Menstrual health communication among Indian adolescents: A mixed-methods study

English version

Autoři: Mukta Gundi ^aff001; Malavika A. Subramanyam ^aff001
Působiště autorů: Indian Institute of Technology Gandhinagar, Gujarat, India ^aff001
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0223923

Souhrn

Background

Research in health communication frequently views it as an information dissemination strategy, thus neglecting the intricacies involved in communicating a sensitive topic such as menstruation. The social patterning in menstrual communication, a taboo in India, and its consequent health-effects on adolescents are under-studied.

Methods

We studied the social determinants of menstrual communication influencing menstrual- health through semi-structured interviews of 21 boys and girls each, 12 key-respondent interviews, followed by a cross-sectional survey of 1421 adolescents from Nashik district, India. We thematically analysed the qualitative data and fit multivariable logistic regression to model risk ratios.

Findings

We found social disparities in adolescents’ experiences of communication taboo regarding menstruation. While boys curbed their curiosity about the topic, girls too faced resistance to their experience-sharing and treatment-seeking for menstrual illnesses. The inequality in menstruation-related communication was evident as more boys than girls faced avoidance to their questions [IRR at 95%CI: 2.75 (2.04, 3.71)]], and fewer tribal than rural girls were communicated severe taboos (OR at 95% CI: 0.18 (0.09, 0.36))]. Girls who had been communicated severe (versus no/mild) taboos reported greater stress about menstrual staining (IRR at 95% CI: 1.31 (1.10, 1.57)], emphasizing the health consequences of such communication inequalities.

Conclusions

Our study highlights the need to address gender and setting-specific communication experiences of adolescents in India, a patriarchal society. The inequality in communication needs attention as it creates unequal patterns in Indian adolescents’ menstrual health and experiences, which may manifest as inequities in reproductive health-related outcomes even in their adult-lives.

Klíčová slova:

Communications – Social communication – Teachers – Socioeconomic aspects of health – Schools – Behavioral and social aspects of health – Adolescents – Communication in health care

Zdroje

1. Population Council & UNICEF. Adolescents in India: A desk review of existing evidence and behaviours, programmes and policies. New Delhi; 2013.

2. Shekhar M, Ghosh S, Panda P. Exploring safe sex awareness and sexual experiences of adolescents in Patna. Econ Polit Wkly [Internet]. 2007 [cited 2019 Feb 12];42(48). Available from: https://www.epw.in/journal/2007/48/reproductive-health-among-youth-bihar-and-jharkhand-special-issues-specials?0=ip_login_no_cache%3D555153658dd36b42eea423847c05d1c2

3. Char A, Saavala M, Kulmala T. Assessing young unmarried men’s access to reproductive health information and services in rural India. BMC Public Health [Internet]. 2011 Dec 17 [cited 2019 Jan 29];11(1):476. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-476

4. Kamath VG, Kamath A, Roy K, Rao CR, Hegde A, Ashok L. Reproductive Health Issues—Who to discuss with? A qualitative study to address unmet needs of adolescent boys. Glob Soc Welf [Internet]. 2017 Sep 13 [cited 2019 Jan 29];4(3):159–65. Available from: http://link.springer.com/10.1007/s40609-016-0054-4

5. Guilamo-Ramos V, Soletti AB, Burnette D, Sharma S, Leavitt S, Mccarthy K. Parent-adolescent communication about sex in rural India: U.S.-India collaboration to prevent adolescent HIV. Qual Health Res [Internet]. 2012 [cited 2018 Dec 19];22(6):788–800. Available from: http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC3343220&blobtype=pdf doi: 10.1177/1049732311431943 22232297

6. Samal J, Dehury RK. Salient features of a proposed adolescent health policy draft for India. J Clin Diagn Res [Internet]. 2017 May [cited 2018 Apr 26];11(5):LI01–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28658817 doi: 10.7860/JCDR/2017/24382.9791 28658817

7. Deo DS, Ghattargi CH. Perceptions and practices regarding menstruation: A comparative study in urban and rural adolescent girls. Indian J Community Med [Internet]. 2005 [cited 2018 Dec 19];30(1). Available from: http://medind.nic.in/iaj/t05/i1/iajt05i1p33.pdf

8. Lahiri-Dutt K. Medicalising menstruation: A feminist critique of the political economy of menstrual hygiene management in South Asia. Gender, Place Cult [Internet]. 2014;22(8):1158–76. Available from: http://apps.webofknowledge.com.proxy.library.nd.edu/full_record.do?product=WOS&search_mode=GeneralSearch&qid=2&SID=4EmsbHHMAYAk4CoIiOu&page=1&doc=1&cacheurlFromRightClick=no

9. Jejeebhoy SJ. Adolescent sexual and reproductive behavior: A review of the evidence from India. Soc Sci Med [Internet]. 1998 May [cited 2019 Mar 18];46(10):1275–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9665560 doi: 10.1016/s0277-9536(97)10056-9 9665560

