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MENSTRUAL KNOWLEDGE AND PRACTICES AMONG ADOLESCENT FEMALES
IN MAKURDI METROPOLIS
Akpenpuun, Joyce Rumun & Azende Peter Msuega
Department of Sociology, Benue State University, Benue State, Nigeria
Abstract
Adolescent girls often lack knowledge regarding reproductive health including menstruation hygiene which can be
due to socio-cultural barriers in which they grow up This study was undertaken to examine the knowledge, perception,
practices and experiences of adolescent females between the ages of 10-19 years old on issues regarding menstruation
and menstrual hygiene. This study is cross sectional using a non-experimental descriptive survey research. The sample
size was selected using a multistage sampling technique: stratified, simple random and purposive sampling technique.
The quantitative data collected was analysed using univariate and bivariate analyses. The study found out that most of the
adolescents used sanitary pads as absorbent during their last menses, changed menstrual dressings 2-4 times per day;
most increased the frequency of bathing. Institutionalizing sexuality education in Nigerian schools; developing and
disseminating sensitive adolescent reproductive health messages targeted at both; parents and their adolescent females
and improving access of the young females to youth health services are vital means of meeting the reproductive health
needs of the adolescent females in Nigeria.
Key Words: Menstruation, menstrual hygiene, young females.
1. Introduction
Adolescence is a significant period in the life of a woman. Adolescent girls often lack knowledge regarding
reproductive health including menstruation which can be due to socio-cultural barriers in which they grow up. These
differences create various problems for the adolescent girls. The need of the hour for girls is to have the information,
education and an enabling environment to cope with menstruation issues (Kamath, Ghosh, Lena, Chandrasekaran, 2013).
The hygiene-related practices of girls in the adolescent period related to menstruation can have an effect on their
health2. The event of menarche may be associated with taboos and myths existing in our traditional society which has a
negative implication for women’s health, particularly their menstrual hygiene. Studies have shown that the girls lack
knowledge about menstruation and due to lack of hygiene, they are likely to suffer from RTI’s Attitude of parents and
society in discussing the related issues are barriers to the right kind of information, especially in the rural areas.
Menstruation is thus construed to be a matter of embarrassment in most cultures. It was therefore decided to conduct a
study to explore the level of knowledge and practices regarding menstrual hygiene among the adolescent girls (Kamath,
Ghosh, Lena, Chandrasekaran, 2013).
Adolescence in girls signifies the transition from girlhood to womanhood. Good menstrual hygiene is crucial for the
health, education, and dignity of girls and women. This is an important sanitation issue which has long been in the closet
and still there is a long standing need to openly discuss it. The onset of menstruation represents a landmark event in
pubertal development of the adolescent girl. Menstruation, and the menstrual cycle are characterized by variability in
volume, pattern and regularity, which at the earlier stages of the development of the adolescent can create emotional
discomfort particularly to the poorly informed girl. Studies have shown that although most girls viewed themselves as
being prepared for menarche, having ‘discussed this with their mothers’, obvious misconceptions on the true
physiological process and characteristics of menstruation and the menstrual cycle is evident from these studies (Juyal,
Kandpal, Semwal, Negi, 2012)
This to a large extent influences menstrual practices of these adolescent girls. It has further been observed that many
girls have a faulty knowledge of the location and function of the reproductive organs and their inter-relationships some
even perceiving events like menstrual bleeding to be emanating from the abdomen, intestines, and kidneys, or occurring
as a consequence of curse from god, sin, and disease. There is a tendency for girls to associate a variety of negative
physical and psychological changes on their body with menstruation a situation found to be more marked in blacks
compared to white girls. This may indicate an imbibitions and internalization of cultural myths and stereotypes
associated with menstruation in many cultures which undoubtedly influence menstrual practices amongst girls in these
cultures particularly amongst those who had no formal education on reproductive biology (Adinma, Adinma, 2008).
Faulty perceptions or misconceptions on menstruation and menstrual cycle will lead to faulty menstrual practices. Either
of these may engender reproductive health problems in the adolescent, such as dysmenorrhoea, gastrointestinal
manifestations; depression; and reproductive tract infections which may in turn cause congestive dysmenorrhoea.
Culturally discussion on sexuality, including menstruation is often shrouded in secrecy, rarely is such discuss carried out
even amongst adults themselves, a situation which may exert little or no influence of mothers on their daughters’ attitude
to menstrual perceptions and practices. This state of affairs however is changing with increasing socialization between
the mothers and their daughters consequent upon Western education, and amongst this group dissimilarities may not exist
on menstrual attitudes and practices between the mothers and their adolescent daughters. This study has been undertaken
amongst adolescent female in Makurdi metropolis of Benue State, Nigeria to determine their perceptions on, medical
problems associated with and key practices during menstruation with a view to identifying information and practice gaps,
and misconception on menstruation requiring address. This will be expected to enable the incorporation of correct and
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appropriate information on menstruation and menstrual practices into the reproductive health education programmes of
schools in Nigeria.
