Abstract
Background
Adolescence in females signifies the transition from girlhood to womanhood and is marked with the onset of menarche. Indian society is interwoven into a set of traditions, myths and misconceptions, especially regarding menstruation and related issues. The present study was conducted to assess knowledge and psycho-social behavior related to menstruation among adolescent girls in urban Haryana (state), India.
Method
A total of 478 adolescent girls in the age group of 15 -19 years from three educational institutes of Rohtak city were selected randomly. It was a community-based, descriptive, cross-sectional questionnaire based study, and a pre-tested, pre-coded, closed ended questionnaire was used.
Results
Feeling of sickness was the most common (in more than two-third of subjects) followed by irritability and emotional disturbances. More than 3/4th of the subjects did not worship during menstruation, 45% were not allowed in kitchen and nearly one-fourth followed dietary restrictions. More than 16% subjects thought menstruation to be a sign of onset of a disease and little more than 7 % thought it to be a curse. Girls preferred to discuss their menstruation related problems either with their mothers or with their friends.
Conclusion
Girls have inaccurate and partial information regarding menstruation. There is a need of early intervention in the area of adolescent psycho-social behavior during menstruation.
Keywords: Psycho-social behavior, menstruation, adolescent girls, urban
Background
Adolescence is period when boys and girls are kindled into a new sense of self. This period can be difficult as it is full of anxiety and new emotions and especially in females it signifies the transition from girlhood to womanhood.1 During this phase as a result of production of sex hormones, overt changes in physical size and shape occur in body. These changes are also associated with some behavioral changes.2,2 In females, this transitional period is marked with the onset of menarche. In Indian cultural milieu, the society is interwoven into a set of traditions, myths and misconceptions, especially about menstruation and related issues. People maintain very conservative attitude in the society where superposition, cultural and religious constrain are dominant.4 Isolation and restrictions imposed during menstruation may incorporate negative attitude towards this phenomenon in girls. The study was conducted to assess knowledge and psycho-social behavior related to menstruation among adolescent urban girls of Haryana State.
Method
The present study was a community-based, descriptive, cross-sectional study conducted among adolescent girls in the age group of 15-19 years, attending educational institutes of Rohtak city (Haryana). Three educational institutes were selected for the study from a total of sixteen educational institutes by random sampling technique. A total of 478 adolescent girls were selected for the study, which was more than the minimum sample size i.e. 440; calculated at 95%confidence interval, 10% allowable error and assuming the proportion of girls having correct psychosocial behavior during menstruation as 0.55-7 with a nonresponse rate of 10%. To maintain uniformity in the study, the female students from the lower standards were enrolled first and the students were called according to their roll numbers. The subjects from a particular standard were enrolled till the desired sample was achieved. All the girls from the last selected standard were enrolled. A pretested, pre-coded, close ended questionnaire was used for this study. Questionnaire consisted of questions targeted at information regarding menstruation and issues related to it e.g. restrictions, behavioral changes, perceptions etc. They were asked to drop the questionnaire in the drop box placed outside their classrooms. The students were also told that it was not mandatory to fill/return the questionnaire. Prior verbal consent was taken from the respondents and teachers for the study. The girls who were not willing to participate were told that they may not return the questionnaire. Anonymity was maintained by not including the names of the respondents. The study was approved by institutional ethical committee.
Results
The present study comprised of 478 adolescent girls, in the age group of 15-19 years. The mean age of menarche among the study group was 13.7 years. Several behavioral changes were reported during the onset of menarche in the study subjects as shown in table 1.
Table 1. Behavioral changes during onset of menstruation (n = 478).
| Behaviour changes* | Number | %ages |
| Irritability | 292 | 61.09 |
| Emotional disturbances | 256 | 53.56 |
| Depression | 149 | 31.17 |
| Feeling of sickness | 318 | 66.53 |
| Absent from school/college | 67 | 14.02 |
| Decreased physical activity | 204 | 42.68 |
Subjects had multiple responses
Feeling of sickness was the most common observation followed by irritability and emotional disturbances. Nearly one third of the subjects felt depressed and more than 14% missed school. Several restrictions were also followed during menstruation (Table 2) e.g. more than 3/4th of the subjects did not worship during menstruation, 45% were not allowed to enter kitchen and families of nearly onefourth girls advocated some dietary restrictions.
Table 2. Activity restriction during menstruation (n = 478).
| Social activities | Number | %ages |
| No worship | 364 | 76.15 |
| Not allowed in kitchen | 217 | 45.40 |
| Dietary restrictions | 118 | 24.69 |
| No daily bath | 34 | 7.11 |
Subjects had multiple responses
Most of the study subjects thought menarche to be a natural phenomenon. Some of them had different perception regarding menarche (Table 3).
