Menstrual hygiene practices among adolescents of selected tea estates of Golaghat District, Assam, with a view to provide awareness on menstrual health and hygiene: a descriptive study

INTRODUCTION

Adolescence is narrowly equated with puberty and the cycle of changing physically culminates in reproductive maturity.¹ Every month 1.8 billion people across the world menstruate and on any given day more than 300 million women worldwide are menstruating. An estimated 500 million lack access to menstrual materials and adequate facilities for menstrual hygiene management. There are millions around the world who are denied from the right to manage their menstruation monthly in a dignified and healthier way.²

Menstruation is a normal biological process and female adolescents often are unaware when they experience menarche. This diminishes their confidence, self-esteem and often causes fear and distress. Unhygienic menstruation such as prolonged use of same menstrual product or not washing the genital area daily, can cause severe health risks which may lead to respiratory tract infections (RTIs) and urinary tract infections (UTIs), and further may result in infertility and complications during birthing process. Soiled menstrual blood materials serve as breeding grounds for pathogens such as Salmonella, Staphylococcus and E. coli which can grow quickly in the reproductive system, starting with the cervix and progressing higher. Menstruation is still a taboo in many parts of India and females are still treated in a different way during periods.³

Globally, the state Assam, situated in the north-eastern region of India is called as the land of the tea. However, the community people who are working in these tea estates and companies are some of the most underprivileged groups, living under miserable condition in terms of health and sanitation. Adolescent girls of these communities are extremely at risk to menstruation problems and unhygienic practices due to lack of awareness and multiple social beliefs that makes a woman impure during menstruation. This often leads to early school dropout among adolescent females, many health related problems like anaemia, dysmennorhea.⁴ Healthy menstrual hygiene practice interventions can help overcome these obstacles to fulfil the unmet demand for menstrual hygiene materials in order to protect dignity, build confidence, and strengthen sexual and reproductive health, particularly among adolescents.

METHODS

A descriptive non-experimental research design was adopted to conduct the study among adolescent girls aged 10-19 years in selected tea-estates of Golaghat district, Assam from 21 September 2024 to 17 January 2025 (4 months).

Sample size

Considering 67% as the prevalence of menstrual hygienic practices among adolescent females in Assam according to the National Family Health Survey-V, assuming it as a baseline for present study a minimum sample of 700 was calculated with 95% confidence, 80% power allowing 5% margin of error, a sample of 759 was selected for the study using multi-stage random sampling technique.

Inclusion criteria

Adolescent girls (10-19 years) who were residing in selected tea estates as well as their surrounding areas of Golaghat district, Assam, present at the time of data collection and physically and mentally sound fulfilled the inclusion criteria of the study.

Exclusion criteria

Adolescents who had not attained menarche, married, pregnant and lactating women were excluded in the study.

After acquiring the ethical and formal permission from the Manager of the Teagarden, participants were informed to gather in a designated place of the tea garden and assent were obtained from them and consent from their parents. A socio-demographic proforma was used in the study which comprises of general information (7 items) and menstruation related proforma (5 items) and standardized tool, menstrual practice needs scale was administered to the participants which took approximately 60 minutes to complete followed by an awareness program on menstrual health and hygiene. It was developed with a view to aware the target population on one of the common problems of adolescents i.e., menstrual health and hygiene.

Statistical analysis

Data were obtained using Microsoft excel 2007 and tabulated, analysed and interpreted by using statistical package for the social sciences (SPSS) 20. For descriptive analysis of socio-demographic variables and Menstrual practice needs scale mean, frequency, percentage and SD was used. Chi-square test was done to analyze the association between different variables for inferential statistics.

RESULTS

The study included 759 adolescents which studied various socio-demographic characteristics. Table 1 shows general information of socio-demographic findings, majority 363 (47.80%) were 14-16 years age, 612 (80.6%) religion were Hindu, 430 (56.70%) education were Secondary education, 675(88.9%) were residing in own residence, 525 (69.2%) were from nuclear family, 268 (35.30%) mother’s had no formal education, 471 (62.1%) monthly family income belongs to upper class (9098 and above).

Table 2 shows menstruation related proforma of socio-demographic variables, majority 242 (31.9%) age of menarche was 12 years, 573 (75.5%) source of information about menstruation were teacher, parents, friends and neighbours, 440 (58.9%). Type of material used during menstruation was cloth, 358 (47.2%) frequency of changing of menstrual materials once get wet in a day were less than 2 times, 318(41.9%) disposal method of used menstrual materials was dumping in the pit.

Figure 1 shows the range, mean and SD of the domains of MPNS-36 i.e., material and home environment needs with 11 questions which are about the extent the participants are satisfied with their needs met with their menstrual products, preference for disposal and environment they are using at home during periods. The minimum score of the participant is 0.00 and maximum score is 33.00 with mean and SD 24.28±4.55 which indicates menstrual practice needs were met in this domain.

Transport and school environment needs has 5 questions where participants needs were met with transportation and changing materials at school. The minimum score of the participant is 0.00 and maximum score is 15.00 with mean and SD 7.67±3.44 which indicates menstrual practice needs were met in this domain.

