MENSTRUAL HYGIENE

MANAGEMENT OF
ADOLESCENT SCHOOL
GIRLS AND NUNS

A Knowledge, Attitude, and

Practices Study in Bhutan

2018

SCHOOL HEALTH AND NUTRITION DIVISION (SHND),

DEPARTMENT OF SCHOOL EDUCATION, MINISTRY OF EDUCATION
MENSTRUAL HYGIENE MANAGEMENT OF
ADOLESCENT SCHOOL GIRLS AND NUNS

School Health and Nutrition Division (SHND),

Department of School Education, Ministry of Education

KAP (Knowledge, Attitude and Practices) of Menstrual Hygiene Management by

Adolescent school-going girls and nuns in Bhutan.
 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

ACKNOWLEDGEMENT
This survey is a byproduct of the Department of School Education (DSE), Ministry of Education in partnership
with the UNICEF, Bhutan.
The DSE would like to acknowledge M/S Bhutan A2Z Statistics, Economics & Environmental Consultancy, all
institutions and individuals at various capacities who contributed to the successful completion of this study:
Menstrual Hygiene Management of adolescent school-going girls and nuns 2017. The department in particular
would like to acknowledge the following individuals and institutions:

Technical Working Group:

• Jamyang Choeden, Chief Program Officer, SHND, DSE, MoE.
• Deki Tshomo, [Link] Program Officer, SHND, DSE, MoE.
• Karma Yangchen, Dy. Chief Program Officer, SHND, DSE, MoE.
• Sangay Thinley, Program Officer, MoH.
• Cheku Dorji, Chief Statistical Officer, NSB.
• Ani Namgay Om, Program Officer, Bhutan Nuns Foundation.
• Thinley Dem, WASH Advisor, SNV Bhutan
• Sonam Gyaltshen, WASH Officer, UNICEF, Thimphu, Bhutan.
Lastly, the DSE would like to thank all those respondents, surveyors, Principals and teachers of those sampled
schools for rendering their kind support in realizing this survey. We hope that the findings of this study would
be beneficial to relevant stakeholders, researchers and in particular our planners and program implementers
in directing the way forward for smooth execution of school health programs.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

PREFACE

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

ACRONYMS
CSPro Census and Survey Processing
SPSS Statistical Package for Social Science
PSU Primary Sampling Unit
SSU Secondary Sampling Unit
CSS Circular Systematic Sampling
PPS Probability Proportional to Size
NSB National Statistics Bureau
FDG Focused Group Discussion
DSE Department of School Education
MoE Ministry of Education
MHM Menstrual Hygiene Management
KAP Knowledge Attitude Practices
SHND School Health and Nutrition Division
PS Primary School
LSS Lower Secondary School
HSS Higher Secondary School
CS Central School

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Contents
EXECUTIVE SUMMARY ............................................................................................................................... 1
Background and Objectives ...................................................................................................................... 1
Key Findings ............................................................................................................................................. 1
Recommendations:................................................................................................................................... 2
CHAPTER 1:INTRODUTION AND METHODOLOGY ................................................................................... 4
Background ............................................................................................................................................... 4
Significance of the study .......................................................................................................................... 4
1.4.1 Sampling Design ....................................................................................................................... 5
Field Operation ..................................................................................................................................... 7
Response rate ....................................................................................................................................... 8
Limitations of the study ............................................................................................................................ 9
CHAPTER 2: SOCIO-DEMOGRAPHIC CHARACTERISTICS ...................................................................... 10
CHAPTER 3:KNOWLEDGE ON MENSTRUAL HYGIENE AND MANAGEMENT ....................................... 13
CHAPTER 4:ATTITUDE TOWARDS MENSTRUATION .............................................................................. 17
4.5 Menstruation as taboo to adolescent school girls ...................................................................... 20
CHAPTER 5: PRACTICES OF MENSTRUAL HYGIENE MANAGEMENT IN SCHOOLS .......................... 22
5.1 Type of menstrual absorbents used ........................................................................................... 22
CHPATER 6: SUMMARY FINDINGS FROM NUNNERIES ......................................................................... 27
6.1 Socio-demographic characteristics of nuns ................................................................................ 27
6.2 Socio-economic Characteristics of parents and guardians ......................................................... 27
CHAPTER 6.1 KNOWLEDGE AND INFORMATION ON MENSTRUATION ...................................... 29
6.1.1 Awareness on menarche and its causes ............................................................................ 29
6.1.2 Sources of information on menarche ................................................................................. 30
6.1.3 Awareness on menstrual related infections ....................................................................... 31
CHAPTER 6.2 ATTITUDE ON MENSTRUAL HYGIENE .......................................................................... 33
6.2.1 Misconceptions and taboos ................................................................................................ 33
6.2.2 Physical impacts of menstruation ...................................................................................... 34
6.2.3 Emotional impacts produced by menstruation .................................................................. 34
6.2.4 Social impacts produced by menstruation ......................................................................... 36
6.2.5 WASH facilities to counter menstruation hygiene management ...................................... 38
CHAPTER 6.3:PRACTICES ON MENSTRUAL HYGIENE ....................................................................... 39
6.3.1 Sanitary facilities at nunneries ............................................................................................ 40
6.3.2 Practice of Menstrual Hygiene at nunneries ...................................................................... 42
6.3.3 Empirical Analysis ............................................................................................................... 44
6.4 Comparative Statics of Schools intervened by SHND on MHM and the control group (not
intervened by SHND with MHM) ....................................................................................................... 45
CHAPTER 7: KEY FINDINGS AND DISCUSSIONS ..................................................................................... 47
i) Key findings for adolescent school girls: ........................................................................................ 47
7.1 Socio-demographic, Economic and Educational Characteristics ............................................ 47
7.2 Girls’ current knowledge and information on menstruation ................................................... 47
7.3 Menarche—knowledge and information ................................................................................ 47
7.4 Source of information regarding menstruation and menstrual hygiene ................................. 48
7.5 Attitude towards menstruation ............................................................................................... 48
7.6 Social Impacts produced by menstruation ............................................................................. 48
7.7 Physical Impacts of menstruation .......................................................................................... 48
7.8 Emotional Impacts .................................................................................................................. 49
7.9 Menstruation as taboo to adolescent school girls .................................................................. 49

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8.0 Type of menstrual absorbents used ....................................................................................... 49

8.1 Menstrual hygiene management prevailing ........................................................................... 49
8.2 Adolescents’ response to menstruation and practices developed as a result ....................... 49
8.3 WASH facilities available at schools to combat menstruation ............................................... 50
ii) Key findings of adolescent nuns: .................................................................................................... 50
8.4 Awareness on menarche and its causes ................................................................................ 50
Sources of information on menarche ................................................................................................. 50
8.6 Adolescent nuns’ knowledge on menstrual hygiene ............................................................. 50
Awareness on menstrual related infections ....................................................................................... 50
Misconceptions and taboos ................................................................................................................ 50
8.9 Physical impacts of menstruation ........................................................................................... 51
9. Emotional impacts produced by menstruation .......................................................................... 51
10. Social impacts produced by menstruation ............................................................................. 51
11. Sanitary facilities to counter menstruation hygiene management ......................................... 51
Practices on menstrual hygiene by adolescent nuns ......................................................................... 51
WASH facilities at nunneries .............................................................................................................. 52
Practice of Menstrual Hygiene at nunneries ...................................................................................... 52
Empirical Findings ............................................................................................................................... 52
Regional situation of MHM ..................................................................................................................... 53
Qualitative Findings ............................................................................................................................ 53
CHAPTER 8:CONCLUSION AND RECOMMENDATIONS ......................................................................... 54
8.1 Conclusion .................................................................................................................................. 54
8.2 Recommendations & way forwards ........................................................................................... 54
8.3 Future Research ............................................................................................................................. 55
REFERENCS ............................................................................................................................................... 56
Annexure I: Questionnaires ....................................................................................................................... 57
Annexure II: REBH Approval Letter ........................................................................................................... 64

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regarding menstruation. About 42

EXECUTIVE SUMMARY percent of schoolgirls and more than half
(54.9%) of nuns received first-hand
Background and Objectives information on menstruation from their
This report highlights the findings of the Menstrual mothers.
Hygiene Management (MHM): KAP (Knowledge,
Attitude & Practices) prevailing among adolescent c) Misconceptions and taboos
schoolgirls and nuns of Bhutan as of 2017. This • One out of every ten (10.4%) schoolgirls
study is the first of its kind. The Ministry of still disagree the statement that ‘it is
Education had initiated WASH (Water, sanitation important to talk about menstrual period
and hygiene) program across schools of Bhutan with men.’ Similarly, One-quarter (25%)
many years ago. The impact assessment of WASH of the adolescent nuns are unaware
in Schools 2013 had revealed various positive whether they should enter
impacts, but very little are known about the shrines/temples during menstruation.
menstrual hygiene management in terms of its • Close to one-third (63.5%) of the
knowledge and information, attitude and practices. adolescent schoolgirls reported that
during menstruation, a woman must not
To find the facts and figures regarding Menstrual
enter shrine or temple. Further
Hygiene and Management among the adolescent
augmenting this superstition, about 21
schoolgirls across schools of Bhutan and
percent of the respondents agreed that
nunneries, a need assessment for Menstrual
women in menstruation are susceptible
Hygiene Management study was carried out.
to get possessed by evil spirit.
Following were the broad objectives of this study:
• Similarly, about 33.2 percent of the
✓ To assess awareness (knowledge) about adolescent nuns reported that women in
menarche and their sources of information menstruation are susceptible to
before its onset; possession by evil spirits.
✓ To find out the prevailing practices for
menstrual hygiene among adolescent girls; d) Type of menstrual absorbents used
✓ To assess restrictions practiced by adolescent • It was found that every nine out of ten
school girls during menstruation; (91.9%) schoolgirls used sanitary pad.
✓ To ascertain the association of awareness of However, around 3 percent of the
menstruation before menarche and practices adolescent schoolgirls did not use any
for menstruation hygiene with educational kind of absorbent material. Similarly,
status of respondents and their mothers; and almost nine out of every ten (87.5%) nuns
✓ To assess the relative contribution of used sanitary pad followed by around 11
educational status of respondents and their percent who used napkin/cloth or towel.
mother’s on the likelihood of using unhygienic
practices during menstruation. e) Prevailing MHM in schools
• Around three-quarters (75.2%) of
Key Findings schoolgirls reported that they dry their
a) Adolescent schoolgirls and nuns’ knowledge cloth pads in sunlight. And around one out
and information on menstruation of every ten (9.6%) dried their pads inside
• A vast majority (83%) of the schoolgirls the house. There are around 8 percent of
and nuns (43%) recognized menstruation schoolgirls who hid reusable sanitary pad
as a physiological process. beneath another cloth and dry them
• Around 2 percent of schoolgirlsand nuns together. Similarly, about 7.1 percent of
(5.4%) defined menstruation as a nuns dried the reusable sanitary pad
disease. About1 percent of former and beneath another cloth.
about 7.1% of the latter defined
menstruation as a curse. f) Adolescent school girls’ response to
menstruation
• About 5.2 percent of the schoolgirls and
nuns (37.5%) were of the opinion that • More than half (52.5%) of the schoolgirls
menstruation is a ‘Curse’. reported of taking rest during
menstruation. It also revealed that close
b) Source of information regarding to one-quarter (21.1%) of them reported
menstruation and menstrual hygiene that they thoroughly involved in activities
to forget the discomforts while 6.4
• For both schoolgirls and nuns, mothers
percent of the rest resorted to medication
are the primary source of information

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followed by Yoga and meditation (3.1%) • This they do since the school did not have
and prayers (1.7%). capabilities to render help to those special
• Similarly, close to half (46.4%) of the children during menstruation; and
adolescent nuns took rest during • All the participants of FDG unanimously
menstruation followed by 19.6 percent of agreed that they didn’t have enough
them who underwent medication. On an WASH facilities to combat menstruation in
equal proportion, about 7.1 percent of their schools.
them reported that they said prayers or
meditated j) Efficacy of SHND’s interventions of MHM
programs in schools and nunneries.
g) WASH facilities at schools to combat The study revealed a vast difference between
menstruation schools with SHND’s intervention MHM
• The survey revealed that close to half programs and those that did not have the
(45.9%) of the school girls agreed that intervention. The comparative statics revealed
they took half body bath during that more than three quarters (80.6%) of the
menstruation due to lack of hot water. adolescent girls in those schools intervened by
• More than two-thirds (78.6%) of the the MHM program of SHND had correct
adolescent nuns agreed that they missed knowledge on menstruation. Interestingly,
classes or activities during menstruation after the intervention of the program, none of
since the toilets were dirty and them believed that menstruation is a curse.
discouraged them to change. However, there are still about 4.4 percent who
still considers that menstruation is a disease.
h) Social Impacts produced by menstruation Around 5 percent of them reported of not
• About 43 percent of the adolescent knowing what menstruation is all about. The
schoolgirls reported having missed study has also revealed that only around 38
school during menstruation because it percent of the adolescent girls in those
made them uncomfortable. The study schools, which did not receive MHM program
has also revealed that about 9.7 percent knew about menstruation. About 9.5 percent
of the boarding schools girls missed of them still consider menstruation as a curse
school as opposed to 31 percent of the followed by 2.2 percent of them considering
day scholars, About 59.3 percent of both menstruation as a disease. About half (50.4%)
the day and boarding schoolgirls missed of them didn’t know about menstruation. This
classes. clearly indicates the efficacy of the SHND’s
• More than two-thirds (76.8%) of the MHM awareness programs in the schools.
adolescent nuns reported that it was
important to buy sanitary pad without Recommendations:
being seen. ✓ Every school and nunnery need to enhance
their WASH facilities;
i) Physical Impacts of menstruation ✓ Every school and nunnery need to enhance
• Close to half (48.1%) of the respondents their sanitary facilities viz. sanitary pad disposal
agreed that they missed school during bin, facility to dry improvised sanitary pad,
period since it was painful. renewable materials to wrap the disposable
pads and etc;
j) Emotional Impacts ✓ Enhance sexuality education programs in
• More than half (57%) of the respondents every school and nunneries;
agreed that they got easily upset during ✓ Education Ministry to bring the adolescent
pre-menstrual and menstrual periods nuns into mainstream in terms of sexuality
than at other times. education and any other forms of education
• More than two-thirds (82.2%) of the imparted to the mainstream adolescent girls
respondents reported that they “just for their overall development;
have to tolerate” with menstruation ✓ The School Health and Nutrition Division to
spearhead the development of spot-check and
i) Menstrual case of special children: Observation checklist to account the existing
• It was found that teachers advised parents WASH facilities for each school (inclusive of
to keep their child at home during nunneries) and compute ratio of users to
menstruation. (Suggested) WASH facilities;
✓ Ministry of Education to closely liaise with
Ministry of Health on their public health

