Objective To test the validity of the novel Menstrual Health Index (MHI) in order to assess safety of menstrual health and hygiene practices in adolescents and young adults.
Methods This is a community-level prospective questionnaire-based study conducted in females between the age group of 11 and 23 years. The number of participants was 2860. The participants were asked to fill in the questionnaire pertaining to four components of menstrual health, viz., menstrual cycle, menstrual absorbents, psychosocial aspects and WASH component associated with menstruation. Based on the score assigned to each component, Menstrual Health Index was calculated. A score of 0–12 was considered poor, 12–24 was considered average, and 24–36 was considered good. Educational interventions were designed to improve the MHI in that particular population according to component analysis. After 3 months, MHI was rescored to see the improvement.
Results A total of 3000 females were handed over the proforma and 2860 females participated. Among participants, 45.4% were from urban area, rest were from rural areas (35.6%) and slum areas (19%). Majority of the respondents were in the age group of 14–16 years (62%). Poor MHI (0–12 score) was seen in 48%, average score (13–24) was found in 37%, and good score was found in 15% participants. When individual components of MHI were assessed, it was found that, as high as 35% of the girls had limited accessibility to menstrual blood absorbents, 43% skipped school for more 4 times in a year, 26% suffered from severe dysmenorrhea, 32% reported difficulty in maintaining privacy while using WASH facilities and 54% were using clean sanitary pads as menstrual sanitation option. Best composite MHI was observed in urban areas, followed by rural and then slum area. In urban area and rural area, menstrual cycle component score was least. In rural area, sanitation component score was least and in slum area, WASH component scored the worst. Severe premenstrual dysphoric disorder was recorded in urban area, and maximum abstinence from school due to menstruation was seen in rural areas. An improvement in score was seen in 87% of the girls (93% individual and 87% composite), after 3 months of education and interventional strategies.
Conclusion Menstrual health is not limited to cycle frequency and duration normalcy. It is a comprehensive subject, encompassing physical, social, psychological and geopolitical aspects. Assessing prevailing menstrual practices in a population, particularly in adolescents, is imperative to design IEC tools, and these objectives are aligned with SDG-M goals of Swachh Bharat Mission. MHI serves as a good screening tool to interrogate KAP in a particular area. Individual problems can also be addressed in a fruitful manner. Rights-based approach to provide essential infrastructure and provisions to promote safe and dignified practices to a vulnerable population like adolescents can be aided by using tools like MHI.
Keywords : Menstrual health hygiene · Menstrual health index · Menstrual health · Menstrual hygiene
Menstruation is the basis of reproductive life, yet so conveniently ignored topic among 1.8 billion menstruators on the earth. There are rare universal phenomena which are associated with shame, taboos, myths, poor knowledge and unsafe practices, and sadly, menstruation is one of them [1]. WHO and UNICEF Joint Monitoring Programme (JMP) for drinking water, sanitation and hygiene has used the following definition of menstrual hygiene management: ‘Women and adolescent girls are using a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required and having access to safe and convenient facilities to dispose of used menstrual management materials. They understand the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort or fear’ [2].
Different problems like lack of awareness and education about menstrual cycle, different practices and perceptions around sanitation, psychosocial aspects related to coping with this have led to profound detriment around menstrual health all across the globe. Lack of dignified access for clean menstruation sanitation options, nonavailability of toilets, water, soaps, social exclusion, stigmatization adds to the host of problems associated with menstrual cycle. Genderbased discrimination, poverty and lack of formal education in females can be held responsible for this.
Menstruation is as primitive as the existence of human being themselves, still human existence is accepted and celebrated, while menstruation is not. Optimal menstrual health is the core of promising a dignified women’s well-being. To menstruate with dignity and safety is a basic human right. If a discussion around women empowerment is generated, it is incomplete without a promise to ensure menstrual rights (Figs. 2 and 3).
1. Rajak I. She got her period: Men’s knowledge and perspectives on menstruation. Mankato: Minnesota State University; 2015.
2. https:// www. unicef. org/ media/ 91341/ file/ UNICEF- Guida ncemenst rual- health- hygie ne- 2019. pdf
3. https:// www. unicef. org/ niger ia/ repor ts/ asses sment- menst rualhygie ne- manag ement- secon dary- schoo lss
4. https:// www. downt oearth. org. in/ blog/ health/ 23- girls- drop- out- ofschool- on- reach ing- puber ty- 59496
5. Vinod Kumar Sharma, M.S.L. Saxena, Climacteric symptoms: a study in the Indian context, Maturitas, 3(1)
6. UNICEF. "Annual report on the implementation of the UNICEF Gender Action Plan, 2018–2021." (2020).
7. Rani A, Sharma M, Singh A. Practices and perceptions of adolescent girls regarding the impact of dysmenorrhea on their routine life: a comparative study in the urban, rural, and slum areas of Chandigarh. Int J Adolesc Med Health. 2016;28(1):3–9.
8. Walia DK, Yadav RJ, Pandey A, Bakshi RK. Menstrual patterns among school going adolescent girls in chandigarh and rural areas of himachal pradesh, north India. Nat J Commun Med. 2015;6:583–6.
9. Kotagasti T. Prevalence of different menstrual irregularities in women with abnormal uterine bleeding (AUB)-an observational study. Int J Curr Res Rev. 2015;7(10):66.
10. Omidvar S, Amiri FN, Bakhtiari A, Begum K. A study on menstruation of Indian adolescent girls in an urban area of South India. J Family Med Primary Care. 2018;7(4):698.
11. Thakre SB, Thakre SS, Reddy M, Rathi N, et al. Menstrual hygiene: knowledge and practice among adolescent school girls of Saoner Nagpur district. J Clin Diagn Res. 2011;5(5):1027–33.
12. Shetty, Sudarshan K. "International Journal of Biomedical and Advance Research."
13. Sanyal A, Muthukrishnan S. Does sanitation influence upper primary educational outcomes? Quantitative evidence from DISE data of Gujarat State. IASSI-Quarterly. 2017;36(2):192–215.
14. Garg S, Anand T. Menstruation related myths in India: strategies for combating it. J Family Med Primary Care. 2015;4(2):184.
15. Nakaye, Zainah. Knowledge Attitude And Practices Towards Menstrual Hygiene Among Secondary School Girls In Makindye Division, Kampala District. Diss. International Health Sciences University, 2018.
16. Thakre SB, Thakre SS, Ughade S, Thakre AD. Urban-rural differences in menstrual problems and practices of girl students in Nagpur India. Indian Pediatrics. 2012;49(9):733–6.
17. Sivakami M, van Eijk AM, Thakur H, Kakade N, et al. "Effect of menstruation on girls and their schooling, and facilitators of menstrual hygiene management in schools: surveys in government schools in three states in India, 2015." Journal of global health, 2019; 9(1).
18. World Health Organization. Global progress report on water, sanitation and hygiene in health care facilities: Fundamentals first. UNICEF, 2020.
19 Hoyer J, Burmann I, Kieseler M-L, Vollrath F, et al. Menstrual cycle phase modulates emotional conflict processing in women with and without premenstrual syndrome (PMS)–a pilot study. PloS One. 2013;8(4):e59780.
20. Mengi N, Rajput P. Social exclusion of women during menstruation: a bio-psychosocial perspective of menstrual health of slum women in India. Asian J Multidimensi Res (AJMR). 2019;8(3):401–14.