Material reliability concerns has 3 questions with reverse scoring, which comprises of questions to know participants worries about the quality of their menstrual materials (that they might leak, or run out of materials, or materials would move out of place). The minimum score of the participant is 0.00 and maximum score is 9.00 with mean and SD 4.25±2.28 which denotes menstrual practice needs were unmet in this domain.

Change and disposal insecurity has 9 questions to which participants’ worries and concerns that they might not be able to change or dispose off materials when they needed to, and their concerns about privacy and safety during menstruation both at home and school. The minimum score of the participant is 0.00 and maximum score is 27.00 with mean and SD 15.15±6.24 which indicates menstrual practice needs were met in this domain.

Figure 1 also shows that 436 participants out of 759 reuse their menstrual materials and are further assessed for their reuse menstrual practice needs i.e., reuse needs and reuse insecurity. Reuse needs comprises of 5 questions applied to those who reused materials and captured the extent to which participants were satisfied with in relation to washing and drying them. The minimum score of the participant is 0.00 and maximum score is 15.00 with mean and SD 12.02±3.41 which indicates menstrual practice needs were met in this domain.

Reuse insecurity has 3 questions with reverse scoring, which comprises of questions applicable to those who reused materials and captured concerns around washing and drying them. The minimum score of the participant is 0.00 and maximum score is 9.00 with mean and SD 1.83±2.24 which indicates menstrual practice needs were unmet in this domain.

Association of menstrual practice need scale with socio-demographic variables

Statistical inference as shown in Table 3 where menstrual practice need scale was found to be associated significantly with religion χ² (4, 759)=56.15, p<0.001, monthly family income χ² (4, 759)=21.93, p<0.001, type of material used during menstruation χ² (4, 759)=60.75, p<0.001, disposal method of used menstrual material χ² (4, 759)=46.16, p<0.001, education χ² (6, 759)=22.03, p=0.001, residence χ² (4, 759)=13.36, p=0.010, source of information about menstruation χ² (8, 759)=20.14, p=0.010, type of family χ² (4, 759)=11.55, p=0.021, marginally significant with age χ² (4, 759)=8.70, p=0.069, and frequency of changing of menstrual materials once get wet in a day χ² (4, 759)=9.00 , p=0.061.

Association of all domains of menstrual practice need scale with socio-demographic variables

Table 4 shows association of all 6 domains of menstrual practice need scale with socio-demographic variables. MPNS-36 scale domain i.e., material and home environment needs was found to be statistically associated with residence χ² (4, 759)=17.38, p=0.002, monthly family income χ² (4, 759)=15.48, p=0.004, source of information about menstruation χ² (8, 759)=29.94, p<0.001, type of material used during menstruation χ² (4, 759)=32.68, p<0.001, frequency of changing of menstrual materials once get wet in a day χ² (4, 759)=12.24, p=0.016, disposal method of used menstrual material χ² (6, 759)=29.58, p<0.001, marginally associated with religion χ² (4, 759)=9.19, p=0.057.

MPNS-36 scale domain i.e., transport and school environment needs was found to be statistically associated with age χ² (4, 759)=11.36, p=0.023, religion χ² (4, 759)=41.26, p<0.001, education χ² (6, 759)=48.02, p<0.001, type of family χ² (4, 759)=15.94, p=0.003, education of mother χ² (6, 759)=27.98, p<0.001, age of menarche χ² (12, 759)=27.67, p=0.006, source of information about menstruation χ² (8, 759)=20.85, p=0.008, type of material used during menstruation χ² (4, 759)=10.36, p=0.035, and disposal method of used menstrual material χ² (6, 759)=17.95, p=0.006. It was found to be marginally significant with residence χ² (4, 759)=9.17, p=0.057.

MPNS-36 scale domain i.e., material reliability concerns was found to be statistically associated with age χ² (4, 759)=18.44, p=0.001, religion χ² (4, 759)=68.41, p<0.001, education χ² (6, 759)=30.81, p<0.001, source of information about menstruation χ² (8, 759)=35.96, p<0.001, type of material used during menstruation χ² (4, 759)=15.95, p=0.003, frequency of changing of menstrual materials once get wet in a day χ² (4, 759)=23.49, p<0.001 and disposal method of used menstrual material χ² (6, 759)=29.25, p<0.001. It was seen that marginally significant with type of family χ² (4, 759)=8.47, p=0.076.

MPNS-36 scale domain i.e., change and disposal insecurity was found to be statistically associated with age χ² (4, 759)=18.5, p=0.001, religion χ² (4, 759)=157.32, p<0.001, education χ² (6, 759)=57.35, p<0.001, type of family χ² (4, 759)=12.09, p=0.017, education of mother χ² (6, 759)=18.73, p=0.005, monthly family income χ² (4, 759)=27.1, p≤0.001, age of menarche χ² (12, 759)=31.77, p=0.002, source of information about menstruation χ² (8, 759)=27.77, p=0.001, type of material used during menstruation χ² (4, 759)=36.83, p<0.001, frequency of changing of menstrual materials once get wet in a day χ² (4, 759)=19.01, p=0.001, disposal method of used menstrual material χ² (6,759)=20.25, p=0.002. However it was found to be marginally associated with residence χ² (4, 759)=8.01, p=0.091.

