ASSESSING THE ATTITUDES TOWARD MENSTRUAL HYGIENE PRACTICES AMONG ADOLESCENTS IN COMMUNITY SECONDARY SCHOOLS IN ETINAN LOCAL GOVERNMENT AREA

CHAPTER ONE

INTRODUCTION

1.1 Background Of The Study

Different batches of adolescents (people between the ages of 10-19 years) enter puberty annually; unaware, unprepared and confused by the physical changes and emotional challenges that come with it. Hygienically managing menstruation in adolescence can be challenging and enigmatic. Social norms and cultural practices surrounding menstruation means that most adolescents receive incomplete or inaccurate information on menstrual hygiene management (MHM). The lack of practical life skills to effectively manage menstruation could reduce adolescent girls’ self-esteem, impair their health and truncate their education. The United Nations Children’s Fund (UNICEF) has been at the forefront of efforts to provide menstruation education; and water, sanitation and hygiene (WASH) facilities in schools. Despite the critical importance of MHM to adolescent girls, studies show that most educational institutions do not provide adolescents with the necessary information prior to menarche. Mothers and female family members, who may not have the necessary knowledge and skills in MHM, are often the main source of information for most adolescents (Chandra-Mouli & Patel, 2017). MHM means “Women and adolescent girls use a clean material to absorb or collect menstrual blood, and this material can be changed in privacy as often as necessary for the duration of the menstrual period” (Sommer et al., 2017). It also includes the use of soap and water for washing the body as often as necessary and access to the necessary facilities for the disposal of used menstrual management materials. Literature shows that most adolescents have inaccurate knowledge and misconceptions about menstruation. Those that have knowledge tend to practice wrong menstrual hygiene management due to factors such as inadequate menstrual sanitary materials and lack of emotional or physical support (Chandra-Mouli & Patel, 2017).

In a study in (Yadav et al., 2017) found that although 67.4% of female adolescent students were aware of MHM, about a quarter (26.4%) of them had adequate knowledge of MHM. In Western Ethiopia, (Upashe et al., 2015) found that 60.9% of them had adequate knowledge of MHM. They also discovered that teachers were their primary source of MHM information. However, in Nepal, (Gultie et al., 2014) revealed that majority (90.7%) of adolescent female students had high level of knowledge on MHM. (Gultie et al., 2014) also found that place of residence and maternal educational status were predictors of knowledge about MHM. Although menstruation is a normal biological process and a key sign of reproductive health, ignorance and misconceptions often lead to shaming and marginalisation of menstruating girls (Santra, 2017). A systematic review revealed that less than half of adolescents in India have menstrual information prior to menarche (Van Eijk et al., 2016). Among adolescent students in Katsina state of Nigeria, (OkaforTerver & Chuemchit, 2017) discovered that although about a third of them had basic knowledge of menstruation, 3-in-5 had no knowledge of the cause of menses, the channel through which menses flow and intervals between menstruation. They also found that knowledge was a predictor of proper menstrual hygiene practice. In Nepal, (Ghimire, 2017) found that among adolescent girls, 5% had good knowledge of MHM. (Upashe et al., 2015) found a statistically significant association between educational status mothers and adequate knowledge of MHM among student adolescent girls.

Regarding attitude towards menstruation, studies show that about half of adolescent girls have a positive attitude towards menstrual hygiene management (Yadav et al., 2017). In India for example, menstruating adolescent girls experience religious restrictions with a quarter (24%) of them missing school during periods (Van Eijk et al., 2016). In Uganda, findings by (Miiro et al., 2018) suggest nearly a fifth of adolescent female students missed school due to pains associated with menstruation. Additionally, menstruation is considered a curse, disease or sin by adolescent girls in Uganda (Boosey et al., 2014). Prior to receiving health education at school, 72.4% of girls in India considered menstrual blood impure ( Nemade et al., 2019). Adolescent girls also refrained from household work including cooking or performing religious activities during menstruation. In developing countries, absenteeism in schools due to menstruation range from 2% of urban-adolescents in Nigeria to 61.7% of their rural counterparts in Nigeria(Chandra-Mouli & Patel, 2017). Early menarche is associated with early sexual initiation, early pregnancy, early marriage and some sexually transmitted infections among adolescent girls in low and middle-income countries (Ibitoye et al., 2017). Among adolescent female students in Nigeria, discomfort at school during menstruation, restriction from performing any activity during menstruation and perception that menstrual problems interfered with school performance were associated with absenteeism (Alam et al., 2017).

