual hygiene as it affects reproductive health which is also a specific role of nurses.
Shantanu Sharma et al., (2019) conducted a systemic review and meta-analysis on menstrual hygiene preparedness in schools in India. In this meta-analysis, he has found that less than half of the girls are aware of menstruation before menarche and teachers are the least sources of information regarding menstruation for girls and most of the schools lack toilet facilities and hence he concluded that the menstrual hygiene management system has to be improved in our country.
Neha Goyal (2018) conducted a cross-sectional study in Haldwani among 574 adolescent girls (10-19 years) in four selected government and private schools. According to this study, the mean age of the girls is 14.95 years and the mean age of their menarche was 12.94 years.
Most of the girls 441 (76.82%) had regular cycles of 21-35 days and
