Prevalence of hygiene awareness during menstruation period among rural women of West Bengal, India

INTRODUCTION

Menstruation is a physiological process of women that is generally initiated at the age of 9-12 years and continues till menopause. Reproductive infection during the menstrual period is a common phenomenon in women, especially in rural areas. Women's reproductive infections during menstruation can be prevented by the practice of menstrual hygiene.^1,2 In Rural areas of India, menstruation hygiene faces social, cultural, and religious restrictions which greatly interrupt menstrual hygiene management. In India, menstruation is still considered a taboo in the society. In many parts of the country especially in rural areas women are not taught about menstrual hygiene so they face a lot of difficulties and challenges at home, schools, and workplaces.^3,4 The risk for disease increases where there is a lack of knowledge on proper hygiene practices, or facilities available for managing waste. Additionally, these issues are compounded by a lack of access to clean water.⁴ The present study was conducted to assess the knowledge, attitude, and practice of menstrual hygiene of rural Bengali women of Paschim Medinipur district in West Bengal. The present study aimed to assess the awareness level, and knowledge of menstrual hygiene along with related diseases, and practices followed during their menstrual cycle.

METHODS

Study design and population

The study was a cross–sectional study. Data were collected from women of rural areas in Belda, Paschim Medinipur, West Bengal. 50 rural women were interviewed separately from the village area of Paschim Medinipur district of West Bengal. Samples were selected randomly by selecting a part of the village where the socioeconomic status of the population was mixed with higher, middle, and poor socio-economic status. The study was conducted in April 2022 as a part of the project of the Master’s thesis of Shyamali Bera, a student of Vidyasagar University, Midnapore, West Bengal, India. The studied women were within the age group of 15-25 years and 26- 34 years. The total no of participants for this study was 50. The study was non-invasive and the subjects were all adults. Prior consent was taken from all participants before the study.

Inclusion and exclusion criteria

Women who gave verbal consent, only those subjects were included.

Questionnaires

A structured questionnaire was developed to know about the socio-economic, basic anthropometric measurements, and basic health information about the subjects. The KAP questionnaire was used to formulate and scoring was done by Likert scale.⁶ All the subjects were interviewed separately. The questionnaire was first prepared in English. Then, it was translated into Bengali by an expert in that language keeping semantic equivalence.

Anthropometric measurements

Height and weight were measured with a stadiometer and electronic weighing scale according to the ISAK protocol.⁵

Statistical analysis

Statistical analysis was done using SPSS version 22.

Study tools

A structured questionnaire regarding the socio-economic, and demographic profile of the participants. The KAP questionnaire had three sections; Section A: Consisted of questions related to socio-demographic characteristics and knowledge about menstrual hygiene, Section B: Consisted of questions related to perception regarding menstruation hygiene and Section C: Comprised of questions on the practice of menstrual hygiene. The questionnaire was first prepared in English. Then, it was translated into Bengali by an expert in that language keeping semantic equivalence.

RESULTS

The average age of the studied women was 27.5±7.6 yr with an average height of 161.1±6.8 cm and an average weight of 52.22±10.6 kg. The nuclear family was the most common family pattern observed. Knowledge of menstruation of Fifty studied Bengali Rural women were shown in (Table 1).

Total 96% knew that menstruation is a natural process of women but nobody knew the source of menstrual blood.

Total 80% of women knew the importance of personal hygiene during menstruation. The (Table 2) showed the attitude towards menstruation of the studied women of the present study. Practice on menstruation hygiene was shown in (Table 3).

A large number of women (76%) clean their hair during the menstruation period whereas 90 % of women clean their hands before and after genital areas. 96% change the sanitary pads 2-4 times in a day. 80% of women dispose the used sanitary pads in dustbins. The (Figure 1) showed the educational status of the studied women. The (Figure 2) showed the distribution of population depending on regularity of the flow.

