A STUDY TO ASSESS KNOWLEDGE, ATTITUDE AND PRACTICES REGARDING MENSTRUAL CYCLE, MENSTRUAL HYGIENE, SEXUAL PROMISCUITY AND USE OF EMERGENCY CONTRACEPTIVES AMONG ADOLESCENT SCHOOL GIRLS IN URBAN POPULATION OF BHOPAL (MP) INDIA

Abstract

Background:

Menstruation is a natural physiological process that requires proper management (1) .Appropriate menstrual hygiene management (MHM) is impeded by taboos and secrecy surrounding menstruation. Unhygienic menstrual practices and unpreparedness for managing menstruation has been associated with adverse health and social outcomes among adolescent girls(2).Many adolescent girls in low-income and middle-income countries lack appropriate facilities and support in school to manage menstruation

(3).Unwanted pregnancy followed by unsafe abortion is one of the major worldwide health problems, which has many negative consequences on the health and well-being of women. Information about women’s knowledge, attitude and practice of emergency contraceptives plays a major role in the reduction of unwanted pregnancy(4).

Objective: To assess the knowledge, attitude and practices regarding menstrual cycle, menstrual hygiene, sexual promiscuity and use of emergency contraceptives amongst adolescent school girls.

Materials and Methods:

Since adolescence is the period when these habits related to menstruation start, the present study was undertaken amongst adolescent school girls in a urban area of Bhopal (MP) to assess their knowledge, attitude and practices regarding menstrual cycle, menstrual hygiene, sexual promiscuity and use of emergency contraceptives. Adolescent girls of class IX to XII were taken from 6 Government and private girl schools of Bhopal city in order to study knowledge, attitude and practices regarding menstruation, menstrual hygiene practices, sexual promiscuity and use of emergency contraceptives amongst adolescent girls. To get a representative sample schools exclusive for girls were chosen. All the students of class IX to XII were included in study. A cross-sectional study was carried out in Government and private schools of Bhopal exclusively for girls, drawing a sample of 2000 adolescent school girls studying in class IX to class XII through simple random sampling method. The sample size was calculated using the formula: 4PQ/L2 where P&Q were taken as 0.5 to get the maximum sample size and by accepting 7% permissible error and 15% as no response rate. Random number table was used for selection of adolescent school girls studying in Government and private schools, in class IX to class XII.

Results: The mean age at menarche was 13.5 years. 86% of the girls knew about menstruation before it occurred and the chief source of this information were mothers (77%) followed by friends (13%) and elder relatives (6%).Majority of the girls had correct idea about menstruation being a physiological process. However, their hygienic practices during menstruation were not satisfactory as almost half of them used cloth during periods and 38 reused cloth without adequate cleaning. Most of them did not use sanitary pads as they thought the same to be tooexpensive.90.5% of the adolescent school girls were aware about emergency contraceptive pills i.e. pills to prevent pregnancy after unprotected sex. 69.8% knew that these pills are available at pharmacy/chemist shops while 40.2% knew about their availability at private clinics of doctors while a lesser than a third (28.6%) of the women were aware that these pills are available at Government health centres and hospitals. Almost a third of the women had apprehensions regarding possible health problems(38.7%) with the use of these pills, side effects to the fetus incase of failure of emergency contraceptive(24.1%),effectiveness of these pills(15.1%) and problems in conceiving later on(33.7%).However, 11.1% also feared that the use of these pills might have more women suffering from sexually transmitted infections/HIV and almost half (49.2%) of the adolescent school girls felt that these pills may result in a casual approach towards sex among adolescent school girls. A total of 14 (1.4%) adolescent school girls had used ECPs during the last year.7 girls had used once, 4 had usedtwice and 3 had used it for 3 or more times during the last one year.

Conclusion: Correct knowledge of the girls was assessed by asking about cause of menstruation, age of menopause and whether menstruation occurs during pregnancy. 83.2% of the girls correctly knew about all the three. The knowledge was significantly associated with the age and number of years of schooling of the girls.90.5% of the adolescent school girls were aware about emergency contraceptive pills i.e. pills to prevent pregnancy after unprotected sex. The source of this information for most of them (75.9%) was through Television / Internet followed by relative / friend / spouse (10.6%). Only 40.7% women correctly knew about the time interval from unprotected sexual intercourse up to which these pills can be taken i.e. 72 hours. Alarmingly, 8.5% believed that these pills would also work in case of menstrual delay which can lead to these pills being unsuccessfully used to abort early pregnancies and may cause serious health problems.

Keywords: Menarche, Menstruation, Menstrual health, Menstrual hygiene management, Adolescent school girls, Taboo, School Absenteeism, Emergency contraceptive pills (ECP), Reproductive Tract Infections (RTI) and Coercion.