Moreover, (Yadav et al., 2017) found that less than half (40%) of adolescent girls practised good menstrual hygiene. Unlike rural areas where about a third of adolescent girls use commercial sanitary pads, the majority of urban adolescent girls use sanitary pads during menstruation (Van Eijk et al., 2016; Barthakur & Barkataki, 2017) found that a third of girls changed their absorbents in school facilities but, approximately a quarter of adolescent girls dispose of their used menstrual materials inappropriately. (Hennegan et al., 2016) discovered that female adolescent students in Uganda prefer reusable pads. However, in areas where there are no support structures, menstruating girls may withdraw, resort to unhygienic practices or miss school for the duration of menstruation. Some of them use improvised materials including cotton wool, cloth, old pieces of mattresses, newspapers and leaves as absorbents (Chandra-Mouli & Patel, 2017;  Kuhlmann et al., 2017). (Chandra-Mouli & Patel, 2017) also noted that a little over a fifth of girls in India and Egypt changed their absorbents in school compared to about half of their counterparts in Nigeria. A study in one urban area in India found that over 9-in-10 adolescent girls said they had access to water and a toilet facility in schools (Gultie et al., 2014). Studies suggest that urban adolescents bath more often than their rural colleagues during menstruation. Studies also show that most adolescents in India clean their genitalia at least twice a day during menstruation. Genital cleaning is also associated with prior MHM education (Chandra-Mouli & Patel, 2017). Although a systematic review found no significant association between sanitary pad provision and school attendance, a randomized control trial (RCT) in Ghana suggested that MHM education together with provision of free pads could improve school attendance among adolescent girls (Montgomery et al., 2021).  Hennegan et al., (2016) found that access to funds was a predictor of good practice of MHM. Hence it is been reported that 40–45% of adolescent school girls have negative attitude and unsafe hygienic practice of their menstrual bleeding (Trinies et al., 2015). This might have a clinical implication to integrate the promotion of menstrual hygienic practice in the health care system and comprehensive efforts including policy implication are needed to improve girls’ knowledge and safe hygienic practices towards menstruation right from her adolescent period (Upashe et al., 2015).

1.2 Statement of the Problem

Menstruation is a universal and normal phenomenon during the reproductive age of females (Nese, 2016). The onset of menses takes place during adolescent period in which dominant physiological and emotional changes take place s (LiPing & Ming, 2021). Adolescent is an essential period where females are preparing and adjusting themselves to manage their menstrual bleeding in safe and clean way (Jarrah and Kamel, 2018). This is also the ideal time that girls often join different environments including high schools and tried to plan for their next adulthood life (Eswi et al., 2016).

The view in which girls perceive towards menstruation also affects their hygienic practice during their menstrual bleeding (Fetohy, 2017). Women with better understanding of menses often have safe and clean way of managing their menstrual bleeding and vice versa (Jarrah and Kamel, 2015). It is uncovered that poor menstrual hygiene practice can be a reason for reproductive and genitor-urinary tract infection, cervical cancer, school absenteeism, or drop-out, poor academic performance, lower self-esteem and poor quality of life (Fetohy, 2017). Moreover, girls have also often experienced feelings of fear, confusion and shame during their menstruation period as a result of smell, leakage, staining of clothes and dropping of sanitary materials during their class schedules (Sudenshana and Dasgupta, 2018). This can have also a negative impact on the concentration, class participation and confidence of their studies (Wong & Khoo, 2021).

Despite safe menstrual hygienic practices can have a paramount importance to help millions of women suffering from such complicated and complex problems (Eswi et al., 2022), it is the missed opportunity to address the level of understanding and hygienic practice of menstruation among girls earlier from their adolescent age in many developing countries, including Nigeria (Nese, 2016). Little available studies in Nigeria had no a particular focus of adolescent school girls’ knowledge and menstrual hygiene practice. Moreover, there is a need to re-examine the association between poor menstrual hygienic practice (PMHP) and obstetric and gynecological factors among adolescent school girls. This is unrecognized and unaddressed public health concern in developing countries like Nigeria. Therefore, this study was aimed to assess the attitudes toward menstrual hygiene practices among adolescents in community secondary schools in Etinan Local Government Area. The result of this study might have a supreme clinical importance and might help for planning, policy preparation and developing appropriate intervention mechanisms. Furthermore, the findings of this study will be used as baseline information for further research works.