Menstruation is part of the female reproductive cycle that starts when girls become sexually mature at the time of
puberty. It is a phenomenon unique to the females. During a menstrual period, a woman bleeds from her uterus via the
vagina. The menstrual rhythm depends on the hypothalamuspituitary- ovarian function whereas the amount of blood loss
depends upon the uterine contraction. The menstrual period lasts from three to seven days. Each period commences
approximately every 28 days if the woman does not become pregnant during a given cycle. A deviation of two or three
days from the twenty eight day rhythm is quite common (Adhikari, Kadel, Dhungel, Mandal, 2007).
The menarche or time of onset of menstruation varies with race and family, but the average for most girls is from 10
to 14 years until 45 to 55 years. Geographical conditions, racial factors, nutritional standards, environmental influences
and indulgence in strenuous physical activity can all affects the age of menarche. A woman will have approximately 500
periods in her lifetime. The estimated blood loss is between 50 ml and 200 ml. Menstruation is just another piece of that
continuing conversation. The girls emphasized the need for emotional support and assurance that menstruation was
normal and healthy--not bad, frightening, or embarrassing. Before bringing any change in menstrual practices they
should be educated about the facts of menstruation and its physiological implications. The girls should be educated about
the significance of menstruation and development of secondary sexual characteristics, selection of a sanitary menstrual
absorbent and its proper disposal. There is a need for compulsory sex education and health education on menstrual
hygiene so that they can discuss freely about it without hesitation. Hence, this study was done to evaluate the knowledge
and practice of menstrual hygiene among adolescent females of Makurdi metropolis.
Menstruation, the periodic vaginal bleeding that occurs with the shedding of the uterine mucosa is one of the signs
of puberty, and occurs one or two years following appearance of secondary sexual characteristics. Once established,
every mature female menstruates on the average 3-5 days (minimum 2 days, maximum 7 days) each month until
menopause. A woman’s period may not be the same every month and it may not be the same as that of other women.
Periods can be light, moderate or heavy and the length of the period also varies. If poorly managed, menstrual period
may be accompanied by discomfort, reproductive tract infection, smelling and embarrassment among others (Lawan,
Yusuf, Musa, 2010).
Menstrual hygiene deals with the special health care needs and requirements of women during monthly
menstruation or menstrual cycle. These areas of special concern include choice of the best “period protection” or
feminine hygiene products; how often and when to change the feminine hygiene products; bathing care of the vulva and
vagina as well as the supposed benefits of vaginal douching at the end of each menstrual period. Provisions for good
menstrual hygiene include home-made remedies like pieces of cotton cloth which are either placed on a woman’s
undergarment or on a home-made belt that wraps around the waist. These cloths can be washed, dried and used again.
Available commercial products for women’s hygiene during menstruation include pads, tampons and cups
(www.infoforhealt.org/inforeports/menstruation.pdf).
Learning about hygiene during menstruation is a vital aspect of health education for adolescent girls as patterns that
are developed in adolescence are likely to persist into adult life. It was against this background that this study was
planned to evaluate adolescent secondary school girls’ knowledge of menstruation and menstrual hygiene, as well as
their practices of menstrual hygiene. It was envisaged that findings from the study will be a pointer to some adolescence
reproductive health needs in northern Nigeria, and will also provide foundation for policy makers and programme
managers to make rational decision on improving adolescence reproductive health in Nigeria (Lawan, Yusuf, Musa,
2010).
1.1 Statement of the Problem
Lack of knowledge and poor personal hygienic practices during menstruation can lead to various gynecological
problems in the reproductive life of girls. To manage menstruation hygienically and with dignity, it is essential that girls
have access to water and sanitation. They need somewhere private to change sanitary cloths or pads; clean water and
soap for washing their hands, bodies and reusable cloths; and facilities for safely disposing of used materials or a clean
place to dry them if reusable. There is also a need for both men and women to have a greater awareness of good
menstrual hygiene practices. Menstruation is a natural process, but in most parts of the world it is a taboo and rarely
talked about. It has also been largely neglected by the society and other sectors focusing on sexual and reproductive
health, and education. As a result, the practical challenges of menstrual hygiene are made even more difficult by sociocultural factors and millions of girls continue to be denied their rights to Water and Sanitary health, education, dignity
and gender equity (Kamath, Ghosh, Lena, Chandrasekaran, 2013).