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development facilities and endeavor to realize ✓ MoE to liaise with relevant coordinating
WASH facilities in schools and nunneries; partners to promote MHM program in all the
✓ Schools needs to enhance the MHM service schools and nunneries; and
providers in their schools; ✓ Ministry of Education to liaise with the Ministry
✓ Ministry of Education to ensure the of Health to reach out MHM programs beyond
establishment of disable-friendly WASH schools and nunnery.
facilities in each school and duplicate this
process in nunneries as well;

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CHAPTER 1: INTRODUTION AND METHODOLOG

1.1 Background effect, SHND in 2014 piloted project for MHM
Programme in 3 nunneries and 10 schools across
May 28 is considered as the global Menstrual the country in collaboration with Bhutan Nuns
Hygiene Day initiated by WASH United. It was Foundation (BNF) through technical and financial
created mainly to publicly recognize the right of support from UNICEF. The core objective was to
women to hygienically manage their menstruation educate young girls and nuns on menstrual
wherever they are. Although it is a normal hygiene management and to train them to make
biological process and a key sign of reproductive re-usable sanitary napkins. Further, after seeing
health, yet in various cultures, it is treated as the success of the programs, it got expanded to 10
something negative, shameful or dirty. A study more schools and nunneries. The trained girls and
from the UNICEF found that 1 out of 3 girls in nuns in turn trained their peers. SHND and BNF
South Asia are completely oblivious about reported that they were able to manage menstrual
menstruation prior to getting it. There are also hygiene in a much better way.
evidences like 48 percent of girls in Iran and 10
percent of girls in India believe that menstruation Nonetheless, there is still inadequate quantitative
is a disease (WaterAid 2013, Menstrual Hygiene and qualitative information to address the issues
Matters). Besides continued social taboos related around MHM in schools and nunneries. To set the
to menstruation, women and girls’ ability to blueprint for MHM to fuse into all the schools and
manage the same is affected by various other nunneries across the country, a need assessment
factors viz. limited access to affordable and is of paramount importance for the reusable
hygienic sanitary materials and disposal options sanitary napkin and disposable methods covering
leading to unhygienic practices. The International other thematic areas viz. existing KAP (Knowledge,
Conference on Population and Development Attitude & Practice) of girls and nuns, believes
reaffirmed women’s reproductive rights and the related to menstruation, key drivers, challenges
right to development. etc.

Bhutan is no exception in terms of Menstrual 1.3 Objectives

Hygiene Management (MHM) especially among
Following are the objectives of the proposed study:
the female adolescent group. The WASH
assessment carried out in 2013 had revealed some ✓ To assess the awareness (knowledge) about
of the following disturbing facts and figures: menarche and their sources of information
before its onset;
• Washing hands with soap in schools is still
✓ To find out the prevailing practices for
very low (only 55% use soap);
menstrual hygiene among adolescent girls;
• Sanitary pad disposal facilities for girls in
✓ To assess the restrictions which were
schools are nonexistent in most schools. The practiced by adolescent schoolgirls during
lack of such facilities in schools actually
menstruation;
compels menstruating girls to take leave;
✓ To ascertain the association of awareness of
• A large number of “WASH schools” do not menstruation before menarche and practices
have bathing facilities; for menstruation hygiene with educational
• Students in the CPS are too small to clean their status of respondents and their mothers; and
toilets properly. Lack of wet sweepers/ ✓ To assess the relative contribution of
cleaners pose a challenge to maintain the educational status of respondents and their
toilets clean; and mother’s on the likelihood of using unhygienic
• There is a general lack of understanding practices during menstruation.
surrounding the girl’s menstruation issues.
1.4 Methodology
1.2 Significance of the study
The central focus of this study was to determine
It was observed both casually as well through the knowledge, attitudes and practices of the
regular reports and reviews conducted by the adolescent (aged 10-19) female students and nuns
School Health and Nutrition Division (SHND) of the specifically focusing on the biological,
Ministry of Education that WASH facilities in psychological and socio-cultural factors that may
schools and nunneries had been neglected. It was affect attitudes and beliefs towards menstruation.
also noted that adolescent girls often risk their The following sub-sections entail the detailed
health using unhygienic clothes and rugs and even methodology involved in this study:
missing out classes during menstruation. To this

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1.4.1 Sampling Design

The diagram below illustrates the suitable sampling method for this survey.

Use of latest Sampling Frame from EMIS

Determination of sample size using proportionate sampling formula and fixing

domain

Computation of probability weights

Sampling method (Multi-stage sampling)

1.4.2 Sampling frame and coverage

The latest sampling frame 2016 extracted from EMIS (Education Monitoring and Information System) is used
as a universe for sampling. The map below represents sampling distribution for this study across 20 districts.

1.4.3 Sample size determination fpc (finite population correction): n1 = n/[1+ (n-
1)/N]where, n1 is the new sample size and N = total
The sample size determination formula for households
proportion is adopted as depicted below.
Therefore, the new sample size after adjusting for
n =(zα/2)2p(1-p)/e2, where n = sample size for fpc is 383 as illustrated below:
proportion, zα/2 = 1.96 @ 95% confidence level, p
= proportion of picking 50-50 right answer and e = n1= 384/[1+ (384-1)/166,550] = 383. Nonetheless,
 5% confidence interval/margin of error. This
the domain is kept both at the areas of residence
requires the sample size of only 384 at the national (urban & rural) and regional (eastern, central &
level reporting, which is up to 95% level of western) levels and finally the sample size
confidence. However, to minimize the width of tantamount to 1,560.
confidence interval, so as not to misguide the
probability of estimating the true answers in that
wide margin of error afpc needs to be computed.

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1.4.4 Sampling method b) Stage two [Selection of schools]: The

schools were selected automatically by
A multi-stage sampling method is applied for this fixing 40 respondents from each school.
study. Each Dzongkhag was considered a stratum. Stage three [Selection of secondary
a) Stage one [Selection of primary sampling sampling units (SSUs)]: The individual
units (PSUs)]: The adolescent adolescent girls and nuns were considered
schoolgirls and nuns were considered the as SSUs.
PSUs. The selection of the PSUs from c) A fixed number of them from each school
each stratum was done by applying were selected by applying Circular
Probability Proportional to Size Systematic Sampling (CSS) method after
(PPS)method of selection. listing them in each sampled school using
school register.

1.4.5 Summary of sampling plan and computation of weights

Table 1 illustrates the sampling plan and computation of statistical weights.
Table 1: Sampling plan and computation of weights (Frame = adolescent female students aged 10-19)
Dzongkhag Female Sampled Disp. Sampled SF SK Wb
Enrolment (aged Female (PPS) Allocation Schools
10 -19)
Bumthang 1,412 36 40 1 2.8 1412 0.35
Chhukha 4,094 105 120 3 2.9 1365 0.34
Dagana 2,402 62 40 1 1.7 2402 0.60
Gasa 305 8 40 1 13.1 305 0.08
Gelephu Thromde 1,265 33 40 1 3.2 1265 0.32
Haa 1,207 31 40 1 3.3 1207 0.30
Lhuentse 1,261 32 40 1 3.2 1261 0.32
Mongar 3,306 85 80 2 2.4 1653 0.41
Paro 3,530 91 80 2 2.3 1765 0.44
PemaGatshel 2,065 53 40 1 1.9 2065 0.52
Phuntsholing Thromde 1,582 41 40 1 2.5 1582 0.40
Punakha 2,823 73 80 2 2.8 1412 0.35
SamdrupJongkhar 2,465 63 40 1 1.6 2465 0.62
Samtse 5,254 135 120 3 2.3 1751 0.44
Sarpang 2,839 73 80 2 2.8 1420 0.35
SJongkhar Thromde 702 18 40 1 5.7 702 0.18
Thimphu 1,385 36 40 1 2.9 1385 0.35
Thimphu Thromde 7,848 202 240 6 3.1 1308 0.33
Trashigang 4,094 105 80 2 2.0 2047 0.51
Trashiyangtse 1,748 45 40 1 2.3 1748 0.44
Trongsa 1,292 33 40 1 3.1 1292 0.32
Tsirang 1,972 51 40 1 2.0 1972 0.49
WangduePhodrang 2,844 73 80 2 2.8 1422 0.36
Zhemgang 1,681 43 40 1 2.4 1681 0.42
Total 59,376 1,526 1,560 39 2.6 1522 0.38
N.B: Sf = Sampling fraction, SK = Skip interval &Wb = Base weight

Similarly, table 2 depicts the sampling framework for nuns.

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Table 2: Sampled nunneries and nuns

Dzongkhag Nunnery Total Sampled Response Wb Wa
nuns Nuns
Bumthang PemaThegchokCholing,Tang 130 62 15 2.10 8.7
Trashigang SamtenChoeling, Womrong 19 9 2 2.10 9.5
Thimphu Shechen Ugyen Choezong, Sisina 130 62 13 2.10 10.0
Sangchen D. Lhendup, Punakha 90 43 12 2.09 7.5
ThangthongDewacenGonpa, Zilukha 55 26 14 2.10 3.9
Total 424 202 56 2.10 7.6

1.5 Quality Control Process A probability sampling was adopted to select the
required number of students from each school
The quality control process spans from based on the determined sample size. To capture
development of sampling frame to the final the relevant variables based on the objectives of
analysis of the enumerated data from the field. The the study, a well-structured questionnaire was
sampling frame was developed based on the designed and pre-tested. After incorporation of the
administrative statistics maintained by the Policy missing variables and other relevant information,
and Planning Division of the Ministry of Education the questionnaire was finalized and presented to
in their Education Monitoring Information System the Technical Working Group comprised of officials
(EMIS). The data pertaining to adolescent from UNICEF, SNV, Bhutan Nuns Foundation,
schoolgirls (aged 10-19) were extracted for all the Ministry of Health, and Ministry of Education as a
schools of Bhutan and treated that as a sampling part of the simulation exercise.
frame for the KAP study of Menstruation Hygiene
Management (MHM).

Finalization of quetstionnaires
Pre-testing of the Launching of the field
Sampling plan and after incorporating the comments
questionnaire and training of surveys and conduct of
computation of weights and suggestions from the
enumerators FGDs with relevant
simulation exercise with UNICEF,
stakeholders
SHND, PHED & BNF.

