PERCEIVED IMPACTS OF MENSTRUATION TO ACCOMPLISH HIGH SCHOOL EDUCATION AMONG GIRLS: A CROSS-SECTIONAL STUDY FROM HILLY REGIONS OF LUMBINI PROVINCE OF NEPAL

Authors: *Badri N. Karki, Khimananda Bhandari & Rudra Dahal

ABSTRACT 

This study aimed to analyze the perceived impacts of menstruation to accomplish high school education among secondary school-level girls in the hilly districts of Lumbini Province, Nepal. Focused on the local context, the study provides a detailed examination of impacts which includes missing regular teaching learning activities, unable to submit assignment/homework on time, unable to attend final exams, getting low grade, anxiety, class repetition, and susceptible for early marriage. The study reveals that 93% of girls have experienced school absenteeism during menstruation, with significant implications for academic achievement, psychological well-being, and long-term opportunities. Despite the global recognition of menstrual health issues, the study emphasizes the lack of attention to this specific context, calling for more research and policies tailored to the hilly districts of Lumbini Province. The research aims to inform the provincial government and advocate for targeted policies to address the identified gaps, contributing valuable insights to the discourse on menstrual health and education in the region. The study’s strengths lie in its comprehensive analysis, contextual relevance, quantitative approach, and explicit policy implications.

Keywords: Menstruation, menstrual barrier, impacts on educational attainment, and Nepal.

