A qualitative study of adolescent girls’ experiences of menarche and menstruation in rural Tamil Nadu, India

Anise Gold-Watts,Marte Hovdenak,Marguerite Daniel,Subramanian Gandhimathi,Rajamani Sudha,Sheri Bastien

doi:10.1080/17482631.2020.1845924

Abstract

ABSTRACT Background: In low- and middle-income countries, women and girls experience menstrual hygiene management-related health and social challenges such as urinary tract infections, social stigma, and school and workplace absenteeism. Purpose: In this study, we sought to explore how adolescent girls in rural Thirumalaikodi, Tamil Nadu, India experience menarche and menstruation, how their experiences connect to the sociocultural context, and what strategies they use to manage menstruation. This study also informed the adaptation and development of a school-based water, sanitation, and hygiene intervention. Methods: We conducted ten semi-structured qualitative interviews with adolescent girls in ninth standard from June-July 2018. Data were analysed using a thematic network approach. Results: Findings revealed that menarche inaugurates biological transitions of puberty and cultural codes that shape gender norms. Gender norms in turn generate, maintain, and reproduce stigmatizing attitudes, beliefs, and practices that influenced the development of coping mechanisms at home and at school. Resulting adaptations to the intervention consisted of two activities (school lesson and an extracurricular activity) that address knowledge gaps and myths. Conclusions: This study demonstrates the importance of qualitative research in unpacking adolescent girls’ experiences with menarche and menstruation. Study findings also show how formative research can contribute to the adaptation and development of a contextually and culturally-relevant water, sanitation, and hygiene intervention.

Highlights

Adolescence marks a time of physical, emotional, cog nitive, and behavioural growth and development
Whilst there has been increased focus on the importance of incorporating menstrual hygiene management (MHM) within health promotion interven tions aiming to address water, sanitation, and hygiene (WASH) challenges, there is a need to develop a better understanding of what approaches are effective and in which contexts
This is an issue of substantial public health importance, given that adolescent girls espe cially, may face a variety of MHM-related health and social challenges such as urinary tract infections, repro ductive tract infections, social stigma, shame, and school absenteeism

Summary

Introduction

Adolescence marks a time of physical, emotional, cog nitive, and behavioural growth and development. Whilst there has been increased focus on the importance of incorporating menstrual hygiene management (MHM) within health promotion interven tions aiming to address water, sanitation, and hygiene (WASH) challenges, there is a need to develop a better understanding of what approaches are effective and in which contexts This is an issue of substantial public health importance, given that adolescent girls espe cially, may face a variety of MHM-related health and social challenges such as urinary tract infections, repro ductive tract infections, social stigma, shame, and school absenteeism The development of effective health promotion interventions to address MHM, includes menstrual education and access to absorbents, soap, clean water, and private sanitation facilities (toilets and place for absorbent disposal) (Sommer & Sahin, 2013) These elements allow for the safe, supportive, and dignified management of men struation to maintain health (Sommer, Caruso, et al, 2016; Sommer, Chandraratna, et al, 2016).

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