Table 3. Perceptions regarding menstruation (n = 478).
| Thoughts | Number | %ages |
| Natural process | 289 | 60.46 |
| Sign of onset of maturity | 252 | 52.71 |
| Onset of disease | 78 | 16.32 |
| Curse | 35 | 7.32 |
| No response | 24 | 5.02 |
Subjects had multiple responses
More than 16% subjects thought menstruation to be a sign of onset of a disease and nearly 7 % thought it is a curse. Nearly 30% of study subjects knew menstruation as the most important sign of attaining adulthood while others had a different opinion (Table 4).
Table 4. Perceptions regarding menstruation (n = 478).
| Signs of adulthood | Number | %ages |
| Increase in weight | 75 | 15.69 |
| Increase in height | 86 | 17.99 |
| Breast enlargement | 77 | 16.11 |
| Menstruation | 152 | 31.80 |
| No response | 88 | 18.41 |
For nearly one-third of subjects increase in height and weight was the criterion of attaining adulthood. Approximately 18% of the girls did not respond to this question. More than half of the girls discussed their menstruation related problems with their mothers and onethird preferred to discuss with friends. Six girls discussed their menstrual related problems with their father.
Discussion
The mean age at menarche in present study was 13.7 years, which was similar to that observed in the Chennai 8 and Delhi 9 surveys (13.6 years and 13.5 years respectively). It could be because of similar nutritional status and racial profiles of the girls in our study population.
Several other studies have also reported restrictions in daily activities such as, not being allowed to take bath, change clothes, comb hair and enter holy places.10-13 Apart from these, dietary restrictions like- taboo on consumption of food like rice, curd, milk, lassi, potato, onion, sugarcane etc, during the menstrual period are also imposed.1
Along with cultural constructs which lead to formation of a certain preconception, the reaction to menstruation also depends upon awareness and knowledge about the subject. Several behavioral changes were reported during menstruation by study subjects. This could be because only less than 40% of the subjects thought it to be a natural phenomenon. More than 7% of the subjects related menstruation as a curse. This showed that there are substantial lacunae in the knowledge towards menstruation among adolescent girls. Several research studies have also revealed this gap and showed that there is low level of awareness about menstruation among girls when they first experience it. 5,11,14
In our study the girls discussed the menstruation related problems with their mothers and friends/peers as also shown by several studies. Mothers and friends/peers generally lack the knowledge regarding menstruation since they have also not been told about this process in life. Many studies have revealed that mothers and friends are the main source of providing information about menstruation.15 Even if parents have knowledge they are not ready to share with their children. Several factors are responsible for this but most important being the social prohibition. The negative attitude of parents/teachers in discussing menstruation related issues openly had blocked the access of adolescent girls to right kind of information making other sources important for their knowledge resulting in propagation of inaccurate and partial information.
Further, the strong bondage with the traditional beliefs, taboos and misconceptions during menstruation has led to much serious health and behavior problems. 16, 17 Inaccurate and incomplete information provided to the girls through limited sources can lead to health problems and complications. Parents and print/electronic media can act as better source of knowledge transfer among adolescent girls, since most of girls have access to both. But it is very important that the information is correct. We must inform them about the good and reputable sources which they should access for correct information. For this parents should be educated first related to adolescent issues. Role of media can also be vital in this area. Media should share the responsibility for disseminating the correct information.
Conclusion
Current research in the area of adolescent psycho-social behavior during menstruation indicates a need of early intervention, rather than dismiss these as a transitory experience. In the absence of intervention, adolescents with abnormal psycho-social behaviour may develop any of several disorders including affective disorder, anxiety disorders, or impulse control disorder.18 Knowing the cultural setup of the community and educating appropriately will help in improving knowledge about menstruation. This in turn could change the practices followed by the families regarding menstruation and would be beneficial for improving their life processes and promoting their quality of life. Based upon our study findings we recommend that school authorities should take up at least a weekly session on the issues related to menstruation with the parents. They can invite various experts at times to address the important issues. Teachers should also address some issues in the class and also inform the students about good and reputable sources which they should access for correct information.
Limitations
Due to the use of closed ended questionnaire the exploration of responses was limited with respect to some of the issues.
Footnotes
PEER REVIEW
Not commissioned. Externally peer reviewed.
CONFLICTS OF INTEREST
Nil
FUNDING
Nil
Please cite this paper as: Goel MK, Page: 49 Mittal K. Psycho-social behaviour of urban Indian adolescent girls during menstruation. AMJ 2011, 4, 1, 48-52 Doi http//dx.doi.org/10.4066/AMJ.2011.534
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