Exporting the
Data entry into the Report writing and
Computer well processed Data analysis
Manual data well designed content analysis
Editing/Batch datasets into (both descriptive
editing interface in CSPro referring to various
Editing SPSS version 22 and empirical)
version 6.0 official documents
and Stata 13

Incorporate the
Draft presentation of comments and
the report suggestions

Production of the
final report

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Field Operation and with dignity. It was also to investigate the

menstruation related knowledge and practices
To enumerate the data based on the sample size among school-going adolescent girls which is
determined for this study, two teams with two beneficial for planning a program for improving the
supervisors were fielded into those sampled awareness level with respect to their life
schools. The data enumeration commenced from processes and promoting their quality of life. A
4th April to 5thMay, 2017. community based cross sectional study was
conducted on 387 school-going girls of Class 8 and
Response rate 9for the study. The study was undertaken among
There were about 3.9 percent computed as non- adolescent school-going girls in the field practice
response rate, meaning the survey covered only area of the Rural Health Unit and Training Centre,
around 96 percent of the sampled respondents. Saoner, in the Nagpur district, with the aim to
This non-response rate is due to minor errors in the assess the knowledge and the practices of
sampling frame generated from the EMIS whereby menstrual hygiene among rural and urban school
some sampled schools lacked 40 adolescent girls going adolescent girls. The studies have reported
aged 10-19, some refused to answers, some were that only 36.95% of the girls were aware of
too young to understand the questions despite menstruation before menarche. The major source
concerted afford to guide the interview etc. The of information about menstruation for them was
same situation arose due to reasons like partially found to be their mothers. More than three fourth
completed forms as well. of the girls in the study were not aware of the
cause and the source of the bleeding. A majority of
1.5.3 Data processing and analysis them had the knowledge about the use of sanitary
The data is processed using Census and Survey pads. Sanitary pads were used by 49.35% and
Processing software (CSPro. 6.2 version) and then 45.74% practice the used of old clothes.
exported to the SPSS 24 and Stata 12 for analysis. Satisfactory cleaning of the external genitalia was
practiced by 33.85% of the girls. Some menstrual
1.6 Literature Review hygiene indices have shown a significant
difference in rural and urban girls. A variety of the
A transition phase from girlhood to womanhood is factors are known to affect menstrual behaviors,
a special period in a life of adolescent girls. Thakre the most influential being economic status and
et al. (2011) pointed out that there is a substantial residential status (rural and urban). Awareness
lacuna in the knowledge about menstruation regarding the need for information about healthy
among adolescent girls. Good hygienic practices menstrual practices is very important. This study
such as the use of sanitary pads and adequate has highlighted the need of adolescent girls to
washing of the genital area are essential during have accurate and adequate information about
menstruation (Dhingra R, 2009). menstruation and its appropriate management. In
Menstruation is generally considered as unclean in view the mother and teacher plays vital role, it is
the Indian society. Isolation of the menstruating important to have correct and appropriate
girls and restrictions being imposed on them in the information on reproductive health. Much more
family has reinforced a negative attitude towards efforts are needed to curb the misbeliefs and
this phenomenon. This has blocked the access of taboos among adolescent schoolgirls. It is found
adolescent girls to the right kind of information, that adolescent schoolgirls in both urban and rural
especially in the rural and tribal communities. areas have poor knowledge on menstruation and
Several research studies have revealed this gap the practices are often not optimal for proper
and they showed that there was a low level of hygiene. Menstrual hygiene is an issue needs to
awareness about menstruation among girls when be addressed at all (THAKRE, 2011, Oct).
they first experienced infections due to lack of According to the study, Soap stories and toilets
hygiene during menstruation (Ahuja A, 1995), (H, tales (2012), many adolescent girls in low-income
1998), (KhannaA, 2005). Many studies have countries struggle to find proper places and
revealed that most of the adolescent girls had facilities in their school that support management
incomplete and inaccurate information about the of menstrual hygiene. Although menstruation is a
menstrual physiology and hygiene. It also revealed natural phenomenon, in many communities like in
that mothers, television, friends, teachers and Bangladesh, it is deemed to be shameful with
relatives were the main sources which provided many negative impacts, and should be hidden and
information on menstruation to the adolescent girls ignored. According to the adolescent girls the old
(Ghattargi CH, 2005), (Dasgupta A, 2008). A key menstrual cloths are buried in the ground for fear
priority of this study was to have women and girls to get possessed by evil spirits. They hide their
the necessary knowledge, facilities and the culture cloths from their fathers and brothers, as it is
environment to manage menstruation hygienically

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

believed if men see menstrual blood, misfortune Discrimination in South Asia (Bangladesh Country
will befall on them. Women on their period are not Report) 2009).
allowed to visit temple or the mosque. Some
The study, Issues in Managing Menstrual Hygiene
women do not leave their homes for seven days
in Rural Schools of Sri Lanka (2014) depicted that
each month during her period. Others observe
many school does not have facilities of getting
dietary restrictions or refrain from reading the
sanitary napkins, changing and washing sanitary
Koran. They are even not allowed to touch food,
napkins and safe disposal. Appropriate disposal are
cooking utensils or the kitchen gardens (Soap
not recommended and practiced by schools and
stories and toilet tales: 10 Case studies
this has led to environmental problem as well. The
Bangladesh: tackling menstrual hygiene taboos
promotion of menstrual hygiene in school is still
(2012)).
challenging though schools provide the facilities.
Many girls prefer to stay home during their Adolescent girls and female teachers should be
menstruation due lack of adequate facilities at empowered in taking the lead and managing
schools, which is effectively one quarter of their menstrual hygiene with dignity, safety and
school time that has direct impact on the student’s personal hygiene. The behavior and attitude
leading to dropping out school. When girls choose change in children is needed for positive effects on
to go to school while they are menstruating, they menstrual hygiene components of school water,
often do not change their menstrual pad for a sanitation and hygiene programs.
whole day which affect their concentration due to
concerns of overflow and staining of clothes lest it Limitations of the study
might lead to deep embarrassment and All the WASH facilities and the menstrual hygiene
uncomfortable (Equity in School Water and management practices reflected in this report are
Sanitation - Overcoming Exclusion and purely based on verbal report and no spot-checks
were carried out.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

CHAPTER 2: SOCIO-DEMOGRAPHIC CHARACTERISTICS

The survey also revealed that almost one-third of
Figure 5: Percentage distribution of the respondents belonged tothe age bracket of 12-
respondents by mother tongue 17. Sharchop speaking respndents were the
highest number who participated in this study
Sharchop 35.2 (35.2%) followed by Lhotsam (23.3%) and Ngalop
Lhotsam (22.1%).
23.3
Ngalop 22.1 Figure 3: Percentage distribution of
20.0 respondents by age
Others 10.8
Khengpa 8.7 15.0

0.0 10.0 20.0 30.0 40.0 10.0

%
This chapter deals with the socio-demographic
characteristics of the respondents who took part in 5.0
this study. The analysis in this chapter begins at
the national level and then delves into 0.0
disaggregated information. Figure 1 shows that 10 11 12 13 14 15 16 17 18 19
most of the respondents covered in this study Age
were from the Central Schools (35.6%) followed
by Primary Schools (20%) and Lower Secondary Figure 4: Grades of the respondents
Schools (14.9%). Going by the areas of residence,
around half of the respondents were from rural 20.0
schools and close to half (49.7%) from urban
schools. 15.0

Figure 1: Respondents by level of 10.0

schools
5.0
Central School 35.6
0.0
PS 20.0 3 4 5 6 7 8 9 10 11 12

MSS 15.3 The respondents comprised of diverse levels of

education spanning from class 3 to class 12.
LSS 14.9 Almost half of the respondents fall between
classes 8 and 10. Hardly one percent of the
HSS 14.1
respondents comprised of grade 3 students.
0.0 20.0 40.0 Figure 6: Girls living back at home by
category of their caretakers
With mother and… 71.2
Figure 2: Respondents by area With stepfather and… 11.6
of residence With mother only 9.6
With relatives 2.9
With stepmother… 2.5
With father only 2.2
Rural
49.7 50.3
Urban 0.0 20.0 40.0 60.0 80.0

A vast majority (71.2%) of the respondents lived

with mother and father followed by around 12
percent of them living with stepfather and mother.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

About 9.6 percent of them with single parent 2.1 Educational and Economic Characteristics
(mother). The lowest is the 2.2 percent of them
who live with lone parents (fathers). Amongthe This sub-section deals with the educaitonal and
adolescent respondent girls, maximum were economic characteristics of respondents’ parents
Budhist (81.5%) followed by Hindu (13.3%) and and guardians. Around eight in every ten (77.6%)
Christain (4.7%). Less than one percent belongs to of the respondents’ mothers have no education.
other faiths. Similarly, figure 10 has revealed that almost six out
of every ten (65.5%) fathers lack education.
Figure 7: Respondents by reliogus
background FIgure 9: Mother's education

No education 77.6
Buddhist 81.5
Classes 1-12 17.2
Hindu 13.3 NFE 3.6

College and above 1.1

Christain 4.7
Diploma 0.5
Others 0.4
0.0 50.0 100.0

0.0 50.0 100.0 Figure 10: Father's level of

Figure 8: Percentage distribution of education
adolescent girls receiving yearly
pocket money No education 65.5

8545+ Classes 1-12 26.9

0.6
College and… 3.3
7490 - 8544 2.3
NFE 1.9
6434 - 7489 1.5
Diploma 1.5
5379 - 6433 2.5 Monastic/Shedra 1.0
4323 - 5378 6.9
0.0 50.0 100.0
3268 - 4322 3.0
2212 - 3267 7.5 Figure 11 has yet again revealed that a large
1157 - 2211 14.3 majority of the respondents’ guardians lack
education. About nine in every ten (90.7%) of the
101 - 1156 41.8 guardians lack education.
<= 100 19.7
FIgure 11: Education level of guardian
0.0 10.0 20.0 30.0 40.0 50.0

The survey revealed that only about 65 percent of

the respondents received pocket money. Figure 8 No education 90.7
shows the amount of yearly pocket money
received by the respondents. The supply of pocket Classes 1-12 6.0
money ranges from Nu. 50 to 9,000 a year. Less
than half of the respondents received the yearly College and above 2.5
pocket money between Nu. 100 and 1,156
followed by around 20 percent who received even Diploma 0.6
less than Nu. 100 a year.
Monastic/Shedra 0.2

0.0 20.0 40.0 60.0 80.0100.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 12: Father's occupation Figure 13: Mother's occupation

Farmer 58.5 Farmer 55.6

[Link] 19.5 Others 17.4
Bussines/trade 5.6 Don't know 12.7
Bussines/trade 6.2
Don't know 5.2
[Link] 5.6
Pvt. Employee 4.8
Pvt. Employee 1.7
Others 4.2
[Link] 0.8
[Link] 2.2
0.0 20.0 40.0 60.0
0.0 20.0 40.0 60.0 80.0

Similar to the educational background, parents and Figure 14: Guardian's occupation
guardians of the respondents are mostly farmers.
There are almost equal proportions of fathers Don't know 45.4
(58.5%) and mothers (55.6%) whose are farmer. Farmer 36.2
Less than half of the respondents reported that Others 7.5
their guardian’s occupation is farmer and on the [Link] 5.9
contrary, close to half (45.4%) did not know the
Bussines/trade 2.4
occupation of their guardians.
Pvt. Employee 1.6
[Link] 1.0
0.0 50.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

CHAPTER 3: KNOWLEDGE ON MENSTRUAL HYGIENE AND MANAGEMENT

This chapter discusses the level of girls’
knowledge on menstruation. The sampled school Figure 16: Causes of menstruation
adolescent girls were asked few questions
intended to gauge their level of knowhow on
Hormones 51.9
menarche and its hygiene and management. The
lack of knowledge, awareness and information is
quite detrimental to adolescent girls’ health both in Don`t know 37.2
the present and in future.

3.1 Girls’ current knowledge and information Curse of God 5.2

on menstruation
This section deals with the knowledge level of the Others 3.5
adolescent girls on menarche. The survey revealed
that a vast majority (83%) of the girls know the
definition of menstruation as the ‘ natural shedding Caused by disease 2.3
of blood on a monthly basis.’ On the contrary, there
are about 14.1 percent of them who don’t know
the same. Around 2 percent of them defined 0.0 20.0 40.0 60.0
menstruation as a disease followed by around 1
percent who defined menstruation as a curse as The survey also sought to find out whether the
depicted in figure 15. When asked about the ethnicity matters regarding the knowhow on
causes of menstruation, about five in every ten menstruation amongst those adolescent girls in
(51.9%) reported that it is caused by hormones. the schools. Figure 17revealed some of the
However, four in every ten (37.2%) have reported glarring facts regarding the misconceptions about
that they don’t know the causes. About 5.2 menstruation. Around 40 percent of the
percent of the respondents were of the opinion Lhotsampa adolescent girls perceived
that menstruation is a ‘Curse of God’ followed by menstruation as disease followed by close to 30
around 2 percent of them who were of the take percent of Ngalop adolescent girls. Around 17
that menstruation is caused by disease. percent of the sharchop adolescent girls too
perceived menstruation as a disease. Figure
Figure 15: Respondents' knowhow on 17revealed some more interesting facts regarding
menstruation mensturation in terms of ethnicity. More than 30
percent of the sharchop adolescent girls have
Natural shedding of perceived mensturation as a curse. Nonetheless,
83.0
blood on monthly… on an average, about 20 percent of the
respondents girls by various ethinicity perceived
Don`t know menstruation as physiological phenomena. On the
14.1
other hand, the survey revealed that as the age
keep increasing till 16 years, the knowledge on
Disease menstruation as physiological phenomena keeps
1.9
increasing. Figure 18 reveals that from the age of
17 till 19 the knowhow on menstruation as natural
Curse 0.9 shedding of blood on a monthly basis gradualy
keeps declining. In terms of other beliefs viz.
menstruation as disease, cure and etc, age has no
Others 0.1 much effect since the opinion shared by the
respondents seems sinosuidal.