REFERENCES

  • Adhikari, P., Kadel, B., Dhungel, S. I., & Mandal, A. (2007). Knowledge and practice regarding menstrual hygiene in rural adolescent girls of Nepal. Kathmandu University Medical Journal (KUMJ), 5(3), 382–386.
  • Davis, J., Macintyre, A., Odagiri, M., Suriastini, W., Cordova, A., Huggett, C., Agius, P. A., Faiqoh, Budiyani, A. E., Quillet, C., Cronin, A. A., Diah, N. M., Triwahyunto, A., Luchters, S., & Kennedy, E. (2018). Menstrual hygiene management and school absenteeism among adolescent students in Indonesia: Evidence from a cross‐sectional school‐based survey. Tropical Medicine & International Health, 23(12), 1350–1363. https://doi.org/10.1111/tmi.13159
  • Ellis, A., Haver, J., Villasenor, J., Parawan, A., Venkatesh, M., Freeman, M. C., & Caruso, B. A. (2016). WASH challenges to girls’ menstrual hygiene management in Metro Manila, Masbate, and South Central Mindanao, Philippines. Waterlines, 35(3), 306–323. https://doi.org/10.3362/1756-3488.2016.022
  • Garg, S., & Anand, T. (2015). Menstruation related myths in India: Strategies for combating it. Journal of Family Medicine and Primary Care, 4(2), 184–186. https://doi.org/10.4103/2249-4863.154627
  • Gupta, N., Kariwala, P., Dixit, A. M., Govil, P., . M., & Jain, P. K. (2018). A cross-sectional study on menstrual hygiene practices among school going adolescent girls (10-19 years) of Government Girls Inter College, Saifai, Etawah. International Journal Of Community Medicine And Public Health, 5(10), 4560. https://doi.org/10.18203/2394-6040.ijcmph20184010
  • Hennegan, J., Dolan, C., Steinfield, L., & Montgomery, P. (2017). A qualitative understanding of the effects of reusable sanitary pads and puberty education: Implications for future research and practice. Reproductive Health, 14(1), 78. https://doi.org/10.1186/s12978-017-0339-9
  • Hennegan, J., OlaOlorun, F. M., Oumarou, S., Alzouma, S., Guiella, G., Omoluabi, E., & Schwab, K. J. (2021). School and work absenteeism due to menstruation in three West African countries: Findings from PMA2020 surveys. Sexual and Reproductive Health Matters, 29(1), 409–424. https://doi.org/10.1080/26410397.2021.1915940
  • Joshi, S. (2022). Chhaupadi practice in Nepal: A literature review. World Medical and Health Policy, 14(1), 121–137. https://doi.org/10.1002/wmh3.491
  • Kaur, R., Kaur, K., & Kaur, R. (2018). Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries. Journal of Environmental and Public Health, 2018, 1–9. https://doi.org/10.1155/2018/1730964
  • Khanal, G., Shrestha, N., Adhikari, K., & Ghimire, U. (2023). Menstruation hygiene management among secondary school students of Chitwan, Nepal:a cross-sectional study. BMC Women’s Health, 23(1), 395. https://doi.org/10.1186/s12905-023-02494-x
  • Kumbeni, M. T., Ziba, F. A., Apenkwa, J., & Otupiri, E. (2021). Prevalence and factors associated with menstruation-related school absenteeism among adolescent girls in rural northern Ghana. BMC Women’s Health, 21(1), 279. https://doi.org/10.1186/s12905-021-01418-x
  • Lancaster, G. A., Dodd, S., & Williamson, P. R. (2004). Design and analysis of pilot studies: Recommendations for good practice. Journal of Evaluation in Clinical Practice, 10(2), 307–312. https://doi.org/10.1111/j..2002.384.doc.x
  • Mason, L., Nyothach, E., Alexander, K., Odhiambo, F. O., Eleveld, A., Vulule, J., Rheingans, R., Laserson, K. F., Mohammed, A., & Phillips-Howard, P. A. (2013). ‘We Keep It Secret So No One Should Know’ – A Qualitative Study to Explore Young Schoolgirls Attitudes and Experiences with Menstruation in Rural Western Kenya. PLoS ONE, 8(11), e79132. https://doi.org/10.1371/journal.pone.0079132
  • Miiro, G., Rutakumwa, R., Nakiyingi-Miiro, J., Nakuya, K., Musoke, S., Namakula, J., Francis, S., Torondel, B., Gibson, L. J., Ross, D. A., & Weiss, H. A. (2018). Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): A feasibility study. BMC Women’s Health, 18(1), 4. https://doi.org/10.1186/s12905-017-0502-z
  • Mohammed, S., & Larsen-Reindorf, R. E. (2020). Menstrual knowledge, sociocultural restrictions, and barriers to menstrual hygiene management in Ghana: Evidence from a multi-method survey among adolescent schoolgirls and schoolboys. PLOS ONE, 15(10), e0241106. https://doi.org/10.1371/journal.pone.0241106
  • Mohammed, S., Larsen-Reindorf, R. E., & Awal, I. (2020). Menstrual Hygiene Management and School Absenteeism among Adolescents in Ghana: Results from a School-Based Cross-Sectional Study in a Rural Community. International Journal of Reproductive Medicine, 2020, 1–9. https://doi.org/10.1155/2020/6872491
  • Montgomery, P., Ryus, C. R., Dolan, C. S., Dopson, S., & Scott, L. M. (2012). Sanitary Pad Interventions for Girls’ Education in Ghana: A Pilot Study. PLoS ONE, 7(10), e48274. https://doi.org/10.1371/journal.pone.0048274
