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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

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Muthusamy, Sivakami, vanEijk, Anna, Harshad, Thakur, Narendra, Kakade, Patil, Chetan, Shinde, Sharayu, Surani, Nikita, Bauman, Ashley, Zulaika, Garazi, Yusuf, Kabir, Dobhal, Arun, Singh, Prathiba, Tahiliani, Bharathy, Mason, Linda, Alexander, Kelly, Thakkar, Mamita Bora, Laserson, Kayla F and Phillips-Howard, Penelope ORCID: https://orcid.org/0000-0003-1018-116X (2019) '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, Vol 9, Issue 1, 010408.

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Abstract

Background
Lack of menstrual knowledge, poor access to sanitary products and a non-facilitating school environment can make it difficult for girls to attend school. In India, interventions have been developed to reduce the burden of menstruation for school girls by government and non-governmental organizations (NGOs). We sought to identify challenges related to menstruation, and facilitators of menstrual management in schools in three states in India.

Methods
Surveys were conducted among menstruating school girls in class 8-10 (above 12 years of age) of 43 government schools selected through stratified random sampling in three Indian states (Maharashtra, Chhattisgarh, Tamil Nadu) in 2015. For comparison, ten model schools supported by NGOs or UNICEF with a focussed menstrual hygiene education program were selected purposely in the same states to represent the better-case scenario. We examined awareness about menarche, items used for menstruation, and facilitators on girls’ experience of menstruation in regular schools and compared with model schools. Factors associated with school absence during menstruation were explored using multivariate analysis.

Findings
More girls (mean age 14.1 years) were informed about menstruation before menarche in model schools (56%, n=492) than in regular schools (36%, n=2072, p<0.001). Girls reported menstruation affected school attendance (6% vs. 11% in model vs. regular schools respectively, p=0.003) and concentration (40% vs. 45%, p=0.1) and was associated with pain (31% vs. 38%, p=0.004) and fear of stain or smell (11% vs. 16%, p=0.002). About 45% of girls reported using disposable pads in both model and regular schools, but only 55% and 29% of pad-users reported good disposal facilities, respectively (p<0.001). In multivariate analysis, reported absenteeism during menstruation was significantly lower in Tamil Nadu (adjusted prevalence ratio [APR] 95% CI 0.24, 0.14-0.40) and Maharashtra (APR 0.56, 0.40-0.77) compared to Chhattisgarh, and halved in model compared to regular schools (APR 0.50, 0.34-0.73). Pain medication in school (APR 0.71, 0.51-0.97) and use of disposable pads (APR 0.57, 0.42-0.77) were associated with lower absenteeism and inadequate sanitary facilities with higher absenteeism during menstruation.

Conclusions
Menstrual hygiene education, accessible sanitary products, pain relief, and adequate sanitary facilities at school would improve the schooling-experience of adolescent girls in India.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WP Gynecology > WP 100 General works
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.7189/jogh.09.010408
Depositing User: Stacy Murtagh
Date Deposited: 07 Dec 2018 10:48
Last Modified: 12 Apr 2019 14:06
URI: https://archive.lstmed.ac.uk/id/eprint/9744

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