Although adolescence is a healthy period of life, many adolescents are often less informed, less experienced and
less comfortable accessing reproductive health information and services than adults. In many parts of the developing
countries, a culture of silence surrounds the topic of menstruation and related issues as a result many young girls lack
appropriate and sufficient information regarding menstrual hygiene. This may result in incorrect and unhealthy behaviour
during their menstrual period (WHO Report, 1999). Also, many mothers lack correct information and skills to
communicate about menstrual hygiene which they pass on to their children, leading to false attitudes, beliefs and
practices in this regard. Recent discuss on the introduction of sexuality education into secondary schools in Nigeria
generated a lot of tension amongst parents and religious scholars particularly in northern parts of the country.
Women and girls are often excluded from decision making and management in development and emergency relief
programmes. At the household level, they generally have little control over whether they have access to a private latrine
or money to spend on sanitary materials. Even when gender inequalities are addressed, deeply embedded power relations
and cultural taboos persist. Most people (and men in particular) find menstrual hygiene a difficult subject to talk about.
As a result of these issues, water, sanitation and hygiene programmes often fail to address the needs of women and girls.
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Menstrual health and hygiene is intended for adolescent girls. Issues associated with menstruation are never
discussed before openly and the girls are ignorant of this biological, physiological and natural function of their body.
After the emergence of the menarche they received little information about physiological processes from peers
(classmates); yet still do not know about hygienic practices. The last decade has seen a widening of the sanitation issue to
include the crucial environmental health related areas of wastewater and solid waste management, but there exist very
little subtext on menstrual health and hygiene management. Young girls often grow up with limited knowledge of
menstruation because their mothers and other women shy away from discussing the issues with them. Adult women may
themselves not be aware of the biological facts or good hygienic practices, instead passing on cultural taboos and
restrictions to be observed. Men and boys typically know even less, but it is important for them to understand menstrual
hygiene so they can support their wives, daughters, mothers, students, sisters, employees and peers. In the development
sector, there is a lack of documentation for sharing best practice on what works.
Taboos surrounding menstruation exclude women and girls from many aspects of social and cultural life as well as
menstrual hygiene services. Such taboos include not being able to touch animals, water points, or food that others will
eat, and exclusion from religious rituals, the family home and sanitation facilities. As a result, women and girls are often
denied access to water and sanitation when they need it most (Kamath, Ghosh, Lena, Chandrasekaran, 2013).
Many schools do not support adolescent girls or female teachers in managing menstrual hygiene with dignity.
Inadequate water and sanitation facilities make managing menstruation very difficult, and poor sanitary protection
materials can result in blood-stained clothes causing stress and embarrassment. Teachers (and male members of staff in
particular) can be unaware of girls' needs, in some cases refusing to let them visit the latrine. As a result, girls have been
reported to miss school during their menstrual periods or even drop out completely. Menstruation is a natural process;
however, if not properly managed it can result in health problems. The impact of poor menstrual hygiene on the psychosocial wellbeing of women and girls (e.g. stress levels, fear and embarrassment, and social exclusion during
menstruation) is also barely considered.
Neglecting menstrual hygiene in water, sanitation and hygiene programmes also have a negative effect on their
sustainability. Failing to provide disposal facilities for used sanitary pads or cloths results in a significant solid waste
issue, with latrines becoming blocked and pits filling quickly. Failure to provide appropriate menstrual hygiene facilities
at home or school also prevents menstrual hygiene measures from being used by the girls all of the time.
The health workers have also failed to discuss various right-based aspects of the issue or strategic needs of girls.
Overall the absence of Menstrual Health and Hygiene in our society and hence in investments and action, is striking.
These problems need to be illustrated and holistically solved in the policies together with practical work on what
adolescent girls require managing their menstrual needs in terms of materials, education and facilities for management
and disposal. Thus, this has given birth to this research which moves in such a direction.
1.2 Objectives of the Study
i.
ii.
iii.
iv.
To examine the perception of menstruation among adolescents female
To highlight the socio-cultural beliefs associated with the management of menstruation
To examine how menstruation is managed by the adolescent female
To highlight the problems associated with menstrual practice
1.3 Significance of the Study
i.
ii.
iii.
iv.
v.
vi.
This research work is significant for the following reasons:
This research breaks the silence on Menstrual Hygiene Management by creating awareness on the topic and
the impact it has on women and girls, exploring and sharing lessons of the management aspects and
promoting integration of Menstrual Health Management in health and hygiene/life orientation strategies.
This study discusses ways of supporting the sanitary campaign for women and girls, by informing the society
of need for females’ access to appropriate, descent, affordable and quality health care, information and
related services.
Providing information that strengthens preventive programmes that promote women’s sanitary health.
This study adds to the existing body of knowledge in menstrual hygiene.
Also this research critically studies an issue that faces every woman in every society in the world over
including ours as well; with the aim of providing viable information for managing menstrual hygiene in
girls and women at large.
