To asses knowledge and attitude

regarding mensturation among urban

and rural adoloscent girls

Mentor
Dr Poonam khattar

Presented By
Dr Manju Malik
 INTRODUCTION

• Adolescence is the period of transition

• from childhood to adulthood.
• WHO has defined adolescence as the age group
of 10-19 years
• The onset of menstruation is one of the most
important changes occurring among girls during
the adolescent years
.
• Menstruation is still regarded as something unclean or
dirty in the Indian society. Because of various myths,
misconceptions and restrictions practiced during
menstruation, the adolescent girls often develop negative
attitudes towards this natural physiological phenomenon

• Majority of the girls lack scientific knowledge about

menstruation and puberty. Adolescent girls often are
reluctant to discuss this topic with their parents and often
hesitate to seek help regarding their menstrual problems.
If you want to change the world, invest in an adolescent
girl

That’s what we believe and that’s why we work to elevate

the interests, needs, and rights of adolescent girls on the
global agenda.

There are more than 600 million adolescent girls in the

developing world alive today, making up half of the
largest youth generation in history.

The opportunities adolescent girls have in the coming

years will shape their lives and the lives of those around
them
Ensure girls have access to quality education and health care;
adequate livelihoods; and freedom from violence, HIV/AIDS, and
harmful practices such as child marriage and female genital
mutilation
Adolescent girls (10-19 years old) comprise about 22% of
women in India.

They are the mothers of tomorrow and the burden of planned

reproduction rests on them.

Yet very little is known about their knowledge and attitudes

towards reproductive health issues
Unhygienic menstrual practices may affect their health such
as increased vulnerability
to RTIs (Reproductive Tract Infections) and PIDs (Pelvic
Inflammatory Diseases) and
other complications. Use of sanitary pads may be increasing
but not among girls from
rural and poor families. Girls should be educated about
“menstruation and healthy
menstrual practices” through expanded programme of health
education in schools.
Data on their level of knowledge and practices are beneficial
for planning programmes
for improving their awareness level.
Review of literature
What is menstruation?
Menstruation is a woman's monthly bleeding.

When you menstruate, your body sheds the

lining of the uterus (womb).

Menstrual blood flows from the uterus

through the small opening in the cervix and passes out
of the body through the vagina .

Most menstrual periods last from 3 to 5 days

What is a typical menstrual period like?

During period, you shed the thickened uterine lining

and extra blood through the vagina.

Period may not be the same every month.

Periods can be light, moderate, or heavy in terms of

how much blood comes out of the vagina. This is called
menstrual flow.
The length of the period also varies. Most periods last
from 3 to 5 days. But, anywhere from 2 to 7 days is
normal.

For the first few years after menstruation begins, longer

cycles are common.

A woman's cycle tends to shorten and become more

regular with age. Most of the time, periods will be in the
range of 21 to 35 days apart.
 Reference WHO health journal study conducted
by H. Tiwari and U.N Oja in dist anand Gujrat
• Around two-thirds of the 900 girls (62.7%) had been
informed about menarche before its onset. major
source of information was the mother (60.7%) followed
by older sisters (15.8%). Teachers and others (which
included near and distant relatives) played a small role.
The mother was usually the first person informed about
the start of menarche (76.1%), followed by an older
sister (13.4%). Two-thirds of the girls (37.2%) had no
prior knowledge about the event, which accounts for
the fact that 16.9% had the initial perception that it was
a life-threatening disease or symptom of illness -
Asked if they felt they had been mentally
prepared (yes/no), 48.2% of girls felt they were
not mentally prepared for menarche . 28.3% felt
shame, 12.6% felt guilt and 20.6% had a sense of
fear. Asked how they felt about the process of
menstruation, a majority of girls believed that
menstruation is a purging of body impurities
(56.5%), 31.0% felt that it was a normal
physiological event, whereas 10.0% felt it was
something dirty.
In this area of India, the custom of celebrating the
event of menarche continues; 3.7% of respondents
reported that a social ceremony is held in their houses
for the first menarche More than two-thirds of
respondents (36.2%) reported that social restrictions
are still observed in their family: the custom of not
allowing them to hold prayers, go to the temple or
enter the kitchen. A few girls reported that food
restrictions are also imposed on them during
menstruation, which do not allow them to consume
spicy or non-vegetarian foods.
Menstruation, though a natural process,has often been
dealt with secrecy in many parts .Hence, knowledge and
about reproductive functioning and reproductive health
problems amongst the adolescent is poor(Adhikari,
2007).

