Abstract
BackgroundQualitative data show negative impacts of menstruation on health and education in many settings, but there are few longitudinal quantitative studies of the impact of menstruation. We analyse associations with menstrual anxiety and school attendance in a study of Ugandan secondary school students.MethodsData were from a longitudinal pilot study of a menstrual health intervention (MENISCUS), conducted in two secondary schools in Entebbe sub-district, Uganda. Self-completed menstrual-related data, including menstrual anxiety, were collected from 232 participants pre- and post-intervention. A sub-cohort of 100 randomly-selected post-menarcheal girls were asked to self-complete daily diaries during 10 months of follow-up, with data on menstrual flow, pain, and school attendance. We used multivariable logistic regression to estimate associations with menstrual anxiety among all girls at baseline, and random-effects logistic regression to estimate associations of menstrual characteristics with school non-attendance for 3 months pre-intervention in the sub-cohort, adjusting for within-girl clustering.ResultsOverall, 130/222 (58.6%) of menstruating girls reported being anxious about their next period. Menstrual anxiety was higher in those not living with their mother (adjusted odds ratio (OR) = 1.91; 95% confidence interval (CI) 1.01–3.60), believing menstrual myths (aOR = 1.83; 0.95–3.50 for not agreeing that it is healthy for a girl to run, dance or cycle during her period; aOR = 1.97; 1.04–3.73 for agreeing that when a girl has her period she is unclean), lower menstrual confidence (aOR = 2.49; 1.33–4.65 for avoiding physical activity during her period; aOR = 1.68; 0.89–3.17 for not feeling comfortable to talk to other girls about her period; aOR = 2.89; 1.28–6.54 for agreeing that boys/girls tease them about their periods; and aOR = 2.27; 1.21–4.27 for worrying about being teased during her period). Those with lower knowledge about menstruation were less likely to report anxiety (aOR = 0.44; 0.23–0.84). During the pre-intervention period of the sub-cohort, school non-attendance was associated with menstrual pain, with 21.7% of girls missing school on days when they reported pain vs. 8.3% on days when no pain was reported (aOR = 3.82; 1.66–8.77).ConclusionsMenstruation causes substantial anxiety in Ugandan schoolgirls, and menstrual pain is associated with missing school on period-days. Menstrual health interventions should address socio-cultural aspects of menstruation to reduce anxiety, and provide education on pain management strategies to support school attendance.
Highlights
Qualitative data show negative impacts of menstruation on health and education in many settings, but there are few longitudinal quantitative studies of the impact of menstruation
Factors associated with anxiety about period Overall, 222 girls (95.7%) reported that they had started menstruating at baseline and were included in analyses of menstrual anxiety
In the multivariable model including variables from all levels (Model B), the following factors were associated with being more likely to report anxiety about their period: not living with their mother, not agreeing that it is healthy for a girl to run, dance or cycle during her period, agreeing that when a girl has her period she is unclean, avoiding physical activity during her period, boys/ girls teasing her during her period and worrying about being teased during her period
Summary
Qualitative data show negative impacts of menstruation on health and education in many settings, but there are few longitudinal quantitative studies of the impact of menstruation. Most quantitative research describing menstrual cycles in girls has been cross-sectional [10,11,12,13,14,15,16,17,18] Many of these studies (from India, Nigeria, Egypt, Italy, Jordan, Ethiopia, Ghana and Morocco) focused on menstrual irregularity, some studies reported on menstrual pain. A systematic review of quantitative studies found associations between menstrual practices and both school attendance and performance in cross sectional studies [2] and several menstrual health (MH) interventions have been developed with an aim of improving school attendance [1, 21, 22]. A better understanding of the menstrual characteristics (e.g. flow, pain, day of menstruation) associated with school attendance would assist in the design of such interventions to improve school attendance, performance and broader health and wellbeing for girls and young women
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