And finally, this work would serve as reference material for future researchers who intend to carry out
researches that are related to this one in particular. A lot of information can be sourced from this work and
they can be further improved on as well.
1.4 Working Definition of Terms
In this section, the researcher will define fundamental terms that are contained in this work. A working definition
will be offered based on their context of usage within this particular work. They include:
i.
Menstruation – menstruation is defined as the discharging of blood, secretions and tissues debris from the
uterus that recurs in non-pregnant breeding-age females at approximately monthly intervals and is
considered to represent a readjustment of the uterus to the non-pregnant state following proliferative
changes accompanying the preceding ovulation.
ii.
Menstrual Hygiene - this is defined as the conditions or practices (as of cleanliness) conducive to menstrual
health of females experiencing menstruation.
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2. Literature Review
2.1 Menstruation
Menstruation is the periodic discharge of blood and mucosal tissue (the endometrium) from the uterus and vagina
(Abioye–Kuteyi, 2000). It starts at menarche at or before sexual maturity (maturation), in females of certain mammalian
species, and ceases at or near menopause (commonly considered the end of a female's reproductive life). The periodicity
of menstruation gives rise to commonly used euphemisms like "period" and "monthly" (Sharma, Malhotra, Taneja, and
Saha, 2008). Women typically stop menstruating if they conceive or if they are breastfeeding. When menstruation stops
for longer than about 90 days in the absence of pregnancy or breastfeeding, a medical evaluation should occur, as a
number of health problems can result in absent of menstruation. Menstruation lasts from puberty until menopause among
non-pregnant women.
Regular menstruation (also called eumenorrhea) lasts for a few days, usually 3 to 5 days, but anywhere from 2 to 7
days is considered normal (Womenshealth.gov). The average menstrual cycle is 28 days long from the first day of one
menstrual period to the first day of the next. A normal menstrual cycle in adult women is between 21 and 35 days. In
adolescents, there is wider variation, and cycles are normally between 21 and 45 day
(http://www.infoforhealth.org/inforeports/menstruation.pdf).
Menstrual symptoms occurring in the time prior to menstruation, such as breast pain, swelling, bloating, acne are
termed premenstrual molimina”. The average volume of menstrual fluid during a monthly menstrual period is 35
milliliters (2.4 tablespoons of menstrual fluid) with 10–80 milliliters (1– 6 tablespoons of menstrual fluid) considered
typical (Abioye–Kuteyi, 2000). Menstrual fluid is the correct name for the menstrual flow, although many people prefer
to refer to it as menstrual blood. Menstrual fluid contains some blood, as well as cervical mucus, vaginal secretions, and
endometrial tissue. Menstrual fluid is reddish-brown, a slightly darker color than venous blood
(http://www.infoforhealth.org/inforeports/menstruation.pdf).
Sometimes menstrual clots or shed endometrial tissue is incorrectly thought to indicate an early-term miscarriage of
an embryo. An enzyme called plasmin – contained in the endometrium – tends to inhibit the blood from clotting. The
amount of iron lost via menstrual fluid is relatively small for most women (Clancy, 2011). Heavy menstrual bleeding,
occurring monthly, can result in anemia.
The average age of menarche is around 12–13, but menarche can typically occur between ages 9 and 15 years.
Premature or delayed menarche should be investigated; many older sources state that this should be done if menarche
begins before 10 yrs or is delayed after 16 years (Ziporyn, Carlson, and Eisenstat, 2004), while newer, more evidencebased sources state that it should be done if menarche begins before 9 yrs, if menarche has not begun by age 15, if there
is no breast development by age 13, or if there is no period by 3 years after the onset of breast development (ACOG,
2013).
Premenopause is when fertility in a female declines, and menstruation may occur less regularly in the years leading
up to the final menstrual period, when a female stops menstruating completely and is no longer fertile. The medical
definition of menopause is one year without a period, and typically occurs between the late 40s and early 50s (Ziporyn,
Carlson, and Eisenstat, 2004).
2.2 Physical Experience
In most women, various physical changes are brought about by natural fluctuations in hormone levels during the
menstrual cycle, and by muscle contractions (menstrual cramping) involving the uterus that can precede or accompany
menstruation. Some may notice water retention, changes in sex drive, fatigue, breast tenderness, or nausea. Breast
swelling and discomfort may be caused by water retention during menstruation. Usually, such sensations are mild, and
some people notice very few physical changes associated with menstruation. According to a report by Mayo Clinic on
"Water retention: Relieve this premenstrual symptom". A healthy diet, reduced consumption of salt, caffeine and alcohol,
and regular exercise may be effective for women in controlling these physical changes. The sensations experienced vary
from person to person and from cycle to cycle. Severe symptoms that disrupt daily activities and functioning may be
diagnosed as premenstrual dysphoric disorder (Abioye–Kuteyi, 2000).