0.0 [Link].0100.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 17: Perception of Figure 19: Perception on menstruation by

menstruation by ethnicity religious background
50.0 100.0
Natural 87.0 Natural
40.0 90.0 shedding of
shedding
80.0 blood on a
30.0 of blood on monthly basis
70.0
monthly 60.0
Disease
20.0 basis. 50.0
10.0 Disease 40.0
30.0 Curse
0.0 13.0
20.0
10.0 0.0
0.0
Buddhist Christain Hindu

Figure 18: Perception on menstruation 3.2 Menarche—knowledge and information

by adolescent girls and by age This sub-section discusses about the menarche
50.0 and its related knowledge and information. The
survey revealed that more than half (59.4%) of the
adolescent girls reported that menstruation came
from uterus. However, there are around 24 percent
of them who are oblivious about the flow of
menstruation. This could be due to the fact that
around 11 percent of the adolescent girls who
participated in this survey are in the age bracket of
0.0
10-11. Figure 20 shows that about 8.2 percent of
10 11 12 13 14 15 16 17 18 19 the respondents reported that menstruation came
Age
Natural shedding of blood on a monthly from the birth canal. Adding further to this shock,
basis about 5.4 percent of them said that menstruation
Disease came from bladder. Asked at which age most girls
usually experience their first period, around 51
percent of the respondents reported 12 as the age.
Close to two-third (65.3%) of Buddhist adolescent Figure 21 shows that around 13 percent of them
girls believed that menstruation is a disease don’t know the age at which menstruation begins.
followed by Hindu (23.1%) and Christain
adolescent girls (11.6%). On the contrary, Buddhist
adolescent girls have rightly described
menstruation as the normal physiological process.
Eight out of ten (80.4%) of the Buddhist
adolescent girls have rightly perceived
menstruation as the natural shedding of blood on a
monthly basis. Only 14.2 percent of the Hindu
adolescent girls have perceived menstruation as
the normal physiological process followed by about
5 percent of Christain adolescent girls. Buddhist
and Hindu adolescent girls have misconceived
menstruation as curse. Figure 19 reveals that
about 87 percent of the Buddhist adolescent girls
have reported that menstruation is a curse
followed by 13 percent of Hindu adolescent girls.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 20: Knowhow on the organ from Figure 22: Duration of normal
which the menstruation come menstruation (days)

Uterus 13-31 1.3

59.4
0.9
11 0.2
Don`t know 23.8 0.2
9 0.8
Birth canal 8.2 0.6
7 12.3
Bladder 5.4 4.3
5 20.8
Abdomen 2.0 13.3
3 17.3
Others 1.3 28.1
1 0.1
0.0 20.0 40.0 60.0 80.0 0.0 10.0 20.0 30.0

Figure 21: Age at which most girls Figure 23: Interval between two
usually get their first period menstrual cycles
16 0.4
15 2.4 47 - 54+ 0.7
14 4.1
13 12.0 29 - 37 33.9
12 50.7
11 10.1 20 - 28 10.4
10 5.6
9 1.4 11 - 19 2.6
8 0.4
5 0.1 <= 10 52.6
Don`t know 12.7
0.0 20.0 40.0 60.0 0.0 20.0 40.0 60.0

When asked about the duration of normal The survey also sought to know the sources of
menstruation, a majority of them were not aware information regarding menstruation to adolescent
of the same. Around six in ten (58.8%) are of the girls. More than two-third (86%) of them have
view that duration (days) of menstruation for a reported that they heard about menstruation from
normal person lasts between 1-4 days. On the someone. Figure 24 revealed that mothers (42%)
contrary, there are about 1.3 percent of them who often provided them with information after
believe that menstruation lasts for about 13-31 menarche is reached followed by teachers (27.1%)
days in a normal person. About 20.3 percent of the and sisters (15.6%). Around 14 percent of the
respondents have reported that the menstruation respondents reported that they received
lasts between 6-12 days. There are only around 21 information on menarche from their friends. About
percent who has reported that the menstruation 1.8 percent of them availed information on
lasts for about 5 days in a normal person. The menstruation from other sources viz. books, TV,
survey found that about 18.2 percent of the Radio and etc.
adolescent girls have reported that the interval
between two menstrual cycles comprised of 28
days. There are more than half (52.6%) of them
who reported that the interval between two
menstrual cycles is less than 10 days. On the other
extreme, less than 1 percent has reported that the
interval lasts between 54 days and above.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 24: Sources of information Figure 26: Reprductive Tract

regarding menstruation Infection due to poor menstrual
hygiene
Mother 42.0
Yes
Teacher 27.1
Sister 15.6 24.2
No
Friends 13.5
Others 1.1
57.1 18.8 Don't
Book 0.4 know
Media (TV,Radio etc) 0.3

0.0 10.0 20.0 30.0 40.0 50.0

Figure 25: Fungal Infection due to poor FIgure 27: Urinary Tract Infection
menstrual hygiene due to poor menstrual hygiene

Yes Yes

24.9
No No
43.8 42.2

Don`t 58.9 16.2 Don't

know know
14.0

Asked whether those adolescent schools girls The adolescent girls were also asked about the
knew about menstrual hygiene, around 61 percent four menstrual phases. This study has revealed
of them reported ‘Yes’. The survey also delved into that more than half (52.3%) of them are not aware
finding whether those girls knew about infections of the menstrual phases.
related to poor menstrual hygiene. Four types, viz.
Figure 28: Menstrual phases
fungal infection, reproductive tract infection,
urinary tract infection and infertility related to
menstrual hygiene were asked. Figure 25 reveals
that close to half (42.2%) have reported that they Don`t know 52.3
are aware of the fungal infection due to poor
Day 14 (Ovulutary
menstrual hygiene. On the contrary, about 57.1 21.1
phase)
percent of them have reported that they are not
aware about reproductive tract infection (figure Day 15-28 (Luteal
14.0
26). When asked if they knew about Urinary Tract phase)
Infection (UTI), more than half (58.9%) said no. Day 1-5 (Menstrual
Only around 25 percent of them have reported that 8.3
phase)
they were aware of UTI.
Day 6-13 (Follicular /
4.3
proliferative phase)

0.0 20.0 40.0 60.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

CHAPTER 4: ATTITUDE TOWARDS MENSTRUATION

This chapter deals with adolescent schoolgirls’
attitude towards menstruation. This chapter also Figure 29: Women must not enter
further delves into the misconception created the shrine /temple during period
around menstruation by the society and the
impacts produced by it to schoolgirls especially in Strongly agree 33.6
terms of their school attendance and societal taboo Agree 29.9
and discrimination as well. Don`t know 16.1
4.1 Sub-factors contributing towards attitude Disagree 13.2
of adolescent girls on menstruation Strongly disagree 7.2

The Exploratory Factor Analysis (EFA) was applied 0.0 10.0 20.0 30.0 40.0
to factor out the sub-factors contributing to the
attitude of adolescent schoolgirls on menstruation. Figure 30: Women in menstruation are
Considering or restricting the factor loadings more susceptible to get possessed by evil
than 0.5, a sum of 12 sub-factors had been spirits
identified as factors contributing towards the Don`t know 34.0
attitude of adolescent schoolgirls on menstruation.
Following are the sub-factors identified by the EFA: Disagree 24.6
a) I can tell my period is approaching because of Strongly disagree 20.4
the breast tenderness, backache, cramps or
other physical signs; Agree 15.6
b) It is important to talk about menstrual period
with men; Strongly agree 5.4
c) It is important to discuss the topic of period at
school with boys and girls; 0.0 10.0 20.0 30.0 40.0
d) We women wish that the period would last for
a few minutes; The survey had revealed that close to two-third
e) It is important to buy sanitary pad without (65%) of the adolescent school girls have agreed
being seen; the approaching of their period signals with
f) Women wish that we do not have our period; varieties of pains viz. breast tenderness, backache,
g) I miss school during my period because am cramps or other physical signs. Around two-third
afraid of staining my clothes; (67.7%) of them have again agreed that the only
h) I miss school during my period because am good thing about menstruation is that they know
afraid of others making fun of me; they are free from pregnancy.
i) I miss school during period because it can
cause pain; Figure 31: I can tell my period is
j) I miss school during my period since it can approaching because of the breast
make me feel uncomfortable or tired; tenderness, backache, cramps or
k) I miss school during my period because there other physical signs
are no places for girls to wash and change at
school; and
l) I miss school during my period because there Agree 38.2
is nowhere to dispose-off sanitary pad. Strongly agree 26.8
4.2 Social Impacts produced by menstruation Don`t know 24.6
Close to one-third (63.5%) of the adolescent
Disagree 8.1
schoolgirls reported that during menstruation, a
woman must not enter the shrine or temple. Strongly disagree 2.3
Further augmenting this superstition, about 21
percent of the respondents agreed that women in 0.0 10.0 20.0 30.0 40.0 50.0
menstruation are susceptible to get possessed by
an evil spirit.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 32: The only thing good with Figure 34: I miss school during my
menstruation is that I come to know period because it cause pain
that I am not pregnant
Agree 32.7
Strongly agree 44.0 Disagree 26.4
Agree 23.7 Strongly agree 15.4
Don`t know 20.3 Strongly disagree 14.1
Disagree 7.6 Don`t know 11.3
Strongly disagree 4.3 0.0 10.0 20.0 30.0 40.0

0.0 10.0 20.0 30.0 40.0 50.0

Figure 35: I miss school during my
period because it makes me feel
The survey revealed that absenteism in school by uncomfortable or tired
the adolecent school girls as a result of
menstruation is quite detrimental. About 32.5 Disagree 29.6
percent of the adolescent schoolgirls have
reported that they miss school during the period Agree 28.9
since they fear others making fun of them. Strongly disagree 14.1
Figue 33: I miss school during my period Strongly agree 14.0
because am afraid of others making fun
of me Don`t know 13.4
Disagree 33.1 0.0 10.0 20.0 30.0 40.0
Strongly disagree 21.5
Agree 18.7 Around one quarter (24.9%) of the adolescent
Strongly agree 13.8 schoolgirls reported that they miss the school
during period there are no places for girls to wash
Don`t know 12.9
and change while in school. In the same manner,
0.0 10.0 20.0 30.0 40.0 figure 37 revealed that close to one quarter
(21.3%) of the respondents reported that they
miss school during menstruation because there is
4.3 Physical Impacts of menstruation no place to dispose off sanitary pad.
The survey had unfolded various physical impacts
produced as a result of menstruation. Figure 34
reveals that adolescent schoolgirls miss school
during menstruation since it causes them pain.
Close to half of the respondents agreed that they
miss school during period since it causes pain.
About 43 percent of the adolescent schoolgirls
have reported that they miss school during period
because it is uncomfortable.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 36: I miss school during my Figure 38: I am more easily upset during
period because there isn't anywhere pre-menstrual and menstrual periods than
for girls to wash and change at school at other times of the month

Disagree 37.4 Agree 35.9

Strongly disagree 25.3 Strongly… 21.1

Agree 15.9 Don`t know 20.8

Don`t know 12.4 Disagree 18.2

Strongly agree 9.0 Strongly… 4.0

0.0 10.0 20.0 30.0 40.0 0.0 20.0 40.0

Figure 37: I miss school during my period Figure 39: Menstruation is

because there is nowhere to dispose off something that I just have to put up
sanitary pad (tolerate) with

Disagree 37.2 Agree 38.5

Strongly disagree 27.7

Strongly agree 24.9
Agree 14.7
Don`t know 21.9
Don`t know 13.9
Disagree 10.8
Strongly agree 6.6

0.0 10.0 20.0 30.0 40.0 Strongly disagree 4.0

0.0 10.0 20.0 30.0 40.0 50.0

4.4 Emotional Impacts

This section explains about the emotional impacts Figure 40 shows one of the emotional impacts of
produced as a result of menstruation to adolescent menstruation. Little more than two-third (69.8%) of
schoolgirls. More than half (57%) of the the adolescent schoolgirls agreed to the
respondents agreed that they get easily upset statement, ‘men have real advanatge of not having
during pre-menstrual and menstrual periods than at monthly period.’ However, on the contrary, around
other times. Some girls are of the opinion that they 13 percent of them contradicted the statement.
just have to put up with the menstruation. Figure Figure 41 revealed that one out of every ten
39 revealed that close to two-third (63.4%) of the (10.1%) of the adolescent schoolgirls have
respondents agreed that menstruation is disagreed that a woman who attributed her
something that they just have to tolerate with. irritability to her approaching menstrual period as
neurotic.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 40: Men have real advantage of FIgure 43: Women are more tired than
not having monthly period usual when they are menstruating
Strongly agree 39.9
Strongly agree 45.5 Agree 38.4

Agree 24.3 Don`t know 12.7

Disagree 7.2
Don`t know 17.2
Strongly disagree 1.8
Disagree 9.0
0.0 10.0 20.0 30.0 40.0 50.0
Strongly disagree 3.9
4.5 Menstruation as taboo to adolescent
0.0 10.0 20.0 30.0 40.0 50.0 school girls
FIgure 41: A woman who attributes her Close to three out of every ten (27.7%) still
irritability to her approaching menstrual disagrees the statement that ‘it is important to talk
period is neurotic about menstrual period with men.’ Figure 45 has
revealed that there are still around 19 percent of
the adolescent schoolgirls who do not yield to the
Don`t know 42.2 statement, ‘it is important to discuss the topic of
period at school with boys and girls.’
Agree 32.1
Figure 44: It is important to talk about
Strongly agree 15.8 menstrual period with men

Disagree 8.3
Agree 33.1
Strongly disagree 1.6
Strongly agree 26.0
0.0 50.0
Disagree 16.4
Figure 42 Shows that about 38.3 percent of the
adolescent schoolgirls agreed that women Don`t know 13.2
complaining of menstrual distress are just using it
as an excuse. Almost equal proportion (78.3%) of Strongly disagree 11.3
the respondents agreed that women are more
tired than usual when they are menstruating (figure 0.0 10.0 20.0 30.0 40.0
43).
Figure 42: Women complaining of
Figure 45: It is important to discuss the
menstrual distress are just using
topic of period at school with boys and
that as an excuse
girls