  • Oduor, C., Alexander, K. T., Oruko, K., Nyothach, E., Mason, L., Odhiambo, F. O., Vulule, J., Laserson, K. F., & Phillips-Howard, P. A. (2015). Schoolgirls’ experiences of changing and disposal of menstrual hygiene items and inferences for WASH in schools. Waterlines, 34(4), 397–411. https://doi.org/10.3362/1756-3488.2015.037
  • Parker, M., Sneddon, A., & Arbon, P. (2010). The menstrual disorder of teenagers (MDOT) study: Determining typical menstrual patterns and menstrual disturbance in a large population‐based study of Australian teenagers. BJOG: An International Journal of Obstetrics & Gynaecology, 117(2), 185–192. https://doi.org/10.1111/j.1471-0528.2009.02407.x
  • Phillips-Howard, P. A., Caruso, B., Torondel, B., Zulaika, G., Sahin, M., & Sommer, M. (2016). Menstrual hygiene management among adolescent schoolgirls in low- and middle-income countries: Research priorities. Global Health Action, 9(1), 33032. https://doi.org/10.3402/gha.v9.33032
  • Pitangui, A. C. R., Gomes, M. R. D. A., Lima, A. S., Schwingel, P. A., Albuquerque, A. P. D. S., & De Araújo, R. C. (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(3), 148–152. https://doi.org/10.1016/j.jpag.2012.12.001
  • Ranabhat, D., Nepal, S., & Regmi, B. (2019). Menstrual Hygiene Practice and School Absenteeism among Rural Adolescent girls of Kalikot district. Nepal Medical College Journal, 21(4), 258–264. https://doi.org/10.3126/nmcj.v21i4.27614
  • Rossouw, L., & Ross, H. (2021). Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low- and Middle-Income Countries. International Journal of Environmental Research and Public Health, 18(5), 2571. https://doi.org/10.3390/ijerph18052571
  • Schmitt, M. L., Hagstrom, C., Gruer, C., Nowara, A., Keeley, K., Adenu-Mensah, N. E., & Sommer, M. (2022). “Girls May Bleed Through Pads Because of Demerits”: Adolescent Girls’ Experiences With Menstruation and School Bathrooms in the U.S.A. Journal of Adolescent Research, 074355842211393. https://doi.org/10.1177/07435584221139342
  • Shah, A. K., Mullainathan, S., & Shafir, E. (2012). Some Consequences of Having Too Little. Science, 338(6107), 682–685. https://doi.org/10.1126/science.1222426
  • Sharma, S., Choudhary, S., Saluja, N., D R, G., Kumari, S., & Pandey, S.M. (2016). Knowledge and Practices About Menstrual Hygiene among School Adolescent Girls in Agroha Village of Haryana. Journal of Evolution of Medical and Dental Sciences, 5(09), 389–392. https://doi.org/10.14260/jemds/2016/89
  • Sharma, S., Mehra, D., Brusselaers, N., & Mehra, S. (2020). Menstrual Hygiene Preparedness Among Schools in India: A Systematic Review and Meta-Analysis of System-and Policy-Level Actions. International Journal of Environmental Research and Public Health, 17(2), 647. https://doi.org/10.3390/ijerph17020647
  • Sivakami, M., Maria Van Eijk, A., Thakur, H., Kakade, N., Patil, C., Shinde, S., Surani, N., Bauman, A., Zulaika, G., Kabir, Y., Dobhal, A., Singh, P., Tahiliani, B., Mason, L., Alexander, K. T., Thakkar, M. B., Laserson, K. F., & Phillips-Howard, P. A. (2019). Effect of menstruation on girls and their schooling, and facilitators of menstrual hygiene management in schools: Surveys in government schools in three states in India, 2015. Journal of Global Health, 9(1), 010408. https://doi.org/10.7189/jogh.09.010408
  • Sommer, M. (2010). Where the education system and women’s bodies collide: The social and health impact of girls’ experiences of menstruation and schooling in Tanzania. Journal of Adolescence, 33(4), 521–529. https://doi.org/10.1016/j.adolescence.2009.03.008
  • Sommer, M., Caruso, B. A., Sahin, M., Calderon, T., Cavill, S., Mahon, T., & Phillips-Howard, P. A. (2016). A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools. PLoS Medicine, 13(2), e1001962. https://doi.org/10.1371/journal.pmed.1001962
  • Tegegne, T. K., & Sisay, M. M. (2014). Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia. BMC Public Health, 14(1), 1118. https://doi.org/10.1186/1471-2458-14-1118
  • Uzoechi, C. A., Parsa, A. D., Mahmud, I., Alasqah, I., & Kabir, R. (2023). Menstruation among In-School Adolescent Girls and Its Literacy and Practices in Nigeria: A Systematic Review. Medicina, 59(12), 2073. https://doi.org/10.3390/medicina59122073
  • Van Eijk, A. M., Sivakami, M., Thakkar, M. B., Bauman, A., Laserson, K. F., Coates, S., & Phillips-Howard, P. A. (2016). Menstrual hygiene management among adolescent girls in India: A systematic review and meta-analysis. BMJ Open, 6(3), e010290. https://doi.org/10.1136/bmjopen-2015-010290
  • Vashisht, A., Pathak, R., Agarwalla, R., Patavegar, B. N., & Panda, M. (2018). School absenteeism during menstruation amongst adolescent girls in Delhi, India. Journal of Family & Community Medicine, 25(3), 163–168. https://doi.org/10.4103/jfcm.JFCM_161_17