A qualitative study of adolescent girls’ experiences of menarche and menstruation in rural Tamil Nadu, India

ABSTRACT

Background: In low- and middle-income countries, women and girls experience menstrual hygiene management-related health and social challenges such as urinary tract infections, social stigma, and school and workplace absenteeism.

Purpose: In this study, we sought to explore how adolescent girls in rural Thirumalaikodi, Tamil Nadu, India experience menarche and menstruation, how their experiences connect to the sociocultural context, and what strategies they use to manage menstruation. This study also informed the adaptation and development of a school-based water, sanitation, and hygiene intervention.

Methods: We conducted ten semi-structured qualitative interviews with adolescent girls in ninth standard from June-July 2018. Data were analysed using a thematic network approach.

Results: Findings revealed that menarche inaugurates biological transitions of puberty and cultural codes that shape gender norms. Gender norms in turn generate, maintain, and reproduce stigmatizing attitudes, beliefs, and practices that influenced the development of coping mechanisms at home and at school. Resulting adaptations to the intervention consisted of two activities (school lesson and an extracurricular activity) that address knowledge gaps and myths.

Conclusions: This study demonstrates the importance of qualitative research in unpacking adolescent girls’ experiences with menarche and menstruation. Study findings also show how formative research can contribute to the adaptation and development of a contextually and culturally-relevant water, sanitation, and hygiene intervention.

KEYWORDS:

• Menstrual hygiene management
• adolescent
• gender norms
• water
• sanitation
• hygiene
• India

Acknowledgments

We would like to acknowledge the contributions and support of teachers, staff, and students who participated and contributed to this research project. In addition, we would like to thank the staff at the Sri Narayani Hospital and Research Centre, Dr. Balaji, Mr. Suresh Babu, Geir Aamodt, Ramesh Shanmugasundaram, Dr. N Srividhya, Aruna Ganesan, and J Poonguzhali.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The datasets generated for this study are available on request to the corresponding author.

Notes

1. Traditional bathing of the head and hair done during menstruation, practiced both for hygiene and to alleviate symptoms associated with menstruation.

2. Ritual acts of devotion and worship.

3. Kumkum is a red powder composed of lime and tumeric that is commonly applied to the centre of one’s forehead.

4. A bindi is a marking applied to the centre of the forehead, traditionally placed on the sixth chakra, or third eye.

Additional information

Funding

This work was financially supported by CINIM (Canadian Institute of Natural and Integrative Medicine); the Meltzer Research Fund; and the Norwegian University of Life Sciences.

Notes on contributors

Anise Gold-Watts

Anise Gold-Watts, earned her Master’s in Public Health from the University of North Carolina, at Chapel Hill’s Gillings School of Global Public Health, USA, and her doctorate degree from the Department of Public Health Science at the Norwegian University of Life Sciences, Norway.

Marte Hovdenak

Marte Hovdenak, earned her MPhil from the University of Bergen, Norway focusing on menstrual hygiene management in India.

Marguerite Daniel

Marguerite Daniel currently serves as a Professor in the Department of Health Promotion and Development and Programme Director for the Master's in Global Development Theory and Practice at the University of Bergen, Norway.

Subramanian Gandhimathi

Subramanian Gandhimathi, is currently a Professor in Community Health at the Sri Narayani College & School of Nursing in Thirumalaikodi, India.

Rajamani Sudha

Rajamani Sudha, is currently a Professor in Obstetrics and Gynaecology Nursing at the Sri Narayani College & School of Nursing in Thirumalaikodi, India.

Sheri Bastien

Sheri Bastien, is currently an Associate Professor of Public Health at the Norwegian University of Life Sciences, Norway and an adjunct professor at the Cumming School of Medicine, University of Calgary, Canada.