Don`t know 26.7 Strongly agree 34.9

Agree 26.0 Agree 32.6

Disagree 24.4 Don`t know 14.0

Strongly agree 12.3 Disagree 11.6

Strongly disagree 10.6 Strongly disagree 7.0

0.0 10.0 20.0 30.0 0.0 10.0 20.0 30.0 40.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 46 reveals the general attitude of

adolescent schoolgirls. More than two-thirds Figure 46: We women wish that the
(80%) of them agreed to the statement, ‘we period would last for few minutes
women wish that the period would last for few
minutes.’ Like in many Asiatic world, this survey Strongly agree 41.6
revealed that menstruation has become a great
taboo to the extent that even a simple Agree 37.4
phenomenon like buying sanitary pad is taken with Don`t know 9.5
great care by adolescent schoolgirls. Figure 47
shows that more than half (55.8%) of the school Disagree 7.7
adolescent girls have reported that ‘it is important
Strongly disagree 3.7
to buy sanitary pad without being seen by others.’
0.0 20.0 40.0 60.0

Figure 47: It is important to buy

sanitary pad without being seen
Agree 30.5

Strongly agree 25.3

Disagree 23.4

Don`t know 12.4

Strongly disagree 8.4

0.0 10.0 20.0 30.0 40.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

CHAPTER 5: PRACTICES OF MENSTRUAL HYGIENE MANAGEMENT IN SCHOOLS

The earlier chapter discussed information on
menarche awareness and attitudes towards FIgure 49: % share of main
menstruation. This chapter discusses the type of absorbent material perferred most by
absorbent used, disposal, hygiene, and etc. Many the adolescent girls
studies have shown that Menstrual Hygiene Sanitray pad 90.8
Management (MHM) is a problem for adolescent
girls in low and middle-income countries and in None of the above 3.0
particular when attending school.1
Others 2.1
5.1 Type of menstrual absorbents used
Tampon 1.4
The survey sought to find out the type of menstrual
absorbents used by the adolescent schoolgirls. Napkin/cloth or… 1.1
Seven specific types of absorbents were made to
check, spanning from sanitary pad to tampon. The Reusable sanitary… 0.7
use of sanitary pad is commonly reported both in
urban and rural areas with a percentage share of Cotton 0.6
52.1 percent and 47.9 percent respectively. Figure
48 has revealed that every nine out of ten (91.9%) Mentrual cup 0.2
uses sanitary pad. Figure 48 has also revealed a
disturbing phenomenon that around 3 percent of 0.0 [Link].0100.0
the adolescent schoolgirls do not use any kind of
absorbent material. Asked why the adolescent girls preferred particular
type of absorbent, almost four in every ten (38.1%)
Figure 48: The main absorbent reported that they use sanitary pad as an absorbent
material used during period/ material since it is easy to use. (32.1%), reported
menstruation that they use sanitary pad since it is easily
available. Around 11 percent of them have
reported that sanitary pad could be used for longer
Sanitary pad 91.9 duration. Affordability is also a reason why they
prefer using sanitary pad. About 5.4 percent of the
None of the above 2.7 respondents have reported that they prefer
sanitary pad to others since it is affordable.
Others 2.5 However, about 4.4 percent of the respondents
said that they can’t afford other good quality ones
Reusable sanitery and landed up using sanitary pad as an absorbent.
1.0
pad
Napkin / cloth or
0.9
towel

Cotton 0.4

Mentrual cup 0.3

Tampon 0.2

0.0 20.0 40.0 60.0 80.0100.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 50: Reason adolescent girls Figure 52: Method of drying cloth pad
perferring the main abosrbent material
during menstruation (%)
Sunlight 75.2
Easy to use 38.1
Inside the house 9.6
Easily available 32.1

Can be uesd longer 10.8 Others 7.8

Others 9.2 Hide beneath the

7.5
another cloth
Affordable 5.4
0.0 20.0 40.0 60.0 80.0
Can`t afford the… 4.4
Figure 58: Number of changing pad or
0.0 10.0 20.0 30.0 40.0 cloth in a day

Figure 51: Method of cleaning cloth

pad
9.7
Water and soap 75.2

Water 12.8 90.3

Hide and dry it

beneath other 8.7 Once Two and more
clothes
To further assess the menstrual hygiene practices,
Others 3.3 the survey sought to find out the method of drying
pad. Around three-quarters (75.2%) of them
reported that they dry their cloth pads in sunlight.
0.0 20.0 40.0 60.0 80.0 Figure 52 also revealed that around one out of
every ten (9.6%) dry their cloth pads inside the
house. Around 8 percent of them hide beneath
Given the economic situations of different another cloth and dry them together.
adolescent schoolgirls, an improvised version of
sanitary pads had been into practices. To this
effect, the survey also sought to learn about the
method of cleaning cloth pad. Figure 51 revealed
that around three-quarters (75.2%) of the
respondents have used water and soap for
cleaning their cloth pads followed by around 13
percent who used water alone. As revealed earlier,
menstruation still seems a taboo. Figure 51 as well
revealed that around 9 percent of the adolescent
schoolgirls hide and dry cloth pad beneath other
clothes to avoid seening by others.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 53: Types of pad wraps used Figure 55: % share of adolesecent
for disposing it girls coming to school during
Papers 62.9 menstruation

Plastic bag 26.8 9.3

Others 7.2 No
No wrap 3.1
Yes
0.0 20.0 40.0 60.0 80.0
90.7
Figure 54: Number of times changing
underwear during menstruation in a day
0.1
6 0.3 FIgure 56: Mentrual problems interfering
1.7 with attendance during school
4 3.5
14.9 Others 55.3
2 52.4
19.9 One day every cycle 26.8
0 7.2
Three days every cycle 6.7
0.0 20.0 40.0 60.0
Four days every cycle 5.6
This study attempted to assess the complete
practices of menstrual hygiene straddling from Two days every cycle 5.5
knowledge and information to practices and
disposal of sanitary pads. Figure 53 reveals that 0.0 20.0 40.0 60.0
close to two-third (62.9%) of the adolescent school
girls used papers as pad wraps for disposing the Menstrual hygiene practices interfering with
kind of sanitary pads they used. It is also revealed school attendance is one of the most common
that more than one-quarter (26.8%) of the phenomenon most of the related studies have
adolescent girls have reported that they use plastic revealed. When asked whether the adolescent
bag or polythene bag to wrap the sanitary pads and schoolgirls remained absent from school during
dispose it. On the contrary, there are about 3.1 menstruation, nine out of every ten (90.7%) of
percent of them who do not use any pad wraps in them have reported that they come to school
disposing the pads. Quite interestingly, the survey despite menstruation. Figure 56 had revealed the
has revealed that more than half (52.4%) of the frequency of interference with school attendance.
adolescent school girls changed underwear during More than half (55.3%) of the adolescent
menstruation twice a day. It was also revealed that schoolgirls have reported other categories of
around 15 percent of them changed underwears attendance counts. This was specified by each one
during menstruation thrice a day. Around 20 of them and on an average, the most common
percent of them have changed underwears during reason was that most of them did not fit into our
period only once a day. The survey revealed the proposed category of question. However, about
two extreme situations whereby about 2.1 percent 44.7 percent of them have reported that they
of them have changed underwears during the missed school ranging from one day to four days
period between 5 to 7 times a day. On the other during every cycle.
extreme, about 7.2 percent of the adolescent girls
have reported that they did not change their
underwear during the period at all.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figue 57: Remedies taken during Figure 59: % share of adolscent girls
menstruation cleaning their genital area during
menstruation
Take rest 52.5
8.7
Thoroughly involve in
21.1
activities

Others 15.2

Medication 6.4 91.3

No Yes
Yoga / Meditation 3.1

Figure 60:% share of taking half body

Prayers 1.7 bath during period due to lack of hot
water
0.0 20.0 40.0 60.0
Agree 25.6
Figure 58: %share of adolescent girls
taking bath during menstruation Don`t know 24.7

Strongly agree 20.3

Daily 58.1

Disagree 19.2
Others 15.5
Strongly disagree 10.2
Only on
12.5
second day 0.0 10.0 20.0 30.0

Only on first
10.0
day Asked whether adolescent schoolgirls clean their
genital area during menstruation, this survey had
Do not bath revealed that nine out of every ten (91.3%) of the
3.9
any time adolescent schoolgirls clean their genital area
during menstruation. Figure 60revealed that close
0.0 50.0 100.0 to half (45.9%) of the respondents agreed that they
take half body bath during period due to lack of hot
water. Figure 61 shows the affordability of sanitary
Figure 57 reveals one of the most important pad. More than two-thirds (73.8%) of the
factors responsible to encounter the menstrual respondents reported that they could afford
pangs of the adolescent schoolgirls. When asked sanitary pad during menstruation. On the contrary,
what remedies they took during menstruation to there are around 8 percent who cannot afford and
overcome pangs, more than half (52.5%) reported similarly, about 4.2 percent of reported
that they take rest. It has been also revealed that unavailability of sanitary pad.
close to one-quarter (21.1%) of them have
reported that they thoroughly involve in activities
to forget the pangs and discomforts while 6.4
percent resort to medication followed by Yoga and
meditation (3.1%) and prayers (1.7%). Similarly,
when asked whether they take bath during period,
more than half (58.1%) reported that they do so.
Around 13 percent of them reported that they take
bath only on second day followed by 10 percent of
them who bathe on the very first day. Around 4
percent of them do not bath any time.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 61: % afforded to buy sanitary The survey also delved into finding out the facilities
pad during menstruation available at schools for menstrual hygiene
practices. Figure 63 reveals that more than half
Can afford 73.8 (55.1%) of the adolescent school girls reported
that they dispose pads into pad disposal bins
Don't know 14.5 followed by around 18 percent of them who
dispose into pit. About 14.2 percent of the
Cannot afford 7.5 respondents reported that they dispose off the
pads in burning place. However, around 9 percent
Not available to buy 4.2 of them reported that there is no disposal facilities
at at schools. Figure 64 shows the perecentage
0.0 20.0 40.0 60.0 80.0 share of place for drying clothes. About 43.2
percent of the respondents have reported that
Figure 62: Materials used to clean there are no place for drying clothes.
gential area during menstruation
Figure 65: % share of toilet/ bathing
Water and soap 68.6 facilities enough for adderssing issues
related to menstruation
Only with water 27.6

Others 3.0
36.0
Towels 0.8

0.0 20.0 40.0 60.0 80.0

64.0

More than two-thirds (68.6%) of the respondents

reported that they used water and soap for
cleaning genital area during menstruation folowed No Yes
by only water (27.6%). Less than one percent have
reported that they use towels. Figure 66: % share of taking half body
bath during period due to lack of hot
Figure 63: % share of disposal facilities water
used to dispose sanitary pads
Agree 25.6
Pad disposal bins 55.1 Don`t know 24.7
Pit 17.9 Strongly agree 20.3
Burning place 14.2 Disagree 19.2
No disposal… 8.5 Strongly disagree 10.2
Others 4.3
0.0 10.0 20.0 30.0
0.0 20.0 40.0 60.0
The survey also explored to seek the availability of
Figure 64: % share of place for drying toilet/bathing facilities enough for addressing
clothes issues related to menstruation. Figure 65 reveals
that only about 64 percent of the respondents
reported that they have adequate toilet/bathing
facilities enough for addressing issues related to
menstruation. The survey had also revelaed that
43.2 close to half (45.9%) of the respondents agreed
that they take half body bath during period due to
56.8 lack of hot water.

No Yes

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

CHPATER 6: SUMMARY FINDINGS FROM Figure 69 reveals that only around 57 percent of
the nuns received the yearly pocket money. The
NUNNERIES nuns have received the yearly pocket money
Concurrently, the adolescent nuns in nunneries ranging from ngultrum 100 to 10,000. Figure 70
were also surveyed using the same questions. Out reveals that most of the adolescent nuns have
of the sampled 202 nuns in the three regions viz. received the yearly pocket money ranging from
estern, central and western, only around 30 ngultrum 100 to 1,200.
percent of the adolescent nuns were covered. This
is due to the lack of proper sampling frame for the Figure 69: Yearly pocket money
nuns and those sampled nunneries felt short of received by nuns
adolescent nuns falling in the age bracket of 10-19.
However, for a pocket study a fairly representative
sample of 56 nuns were covered and upon
applying the weights, it has been extrapolated to Yes
202 sampled nuns. No
43.2
6.1 Socio-demographic characteristics of nuns
A majority of the participants of this survey were 56.8
aged 12, 15 and 17. Figure 68 shows the grade
wise distribution of adolescent nuns. They call their
grading system a “Zindra.” More than half (57.3%)
of the respondents are in Zindra one followed by
close to one-quarter (22%) of them in Zindra two.
About 12 percent of them have no grade so far.
Figure 70: Yearly pocket money received
by the respondents
Figure 67: Percentage distribution of
age of respondents 45.0
40.0
16.0
35.0
14.0 30.0
25.0
12.0
20.0
10.0 15.0
8.0 10.0
5.0
6.0 0.0
4.0
2.0
0.0
10 11 12 13 14 15 16 17 18 19
6.2 Socio-economic Characteristics of parents
Figure 68: Grade wise distribution of and guardians
respondents (Zindra)
Almost on an equal proportion (more than two-
thirds) of the adolescent nuns’ parents do not have
5 1.8 modern education. On an average, close to quarter
4 2.4 of their parents have education ranging from
classes 1-12. Very few have non-formal education
3 4.6 and monastic/shedra.

