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Indian Journal of Community Medicine

Perceptions and Practices Regarding Menstruation: A Comparative Study in Urban and Rural Adolescent Girls

Author(s): D.S. Deo, C.H. Ghattargi

Vol. 30, No. 1 (2005-03 - 2005-03)

Introduction

Adolescence in girls is a turbulent period, which includes stressful events like menarche, considered as a landmark of female puberty1. One might expect that menarche will be positively received by young women; however negative responses such as shame, fear, anxiety and depression are more common. The manner in which a girl learns about menstruation and its associated changes may have an impact on her response to the event of menarche.

Myth, mystery and superstition have long enveloped the facts about menstruation. In India even mere mention of the topic has been a taboo in the past and even to this date the cultural and social influences appear to be hurdle for advancement of the knowledge of the subject2. The social practices about menstruation make girl child feel subnormal and may hamper her development. Menarche may remain a traumatic event for her unless she is prepared for it. Adolescent girls constitute a vulnerable group, particularly in India where female child is neglected one. Most studies on female adolescence focus on the gynecological problems but problems of nutritional and psychological origin cannot be ignored1.

Hence present study was undertaken to assess the 1) source of information regarding menstruation, 2) reaction to first and subsequent menstruation, 3) taboos and restrictions as result of menstruation and 4) hygiene practiced during menstruation.

Material and Methods

The present study was undertaken in adolescent school girls of urban and rural field practice area of Swami Ramanand Teerth Rural Medical College Ambajogi. The girls were selected according to the WHO criteria for adolescence that is 10-19 yrs3. The study was restricted to only secondary school girls. The rural and urban schools having teaching facility up to 10th standard were included. In rural area Jai Bhavani Vidyalaya Lokhandi Sawargaon was having school facility up to 10th standard only. Kholeshwara Vidyalaya Ambajogai was randomly selected as urban school. 94 girls from urban school and 74 from rural school who had attained menarche were included in the present study.

This was a cross sectional study carried out in educational year 1999-2000. The data was collected after taking permission from school authority. Age of the girls was ascertained from school records and rounded of to nearest completed year. Pretested questionnaire regarding perceptions and practices about menstruation was provided which included questions related to awareness about menstruation, emotional reaction to first and subsequent menstruation, source of information regarding menstruation, taboos and restrictions as result of menstruation and hygiene practiced during menstruation. The queries of the respondents were answered by principal research worker during the study. Perceptions and practices about menstruation were compared among urban and rural girls.

Results

The age of menstruating girls ranged from 12-17 yrs with maximum number of girls between 13-15 yrs of age. 40 (42.5%) urban and 41 (55.4%) rural girls were aware about menstruation prior to attainment of menarche. In urban girls mother was the main source of information about menstruation (27.5%), while it was teacher in the rural counterparts (27.01%). Other sources of information were friends, relative and books.

Table I : Distribution of Girls by Their Emotional Response to First and Subsequent Menstruation

  a. Reaction to first menstruation b. Reaction to subsequent
menstruation
Response Urban
(n=94)
% Rural
(n=74)
% Total % Response Urban
(n=92)
% Rural
(n=72)
% Total
(n=164)
%
Scared 44 (46.8) 33 (44.6) 77 (44.8) Scared 13 (14.1) 6 (8.3) 19 (11.6)
Indifferent 20 (21.7) 25 (33.9) 45 (26.8) Indifferent 48 (52.2) 51 (70.8) 99 (60.4)
Discomfort 21 (22.3) 3 (4.05) 24 (14.3) Accepted 44 (47.8) 46 (22.2) 60 (36.6)
Disgusted 5 (5.3) 3 (4.05) 8 (4.8) Disgusted 6 (6.5) 1 (1.4) 7 (4.3)
Guilty 16 (17.02) 5 (6.7) 21 (12.5) Boredom 2 (2.2)   - 2 (1.2)
Other 8 (8.5) 6 (8.1) 14 (8.3) - - - - - -  

The reaction to first menstruation were scare, indifference discomfort, disgust and guilt and other reactions like surprise, pleasure, depression, fear as shown in Table I.

The number of girls not practicing any taboo was significantly more among rural girls (21.6%) as compared to urban girls (4.3%). (Z=3.6, P<0.01). No entry in kitchen and prohibition on touching others were practiced significantly more in urban than in rural girls. Restriction of activity was significantly more in rural girls than in urban girls (Z=2.2, p<0.05) there was no significant difference between urban and rural girls as far as types of restrictions were concerned (Table II). Majority of urban as well as rural girls in present study preferred cloth pieces to the sanitary pads to deal with the menstrual flow.