10. Daruwalla N, Mishra T, Karandikar N, Pantvaidya S, Osrin D. Good girls and boys: Findings from a cross-sectional survey on adolescent rights, relationships, and sexuality in an urban informal settlement in India. Int J Adolesc Youth [Internet]. 2018 Jul 3 [cited 2018 Dec 19];23(3):308–24. Available from: https://www.tandfonline.com/doi/full/10.1080/02673843.2017.1371613 30101040

11. Gupta Tuli A, Dhar T, Garg N.Menstrual hygiene- knowledge and practice among adolescent school girls in rural areas of Punjab. Orig Res Artic J Evol Med Dent Sci [Internet]. 2017 [cited 2019 Jan 27];6. Available from: https://www.jemds.com/data_pdf/Arti Gupta Tuli—oct 16—.pdf

12. Behera D. Menarche and menstruation in rural adolescent girls in Maharashtra, India: A qualitative study. J Heal Manag [Internet]. 2015 [cited 2019 Jan 27]; Available from: https://www.researchgate.net/publication/286488436

13. Vashisht A, Pathak R, Agarwalla R, Patavegar BN, Panda M. School absenteeism during menstruation amongst adolescent girls in Delhi, India. J Family Community Med [Internet]. 2018 [cited 2018 Oct 9];25(3):163–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30220845 doi: 10.4103/jfcm.JFCM_161_17 30220845

14. WaterAid. Is menstrual hygiene and management an issue for adolescent school girls? Nepal; 2009.

15. Mishra SK, Mukhopadhyay S. Socioeconomic correlates of reproductive morbidity among adolescent girls in Sikkim, India. Asia Pacific J Public Heal [Internet]. 2012 Jan 25 [cited 2018 Oct 23];24(1):136–50. Available from: http://journals.sagepub.com/doi/10.1177/1010539510375842

16. Mason L, Sivakami M, Thakur H, Kakade N, Beauman A, Alexander KT, et al. “We do not know”: A qualitative study exploring boys perceptions of menstruation in India. Reprod Health [Internet]. 2017 [cited 2018 Aug 9];14(174). Available from: https://reproductive-health-journal.biomedcentral.com/track/pdf/10.1186/s12978-017-0435-x?site=reproductive-health-journal.biomedcentral.com

17. Mahanta TG, Boruah M, Singh VK, Gogoi P, Rane T, Mahanta BN. Effect of social and behavior change communication by using infotainment in community perception of adolescent girls for reproductive and sexual health care in high priority districts of Assam. Clin Epidemiol Glob Heal [Internet]. 2016 Sep [cited 2019 Jan 29];4(3):133–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213398415000901

18. Viswanath K. Public communications and its role in reducing and eliminating health disparities. In: Thomson GE, Mitchell F, Williams M, editors. Examining the health disparities research plan of the National Institutes of Health: Unfinished business [Internet]. Washington (DC): National Academies Press (US); 2006 [cited 2018 Dec 11]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK57046/

19. World Health Organization (WHO). Social determinants of health [Internet]. World Health Organization (WHO); 2019 [cited 2019 Aug 20]. Available from: https://www.who.int/social_determinants/sdh_definition/en/

20. Svanemyr J, Amin A, Robles OJ, Greene ME. Creating an enabling environment for adolescent sexual and reproductive health: A framework and promising approaches. Journal of Adolescent Health. 2015.

21. Lawan UM, Yusuf NW, Musa AB, Mensch B, Bruce J, Greene M, et al. Adolescence: A foundation for future health. Lancet [Internet]. 2007;379(9826):237. Available from: Reproductive Health

22. Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, et al. Adolescence and the social determinants of health. Lancet [Internet]. 2012;379(9826):1641–52. Available from: doi: 10.1016/S0140-6736(12)60149-4 22538179

23. Viswanath K, Ramanadhan S, Kontos EZ. Mass Media. In: Galea S, editor. Macrosocial determinants of population health. New York: Springer; 2007. p. 275–94.

24. Bekalu M, Eggermont S. The role of communication inequality in mediating the impacts of socioecological and socioeconomic disparities on HIV/AIDS knowledge and risk perception. Int J Equity Health [Internet]. 2014 [cited 2018 Dec 11];13(1):16. Available from: http://equityhealthj.biomedcentral.com/articles/10.1186/1475-9276-13-16

25. Nashik District Collectorate. District at a glance [Internet]. 2017 [cited 2017 Aug 22]. Available from: http://nashik.nic.in/htmldocs/disoverview.html

26. Registrar General And Census Commissioner India. Census of India 2011: District Census Handbook Nashik [Internet]. New Delhi, India: Government of India; 2014 [cited 2019 Feb 25]. Available from: http://www.censusindia.gov.in/2011census/dchb/DCHB_A/27/2720_PART_A_DCHB_NASHIK.pdf

27. Jayachandran U. Maharashtra human development report 2012 [Internet]. Mumbai; 2014. Available from: http://www.in.undp.org/content/dam/india/docs/human-development/MHDR English-2012.pdf

28. Creswell JW, Plano Clark V. L., Gutmann ML, Hanson WE. Advanced mixed methods research designs. In: Tashakkori A, Teddlie C, editors. Handbook of mixed methods in social and behavioral research. Thousand Oaks, CA: SAGE publications; 2003. p. 209–40.

