Practices and Problems during Menarche among Adolescent Girls in Sultanpur, Uttarpradesh, India

: Introduction : Menarche is a highly emotional experience for the young pubescent. The intensity of experience for the young pubescent is maximum at the time of menarche and depends on how well she is informed about menstruation and the type of support system around her. The subject of menstruation revolves around notion of dirt, taboos and restrictions in various spheres of a woman’s life. The objective of this study is to ascertain and compare practices and problems during menarche among adolescent girls in Sultanpur, Uttarpradesh (UP), India. Methods : The comparative study was conducted in both urban (Civil Lines) and rural (Wallipur Village) areas in Sultanpur district of UP, India. A cross-sectional study was followed from August to November 2011. Two hundred adolescence girls were selected through simple random procedure. Interview schedule was used to collect information from respondents. Results : The mean age of menarche among adolescence girls was 12.16 years. There was no statistical difference between rural and urban population with regard to knowledge about menstruation. Menstruation was taken as a disease by 20.6% and 23.7%. in each population. Use of sanitary pads was more in urban girls. Unhygienic practices like using no means of menstrual absorbent were more prevalent among rural girls. Conclusion : Unhygienic practices during menstruation among adolescent girls was common in adolescent girls in rural population.


INTRODUCTION:
Menstruation is a physiological process but its onset profoundly changes a young woman's life. It is a well known fact that menarche is a highly emotional experience for a young pubescent. It is now becoming increasingly recognized that the social and cultural significance of menstruation interact with the physiological process. This produces culturally determined norms and practices. 1 Multicultural and multi-religious environment, numerous superstition and practices regarding menstruation are prevalent in India. In various cultures all over the world, the onset of menstruation is related to "pubertyrites", which is prevalent in some parts of India. In the Indian culture the onset of menarche is associated with physical maturity and the ability to marry and reproduce, however, a culture of silence surrounds menarche. Most adolescent girls were previously unaware that menstruation would happen because the information they were given was sparse. Menstruation is associated with taboos and restriction on work, sex, food and bathing but the taboos observed by most of the women were avoidance of sex and not participating in religious practices. The taboo of not going into the kitchen, which has been observed in rural joint households, was not being observed after migration from the rural areas due to lack of social support mechanism. This study was done to ascertain and compare practices and problems during menarche in areas of Uttarpradesh, India.

METHODS:
This descriptive, cross-sectional, comparative study was conducted in district of UP, India from August to November 2011. Hundred adolescence girls from each urban (Civil Lines) and rural (Wallipur Village) areas in Sultanpur were selected through simple random procedure. Interview schedule was used to collect information. Pretest procedure was applied in order to verify validity of the interview schedules. Data were collected through face-to-face interview procedure. Special care was taken to maintain ethical issues during the time of data collection and anonymity of all participants was maintained. Information was analyzed through SPSS-16.

Demographic Profile:
The maximum number of respondents were between 12 to 14 years (42%) and 30.5% were between 10-12 years. Most respondents were Hindus 51.5% and Muslims 40%.However, only 4% were illiterate and 45% were done upto higher secondary school. The age at menarche was at 12 years for most of respondents 38% (Table 1).

Knowledge About Practices During Menstruation:
There was no statistical difference between rural and urban population with regard to knowledge about menstruation (p=0.3), but it was significant statistically with respect to knowledge about sanitary pads which was 83.2% Vs 33.3% in urban and rural respondents. However menstruation knowledge received from mother was similar in both groups 51.6 Vs 49.5% (Table 2).

Feeling At The Time Of First Menstruation:
Feeling of fear and anxiety was similar in both groups during menarche, 47.3% vs 41% in rural and urban respondents. Menstruation was taken as a disease by 20.6% and 23.7%. in each population ( Figure 1).