2.3 Painful Menstrual Cramps
Many women experience painful uterine cramps during menstruation. Pain results from ischemia and muscle
contractions. Spiral arteries in the secretory endometrium constrict, resulting in ischemia to the secretory endometrium.
This allows the uterine lining to slough off. The myometrium contracts spasmodically in order to push the menstrual
fluid through the cervix and out of the vagina. The contractions are mediated by a release of prostaglandins.
Dysmenorrhea is the medical term for painful periods (Marjoribanks, Proctor, Farquhar, 2010).
Painful menstrual cramps that result from an excess of prostaglandin release are referred to as primary
dysmenorrhea. Primary dysmenorrhea usually begins within a year or two of menarche, typically with the onset of
ovulatory cycles (merckmanuals.com). Treatments that target the mechanism of pain include non-steroidal antiinflammatory drugs (NSAIDs) and hormonal contraceptives. NSAIDs inhibit prostaglandin production. With long-term
treatment, hormonal birth control reduces the amount of uterine fluid/tissue expelled from the uterus. Thus, resulting in
shorter, less painful menstruation. According to Marjoribanks, Proctor, Farquhar, (2010), these drugs are typically more
effective than treatments that do not target the source of the pain. Risk factors for primary dysmenorrhea include: early
age at menarche, long or heavy menstrual periods, smoking, and a family history of dysmenorrhea. Regular physical
activity may limit the severity of uterine cramps.
For many women, primary dysmenorrhea gradually subsides in late second generation. Pregnancy has also been
demonstrated to lessen the severity of dysmenorrhea, when menstruation resumes. However, dysmenorrhea can continue
until menopause. 5–15% of dysmenorrhea patients experience symptoms severe enough to interfere with daily activities
(merckmanuals.com).
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Secondary dysmenorrhea is the diagnosis given when menstruation pain is a secondary cause to another disorder.
Conditions causing secondary dysmenorrhea include endometriosis, uterine fibroids, and uterine adenomyosis. Rarely,
congenital malformations, intrauterine devices, certain cancers, and pelvic infections cause secondary dysmenorrhea.
Symptoms include pain spreading to hips, lower back and thighs, nausea and frequent diarrhea or constipation. If the pain
occurs between menstrual periods, lasts longer than the first few days of the period, or is not adequately relieved by the
use of non-steroidal anti-inflammatory drugs (NSAIDs) or hormonal contraceptives, patients should be evaluated for
secondary causes of dysmenorrhea(Ziporyn, Carlson, and Eisenstat, 2004).
2.4 Emotional and Psychological Experience
Some women experience emotional disturbances associated with their menstruation. These range from irritability,
to tiredness, or "weepiness" (i.e. easily provoked tearfulness). Adhikari, Kadel, Dhungel and Mandal, (2007) estimate
the prevalence of premenstrual syndrome (PMS) to be between "3% and 30%". More severe symptoms of anxiety or
depression may be signs of premenstrual dysphoric disorder. Rarely, in individuals susceptible to psychotic episodes,
menstruation may be a trigger; menstrual psychosis.
2.5 Premenstrual Syndrome
In some cases, stronger physical and emotional or psychological sensations may become debilitating, and include
significant menstrual pain (dysmenorrhea), migraine headaches, and severe depression. Dysmenorrhea, or severe uterine
pain, is particularly common for adolescents and young females a study found that 67.2% of girls aged 13–19 suffer from
it, (Sharma et al. 2008). This phenomenon is called premenstrual syndrome. More severe symptoms may be classified as
premenstrual dysphoric disorder (PMDD).
2.6 Menstrual Disorders
There is a wide spectrum of differences between how people may experience menstruation. There are several ways
that a person's menstrual cycle can differ from the norm, any of which should be discussed with a doctor to identify the
underlying cause:
Symptom
i.
Infrequent periods
ii.
Short or extremely light periods
iii. Too-frequent periods
iv.
Extremely heavy or long periods
v.
Extremely painful periods
vi. Breakthrough bleeding between periods
vii. Absent periods
viii. There is a movement among gynecologists to discard the terms noted above, which although they are widely
used, do not have precise definitions. Many now argue to describe menstruation in simple terminology.
Fraser, Critchley, Munro and Broder, 2007) provide some which include:
i.
Cycle regularity (irregular, regular, or absent)
ii.
Frequency of menstruation (frequent, normal, or infrequent)
iii. Duration of Menstrual flow (prolonged, normal, or shortened)
iv. Volume of menstrual flow (heavy, normal, or light)
2.7 Culture and Menstruation
The relationship between culture and menstruation is expressed in many ways. A variety of menstrual-related
traditions exist. One group of authors has even theorized that menstruation may have played a key role in the
development of symbolic culture in early human society.