DISCUSSION

The study was conducted on Bengali Rural women on the prevalence of hygiene awareness during menstruation. 96% of women knew that the menstrual cycle is a natural process whereas 4% of women did not have any knowledge on menstruation whether menstruation is a natural or unnatural process (Table 1). The reason behind their unawareness was illiteracy as women in rural areas did not have a chance to go to school due to poverty or social barriers^7,8,9. Education for women in rural Bengal is still a challenge.^10,11 In the present study, more than 50% of women were illiterate without primary education (Figure 1). The Impact of education or literacy was reflected when physiological knowledge of menstruation was considered. A large number of women did not have proper knowledge of menstruation. 22% of women had the idea that menstrual blood comes from the urinary bladder whereas 22% did not have any idea from where blood comes. Only 56% of studied women knew that menstrual blood comes from Uterus. Solvic et al also observed similar findings while working on Indian rural and urban women.¹²

When personal hygiene was considered, 80% of studied women took care of their hygiene during menstrual periods whereas 14% of women did not agree that personal hygiene was important during menstrual periods. The remaining 6% of women did not have any idea about personal hygiene during the menstruation period. 78% of women had the idea that a sanitary pad is a good absorbent whereas 10% of women had the impression that a pad made of old clothes is also a good absorbent like a sanitary pad. 12% of women did not have any idea which one is good or better absorbent. Though a large number of women prefer using sanitary pads instead of homemade cloth pads, they use homemade cloth pads due to poor economic conditions. As a result, most of the studied women suffer from reproductive organ-related degasses along with urinary infections. 80% of village women in the present study do not have any knowledge about menstruation before menarche. 16% of women know that whereas 4% do not have any knowledge of menstruation before menarche (Table 1). While considering the attitude towards menstrual hygiene, 70% of studied women agreed to maintain personal hygiene to prevent reproductive-related diseases. 44% of women had a positive attitude towards the cleanness of genital areas with clean water whereas 40% of women did not show any interest in it. The rest 16% could not decide as they did not have any knowledge of it. Washing hands before and after cleaning the genital areas is an important health and hygiene issue.¹³ 80% of agreed with it but 4% of women did not agree. The rest 16% did not have any idea about washing hands as they don’t have any knowledge of personal hygiene (Table 2). Knowledge of menstruation is important for women. In the present study, 90% of studied women knew menstruation is a normal physiological procedure whereas 10% did not know whether it is a normal or pathological phenomenon. Cleaning panties or underwear is also an important part of maintaining hygiene. 30% of young women agreed that cleaning panties or underwear with clean water is enough but 50% of women did not agree with that. 20% of women did not have any idea as they don’t wear panties or underwear due to poor economic conditions for purchasing panties or underwear (Table 2). A similar observation was observed by Golecha while working on Rajasthani rural women of India.¹⁴

Regarding the practice of menstruation hygiene, 76% of women use shampoo for cleaning their hair. 20% of women disagree with cleaning hair during the menstruation period. 4% of women do not know whether cleaning hair with shampoo during menstruation is a good practice for maintaining hygiene or not. 96% of studied women change sanitary pads 2-4 times a day to maintain menstrual hygiene as they have enough toilet facilities. While disposing of used sanitary pads, 80% of the studied population use home garbage areas to dispose of their used sanitary pads whereas the rest use open fields outside the home. Kaur et al revealed that the disposal of used pads in rural areas is a social problem where women want to keep it secret.³ Sarkar et al studied rural women and they revealed that 23% of studied women dried up their used sanitary napkins in sunlight after washing them in water.¹¹ They also revealed that 58% of studied women kept their used sanitary napkins in a hidden place for reusing it again (Table 3). 90% of the studied women had regular menstrual periods while only 10% had irregular menstrual periods (Figure 2). The present study also showed that only 8% of the subjects used to take medication during periods for pain management, rest 92% did not need any kind of medication. Remarkably, females within the age range of 15 to 25 years are more knowledgeable about personal hygiene than women having the age range of 26 to 45 years. This may be because the young are more literate than the seniors (Table 3). The present study revealed that the level of knowledge, attitude, and practice among the women from villages were good enough to maintain hygiene during the menstrual period regardless of their education level though they could not maintain it due to their low economic status. Similar findings were also observed by Balqis et al while working on high school girls in rural areas in India.² The findings of the present study were very similar to different studies on Indian rural women.^15-25

Limitations

As the study was a part of a project for a Master’s Thesis, the duration was limited to only one month. Thus, numbers of subjects were limited to a small group of fifty so that the study could be completed within one month.

CONCLUSION

Thus, from the above study, it was observed that the hygiene awareness during the menstruation period among rural women of West Bengal, India is not satisfactory. Educational intervention is required to improve the hygienic awareness of rural women during the menstrual period.

Funding: No funding sources

Conflict of interest: None declared

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

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