Practice (Using Materials) During First Menstruation:
Practice of using sanitary pads was more with urban girls 57.9% than rural girls 21.5% ( Figure 2

DISCUSSION
Menstrua� on is considered as private ma� er to the domes� c sphere, it is barely discussed and young girls take menarche by surprise. The present study had shown that the average age at both rural and urban adolescent were 12.16 (±1.12) years was compare to average age of menarche of girls was 13.6(±0.83years) in Haryana 2 and similar to the average age(12±1yrs) of menarche among the girls in Riyadh. 3 Maximum adolescent girls [44.0% (rural girls = 41% and unban girls = 47%)] suffered from fear and anxiety at menarche only around 9 % adolescent girls believed that menstrua� on is a natural physiological event, 20.6% and 28% urban adolescent girls thought it could be a disease and internal injuries respec� vely but 43% of the girls knew that menstrua� on is a physiological process, 12, 4 and 5 thought it to be a curse from god, caused by a sin and a disease respec� vely in Guntur District of India. 4 The study indicated that majority of respondents (75.3%) knew about menstrua� on and they could get informa� on from their mothers in rural area while in urban area the major source was friends. None of the mothers of the girls in the study had imparted any knowledge to them prior to menstrua� on and very few consulted their mothers when their menstrua� on period started. 5 Majority (97.8 %) of the girls in rural areas knew about the age of menopause while 77.5 % of the urban girls could answer the age of menopause which was similar to 74% of the sample reported to know menopause (45-50 yrs) in other parts of India. 6 The no� on of uncleanness a� ached to menstrua� on in the study can also explained by socio-cultural belief of Indian society, almost Similar fi ndings were reported from Egypt, other parts of India, Indonesia and Yugoslavia where a considerable proportion of respondents believed that it was inadvisable for menstrua� ng women because of their impure state to visit temple and ritual places. 7 The most common protec� on used by the adolescent girls in rural area during menstruation was ragged rejected clothes 36.6% while 57.9% girls in the urban area could used commercially available sanitary pads was compared to school girls (66.3%) were used sanitary materials as menstrual absorbent in Nigeria. 8 28% used co� on wool both in rural and urban area. Some girls suff ered from menstrual problems due to bad prac� ces, near about half of the girls students in Hariyana faced menstrual problems like dysmenorrheal, irregular means, pain and weakness. 9 In the present study, the problems faced by the respondent during menstrua� on were

KNOWLEDGE ABOUT PRACTICES DURING MENSTRUATION
There was no sta� s� cal diff erence between Rural and Urban population with regard to knowledge about menstruration P>0.05, but was it was significant sta� s� cally with respect to knowledge about sanitary pads which was 83.2% Vs 33.3% while comparing Urban and Rural respondents. However menstrua� on knowledge received by mother was similar in both groups 51.6 vs 49.5%

FEELING AT THE TIME OF FIRST MENSTRUATION
Feeling of fear and anxiety was similar in both group during menarche 47.3% vs 41% in Rural and Urban respondents. Menstrua� on was thought as disease by many in both popula� on 20.6 and 23.7%.

PRACTICE (USING MATERIALS) DURING FIRST
MENSTRUATION Prac� ce of using sanitary pads was more with Urban girls 57.9% than Rural girls 21.5%. Many Rural girls use ragged and rejected clothes 36.6% as compared to Urban girls which was only 16.8%. Surprisingly, 4.3% of Rural girls said they were nothing as compared to