29. Goyal S, Pandey P. How do government and private schools differ? Econ Polit Wkly. 2012;47(22):67–76.

30. National Institute of Educational Planning and Administration (NIEPA). School report cards [Internet]. National Institute of Educational Planning and Administration (NIEPA); [cited 2019 Feb 26]. Available from: http://schoolreportcards.in/SRC-New/SchoolDirectory/Directory.aspx

31. Braun V, Clarke V, Hayfield N, Terry G. Thematic analysis. In: Handbook of research methods in health social sciences [Internet]. Singapore: Springer Singapore; 2019 [cited 2019 Feb 26]. p. 843–60. Available from: http://link.springer.com/10.1007/978-981-10-5251-4_103

32. Farmer T, Robinson K, Elliott S, Eyles J. Developing and implementing a triangulation protocol for qualitative health research. Qual Health Res [Internet]. 2006 [cited 2019 Feb 18];16(377). Available from: http://qhr.sagepub.com/cgi/content/abstract/16/3/377

33. DeVallis RF. Scale development: Theory and applications. 2nd ed. SAGE publications; 2003.

34. StataCorp. Stata statistical software: release 12. College Station, TX, USA: Stata Corporation; 2012.

35. Kamath VG, Kamath A, Roy K, Rao CR, Hegde A, Ashok L. A qualitative study on how adolescent males in South India view reproductive health. Int J Adolesc Med Health. 2018;30(1):1–7.

36. Bloom S, Tsui AO, Plotkin M, Bassett S. What husbands in northern India know about reproductive health: Correlates of knowledge about pregnancy and maternal and sexual health. J Biosoc Sci [Internet]. 2000 [cited 2018 Sep 8];32(2):237–51. Available from: https://www.cambridge.org/core/journals/journal-of-biosocial-science/article/what-husbands-in-northern-india-know-about-reproductive-health-correlates-of-knowledge-about-pregnancy-and-maternal-and-sexual-health/DF1943283A0D44B6A490DD6037BADDFE doi: 10.1017/s0021932000002376 10765613

37. Dhingra R, Kumar A, Kour M. Knowledge and practices related to menstruation among tribal (Gujjar) adolescent girls. Stud Ethno-Medicine. 2009;3(1):43–8.

38. Narayan K a., Srinivasa DK, Pelto PJ, Veerammal S. Puberty rituals, reproductive knowledge and health of adolescent schoolgirls in south India. Asia-Pacific Popul J. 2001;16(2):225–38.

39. Markham CM, Lormand D, Gloppen KM, Peskin MF, Flores B, Low B, et al. Connectedness as a predictor of sexual and reproductive health outcomes for youth. Journal of Adolescent Health. 2010.

40. Wilson E, Dalberth B, Koo H. "We're the Heroes!": Fathers' perspectives on their role In protecting their preteenage children from sexual risk. Perspect Sex Reprod Health [Internet]. 2010 [cited 2019 Jan 26];42:117–24. Available from: https://www.jstor.org/stable/pdf/20752626.pdf doi: 10.1363/4211710 20618751

41. Krieger N. Embodiment: A conceptual glossary for epidemiology. J Epidemiol Community Health [Internet]. 2005;59(5):350–5. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1733093&tool=pmcentrez&rendertype=abstract doi: 10.1136/jech.2004.024562 15831681

42. Ministry of Health and Family Welfare. Strategy handbook—Rashtriya Kishor Swasthya Karyakram (RKSK) [Internet]. India: Government of India; 2014 [cited 2019 Mar 7]. Available from: http://nhm.gov.in/images/pdf/programmes/rksk-strategy-handbook.pdf

43. International Institute for Population Sciences (IIPS) and Macro international. National Family Health Survey (NFHS-3), 2005–06. Mumbai, India; 2007.

44. Rao RSP, Lena A, Nair NS, Kamath V, Kamath A. Effectiveness of reproductive health education among rural adolescent girls: A school based intervention study in Udupi taluk, Karnataka. Indian J Med Sci. 2008;62(11).

45. Verma RK, Pulerwitz J, Mahendra V, Khandekar S, Barker G, Fulpagare P, et al. Challenging and changing gender attitudes among young men in Mumbai. Reprod Health Matters [Internet]. 2006 [cited 2019 Mar 27];14:135–43. Available from: https://www.tandfonline.com/action/journalInformation?journalCode=zrhm21 doi: 10.1016/S0968-8080(06)28261-2 17101432