Knowledge, Attitudes and Practices Regarding Menstruation in University Level Women in Faisalabad, Pakistan: A Cross-Sectional Study

Anam Batool; Syeda Afnan Fatima

doi:10.71146/kjmr972

Authors

Anam Batool Department of Epidemiology and Public Health, University of Agriculture, Faisalabad, Pakistan Author
Syeda Afnan Fatima Department of Public Health, University of Punjab, Pakistan Author

DOI:

https://doi.org/10.71146/kjmr972

Keywords:

Menstrual hygiene management, knowledge attitudes and practices, dysmenorrhea, university students, Pakistan, reproductive health, menstrual taboos

Abstract

Background:

Menstruation is a reproductive experience that affects all people irrespective of their geographical location, however, there exists a lack of awareness regarding the issue leading to inadequate management of the menstrual cycle among adolescents and women from low-and-middle income countries. In Pakistan, owing to the existence of a patriarchal society, period poverty and lack of health education, proper MHM has become challenging.

Methods:

In order to examine the knowledge, attitudes, and practices regarding menstruation, a cross-sectional study was conducted among women of university-level in the Faisalabad district of Punjab province, Pakistan. A pre-validated self-reported questionnaire adapted from Brooks-Gunn & Ruble (1982) was administered among 384 female university students who were selected using probability sampling method. Information related to demographic characteristics, menstrual knowledge, practice and attitudes as well as symptoms experienced during menstruation was obtained through questionnaire and analyzed by descriptive statistics and Pearson's chi-square test (SPSS v25.0, p<0.005).

Results:

The average age of the respondents was 25 years old (age range of 19 to 45 years). Menarche at age 13 years was the most common age group among the respondents (43.34%). Only 57.02% had adequate knowledge about delayed periods and its causes, while 44.04% had no knowledge about menstruation. One-time use sanitary pads were commonly used among the participants (36.65%), while 79.9% disposed of the menstrual products in the dustbins. As many as 76.82% of the respondents experienced absence from the educational institutions during their menstrual period. Eighty-one percent of the respondents reported having dysmenorrhea. Irritability (45.8%), anxiety (45.3%), depression (38.0%), and insomnia (41.1%) were common psychological symptoms among the respondents. What is alarming is that 89.75% found themselves embarrassed purchasing menstrual products, while 51.30% used.

Conclusion:

The problems associated with ignorance, hygienic behavior, and cultural myths surrounding menstrual health are widespread among girls attending universities in Faisalabad. According to the above analysis, there seems to be an urgent need for the introduction of menstrual health education programs in order to address the problem.

Downloads

Download data is not yet available.

References

Akpenpuun, J.R. and S.A. Azende. 2014. Menstrual practices among female students in Benue State University, Makurdi. Nigerian Journal of Medicine 23: 120-126.

Ali, T.S. and S. Rizvi. 2010. Menstrual knowledge and practices of female adolescents in urban Karachi, Pakistan. Journal of Adolescence 33: 531-541.

Alherbi, A.S. 2018. A validated questionnaire for assessment of menstrual health knowledge and practices. Journal of Women's Health 27: 1150-1158.

Anthoney, M. 2017. Reproductive physiology and menstrual cycle. Clinical Obstetrics and Gynaecology 12: 45-60.

Balbi, C., R. Musone, A. Menditto, L. Di Prisco, E. Cassese, M. D'Ajello and A. Cardone. 2000. Influence of menstrual factors and dietary habits on menstrual pain. European Journal of Obstetrics and Gynecology 91: 143-148.

Bano, F. and Al Sabhan. 2015. Reproductive health knowledge and practices among university students. Journal of the Pakistan Medical Association 65: 755-760.

Bartram, J., C. Brocklehurst, M.D. Fisher, R. Luyendijk, D. Hossain, D. Wardlaw and A. Wright. 2005. Global monitoring of water supply and sanitation: History, methods and future challenges. International Journal of Environmental Research and Public Health 6: 3-24.

Berk, L.E. and A.B. Meyers. 1996. Infants, children, and adolescents. Allyn and Bacon, Boston. pp. 815-816.

Blakey, H., C. Chisholm, F. Dear, B. Harris, R. Hartwell, A.J. Daley and K. Jolly. 2010. Is exercise associated with primary dysmenorrhoea in young women? BJOG 117: 222-224.

Borjigen, A., C. Huang, M. Liu, J. Lu, H. Peng, C. Sapkota and J. Sheng. 2019. Status and factors of menstrual knowledge, attitudes, behaviors and their correlation with psychological stress in adolescent girls. Journal of Pediatric and Adolescent Gynecology 32: 584-589.