DISCUSSION
Menstrua� on is considered as private ma� er to the domes� c sphere, it is barely discussed and young girls take menarche by surprise. The present study had shown that the average age at both rural and urban adolescent were 12.16 (±1.12) years was compare to average age of menarche of girls was 13.6(±0.83years) in Haryana 2 and similar to the average age(12±1yrs) of menarche among the girls in Riyadh. 3 Maximum adolescent girls [44.0% (rural girls = 41% and unban girls = 47%)] suffered from fear and anxiety at menarche only around 9 % adolescent girls believed that menstrua� on is a natural physiological event, 20.6% and 28% urban adolescent girls thought it could be a disease and internal injuries respec� vely but 43% of the girls knew that menstrua� on is a physiological process, 12, 4 and 5 thought it to be a curse from god, caused by a sin and a disease respec� vely in Guntur District of India. 4 The study indicated that majority of respondents (75.3%) knew about menstrua� on and they could get informa� on from their mothers in rural area while in urban area the major source was friends. None of the mothers of the girls in the study had imparted any knowledge to them prior to menstrua� on and very few consulted their mothers when their menstrua� on period started. 5 Majority (97.8 %) of the girls in rural areas knew about the age of menopause while 77.5 % of the urban girls could answer the age of menopause which was similar to 74% of the sample reported to know menopause (45-50 yrs) in other parts of India. 6 The no� on of uncleanness a� ached to menstrua� on in the study can also explained by socio-cultural belief of Indian society, almost Similar fi ndings were reported from Egypt, other parts of India, Indonesia and Yugoslavia where a considerable proportion of respondents believed that it was inadvisable for menstrua� ng women because of their impure state to visit temple and ritual places. 7 The most common protec� on used by the adolescent girls in rural area during menstruation was ragged rejected clothes 36.6% while 57.9% girls in the urban area could used commercially available sanitary pads was compared to school girls (66.3%) were used sanitary materials as menstrual absorbent in Nigeria. 8 28% used co� on wool both in rural and urban area. Some girls suff ered from menstrual problems due to bad prac� ces, near about half of the girls students in Hariyana faced menstrual problems like dysmenorrheal, irregular means, pain and weakness. 9 In the present study, the problems faced by the respondent during menstrua� on were clothes which was high compared to urban girls which was only 16.8%. Surprisingly, 4.3% of rural girls said they used nothing which was seen in 0% of urban girls.
Problems during first menstruation, 26.2% of total girls did not have any problems during first menstruation. But 32.5% girls had abdominal pain which was similar in both the groups. However only 1% had nausea and vomiting but 18.5% had excessive bleeding which was more with urban girls.

DISCUSSION:
Menstruation is considered as a private matter in the domestic sphere. It is barely discussed and young girls take menarche as a surprise. The present shows the average age of menarche in both rural and urban adolescent was 12.16 yrs (SD=1.12) which is earlier than the average age of 13.6 years (SD=0.83) Ghimire et al. Practices and problems during menarche among adolescent girls at menarche seen in a study done in Haryana and similar to the average age of 12 yrs (SD=1) among the girls in Riyadh. 2,3 Maximum (44.0%) adolescent girls (rural = 41% and urban girls = 47%) suffered from fear and anxiety at menarche. Only around 9% adolescent girls believed that menstruation is a natural physiological event; 20.6% urban adolescent girls thought it could be a disease and 28% thought it was internal injuries but 43% of the girls knew that menstruation is a physiological process. In a study done in Guntur District of India, 12 thought it to be a curse from god, four took it as a cause of sin and five thought it was a disease. 4 This study indicated that majority of respondents (75.3%) knew about menstruation and they could get information from their mothers in rural area; while in urban area the major source of information was friends. None of the mothers of the girls in the study had imparted any knowledge to them prior to menstruation and very few consulted their mothers when their menstruation started this finding is similar to a study done in slums of Delhi. 5 The notion of uncleanness attached to menstruation in the study can also be explained by socio-cultural belief of Indian society which is similar to the findings reported from Egypt, other parts of India, Indonesia and Yugoslavia where a considerable proportion of respondents believed that it was inadvisable for menstruating women to visit temple and ritual places because of their impure state. 6,7 The most common protection used by the adolescent girls in rural area during menstruation was ragged rejected clothes while girls in the urban area used commercially available sanitary pads. In a study in Nigeria, 66.3% girls used sanitary materials as a menstrual absorbent. 8 Some girls suffered from menstrual problems due to bad practices. Near about half of the girl students in Haryana faced menstrual problems like dysmenorrheal, irregular means, pain and weakness. 9 Similarly in the present study, the problems faced by the respondent during menstruation were abdominal pain, nausea, pain in thighs, weakness and excessive bleeding.

CONCLUSION:
The mean age of menarche among adolescence girls was 12.16yrs (SD=1.12) yrs. Problems during menarche were more common in both groups. Respondents who had knowledge regarding menstruation and their menstrual practices were significantly associated.