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OBJECTIVES: Menstrual hygiene management (MHM) in developing countries is linked to human rights, social justice, and the education and empowerment of young girls. The objective of this study was to assess menstrual hygiene practices and their determinants among adolescent girls, including school dropouts, and the effects of pad distribution programs in urban resettlement areas of Delhi, India. METHODS: A cross-sectional study was conducted from March 2019 to February 2020 in urban resettlement colonies and 2 villages of Delhi among 1,130 adolescent girls aged 10 to 19 years, who were interviewed face to face. RESULTS: In total, 954 participants (84.4%) used only disposable sanitary pads, 150 (13.3%) used both sanitary pads and cloths, and 26 (2.3%) used only cloths (n=1,130). Most school-going girls utilized the scheme for pad distribution, but only two-thirds of the girls who were out of school utilized the scheme. In the adjusted analysis, girls with lower educational status, those who had dropped out of school, and those from the Muslim religious community were more likely to use cloths for MHM. CONCLUSION: More than 4 out of 5 adolescent girls in Delhi in low-income neighborhoods preferred sanitary pads for MHM. The government free pad scheme reached near-universal utilization among school-going girls (97%), but the subsidized pad scheme for girls who did not attend school was insufficiently utilized (75%).
RESUMO
BACKGROUND: Government schemes for the promotion of Menstrual Hygiene Management (MHM) among adolescent girls in India are underpinned by crucial implementation efforts from the frontline health workers, community health workers, and school teachers. AIM: The aim of the study is to identify the perspectives on menstrual health and hygiene management with regard to government schemes for sanitary pad distribution to adolescent girls among the frontline workers and the government school teachers located in urban resettlement colonies in Delhi. METHODS: In-depth interviews were conducted with 30 accredited social health activisits, 30 Anganwadi Workers (AWW), and 30 auxiliary nurse midwives (ANMs) and five focus group discussions among 28 government school teachers from the middle, high, and secondary standard. RESULTS: Most participants recognized the phenomenon of menstruation-related problems in adolescent girls and were aware of some of the common sociocultural, religious, and hygiene-related menstrual restrictions prevalent in their communities. All the participants believed that the pad distribution scheme was highly beneficial. However, in spite of inclusion of menstrual health promotion in the school curriculum, teachers often lacked self-efficacy in discussing challenges and health concerns related to MHM with their students. CONCLUSIONS: Despite their potential as community resources for adolescent girls, FHWs, ANMs, and school teachers often fail to impart crucial menstrual hygiene information and skills-building needed toward achieving effective, safe, and optimal MHM.
RESUMO
INTRODUCTION: Menstruation, a physiological phenomenon, till date is associated with myths, taboos, and malpractices. These interfere with the emotional, physical, and mental health of adolescent girls. This study attempts to draft a validated questionnaire to measure menstruation-related activity restriction. OBJECTIVE: The objective was to study activities restricted during menstruation among adolescent girls residing in urban resettlement colonies of Delhi and to develop and validate a questionnaire for menstruation-related activity restriction. MATERIALS AND METHODS: A community-based cross-sectional study was conducted among adolescent girls residing in urban resettlement colonies of Delhi during 2019. A multistage random sampling technique was used to select 1100 girls across four districts of Delhi. A 15-item questionnaire was developed by an expert committee and validated with principal component analysis (PCA). RESULTS: In total, 1100 adolescent girls were included in the study whose mean age was 15.8 (±2.1) years. School/college/work was missed due to menstruation in 60% of the adolescent girls, 66% were not comfortable during menstruation, and 92% were restricted from entering religious places. In exploratory factor analysis using PCA, 6 principal components were identified which had eigenvalues more than 1. CONCLUSION: Religious restrictions during menstruation (94%) were highly prevalent among adolescent girls, followed by restriction of routine activity (69%) and work/academically related activity (60%). Construct validity has identified a six-factor structure for the menstruation-related activity restriction questionnaire. This was identified as a valid and internally consistent tool to assess activities restricted during menstruation among Indian adolescent girls.