2 22.0

1 57.3

No grade 12.0

0.0 20.0 40.0 60.0 80.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 71: Father's education level Figure 73: Father's occupation

Farmer 75.0
NFE 0.9
Don't want to report 10.7
Monastic/Shedra 2.4
Bussines/trade 7.1

Classes 1-12 20.4 [Link] 3.6

Others 1.8
No education 76.3
[Link] 1.8
0.0 50.0 100.0
0.0 20.0 40.0 60.0 80.0

Figure 72: Mother's education level

Figure 74: Mother's occupation

NFE 2.4
Farmer 82.1
Monastic/Shedra 0.9 Others 7.1

Bussines/trade 5.4
Classes 1-12 23.1
Don't want to… 3.6
No education 73.7 [Link] 1.8

0.0 20.0 40.0 60.0 80.0 0.0 50.0 100.0

Similarly, most of the parents and guardians of the

adolescent nuns are farmers. Figure 72 depicts the The study revealed that most of the guardians are
mother’s education level. About three- quarters farmers as well. Figure 75 shows that almost nine
(75%) of fathers are farmers. On a similar situation, out of every ten (87.5%) nuns did not want to
mothers and guardians have almost same report the occupation of their parents. Around 11
proportions. Eight out of every ten (82.1%) of them percent reported are farmers.
are farmers.
Figure 75: Guardian's Occupation

Don't want to
87.5
report

Farmer 10.7

[Link] 1.8

0.0 50.0 100.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

CHAPTER 6.1: KNOWLEDGE AND Figure 77: Cause of menstruation

INFORMATION ON MENSTRUATION
This chapter extensively discusses the knowledge
Hormones 41.1
and information the nuns possess in regard to
menstruation. The nuns were administered the
same level of questionnaire used for the Curse of God 37.5
adolescent schoolgirls. The facts and figures
generated from this chapter would be used to
determine unmet needs of the adolescent nuns. In Don`t know 10.7
this chapter the sections spans from nuns’
awareness on menarche to infections related to
lack of improper menstrual hygiene management. Caused by disease 7.1

6.1.1 Awareness on menarche and its causes

Others 3.6
This sub-section deals with the nuns’ entire
knowhow on menarche and its related issues.
When nuns were asked to define menstruation, 0.0 10.0 20.0 30.0 40.0 50.0
close to half (42.9%) reported and checked the
category, ‘Don’t know,’ which is quite detrimental When asked from which organ does menstruation
in relation to the menstrual hygiene management. come, a large majority (82.2%) of the nuns
Figure 81 depicts the various forms of definitions reported that it comes from the uterus. On the
on menstruation. Only around 43 percent of the contrary, there are about 13.3 percent of them who
nuns have reported correctly that the menstruation reported that they don’t know. About 2.2 percent
is a ‘natural shedding of blood on a monthly basis.’ of the nuns have reported that the menstruation
About 7.1 percent of the nuns reported that comes from the birth canal. The adolescent nuns
menstruation is a curse followed by 5.4 percent of were also asked the age at which menarche
them considering it as a disease. The survey also begins. Figure 79 revealed that around 36 percent
explored to find out the nuns’ knowhow on causes of them have reported that at the age of 12 the
of menstruation. Figure 82 reveals that only about menarche begins. Close to one-quarter (21.4%) of
41.1 percent of them reported that it is the them have reported that menarche begins
hormones. A substantial share of percentage betwwen the age of 9 and 11. On the other
(37.5%) of nuns considered the cause as curse of extreme, more than one-quarter (26.9%) of the
God followed by about 7.1 percent who considered respondents reported that menarche begins from
its cause as disease. the age of 14-18.

Figure 76: Definition of menstruation Figure 78: The organ from which
mensturation come

Don`t know 42.9

Uterus 82.2
Natural shedding of
blood on monthly 42.9
basis. Don`t know 13.3

Curse 7.1
Others 2.2

Disease 5.4
Birth canal 2.2
Others 1.8
0.0 50.0 100.0
0.0 [Link].050.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 79: Age of menstruation for girls

Figure 81: Interval between two
40.0 menstruations
35.0
60.0
30.0
25.0 50.0
20.0
40.0
15.0
10.0 30.0

5.0 20.0
0.0
10.0
9 11 12 13 14 15 16 18

The survey had revealed that nuns have reported 0.0

duration of normal menstruation spans from 3-62
days. About one-quarter (25%) of the nuns
reported that they don’t know. Around 4 percent
reported that it lasts for 62 days followed by
around 2 percent of them who reported to have
lasted for 32 days. Nonetheless, more than half
6.1.2 Sources of information on menarche
(54.3%) of them have reported that it lasts This sub-section deals with the sources of
between 3 to 6 days. Similarly, when asked the information on menarche for nuns. The survey
interval between two menstruations, figure 81 has revealed that more than two-thirds (83.9%) of the
revealed that more than half (57.1%) of the nuns have reported that someone in their life told
adolescent nuns have reported that 21 days of them about menarche. Mothers are the first and
interval exists between two menstruations. Again main source of information for the nuns. Figure 83
there are two extreme reports, around 2 percent revealed that more than half (54.9%) of the nuns
believes that it lasts from 14-20 days followed by received information on menstruation from their
the other extreme, where it is reported that it lasts mothers. This is followed by about 35.3 percent
from one to three months. reporting teachers as their source of information
on menarche. About 7.8 percent of them have
Figure 80: Duration of Normal reported the source as their sisters followed by 2
Menstruation percent of them who cited the source as their
friends.
30.0
25.0
20.0
15.0
10.0
5.0
0.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 82: Did anyone tell you Figure 84: Do you know about
about the menstruation menstruation hygiene

No Yes

No Yes 16.1
46.4

53.6

83.9

Figure 83: From whom you got Figure 85: Menstrual blood perceived as
information about menstruarion unhygienic

Sister 7.8

Frindes 2.0 32.1

Yes
Teacher 35.3 No
67.9
Mother 54.9

0.0 20.0 40.0 60.0

The survey also revealed that more than half 6.1.3 Awareness on menstrual related infections
(53.6%) of the nuns are aware of the menstruation
hygiene. Asked how nuns perceive menstruation The survey also sought to learn the level of
blood as, figure 85 revealed that more than one- knowhow of nuns on menstrual related infections.
third (67.9%) of them perceived it as unhygienic. Figure 86 revealed that equal proportion (28.6%) of
When questioning the nuns’ knowhow on the nuns were aware and unaware of the
menstrual hygiene management, they reported infections related to menstruation. Figure 86 as
the followings: well revealed that close to half (42.9%) ‘don’t
know at all’ about the infections resulting from the
• We need to clean our genital area with hot poor menstrual hygiene. Similarly, to check
water; awareness on other forms of infections, nuns were
• We need to change our pad from time to time; asked about RTI (Reproductive Tract Infection).
• We have to take bath regularly; Only around 36 percent of them are aware of the
• We have to wash our hands with soap after same and almost equal proportion of the remaining
changing the pad; nuns reported as either ‘don’t know’ or No
• We need to keep our body clean during period; awareness on infections related to menstruation.
• We need to change underwear regularly; and
• Apply perfume to avoid bad smell.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 86: Awareness on Fungical Figure 88: Awareness on Urinary Tract

Infection infection

28.6 19.6
42.9

53.6
26.8
28.6

Yes No Don`t know Yes No Don't know

Figure 87: Awareness on Reproductive Figure 89: Awareness on Susceptible to

Tract Infaction infertility

30.4 16.1
35.7
42.9

41.1

33.9

Don't know No Yes Yes Don't know No

When further asked about the awareness on the When asked about the susceptibility of infertility as
infections like UTI (Urinary Tract Infection), figure a result of poor menstrual hygiene management,
93 reveals that more than half (53.6%) of the nuns only around two out of every ten (16.1%) are
are unaware about UTI. aware of the same. Remaining two-thirds (84%)
are unaware of the infections related to
menstruation.
Lastly, in this section, four phases of menstruation
were asked to the respondents. Figure 90 reveals
that one-quarter (25%) of them don’t know and
remaining three-quarters have defined in various
ways.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 90: Menstrual Phase Figure 92: Women in menstruation are

susceptible to get
possessed by evil spirits
Don`t know 25.0
Don`t know 42.9
Day 14 (Ovulutary
23.2
phase)
Disagree 19.6
Day 1-5 (Menstrual
21.4
phase) Agree 17.9
Day 6-13 (Follicular
19.6
/ proliferative… Strongly agree 14.3
Day 15-28 (Luteal
10.7
phase) Strongly disagree 5.4
0.0 10.0 20.0 30.0
0.0 10.0 20.0 30.0 40.0 50.0

CHAPTER 6.2: ATTITUDE ON MENSTRUAL More than half (51.8%) of the adolescent nuns
agreed that they should not sleep with a man
HYGIENE during their periods since it will pass on the
This chapter focuses on the attitude towards negative energy to man. And one-quarter (25%) of
menstrual hygiene and menstruation. Many them unanimously believe that drinking tea will
studies have shown the taboos and the beliefs increase the menstrual flow.
created around menstruation.
Figure 93: Sleeping with a man
6.2.1 Misconceptions and taboos
during your periods will pass on the
This sub-section deliberates on the "drip" to man
misconceptions and taboos that surround the
psyche of nuns. This survey had revealed that Strongly agree 26.8
there are many adolescent nuns who are not
aware of menstruation and menstrual hygiene. Agree 25.0
Figure 91revealed that one-quarter (25%) of the
adolescent nuns don’t know whether they must Don`t know 21.4
enter shrines/temples while having periods. About
21.5 percent of them agreed that they must not Disagree 14.3
enter the shrine/temples during period. About 33.2
percent on a similar note have reported that Strongly disagree 12.5
women in menstruation are susceptible to get
possessed by evil spirits. 0.0 10.0 20.0 30.0

Figure 91: Women must not enter

shrines/temples while having periods
Figure 94: Drinking tea will increase
the blood flow

Strongly disagree 28.6 Don`t know 37.5

Disagree 21.4
Disagree 25.0
Agree 17.9
Don`t know 25.0
Strongly disagree 16.1
Agree 12.5
Strongly agree 7.1
Strongly agree 8.9
0.0 20.0 40.0

0.0 10.0 20.0 30.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

6.2.2 Physical impacts of menstruation

Figure 97: Menstruation doesnot affect
Menstruation and varieties of concepts and beliefs my usual activities
surrounding it has impacted at various levels viz.
physical, emotional and social. This sub-section
discusses the physical impacts of menstruation. Agree 33.9
The survey revealed that close to half (48.2%) of
the adolescent nuns have agreed that repeated Strongly disagree 19.6
changing of clothes or pads might aid the flow of Disagree 19.6
blood. Figure 101 shows that more than half
(53.6%) agreed that women are more tired than Don`t know 16.1
usual when they are menstruating.
Strongly agree 10.7
Figure 95: Changing often/staying 0.0 20.0 40.0
clean will increase the blood flow

6.2.3 Emotional impacts produced by menstruation

Agree 28.6
This sub-section deals with the emotional aspects
of menstruation. More than two-thirds (69.8%) of
Disagree 19.6
the respondents agreed that they are more easily
upset during pre-menstrual periods than at other
Don`t know 19.6 times of the month. Figure 99shows that more
than two-thirds (82.2%) of the respondents have
Strongly agree 19.6 reported that they just have to tolerate with
menstruation.
Strongly disagree 12.5
Figure 98: I am more easily upset during
pre-menstrual periods than at other
0.0 10.0 20.0 30.0
times of the month

Figure 96: Women are more tired than Strongly agree 35.7
usual when they are menstruating
Agree 33.9

Agree 30.4 Don`t know 19.6

Disagree 7.1
Disagree 25.0
Strongly disagree 3.6

Strongly agree 23.2 0.0 10.0 20.0 30.0 40.0

Don`t know 12.5 Figure 99:Menstruation is something

that I just have to put up (tolerate)
with
Strongly disagree 8.9

0.0 10.0 20.0 30.0 40.0 Agree 42.9

Contrary to more than half of the adolescent nuns Strongly agree 39.3
who reported that they feel more tired than usual
during period, figure 97 unfolded that close to half
Don`t know 14.3
(44.6%) of them have reported that menstruation
does not affect their usual activities.
Disagree 3.6

0.0 20.0 40.0 60.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Many nuns have reported their disgruntlement for Figure 102:Menstruation allows
being female. Figure 100 reveals that close to half women to be more aware of their
(44.7%) of them have reported that men have real body
advantage of not having monthly period. On the
other hand, figure 101 has revealed that more than
two-thirds (76.8%) of the adolescent nuns have Don`t know 39.3
reported that the only good thing with
menstruation is that they come to know that they Agree 26.8
are not pregnant.
Strongly agree 21.4
Figure 100:Men have real advantage Disagree 10.7
of not having monthly period
Strongly disagree 1.8
Don`t know 26.8 0.0 50.0
Agree 26.8
Figure 103: The recurrent monthly
Strongly agree 17.9 flow of menstruation is an external
indications of women's general
Disagree 16.1 good health
Strongly disagree 12.5 Agree 44.6
0.0 10.0 20.0 30.0 Don`t know 26.8
Strongly agree 23.2
Figure 101: The only good thing
with menstruation is that I come to Disagree 3.6
know that am not pregnant
Strongly disagree 1.8

0.0 50.0
Strongly agree 39.3 Close to two-thirds (64.3%) of the nuns are aware
of the pre-menstrual phenomena through physical
Agree 37.5 symptoms like breast tenderness, backache,
cramps or other physical signs. Figure 105reveals
Don`t know 21.4 some of the emotional aspects of menstruation.
About 50 percent of the adolescent nuns agreed
Disagree 1.8 that a woman who attributes her irritability to her
approaching menstrual period as neurotic.
0.0 50.0
Figure 104: I can tell my period is
Contrary to earlier assertions by the adolescent approaching because of the breast
nuns, close to half (48.2%) of them reported that tenderness, backache, cramps or
menstruation allows them to be more aware of other physical signs
their body followed by 67.8 percent of them who
reported that the recurrent monthly flow of Agree 41.1
menstruation is an external indications of women’s Don`t know 23.2
general good health.
Strongly agree 23.2
Disagree 8.9
Strongly disagree 3.6

0.0 50.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 108 has revealed that about 60.7 percent of

Figure 105: A women who attributes the adolescent nuns have perceived period dirty
her irritability to her approaching and annoying. About 39.2 percent of them wished
menstrual period is neurotic that a period would last for a few minutes.