MPNS-36 scale domain i.e., reuse needs was found to be statistically associated with religion χ² (2, 759)=12.03, p=0.002, residence χ² (2, 759)=13.02, p=0.001, type of family χ² (2, 759)=7.43, p=0.024, education of mother χ² (3,759)=14.91, p=0.002, monthly family income χ² (2, 759)=6.96, p=0.031, type of material used during menstruation χ² (2, 759)=241.32, p<0.001, disposal method of used menstrual material χ² (3, 759)=83.74, p<0.001. The same was found to be marginally statistically associated with source of information about menstruation χ² (4, 759)=8.65, p=0.070, and frequency of changing of menstrual materials once get wet in a day χ² (2, 759)=4.76, p=0.093.

MPNS-36 scale domain i.e., reuse insecurity was found to be statistically associated with religion χ² (4, 759)=28.22, p<0.001, education χ² (6, 759)=18.67, p=0.005, education of mother χ² (6, 759)=24.4, p<0.001, monthly family income χ² (4, 759)=14.37, p=0.006, source of information about menstruation χ² (8, 759)=19.83, p=0.011, type of material used during menstruation χ² (4,759)=275.01, p<0.001, disposal method of used menstrual material χ² (6, 759)=107.98, p<0.001. Marginal significance was found between reuse insecurity and residence χ² (4, 759)=7.87, p=0.097, type of family χ² (4, 759)=7.97, p=0.093 and frequency of changing of menstrual materials once get wet in a day χ² (4, 759)=7.9, p=0.095.

^NSNot significant, p>0.05, ^MSmarginally significant, p>0.05 but <0.10, *significant, p<0.05, **highly significant, p<0.01, ***very highly significant, p<0.001

^NSNot significant, p>0.05, ^MSmarginally significant, p>0.05 but <0.10, *significant, p<0.05, **highly significant, p<0.01, ***very highly significant, p<0.001

DISCUSSION

The present study shows that overall mean and SD of MPNS-36 is 60.11±13.45, domains of MPNS-36 i.e., material and home environment needs 24.28±4.55, Transport and school environment needs 7.67±3.44, material reliability concerns 4.25±2.28, change and disposal insecurity 15.15±6.24, Those reusing materials i.e., reuse needs 12.02±3.41 and reuse insecurity 1.83±2.24. The result is contrast with the findings of the study conducted by Rupe et al on menstrual health among adolescents and young adults where the overall mean MPNS-36 score was 2.2 (SD:0.33); 68% of participants had a mean MPNS-36 score of 3 or less, indicating unmet MH needs.

The mean score and SD for materials and home environment was 2.3 (SD: 0.16), transport and school environment needs was 2 (SD: 0.24), menstrual reliability concerns were 1.8 (SD: 0.17), change and disposal security was 2.2 (SD: 0.17), reuse needs was 2.7 (SD: 0.18) and reuse insecurity was 1.9 (SD: 0.34).⁵

Discussion on association of menstrual practice needs scale with socio-demographic variables

The study finding reveals a significant association between socio-demographic variables i.e., religion monthly family income, type of material used during menstruation, disposal method of used menstrual material, education, residence, source of information about menstruation, type of family, marginally significant with age and frequency of changing of menstrual materials once get wet in a day with menstrual practice needs scale. Similar study conducted by Baruah et al on knowledge and practice on menstrual hygiene among girl students which reveals a significant association between practice and demographic variables religion and family income, and further contrasted where there was no significant association between practice and demographic variables of age of the girl, age at menarche, type of family, education of the mother, occupational status of father and mother, and information received on menstruation hygiene.⁶

Similar study conducted by Siabani et al showed that the participants practice regarding menstruation was significantly associated with age and mother's education (p≤0.05).⁷ In a cross sectional study done by Sarkar et al at West Bengal also showed that there was an association between the type of family and good menstrual hygiene practices.⁸

CONCLUSION

Menstruation in adolescence is a normal physiological process that begins in menarche and continues throughout the reproductive years. There is nothing to feel anxious, scared or embarrassed about it. While irregular periods are common initially, understanding the normal cycle, menstrual hygiene and potential concerns like dysmenorrhea is crucial for adolescent’s well-being and overall health.

The study highlights the need for improved menstrual health and sanitation among adolescents of tea-estates. This study revealed a scenario of adolescent girls living in tea-garden communities of Assam and their different challenges faced during their menstruation. Thus it can be concluded that by prioritizing menstrual health and hygiene we can promote overall well-being, dignity and empowerment of adolescents.

ACKNOWLEDGEMENTS

Authors would like to thank the authors of Menstrual Practice Needs Scale (MPNS-36) for easy accessibility of the tool for the research project without which the study would have been incomplete. They also acknowledge all the participants of the research project and their parents.

Funding: The study was funded by VKNRL School of Nursing, Numaligarh as a part of faculty development program

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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