Many religions have menstruation-related traditions; these may be bans on certain actions during menstruation
(such as sexual intercourse in some movements of Judaism and Islam), or rituals to be performed at the end of each
menses (such as the mikvah in Judaism and the ghusl in Islam). Some traditional societies sequester women in residences
called "menstrual huts" that are reserved for that exclusive purpose ( Devi and Ramiah, 1994).
In Hinduism, it is also frowned upon to go to a temple and do Pooja (i.e., prayer) or do Pooja at religious events if
you are a woman who is menstruating. Saraswati, the Hindu goddess of knowledge, is associated with menstruation; the
literal translation of her name is "flow – woman".
2.8 Menstrual Hygiene
Poor menstrual health management (MHM) in schools have been shown to cause adolescent girls worry and
humiliation, contribute to monthly absenteeism and lead to poor performance in schools (Patle and Kubde, 2014).
UNICEF (2010) stresses the importance of school toilets which are built to accommodate menstruating girls’ specific
needs for privacy, space, washing facilities and correct disposal or cleaning of menstrual pads. An environment where
these hygienic needs are met can lead to improved dignity and attendance, thus improving girls’ education and
consequently the development of a country.
Sommer (2010) suggests that acquaintance with a country’s beliefs around menstruation and providing girls with
correct information about puberty are important elements in a holistic school MHM package. Ignorance about menstrual
issues is prevalent not only amongst schoolgirls but also in organizations and communities.
The issue of menstrual hygiene has the growing attention of women in developing countries; this applies to both
individuals and self–help groups. Menstrual hygiene seems to be an insufficiently acknowledged problem especially in
official programmes. From research, it becomes clear that the lack of menstrual hygiene in many countries in Africa and
Asia is perceived as an urgent problem and that several grass roots initiatives are trying to find a solution. In a pilot
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project in Kisumu (Kenya), boys and girls not only have the task to inspect and clean latrines, with clean water, in
combination with information about hygiene issues. This has clearly resulted in a lower rate of school drop–out among
girls. The Forum for African Women Educationalists (FAWE, 2011) in Uganda observes that menstruation is the most
important factor affecting school dropout among girls. According to them, the cause lies in a combination of poverty,
local customs, cultural traditions and taboos. FAWE organizes workshops to facilitate discussion and have an open
dialogue in which girls and women feel free to talk about issues such as menstruation and menstrual hygiene. This has
led perceptibly to a wider distribution of sanitary napkins by the retail trade, a fall in prices and a larger effective
demand.
Women and girls in rural areas, who are often the poorest and cannot afford to buy sanitary napkins, catch their
menstruation blood in an extra sari, or in cloths. Washing the cloth is problematic, because the women must often walk to
distant spots near a river or a lake. As a result, women and girls run an increased risk of becoming victims of sexual
violence and abuse (UNICEF, 2010). Frequently, there is no possibility of properly drying the cloth, because nobody,
especially men, may see any sign of the menstruation (shame–based culture). The consequence is that women and girls
mostly have to hang it in well–hidden, often unhealthy places and use moisture and damp cloths. Incinerators are of little
use if girls continue to use washable cloths, in which case, the availability of water and soap in every school toilet,
together with social mobilisation, are vital.
3. Research Design
This study is cross sectional using a non-experimental descriptive survey research. It is designed to reveal facts
about the study in order to examine the perception about menstruation, highlight the socio-cultural beliefs associated with
managing menstruation, and the problem associated with menstrual practice.
The Study Population and Size
The population chosen to provide answers to research questions in the study is adolescent females between the ages
of 10-19 years in Makurdi metropolis. Adolescent females were studied to get the actual experience of menstruation. The
sample size for the study was 200 adolescent females.
Sampling Technique
The adolescents were selected using the multistage sampling technique. A list of all secondary schools within
Makurdi metropolis were put into clusters that is, private schools and public schools; and two schools were randomly
selected from each of the two categories using simple random sampling. This resulted in the selection of Makurdi
International School and Cornerstone Secondary School (private) while Government Model College and Command Day
Secondary School were select from the public schools. Stratified sampling method was use in grouping the Junior
Secondary School female adolescents and the Senior Secondary School adolescents and purposive sampling method was
applied in selecting 25 female adolescents from both the Junior and Secondary School female adolescents totaling 50
respondents from each school. This method was used in obtaining eligible students in each school till the subjects
required for the study were gotten. Data on the students’ knowledge of menstruation and menstrual hygiene and their
practices of menstrual hygiene was collected using pretested self administered questionnaires.
Method of Data Collection
Structured questionnaire was used in collecting data for the study. The structured questionnaire was administered to
two hundred (200) respondents to adolescent females. This selection is done to get the view of those who are likely to be
affected by the phenomenon under study.