Agree 32.1 Figure 108: The period is dirty and

annoying
Don`t know 30.4

Strongly agree 17.9 Agree 33.9

Disagree 16.1 Strongly agree 26.8

Strongly disagree 3.6 Disagree 19.6

0.0 10.0 20.0 30.0 40.0 Strongly disagree 10.7

6.2.4 Social impacts produced by menstruation Don`t know 8.9

This sub-section deals with the social impacts 0.0 10.0 20.0 30.0 40.0
produced by menstruation. Around 38 percent of
the adolescent nuns disagreed with the statement Figure 109: We women wish that
that ‘I barely notice minor physiological effect out the period would last for a few
of my menstrual periods.’ Figure 107 has revealed minutes
that close to half (46.4%) of the adolescent nuns
reported that women complaining of menstrual
distress are just using that as an excuse. Disagree 33.9

Figure 106: I barely notice the minor Agree 19.6

physiological effect out of my
menstrual periods Strongly agree 19.6

Strongly disagree 17.9

Don`t know 30.4
Don`t know 8.9
Agree 23.2

Disagree 19.6 0.0 10.0 20.0 30.0 40.0

Strongly disagree 17.9 Most of the activities related to menstrual hygiene

are taboos to nuns. Figure 110 has revealed that
Strongly agree 8.9 more than two-thirds (76.8%) of the adolescent
nuns reported that it is important to buy sanitary
0.0 10.0 20.0 30.0 40.0 pad without being seen. On the other hand, around
60 percent of them wished they did not have to
menstruate.
Figure 107: Women complaining of
menstrual distress are just using that
as an excuse

Agree 25.0

Disagree 23.2

Strongly agree 21.4

Strongly disagree 16.1

Don`t know 14.3

0.0 10.0 20.0 30.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 110: It is important to buy Figure 112: It is uncomfortable for us

sanitary pad without being seen women to talk about our periods

Agree 39.3
Strongly
23.2
disagree
Strongly agree 37.5
Agree 23.2

Disagree 12.5 Don`t know 21.4

Don`t know 8.9 Disagree 19.6

Strongly agree 12.5

Strongly disagree 1.8
0.0 10.0 20.0 30.0
0.0 20.0 40.0 60.0

Figure 111: Women wish that we Figure 113:

do not have our period I miss classes/activities during my
period because am afraid of staining
my clothes
Strongly agree 41.1

Agree 33.9
Disagree 23.2
Disagree 26.8

Agree 17.9 Strongly

17.9
disagree

Strongly disagree Don`t know 12.5

8.9

Strongly agree 8.9

Don`t know 8.9
0.0 20.0 40.0
0.0 20.0 40.0 60.0

Around 35.7 percent of the respondents reported About half (50%) of the adolescent nuns reported
that they miss classes or other activities for the
that it is uncomfortable for them to talk about their
periods. Close to half (42.8%) of the respondents fear of being ridiculed by others during period.
About 41.1 percent of them missed classes or
reported that they miss classes or other activities
other forms of activities at nunnery for fear of pain
for fear of staining their clothes during period.
during menstruation.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 116: I miss classes/activities

Figure 114: I miss classes/activities
during my period because there isn't
during period because am afraid of
privacy anywhere for girls to wash
others making fun of me
and change at nunnery

Disagree 26.8
Disagree 28.6

Agree 25.0
Strongly disagree 26.8

Strongly agree 25.0 Don`t know 17.9

Strongly disagree 12.5 Agree 16.1

Don`t know 10.7 Strongly agree 10.7

0.0 10.0 20.0 30.0 0.0 10.0 20.0 30.0

Figure 115: I miss classes/activities

during period because it can cause Figure 117: I miss classes/activities
pain during my period because there is no
where to dispose off sanitary pad
Agree 28.6
Agree 30.4
Disagree 26.8
Strongly agree 23.2
Strongly disagree 16.1
Disagree 21.4
Don`t know 16.1
Strongly disagree 17.9

Strongly agree 12.5 Don`t know 7.1

0.0 10.0 20.0 30.0 0.0 10.0 20.0 30.0 40.0

6.2.5 WASH facilities to counter menstruation Around close to one-quarter (21.5%) of the
hygiene management adolescent nuns reported that they missed classes
or activities since they don’t have sanitary pad.
This sub-section deals with the WASH facilities Figure 119 has revealed that more than two-thirds
available at nunneries to combat MHM. More than (78.6%) of the respondents agreed that they
a quarter (26.8%) of the adolescent nuns reported missed classes or activities during period since the
that they missed classes or activities because of toilets are too dirty and don’t feel like to change.
lack of privacy for girls to wash and change. More
than half (53.6%) of the respondents again
reported that they missed classes or activities
during menstruation since there is no place to
dispose-off sanitary pad.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 118: I miss classes/activities Figure 120: Main absortent material

during my period because I don't have do you use during period
sanitary pad

Disagree 30.4
Sanitary pad 87.5
Strongly
26.8
disagree

Don`t know 21.4 Napkin / cloth or

10.7
towel
Agree 17.9

Strongly agree 3.6 Others 1.8

0.0 20.0 40.0

0.0 50.0 100.0
Figure 119:I miss classes/activities
during my period since toilets are too
Figure 121: Which one of the above do
dirty and don't feel like to change
you perferred most

Strongly agree 67.9

Tampon 33.9
Agree 10.7
Sanitray pad 33.9
Napkin/cloth or
Disagree 8.9 14.3
towel
Reusable
12.5
Don`t know 8.9 sanitary pad
Mentrual cup 3.6
Strongly disagree 3.6
Cotton 1.8
0.0 20.0 40.0 60.0 80.0
0.0 20.0 40.0

Asked why adolescent nuns preferred various

CHAPTER 6.3: PRACTICES ON MENSTRUAL types of absorbent materials, more than two-thirds
HYGIENE (71.4%) of them said that they are affordable
(figure 122). Around one in every ten (10.7%) of
This chapter deals with the practices prevailing in
them reported that absorbent materials are easy to
nunneries on menstrual hygiene. When adolescent
use. About 7.1 percent of the adolescent nuns
nuns were asked what type of absorbent materials
reported that it is easily available. Figure 123
they used, almost nine out of every ten (87.5%)
shows the method of cleaning cloth pad. It is
use sanitary pad followed by around 11 percent
revealed that more than half (55.4%) of the
who used napkin/cloth or towel. When asked
adolescent nuns reported that they use water
which one of the absorbent materials they
alone to clean the cloth pad followed by one-
preferred, on an equal proportion (33.9%) of them
quarter (25%) of them who used both water and
preferred tampon and sanitary pad. Around 14
soap. It has been repeatedly displayed in the entire
percent of them preferred napkin/cloth or towel
study that menstrual hygiene practices is also
and about 3.6 percent of them preferred menstrual
perceived as something shameful (taboo). Figure
cup. Figure 121 also has revealed that around 13
123revealed beyond doubt that around 18 percent
percent of the adolescent nuns had preferred
of the adolescent nuns hide and dry the cloth pad
reusable sanitary pad.
beneath other clothes.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 124: Method of drying the

Figure 122: Why do you perfer cloth pad

Affordable 71.4 Inside the house 66.1

Easy to use 10.7

Sunlight 25.0

Easily available 7.1

Hide beneath the
7.1
another cloth
Others 5.4
Other 1.8
Can`t afford the
5.4
good quality ones
0.0 20.0 40.0 60.0 80.0
0.0 20.0 40.0 60.0 80.0

Figure 123: Method of cleaning cloth Figure 125: Number of times changing
pad pad in a day

Water 55.4

Water and soap 25.0 28.6

Hide and dry it

beneath other 17.9
clothes 71.4

Others 1.8

0.0 50.0 100.0

Two and more Once

On the method followed in drying the cloth pad 6.3.1 Sanitary facilities at nunneries
besides washing, about two-thirds (66.1%) of the This sub-section deals with sanitary facilities at
respondents reported that they dry it inside the nunneries. When asked about the place of disposal
house followed by one-quarter (25%) of them who of pad, close to half (46.4%) of them reported that
dried them in sunlight. Again, quite a sizable they dispose into pad disposal bin followed by
proportion of adolescent nuns have dried the cloth equal proportions (23.2%) of them who reported
pad by hiding beneath another cloth (7.1%). The that they dispose it into toilet and drain. Around 2
study also sought to learn how frequently percent of them reported that they disposed the
adolescent nuns changed their absorbent material. absorbent material into routine waste and an equal
Figure 125revealed that more than two-thirds proportion of them said they threw in open field.
(71.4%) of them changed only once a day. The
remaining 28.6 percent of them changed twice a
day.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 126: Place of disposal of pad Figure 128: Number of times

changing underwear
80.0

Pad disposal bin 46.4 70.0

60.0
Toilet 23.2
50.0
Drain 23.2 40.0
Others 3.6 30.0

Routine waste 20.0

1.8
10.0
Open field 1.8
0.0
0.0 50.0 1 2 3 5

Figure127: Type of pad wraps

Figure129: Do you come to nunnery
used for disposing it
during menstruation

Papers 48.2 No Yes 5.4

Plastic bag 35.7

No wrap 16.1

94.6
0.0 20.0 40.0 60.0

Figure 127revealed that close to half (48.2%) of the Asked how many times the adolescent nuns
respondents reported that they used papers as pad changed their underwear during menstruation,
wraps followed by 35.7 percent of them who used more than two-thirds (67.9%) reported to have
plastic bag. About 16.1 percent of them have not changed only once a day. However, figure 128 had
used pad wrap at all. revealed that around 20 percent changed twice a
day followed by around 11 percent of them who
reported to have changed thrice a day. About 1.8
percent of them reported that they changed even
five times a day. When asked their attendance at
nunnery during menstruation, about 94.6 percent
of them reported ‘Yes.’ So, only around less than
one out of every ten (5.4%) missed the session.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure130: Menstrual problem Figure 132: How often do you take

interferes with attendances bath during period

Others 48.2
Daily 80.4
Four days every
25.0
cycle Others 12.5
One day every
14.3 Only on first day 3.6
cycle
Three days every Do not bath any
7.1 1.8
cycle time
Two days every Only on second
5.4 1.8
cycle day

0.0 20.0 40.0 60.0 0.0 50.0 100.0

Figure131: Remedies di you take Figure 133: Do you clean genital area
during menstruation during menstruation

Take rest 46.4

Medication 19.6 32.1

Others 10.7
Thoroughly involve in
8.9 67.9
activities
Prayers 7.1

Yoga / Meditation 7.1 No Yes

0.0 20.0 40.0 60.0

6.3.2 Practice of Menstrual Hygiene at nunneries Figure 134shows that close to two-third (63.6%)
cleaned the genital area with only water followed
This study has revealed that eight out of every ten by about 18.2 percent who used water and soap.
(80.4%) take bath on a daily basis during Around 13 percent used towel. About 67.9 percent
menstruation. Figure 132 shows that around 4 of the adolescent nuns reported that they have
percent of the adolescent nuns took bath only on burning place for sanitary pad followed by pit
the first day. About 1.8 percent of them have (23.2%) and pad disposal bins (8.9%).
reported that they do not bath at all. The survey
had also revealed that more than two-thirds
(67.9%) of the adolescent nuns clean their genital
area during menstruation.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Figure 134: Method of cleaning Figure 137: Does your nunnery have
genital Toilet/ bathing facilities for
addressing issues related to
menstruation
Only with water 63.6

Water and soap 18.2 21.4

Towels 12.7

Others 5.5
78.6
0.0 20.0 40.0 60.0 80.0

No Yes
Figure 135: Which one of the following
sanitary pad facilities does your nunnery
have Figure 138 shows the bathing habits during period.
More than half (51.8%) of the respondents have
reported that they take half body bath during period
Burning place 67.9 due to lack of hot water. When asked whether they
could afford to buy sanitary pad, about 33.3
percent of them reported that they do followed by
Pit 23.2 equal proportions of them (20%) who reported that
they couldn’t or its unavailability.

