Abstract
To assess the prevalence of menstrual hygiene management (MHM) knowledge and practices among adolescent schoolgirls in Indonesia, and assess factors associated with poor MHM and school absenteeism due to menstruation. A cross-sectional survey enrolled a representative sample of urban and rural school-going girls aged 12-19years in four provinces of Indonesia. A semi-structured, self-administered questionnaire obtained socio-demographic characteristics, knowledge, practices and attitudes related to menstruation, MHM and school absenteeism. School water, sanitation and hygiene (WASH) facilities were also assessed. Univariate weighted population prevalence was estimated and multivariable logit regression analyses applied to explore associations. A total of 1159 adolescent girls with a mean age of 15years (SD=1.8) participated. Most girls (90.8%, 95% confidence interval (95% CI)=79.7-96.1) had reached menarche. Over half (64.1%, 95% CI=49.9-76.2) reported poor MHM practices, and 11.1% (95% CI=8.1-15.2) had missed one or more days of school during their most recent menstrual period. Poor MHM practices were associated with rural residence (Adjusted odds ratio (AOR)=1.73, 95% CI=1.13-2.64), province (various AOR), lower school grade (AOR=1.69, 95% CI=1.05-2.74) and low knowledge of menstruation (AOR=3.49, 95% CI=1.61-7.58). Absenteeism was associated with living in rural areas (AOR=3.96, 95% CI=3.02-5.18), province (various AOR), higher school grade (AOR=3.02, 95% CI=2.08-4.38), believing menstruation should be kept secret (AOR=1.47, 95% CI=1.03-2.11), experiencing serious menstrual pain (AOR=1.68, 95% CI=1.06-2.68) and showed mixed associations with school WASH facilities. High prevalence of poor MHM and considerable school absenteeism due to menstruation among Indonesian girls highlight the need for improved interventions that reach girls at a young age and address knowledge, shame and secrecy, acceptability of WASH infrastructure and menstrual pain management.
Highlights
Menstrual hygiene management (MHM) refers to the specific hygiene and health requirements of girls and women during menstruation, including the information, materials and facilities needed to manage menstruation effectively and privately
MHM-related knowledge, attitudes, practices and impacts among girls in Indonesia are not well understood and, as a result, an evidence-base for programming and interventions to improve MHM is lacking. To address this information gap, a school-based survey among adolescent girls was conducted in Indonesia to assess the prevalence of MHM practices and school absenteeism due to menstruation, to explore factors associated with poor MHM and absenteeism, and to identify key targets for policy and programme interventions
Our study identified poor MHM practices among half to three quarters of adolescent schoolgirls in Indonesia, and among those in rural areas, in lower school grades, and with lower knowledge of menstruation
Summary
Menstrual hygiene management (MHM) refers to the specific hygiene and health requirements of girls and women during menstruation, including the information, materials and facilities needed to manage menstruation effectively and privately. MHM-related knowledge, attitudes, practices and impacts among girls in Indonesia are not well understood and, as a result, an evidence-base for programming and interventions to improve MHM is lacking. To address this information gap, a school-based survey among adolescent girls was conducted in Indonesia to assess the prevalence of MHM practices and school absenteeism due to menstruation, to explore factors associated with poor MHM and absenteeism, and to identify key targets for policy and programme interventions
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