Methods of Data Analysis
The method of data analysis was based on univariate and bivariate analyses. The univariate analysis which is purely
descriptive will use frequency counts and percentages to present the data. This will be processed through Statistical
Package for Social Sciences (SPSS). For qualitative data, raw data will be sorted and transcribe and content analysis will
be done to sort similarities and dissimilarities of respondents’ opinion or responses. The quantitative and qualitative
analysis will complement each other.
Ethical Consideration
According to Babbie (1998), ethical principle comprises the consideration for voluntary participation, anonymity,
and confidentiality. These principles were strictly observed in the course of this study. In view of the above and sensitive
nature of the study, informed consent was obtained from each participant in the study. Each participant was made to
know the intent and value of the study in order to sustain their confidence.
4. Results
Table 1 below shows the findings of the research and a clear presentation of the data in frequencies and
percentages. Most of the girls were between the age bracket of 14 to 16 years with a percentage of 54% and were found
in JSS1-JSS3 classes with a percentage of 50.5%. Around 56.0% of girls mentioned that menstruation begins between
the ages of 12-14 years. 93.0% participants were aware about menstruation and mothers were the main source of
information about menstruation with 65.0%.
On asking to the cause of menstruation 92.5% replied that it is natural or physiological though their knowledge
seems to be inefficient because only 12.0% know that bleeding is from the uterus. Around 70.5% of adolescents use
sanitary napkins during their period. There are 16.5% of the girls who use feminine wash while cleaning their genitalia
during their menstruation while most of the girls 50.5% use ordinary water to clean their genitalia.
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G.J.I.S.S.,Vol.3(3):113-121
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ISSN: 2319-8834
TABLE 1. Socio-Demographic Characteristics of Respondents and their Level of Knowledge about Menstruation
Variables
Frequency
Percent (%)
Age
10-13
14-16
17-19
Class
JSS 1- JSS3
SSS1- SSS 3
69
108
17
101
86
34.3
53.7
8.5
50.5
43.0
186
5
93.0
2.5
185
4
8
92.5
2.0
4.0
10
24
31
135
5.0
12.0
15.5
67.5
171
18
85.5
9.0
119
76
59.5
38.0
176
16
88.0
8.0
174
16
87.0
10.0
53
96
51
26.5
48.0
25.5
130
28
4
35
65.0
14.0
2.0
17.8
49
146
24.5
73.0
112
79
56.0
39.5
53
101
33
9
26.5
50.5
16.5
4.5
141
6
11
11
11
6
10
70.5
3.0
5.5
5.5
5.5
3.0
5.0
180
20
90.0
10.0
150
50
74.6
24.9
66
134
32.8
66.7
Knowledge about menstruation
Yes
No
Causes of menstruation
Natural or Physiological
Disease
Others
Where bleeding occur in menstruation
Bladder
Uterus
Fallopian Tube
Vagina
Menstruation in early adolescent is normal
Yes
No
Duration of a normal period
2-4 days
5-7 days
Have heard of menstrual cycle
Yes
No
How long is a normal cycle
26-28 days
29-35 days
How did you feel at your first menstruation
Normal
Upset
Tensed
Source of knowledge about menstruation
Mother
Sister
Peers
School
Do you take rest during your periods
Yes
No
Do you shave genitalia for menstrual purpose
Yes
No
What do you use in washing your genital during menstruation
Ordinary
Water
Feminine Wash
I don’t wash/clean up
Absorbent used during menstruation
Sanitary Napkin
Tampons
Pieces of cloth
Tissues
Cotton wool
Multiple materials
Others specific
Are you aware that poor hygiene during menstruation can cause
infections
Yes
No
Do you change absorbents during school hours
Yes
No
Does school have adequate toilet facilities
Yes
No
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5. Discussion
Menstruation is a very complex process involving many different hormones, the sexual organs and the nervous
system. Regular exercise and keeping fit and healthy can help to regulate the menstrual cycle. Menstruation is an
awkward subject to talk about especially with preteen girls, who seem to get embarrassed more easily. The knowledge of
the adolescent girls regarding the average flow and duration of cycle seems to be adequate. Most of the adolescents were
acquainted with age of menarche, length of the menstrual cycle, and duration of menstrual bleeding. Though all girls
were literate, only few percentages (12.0%) of them know that menstruation occurs through the uterus.
Sanitary napkins (pads) should be changed as often as necessary, before the pad is soaked with menstrual flow.
There is a risk of Toxic Shock Syndrome by using super absorbency materials. It can be lessened or avoided by not using
tampons, or by alternating between tampons and pads during the period. In similar study done in Nigeria, around 84.0%
were not psychologically prepared for the first menses and 66.3% used insanitary materials as menstrual absorbent. Study
done by Koffe E et al showed that many girls felt uncomfortable talking about menstruation with fathers, wanting them
to be supportive but silent; others believed that fathers should be excluded completely.