A great deal of womens‘ and girls' scant knowledge is

informed by peers and female family members.

A study of Indian women shows that young girls are

generally told nothing about menstruation until their
first experience
A study conducted by Narayan et al, 2001). Several
traditional norms and beliefs, socio-economic
conditions and physical infrastructure do influence
the practices related to menstruation. For example, a
Hindu Nepali woman abstains from worship, cooking
and stay away from her family as her touch is
considered impure during this time.

Women and girls in poor countries can’t afford

sanitary napkins which would normally be changed
around two to four times a day during menstruation.
Instead, the vast majority of women and girls in Nepal
use rags, usually torn from old saris. Rags are washed
quickly inside the latrine or in public bath early in the
morning and used several times. There is no private
place to change and clean the rags and often no safe
water and soap to wash them properly. The gender
unfriendly schools and infrastructure, and lack of
adequate menstrual protection alternatives and / or
clean, safe and private sanitation facilities for female
girls and teachers, undermine the right of privacy,
which results in a fundamental infringement of the
human rights of female students and teachers (Ten,
2007).
Even in the homes, a culture of shame forces
women to find wellhidden places to dry the rags.
These places are often damp, dark and unhealthy.
Rags that are unclean can cause urinary, vaginal
and perineal infection. Very often serious
infections are left untreated and may sometimes
lead to potentially fatal toxic shock syndrome.

A Water Aid report

Written by: Thérèse Mahon and Maria Fernandes
The taboos and rituals surrounding menstruation in South Asia
exclude women and girls from aspects of social and cultural life.
For example, in Hinduism, notions of purity and pollution
determine the basis of the caste system, and are central to
Hindu culture, including gender relations. Bodily excretions are
considered to be polluting, as are human bodies in the process
of producing them.

All women, regardless of their social caste, incur pollution

through the bodily processes of menstruation and childbirth.
There are two main ways to achieve purity: by avoiding contact
with pollutants, or purifying oneself to remove or absorb the
pollution. Water is the most common medium of purification.
The protection of water sources from such pollution,
particularly running water, which is the physical manifestation of
Hindu deities, is therefore a key concern (Joshi and Fawcett,
2001).
• Do you think menstrual blood is impure?
• Influence of hot and cold food on menses
• Does excessive bleeding lead to anaemia
• During Menstruation Is it okay to have sex
during menses
• Does a woman have menses during pregnancy
 REFRENCES-A WaterAid in Nepal publication
March 2009
A copy of the report can be downloaded from
www.wateraid.org/nepal

A Water Aid report

Written by: Thérèse Mahon and Maria Fernandes
In the Nepal study (WaterAid in Nepal 2009a), 89 per cent of
respondents practiced some form of restriction or exclusion
during menstruation. The restrictions practiced by the girls in
the Nepal (ibid.) and West Bengal (Dasgupta and Sarkar 2008)
studies. The concept of pollution was strongly associated with
menstruation and was described in few references.
. Do you do household activities during
menses
Do you practice isolation during menses
you wash your genitalia
. Do you bathe daily during menses?
'A woman is ritually impure during menstruation and anyone
or anything she touches becomes impure as well. It is usually
the mothers who enforce these restrictions.‘ (WaterAid in
Nepal 2009a, 10).