1.3 Objectives Of The Study

The overall aim of this study is to critically examine attitudes toward menstrual hygiene practices among adolescents in community secondary schools in Etinan Local Government Area. Hence, the study will be channeled to the following specific objectives;

To assess the level of knowledge about menstrual hygiene among adolescents in community secondary schools in Etinan Local Government Area.

Ascertain the attitude of female adolescents towards menstrual hygiene practices in community secondary schools in Etinan Local Government Area

To identify common menstrual hygiene practices adopted by adolescents in community secondary schools in Etinan Local Government Area

1.4 Research Question

This study will be guided by the following questions;

What is the level of knowledge about menstrual hygiene among adolescents in community secondary schools in Etinan Local Government Area?

What is the attitude of female adolescents towards menstrual hygiene practices in community secondary schools in Etinan Local Government Area?

What are the common menstrual hygiene practices adopted by adolescents in community secondary schools in Etinan Local Government Area?

1.5 Research Hypothesis

Ho: Female adolescents has a positive attitude towards menstrual hygiene practices in community secondary schools in Etinan Local Government Area. 

Ho: Female adolescents has a negative attitude towards menstrual hygiene practices in community secondary schools in Etinan Local Government Area.

1.6 Significance Of The Study

The significance of this study on "Attitudes Toward Menstrual Hygiene Practices Among Adolescents in Community Secondary Schools" will be substantial, with multiple beneficiaries gaining critical insights and practical benefits.

Firstly, adolescents in community secondary schools will be the primary beneficiaries. The study will shed light on their attitudes and behaviors toward menstrual hygiene, identifying knowledge gaps and misconceptions. By addressing these gaps, the study will empower young girls with accurate information and practical guidance on proper menstrual hygiene practices. This will improve their overall health, reduce the incidence of menstrual-related health issues, and enhance their confidence and comfort during menstruation.

Educational institutions, including secondary schools and their administration, will benefit significantly from this research. The findings will provide these institutions with a clearer understanding of the challenges and barriers that students face regarding menstrual hygiene. This knowledge will enable schools to implement more effective health education programs and provide necessary facilities, such as clean and private restrooms and access to menstrual hygiene products. These improvements will create a supportive environment that promotes the well-being and academic performance of female students.

Parents and guardians will also gain valuable insights from this study. By understanding the attitudes and practices of adolescents regarding menstrual hygiene, parents can better support their children through education and open communication about menstruation. This will foster a more positive and informed approach to menstrual health within families, reducing stigma and ensuring that girls receive the care and support they need.

Healthcare providers and public health organizations will benefit from the study's findings as well. The research will highlight the prevalent menstrual hygiene practices and the associated health risks faced by adolescents. This information will enable healthcare professionals to design targeted interventions and educational campaigns that address the specific needs of this demographic. Improved menstrual hygiene education and resources will lead to better health outcomes and reduce the burden on healthcare services.

Policy makers and government agencies will find the study valuable for informing policies and programs related to adolescent health and education. The research will provide evidence-based recommendations on how to improve menstrual hygiene management in schools and communities. By incorporating these recommendations into policy frameworks, government agencies can enhance the health and educational attainment of adolescent girls, contributing to broader social and economic development goals.

Lastly, non-governmental organizations (NGOs) and advocacy groups focused on gender equality and health will benefit from the study. The findings will provide these organizations with data to support their advocacy efforts and program initiatives aimed at improving menstrual hygiene management. This will strengthen their ability to mobilize resources, influence policy changes, and implement effective programs that promote menstrual health and hygiene.

1.7 Scope Of The Study

This study is structured to generally examine the attitudes toward menstrual hygiene practices among adolescents in community secondary schools in Etinan Local Government Area. The study will therefore be delimited to some community secondary schools in Etinan Local Government Area, Akwa Ibom State.

1.8 Limitation Of The Study

Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.

1.9   Definition Of Terms

Attitudes: refers to the beliefs, perceptions, and feelings of adolescents regarding menstrual hygiene practices.

Menstrual hygiene practices: include the use of sanitary pads, tampons, menstrual cups, cloths, and the methods of cleaning and disposing of these products, as well as personal hygiene behaviors during menstruation.

Adolescents:  refers to individuals, both male and female, aged 10 to 19 years, attending school or living in the community under study.