These girls in Makurdi metropolis experienced upset and tension during their 1st period with 48.0% and 25.5%
respectively. Study done by Abraham et al among the Australian women revealed that a high proportion (80%)
considered menstruation to be inconvenient or embarrassing. Similar research done in Andhra Pradesh University by
Drakshayani et al detected that around 78.5% knew menstrual bleeding originated from the uterus. But our study showed
different results. Girls' knowledge of the location and function of reproductive structures was faulty, and most did not
understand how they were interrelated. Received information about menstruation from their mothers from these studies
showed that either our mothers were uneducated to express their views on menstruation or they hesitate to express their
views to daughters. Study done in Andhra Pradesh revealed that only 4.6% students used water and soap to clean their
genitalia. And 58.5% would rest more often during menstruation but in our girls only 24.5% are taking rest. Girls' needs
good information about the menstrual cycle and all the other changes that puberty bring. If other children are her only
sources of information, she may hear some nonsense and take it for fact.
Parents/ Teachers/ Health workers should motivate and improve the knowledge and practices about menstruation of
these girls. And the government should also focus on this topic by giving different programs on televisions, Radios and
Newspapers. Though this study is done in a small sample, but we are successful to find out the standard of the girls in
Makurdi metropolis.
Menstruation is a normal physiology in females. Poor hygiene during menstruation has been associated with serious
ill-health ranging from reproductive tract infection, urinary tract infection, bad odour and many more. Females are
generally expected to exercise good hygienic practices during menstruation to prevent themselves from these problems.
However, remaining stable during menstruation requires that females especially the adolescents are prepared
psychologically to develop the associated power and mastery over the physiological changes that occur during this
period. They should have sufficient knowledge surrounding menstruation, menstrual cycle and of menstrual hygiene even
before they attain menarche. In this study however, majority of the students had fair knowledge about menstruation and
menstrual hygiene.
Learning about menstrual cycle is important for adolescents for the purpose of knowing about fertile periods and of
contraception. Collective knowledge of age at menarche, menstrual cycle and duration of menstrual flow in adolescents
is also useful for allaying fears and psychological trauma that may arise from an unexpected appearance of blood. In
addition, sufficient knowledge of menstruation is expected to empower the adolescents to delineate between physiologic
and abnormal uterine bleeding.
Further more, it is a well known fact that adolescence is a period of increased risk taking and therefore
susceptibility to behavioural problems at the time of puberty. While learning about menstruation and what surrounds it,
the girls should also be exposed to consequences of intimate relationships with their male counterparts and of
contraceptive knowledge to prevent unwanted abortions and STIs including HIV and AIDS.
Promotion of healthy sexual maturation and prevention of diseases are among the key reasons for menstrual
hygiene. Our study found that majority of the school girls used sanitary pads during their menstruation. The use of
sanitary pad as absorbents is simple, hygienic and convenient as the pads come in different sizes that a female can choose
from depending on her menstrual flow. Soiled pads are easily discarded and as such saves the trouble of re-treatment for
future use. Although the use of designated reusable cloth is hygienic for adults, it may not be the best product for
adolescents where the requirements for maintaining its hygiene in terms of time, effort and resources may not be assured.
Our study however found that few of the school girls (5.5%) used reusable pieces of cloth or any old piece of cloth to
catch menstrual blood during their menstruation. The main reason for using reusable pieces of cloth could be that they
cannot afford sanitary pads. Other respondents’ practices like regular changing of all forms of menstrual absorbents,
shaving of genitalia for menstrual purpose and the practice of not using reusable absorbents which prevail amongst the
majority of our respondents signify good state of menstrual hygiene practices. In summary, this study observed that the
majority of the school girls examined incidentally had good practices of menstrual hygiene.
6. Recommendation
Sexuality education is a formidable strategy for ensuring healthy sexual maturation and hygiene amongst school
adolescents. The government should therefore not relent in its efforts to institutionalize sexuality education in both public
and private secondary schools and in tertiary institutions of learning in Nigeria.
Information is power, and knowledge is well known to influence attitude over time. The government and NGOs
should therefore work towards developing and disseminating sensitive programmes targeted at both parents and the
adolescents on the unmet needs of adolescents including sexuality education. The electronic and print media, community
organizations and faith-based organizations are veritable means of disseminating these messages
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Parents should be made to acknowledge the need to support their children at school with sanitary menstrual
absorbents in addition to other basic hygienic products. The government and/or schools administrations should on the
other compliment these provisions as part of the school health programmes.
Youth friendly services provide good milieu for the adolescents to interact and learn more about their health. The
government and NGOs should tap from these wealth of experience and facilitate access to these services for all
adolescents both in school and at home.
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