Another girl reported that, due to the ‘polluting touch’, during

winter she is not provided with sufficient warm clothes during
menstruation, as the clothes would become polluted.
Impact on girls’ education
One major concern is the impact of cultural practices and lack of
services for menstrual hygiene management on girls’ access to
education. A study in South India reported that half the girls
attending school were withdrawn by their parents once they
reached menarche, mostly to be married. This was either
because menstruation
was regarded as a sign of readiness for marriage, or because of
the shame and danger associated with being an unmarried
pubescent girl (Caldwell, Reddy and Caldwell 2005, cited in Ten
2007).
In our school, there is no water facility in the toilet – it is so
difficult…, sometimes I have to miss school. The water supply
is outside the bathroom. There is only one tap. We have to
carry water to the toilet‘

(WaterAid in Nepal 2009a, 12)

'Some days we bleed heavily and we need to change cloths at

least two or three times during school hours. There is no
place to change and dispose the cloth –there is a question of
putting used cloth in our pockets. So we just bunk classes
when we have to change cloths.'
In focus group discussions in one study, many girls revealed
that when they did
attend school during menstruation they often performed
poorly, due to the worry that
boys would realise their condition (WaterAid in Nepal 2009a).
Similar findings were
reported by a survey undertaken by WaterAid in India, in
which 28 per cent of
students reported not attending school during menstruation,
due to lack of facilities.
Many mentioned that fear of staining on their clothes caused
them stress and
depression (Fernandes 2008).
 IMPACT ON DEVELOPMENT GOALS
The cumulative effects of ignoring menstrual hygiene and
management (on social exclusion, access to water, sanitation and
hygiene services, education and health)
Discussed above may affect the achievement of the development
goals which governments, donors and agencies have committed
through the Millennium Development Goals (Ten 2007).
Given the potential of a focus on menstrual hygiene to support the
achievement of global targets, it is essential that development
professionals and their agencies incorporate this issue into their
work. This also requires fostering greater links between the relevant
sectors, including WASH, health and education.
The following case study of WaterAid in India shows how menstrual
hygiene can be incorporated by WASH sector agencies, and
highlights the experiences, successes and challenges faced.
WaterAid has been working in India since 1986, supporting
communities, in partnership with local organisations, to
access water, sanitation and hygiene.
Hygienic management of menstruation is a challenge for
women in India, raising serious health concerns. However,
until 2007, the hygiene promotion programme did
not specifically address women’s hygiene issues. Despite
women and adolescent girls being a target group, the
programme did not address the issues related to poor
menstrual hygiene.
In January 2007, during a project visit to a village in
Sehore district of Madhya Pradesh State, an
adolescent girl told WaterAid staff that her mother
did not allow her to use the household’s toilet during
menstruation, because she is impure. During another
visit to a village in Sheopur district, a woman casually
mentioned in discussion that during menstruation she
has used the same set of cloths for the last four years.
These two small incidents brought to light another
dimension of hygiene, and WaterAid realised that this
is an area which has to be addressed, to ensure that
girls develop with dignity, and that young and adult
women have necessary facilities
to address their female needs.
Objectives
 GENERAL OBJECTIVE

To study the existing level of knowledge and practices

regarding menstruation among adolescent school girl”

SPECIFIC OBJECTIVES

1. To assess the source of information related to

mensturation
2. To asses beliefs, misconceptions and restriction
related to menstruation; and
3. To find out the status of menstrual hygiene among
adolescent school girls.
 SPECIFIC OBJECTIVES (Contd..)

4. To identify issues and challenges faced (including

health) by adolescent school girls due to their
menstruation, and
5. To propose specific measures to improve menstrual
hygiene knowledge and Management
6. To asses knowledge regarding RTI/STI
 Methadology
• Study design: cross sectional descriptive study

• Study area: is dist. Meerut and village Daurala

• Study population: urban and rural school girls

 Sampling
• Simple random sampling will be adopted
• Sample size –from urban and rural girls
school
• Two groups will be made between 10-12 years
and 13-16 years from both rural and urban
school, random selection will be done
 Development of Tools and Technique
• As per the objective study would be done by
Following method-the adolescent girls would
be asked to fill up the following
questionnaire-
• Did you know about menstruation before you
had period?
• Who gave you information?
•Do you visit holy places during menstruation
•Do you visit relatives, friends, and neighbors
during menses?
•Do you do household activities during menses
•Do you practice isolation during menses?
•Do you bathe daily during menses
•Do you visit holy places during menstruation
•Do you visit relatives, friends, and neighbors
during menses
•Do you practice isolation during menses
•Do you wash your genitalia with soap and water
after changing cloth/napkin
•Do you bathe daily during menses
 Data analysis
• Data analysis- will be done after collecting,
assembling and tabulating the data