Discussion

The awareness about menstruation prior to menarche was low in urban as well as rural girls. This level of low awareness about menstruation in urban girls in reported by other authors as well4,5. Though there was no significant difference regarding awarness in urban and rural girls their sources of information varied. In the urban study group mother was the main source of information. This might be due to better literacy level of mother and better relation among mother and daughter.

Teacher was the more common source of information in rural study group. This difference was statistically significant (Z=4.6, p<0.01). The reason might be there was a teaching programme regarding the menstruation for girls from 5th to 10th standard in the rural school. The programme was conducted by teachers with help of a few books and audiovisual aids and included information about anatomy and physiology of reproductive tract and menstruation. Prasad B, G, et al5 in their urban based studies found that 56% and 84% girls received information about menstruation from their mothers. The inefficiency of rural mother to transfer her knowledge about menstruation was also noted by Durge PM et al4.

The reaction to menstruation depends upon awarness and knowledge about the subject. Rama Rao A2 highlighted the fact that girls with no previous knowledge about menstruation felt more scared at menarche. The girls with little knowledge felt uncomfortable, indifferent or disgusted. Majority of girls had negative reaction to menarche and this might be a reflection of taboos and prejudices in society about menstruation. The unawareness of girls about menstruation might be the cause for nearly 44.8% girls in present study to become scared at the onset of menarche. Discomfort and guilt were significantly more in urban than rural girls. Less discomfort in rural group might be due to better tolerance. In study of Prasad B G et al4 majority of the girls were uncomfortable with menarche while other half were either surprised, stunned, scared, horrified etc.

Reaction to subsequent menses could be assessed only in 164 girls as 4 had only first menstruation (menarche). Majority of the girls were indifferent to subsequent menses. The indifference to subsequent menses was significantly more in rural girls than in urban girls probably due to lack of source of information or shyness in rural girls. Urban girls had either positive (accepted) or negative (disgusted, scared etc.) reaction to subsequent menses. Significantly more urban girls accepted the subsequent menses. Probably they discussed the topic of newly acquired menses with their mother or some one else. This might be due to urge to know more about menses among urban girls. Rama Rao A2 noted that acceptance of menstruation grew as girls grew up in age and move towards higher class. Isolation of menstruating girls in family, treatment given by their family members to other menstruating women might be responsible to retain negative emotional responses in girls. Menstruation is still regarded as something unclean or dirty in Indian society.

Table II : Distribution of Girls by The Type of Restrictions.

Restriction of
Outdoor Activity
Urban (n=94) Rural (n=74) Total (n=168)
  No % No % No %
No restriction 59 62.7 34 45.6 93 55.3
Restrictions on type of clothing 22 23.4 26 35.1 46 27.4
Avoiding interaction with boys 20 21.3 22 29.7 42 25.0
Physical activity 10 10.6 15 20.3 25 14.9
Not allowed to leave/travel alone 5 05.3 14 18.9 19 11.3

Contrary to expectation the number of girls not practicing taboos was significantly more among rural girls in present study. This might be due to cast composition of the study group. The fact that rural girls Buddhist were more compared to urban girls and Buddhists did not practice any taboos during menstruation. Restriction of physical activity was more in rural girls. It could be simply because they undergo more compulsory physical activity than in urban counterparts like fetching water, walking long distances in absence of transport, working in the fields etc. In the present study, there was no significant difference between urban and rural girls as far as types of restrictions were concerned. Majority of urban as well as rural girls in present study preferred cloth pieces to the sanitary pads to deal with the menstrual flow. Use of sanitary pads is not a desirable practice in place of a cloth piece in view of poverty and high cost of these pads. What is more important that girls use a clean cloth piece.

References

  1. Bansal R D and Mehra M. Adolescent girls: An emerging priority. Indian Journal of public health, 1998; 42 (1): 1.
  2. Rama Rao A. A study on menstruation in adolescents. Journal of Indian medical association, 1963; 40 (1): 15- 19.
  3. WHO Technical report series, 1984; 854:263-311.
  4. Durge P M and Waradpande U. Impact assessment of health education in adolescent girls. Journal of obstetric and gynecology of India, 1993; 43 (5): 768-772.
  5. Prasad B G and Sharma P. A study on menstruation of medical college girls at Lucknow. Journal of Obstetric and Gynecology of India, 1972; 22:690-694.

Swami Ramanand Teerth Rural Medical College, Ambajogai,
Dist: Beed (MS).
E-mail: [email protected]

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