Brooks-Gunn, J. and D.N. Ruble. 1982. The development of menstrual-related beliefs and behaviors during early adolescence. Child Development 53: 1567-1577.

Cardozo, E.R., A.D. Clark, N.K. Banks, M.B. Henne, B.J. Stegmann and J.H. Segars. 2012. The estimated annual cost of uterine leiomyomata in the United States. American Journal of Obstetrics and Gynecology 206: 211.e1-211.e9.

Chaturvedi, D., P.K. Chaudhuri, C.A. Priyanka and A.K. Chaudhary. 2017. Study of correlation between dietary habits and anemia among adolescent girls in Ranchi. International Journal of Contemporary Pediatrics 4: 1165-1168.

Crofts, T. and J. Fisher. 2012. Menstrual hygiene in Ugandan schools: An investigation of low-cost sanitary pads. Journal of Water, Sanitation and Hygiene for Development 2: 50-58.

Deo, D.S. and C.H. Ghattargi. 2005. Perceptions and practices regarding menstruation: A comparative study in urban and rural adolescent girls. Indian Journal of Community Medicine 30: 33-38.

El-Gilany, A.H., K. Badawi and S. El-Fedawy. 2005. Menstrual hygiene among adolescent schoolgirls in Mansoura, Egypt. Reproductive Health Matters 13: 147-152.

Fingerson, L. 2012. Girls in power: Gender, body, and menstruation in adolescence. SUNY Press. pp. 1-9.

Garg, S. and T. Anand. 2015. Menstruation related myths in India: Strategies for combating it. Journal of Family Medicine and Primary Care 4: 184-189.

Grandner, M.A. 2017. Sleep, health, and society. Sleep Medicine Clinics 12: 1-22.

Hennegan, J. and P. Montgomery. 2016. Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low- and middle-income countries? A systematic review. PloS One 11: e0146985.

Hennegan, J., A.K. Shannon, J. Rubli, K.J. Schwab and G.J. Melendez-Torres. 2019. Women's and girls' experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PLoS Medicine 16: e1002803.

Hennegan, J., D.J. Brooks, K.J. Schwab and G.J. Melendez-Torres. 2020. Measurement in the study of menstrual health and hygiene: A systematic review and audit. PLoS One 15: e0232935.

House, S., T. Mahon and S. Cavill. 2013. Menstrual hygiene matters: A resource for improving menstrual hygiene around the world. Reproductive Health Matters 21: 257-259.

Houston, A.M., A. Abraham, Z. Huang and L.J. D'Angelo. 2006. Knowledge, attitudes, and consequences of menstrual health in urban adolescent females. Journal of Pediatric and Adolescent Gynecology 19: 271-275.

Kaur, S., P.R. Deshmukh and B.S. Garg. 2006. Epidemiological correlates of nutritional anemia in adolescent girls of rural Wardha. Indian Journal of Community Medicine 31: 255-258.

Kennedy, K.E., C. Onyeonwu, S. Nowakowski, L. Hale, C.C. Branas, W.D. Killgore, C.C. Wills and M.A. Grandner. 2022. Menstrual regularity and bleeding is associated with sleep duration, sleep quality and fatigue in a community sample. Journal of Sleep Research 31: 13-34.

Khan, A. 1999. Mobility of women and access to health and family planning services in Pakistan. Reproductive Health Matters 7: 39-48.

Khisro, S.S. and A.U. Rahman. 2012. Paving way for menstrual hygiene management in rural Pakistan. Asia Regional Sanitation and Hygiene Practitioners Workshop, Dhaka, Bangladesh 4: 45-51.

Kumar, A. and K. Srivastava. 2011. Cultural and social practices regarding menstruation among adolescent girls. Social Work in Public Health 26: 594-604.

Kuhlmann, A.S., K. Henry and L.L. Wall. 2017. Menstrual hygiene management in resource-poor countries. Obstetrical and Gynecological Survey 72: 354-356.

Marjoribanks, J., A. Lethaby and C. Farquhar. 2016. Surgery versus medical therapy for heavy menstrual bleeding. Cochrane Database of Systematic Reviews 1: CD003855.

Mathews, G. 1995. Menstrual hygiene management among Bangladeshi girls. Journal of Adolescent Health 16: 210-218.

Michael, J., Q. Iqbal, S. Haider, A. Khalid, N. Haque, R. Ishaq, F. Saleem, M.A. Hassali and M. Bashaar. 2020. Knowledge and practice of adolescent females about menstruation and menstruation hygiene visiting a public healthcare institute of Quetta, Pakistan. BMC Women's Health 20: 1-8.

Moawed, S. 2001. Indigenous practices of Saudi girls in Riyadh during their menstrual period. Eastern Mediterranean Health Journal 7: 197-203.

