Uncovering the challenges to menstrual health: Knowledge, attitudes and practices of adolescent girls in government schools of Delhi

Abstract

Background: Menstrual hygiene management is a significant issue affecting the health of women around the world. Lack of knowledge and awareness about menstruation and the silence surrounding it is a risk factor for all women. Objective: The objectives of this study were to elicit the knowledge, attitudes, and practices of adolescent girls (13–15 years) regarding issues related to menstruation and to assess the barriers that prevent them from practising menstrual hygiene. Design and Setting: Cross-sectional study involving 187 adolescent girls from four government schools of Delhi. Method: Information was obtained using a mixed-methods approach, including a pretested questionnaire and focus group discussions with girls, parents and school staff. Results: Only 40% of girls were aware of menstruation prior to menarche. The majority of girls (95.7%) did not know the source of menstrual blood. About two-thirds (65.8%) of girls were unaware that the menstrual blood flow could be affected by anaemia. Approximately 17% of the girls believed a woman to be impure during menstruation. About half of the girls absented themselves from school for the first 2–3 days of their menstrual cycle. Thirty-four percent girls did not bathe at all during their menstrual period and a similar number of girls did not bathe daily while menstruating. Dysmenorrhoea was a common problem among 60% of girls. The mothers of girls were identified as the major source of information about menstruation. However, mothers believed that school teachers should also be imparting this knowledge. Teachers expressed the belief that menstrual hygiene was poor among girls. The provision of free sanitary napkins in school has improved hygiene levels. Conclusion: Strategic behaviour change interventions should be designed involving all stakeholders to ensure a sustained change in knowledge, attitude and practices so as to ensure the better health of adolescent girls.