Mohamadirizi, S. and M. Kordi. 2013. Association between menstruation signs and anxiety, depression, and stress in school girls in Mashhad in 2011-2012. Iranian Journal of Nursing and Midwifery Research 18: 400-402.

Montgomery, P., C.R. Ryus, C.S. Dolan, S. Dopson and L.M. Scott. 2012. Sanitary pad interventions for girls' education in Ghana: A pilot study. PloS One 7: e48274.

Mumtaz, S. and S.K. Ansari. 2016. Psychology of beliefs and practices relating to menstrual hygiene of adolescent girls in rural Islamabad, Pakistan. Imperial Journal of Interdisciplinary Research 2: 670-677.

North, B.B. and M.J. Oldham. 2011. Preclinical, clinical, and over-the-counter postmarketing experience with a new vaginal cup: Menstrual collection. Journal of Women's Health 20: 303-311.

Oster, E. and R. Thornton. 2012. Determinants of technology adoption: Peer effects in menstrual cup take-up. Journal of the European Economic Association 10: 1263-1293.

Pitangui, A.C.R., M.R.D.A. Gomes, A.S. Lima, P.A. Schwingel, A.P.D.S. Albuquerque and R.C. de Araújo. 2013. Menstruation disturbances: Prevalence, characteristics, and effects on the activities of daily living among adolescent girls from Brazil. Journal of Pediatric and Adolescent Gynecology 26: 148-152.

Poureslami, M. and F. Osati-Ashtiani. 2002. Assessing knowledge, attitudes, and behavior of adolescent girls in suburban districts of Tehran about dysmenorrhea and menstrual hygiene. Journal of International Women's Studies 3: 51-61.

Premila, E., K. Ganesh and L. Chaitanya. 2015. Impact of planned health education programme on knowledge and practice regarding menstrual hygiene among adolescent girls in Puducherry. Asia-Pacific Journal of Operational Research 1: 5.

Puri, S. and S. Kapoor. 2006. Taboos and myths associated with women's health among rural and urban adolescent girls in Punjab. Indian Journal of Community Medicine 31: 295.

Romans, S.E., D. Kreindler, G. Einstein, S. Laredo, M.J. Petrovic and J. Stanley. 2015. Sleep quality and the menstrual cycle. Sleep Medicine 16: 489-495.

Sapkota, D., D. Sharma, H.P. Pokharel, S.S. Budhathoki and V.K. Khanal. 2013. Knowledge and practices regarding menstruation among school going adolescents of rural Nepal. Journal of Kathmandu Medical College 2: 122-128.

Schoep, M.E., T.E. Nieboer, M. van der Zanden, D.D. Braat and A.W. Nap. 2019. The impact of menstrual symptoms on everyday life: A survey among 42,879 women. American Journal of Obstetrics and Gynecology 220: 569.e1-569.e7.

Singh, A., D. Kiran, H. Singh, B. Nel, P. Singh and P. Tiwari. 2008. Prevalence and severity of dysmenorrhea: A problem related to menstruation, among first and second year female medical students. Indian Journal of Physiology and Pharmacology 52: 389-397.

Sommer, M., B.A. Caruso, B. Torondel, E.C. Warren, B. Yamakoshi, J. Haver, J. Long, T. Mahon, E. Nalinponguit, N. Okwaro and P.A. Phillips-Howard. 2021. Menstrual hygiene management in schools: Midway progress update on the MHM in Ten 2014-2024 global agenda. Health Research Policy and Systems 19: 1-14.

Sun, S. and S. Wang. 2015. The Children's Depression Inventory in worldwide child development research: A reliability generalization study. Journal of Child and Family Studies 24: 2352-2363.

Unsal, A., U. Ayranci, M. Tozun, G. Arslan and E. Calik. 2010. Prevalence of dysmenorrhea and its effect on quality of life among a group of female university students. Upsala Journal of Medical Sciences 115: 138-145.

Wilson, E., J. Haver, B. Torondel, J. Rubli and B.A. Caruso. 2018. Dismantling menstrual taboos to overcome gender inequality. Lancet Child and Adolescent Health 2: 17.

Xing, X., P. Xue, S.X. Li, J. Zhou and X. Tang. 2020. Sleep disturbance is associated with an increased risk of menstrual problems in female Chinese university students. Sleep and Breathing 24: 1719-1727.

Yasmin, R., M. Afzal, M. Hussain and S.A. Gillani. 2019. Knowledge, attitude and practice of teenage girls regarding menstruation. European Academic Research 1: 360-379.

Zaman, K., S. Ashraf, F. Sajjad, S. Saleem and U.M. Raja. 2015. Quality versus quantity in health care and educational reforms: Combating poverty. Quality and Quantity 49: 267-293.