Pad disposal bins 8.9 Figure138: I have a half body bath

during period due to lack of hot water

0.0 20.0 40.0 60.0 80.0

Disagree 42.9
About 85.7 percent of the adolescent nuns
reported that they have place for drying clothes. Agree 33.9
Similarly, about 78.6 percent of them reported that
they have toilet/bathing facilities for addressing Strongly agree 17.9
issues related to menstruation.
Don`t know 5.4
Figure136: Does your nunnery have
place for drying clothes 0.0 20.0 40.0 60.0

Figure 139: Do you Afford to buy

14.3 sanitary pad

Can afford 33.3

Don't know 26.7

Not available
85.7 20.0
to buy
Cannot
20.0
afford
Yes No
0.0 20.0 40.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

6.3.3 Empirical Analysis: To assess the relative respondents and their mothers have positive effect
contribution of educational status of respondents and on the menstrual hygienic practices. To establish
this causal effect, a probit regression is employed
their mother’s on the likelihood of using unhygienic as follows:
practices during menstruation.
One of the core objectives of this study is to
assess whether the educational status of

Table 3: Results of Probit regression Probit dprobit

VARIABLES Menstrualhygiene Menstrualhygiene
age 0.521** 0.188**
(0.239) (0.0862)
Age2 -0.0143* -0.00515*
(0.00825) (0.00298)
grade 0.00822 0.00296
(0.00844) (0.00304)
total female teachers 0.00629 0.00227
(0.00488) (0.00176)
father’s education 0.0141 0.00509
(0.0362) (0.0131)
Mother’s education 0.0288 0.0104
(0.0405) (0.0146)
Guardian’s education -0.109 -0.0391
(0.0853) (0.0308)
boarding -0.645*** -0.250***
(0.203) (0.0796)
urban -0.0639 -0.0230
(0.107) (0.0384)
Buddhist -0.780 -0.244
(0.666) (0.171)
Christian -0.203 -0.0758
(0.700) (0.269)
Hindu -0.211 -0.0783
(0.679) (0.258)
yearly pocket money 8.68e-05*** 3.13e-05***
(2.47e-05) (8.85e-06)
Constant -3.671**
(1.816)
Observations 891 891
Standard errors in parentheses
*** p<0.01, ** p<0.05, * p<0.1

Table 3 depicts the probit regression results. The explanatory variables. The result of probit
probit model is nonlinear model and, therefore, we regression revealed that age is one of the highly
differentiate it and generated the results of dprobit. significant factors up to 95% level of confidence.
The dependent variable is the adolescent girls’ On an average, if an adolescent girl grows older by
knowledge on menstrual hygiene management. one more year, there is a probability that her
The independent variables taken under knowledge on menstrual hygiene would be
consideration were age and grade of adolescent enhanced by 18.8 percent, holding other factors
girls and their religious backgrounds. The main line constant. However, it also revealed that as the age
of inquiry is the relationship between girls’ keeps increasing there is a probability that the
knowhow on menstrual hygiene management as a knowhow on menstrual hygiene amongst
result of their own and the parental educational adolescent girls would keep growing till the
status. The yearly pocket money received from the tangency (point of no change) point and then starts
parents is also considered as one of the declining by 0.52 percent on an average, holding

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

other factors constant. Similarly, if an adolescent 6.4 Comparative Statics of Schools intervened by
girl lives in a boarding school, on an average, there SHND on MHM and the control group (not intervened
is a probability of not learning menstrual hygiene
management declining by 25 percent, holding
by SHND with MHM)
other factors constant. The main factors like an Tables 4 and 5 illustrate the comparative statics of
adolescent girl’s own education and her parental schools intervened by SHND with MHM program
education have no effect at all in menstrual and their outcomes on the knowledge on
hygiene management. On the other hand, the menstruation and superstition associated with it.
yearly pocket money received by adolescent girls Five schools intervened by MHM programs were
has tremendous effect on the menstrual hygiene
selected by chance in this study for which we
management by the girls. The regression result
took five others who were not intervened by the
has revealed that, on an average, if an adolescent
girl receives pocket money from their parents, same program.
there is a probability enhancing the menstrual
hygiene management knowledge by 0.8 percent.

Table 4: Awareness about the phenomenon of menstruation by schools intervened by SHND

Natural shedding of blood Don`t

Schools Disease Curse Total
on monthly basis. know

Dechencholing HSS 181 15 - 5 201

Gedu HSS 998 26 - - 1,024
Lungtenphu LSS 197 - - 5 202
Nubding LSS 1,173 107 - 142 1,422
Yangchengatshel LSS 186 - - 15 201
Total 2,735 148 - 167 3,050
% share 80.6 4.4 - 4.9 89.9

Awareness about the phenomenon of menstruation by schools not intervened by SHND

Natural shedding of blood Don`t

Schools Disease Curse Total
on monthly basis. know
Chumey C.S (MSS) 1,024 35 247 1,341 2,647
Gasa PS 380 15 409 804 1,608
Sarpang LSS 804 24 47 899 1,774
Wanakha CS (MSS) 1,677 44 44 1,765 3,530
Lingmethang PS 909 165 455 1,570 3,099
Total 4,794 283 1,202 6,379 12,658
% share 37.9 2.2 9.5 50.4 100.0

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Table 4 revealed that more than three quarters table 5 revealed that only around 38 percent of the
(80.6%) of the adolescent girls in those schools adolescent girls in those schools which did not
intervened by the MHM program of SHND had receive MHM program from the SHND knew what
correct knowledge on menstruation. Interestingly, menstruation is all about. About 9.5 percent of
after the intervention of the program, none of them them still consider menstruation as curse followed
believed that menstruation is a curse. However, by 2.2 percent of them considering menstruation
there are still about 4.4 percent of them who still as disease. About half (50.4%) of them don’t know
considers that menstruation is a disease. Around 5 what menstruation is all about. This clearly
percent of them reported that they don’t know indicates the efficacy of the SHND’s MHM
what menstruation is all about. On the contrary, awareness programs in the schools

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CHAPTER 7: KEY FINDINGS AND DISCUSSIONS

This chapter deals with the key findings and 7.2 Girls’ current knowledge and information on
discussions. The study has covered 39 schools in menstruation
20 Dzongkhags. There are two sub-sections under
this chapter that deals with the key findings of: i) • A vast majority (83%) of the girls recognized
adolescent schoolgirls; and ii) adolescent nuns. menstruation as physiological process. On the
contrary, there are about 14.1 percent of them
i) Key findings for adolescent schoolgirls: who are unaware of this.
• Around 2 percent of them defined
7.1 Socio-demographic, Economic and Educational menstruation as a disease followed by around
Characteristics 1 percent who defined menstruation as a
• Most of the respondents covered in this study curse.
were from the Central Schools (35.6%) • About five in every ten (51.9%) reported that it
followed by Primary Schools (20%) and Lower is caused by hormones. However, four in
Secondary Schools (14.9%). Going by the every ten (37.2%) reported not knowing the
areas of residence, around half of the causes.
respondents were from rural schools and close • About 5.2 percent of the respondents were of
to half (49.7%) from urban schools. the opinion that menstruation is a ‘Curse of
• The respondents comprised of diverse level of God’ followed by around 2 percent of them
education spanning from class 3 to class 12. who were of the notionthat menstruation is
Almost half of the respondents fell between caused by disease.
classes 8 to 10. Hardly one percent of the • Close to two-third (65.3%) of Buddhist
respondents comprised of grade 3 students. adolescent girls believe that menstruation is a
• A vast majority (71.2%) of the respondents disease followed by Hindu (23.1%) and
lived with mother and father followed by Christain adolescent girls (11.6%).
around 12 percent of them living with • Eight out of ten (80.4%) of the Buddhist
stepfather and mother. About 9.6 percent of adolescent girls have rightly perceived
them live with single parent (mother). The menstruation as the natural shedding of blood
lowest is the 2.2 percent of them who live with on a monthly basis. Only 14.2 percent of the
lone parents (fathers). Amongst those Hindu adolescent girls have perceived
adolecent respondent girls, maximum were menstruation as the normal physiological
Budhist (81.5%) followed by Hindu (13.3%) process followed by about 5 percent of
and Christain (4.7%). Less than one percent Christain adolescent girls.
belongs to other faiths. • About 87 percent of the Buddhist adolescent
• Around eight in every ten (77.6%) of the girls have reported that menstruation is a curse
respondents’ mothers have no education. followed by 13 percent of Hindu adolescent
Similarly, almost six out of every ten (65.5%) girls.
fathers lack education and about nine in every 7.3 Menarche—knowledge and information
ten (90.7%) of the guardians lack education as
well. • More than half (59.4%) of the adolescent girls
• The survey revealed that only about 65 percent reported that menstruation comes from
of the respondents received yearly pocket uterus. However, there are around 24 percent
money. The supply of pocket money ranges of them who are oblivious about the flow of
from Nu. 50 to 9,000 year. Less than half of the menstruation. This could be due to the fact
respondents received the yearly pocket money that around 11 percent of the adolescent girls
between Nu. 100 and 1,156 followed by who participated in this survey are in the age
around 20 percent who received even less bracket of 10-11.
than Nu. 100 a year. • About 8.2 percent of the respondents reported
• The parents and guardians of the respondents that menstruation comes from the birth canal.
are mostly farmers. There are almost equal Adding further to this shock, about 5.4 percent
proportions of fathers (58.5%) and mothers of them have reported that menstruation
(55.6%) whose occupation is also farmer. Less comes from the bladder.
than half of the respondents have reported • Asked at which age most girls usually get their
that their guardian’s occupation is farmer and first period, around 51 percent of the
on the contrary close to half (45.4%) did not respondents reported 12 as theage. Around 13
know the occupation of their guardians. percent of them don’t know the age at which
menstruation begins.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

5. It is important to buy sanitary pad without

• Around six in ten (58.8%) are of the view that being seen;
duration (days) of menstruation for a normal 6. Women wish that we do not have our period;
person lasts between 1-4 days. There are 7. I miss school during my period because am
about 1.3 percent of them who believe that afraid of staining my clothes;
menstruation lasts for about 13-31 days in a 8. I miss school during my period because am
normal person. afraid of others making fun of me;
• About 20.3 percent of the respondents 9. I miss school during period because it can
reported that menstruation lasts between 6-12 cause pain;
days. Only around 21 percent reported that 10. I miss school during my period since it can
menstruation lasts for about 5 days in a normal make me feel uncomfortable or tired;
person. 11. I miss school during my period because there
• About 18.2 percent of the adolescent girls isn’t anywhere for girls to wash and change at
reported that the interval between two school; and
menstrual cycles comprised of 28 days. There 12. I miss school during my period because there
are more than half (52.6%) of them who said is nowhere to dispose-off sanitary pad.
that the interval between two menstrual
cycles is less than 10 days. On the other
7.6 Social Impacts produced by menstruation
extreme, less than 1 percent reported that the • Close to one-third (63.5%) of the adolescent
interval lasts between 54 days and above. school girls have reported that during
menstruation, a woman must not enter the
7.4 Source of information regarding menstruation and shrine or temple. Further augmenting this
menstrual hygiene superstition, about 21 percent of the
• Mothers (42%) often provided the information respondents have agreed that women in
regarding menstruation followed by teachers menstruation are susceptible to get possessed
(27.1%) and sisters (15.6%). Around 14 by an evil spirit.
percent of the respondents reported that they • Close to two-third (65%) of the adolescent
received information on menarche from their school girls have agreed the approaching of
friends. About 1.8 percent of them availed period signals with varieties of pains viz. breast
from other sources viz. books, TV, Radio, tenderness, backache, cramps or other
online and etc. physical signs. Around two-third (63.7%) of
• Close to half (42.2%) reported that they are them again agreed that the only good thing
aware of the fungal infection due to poor about menstruation is that they know they are
menstrual hygiene. On the contrary, about free from pregnancy.
57.1 percent of them reported that they are not • About 37.2 percent of them have reported that
aware about reproductive tract infection. More they miss school during menstruaiton since
than half (58.9%) are not aware. Only around they are afraid of staining the clothes. Similarly,
25 percent of them have reported that they are about 32.5 percent of the adolescent
aware of UTI. schoolgirls reported that they miss school
• More than half (52.3%) of them don’t know the during period since they fear others making
menstrual phases. fun of them.

7.5 Attitude towards menstruation 7.7 Physical Impacts of menstruation

The Exploratory Factor Analysis (EFA) was applied • Close to half (48.1%) of the respondents
to factor out the sub-factors contributing to the agreed that they miss school during period
attitude of adolescent schoolgirls on menstruation. since it causes pain. About 43 percent of the
Following are the sub-factors identified by the EFA: adolescent schoolgirls reported that they miss
school during period because it makes them
1. I can tell my period is approaching because of feel uncomfortable.
the breast tenderness, backache, cramps or • Around one quarter (24.9%) of the adolescent
other physical signs; schoolgirls reported that they miss school
2. It is important to talk about menstrual period during period as there are no places for girls to
with men; wash and change at school. Similarly, close to
3. It is important to discuss the topic of period at one quarter (21.3%) of the respondents
school with boys and girls; reported that they missing school during
4. We women wish that the period would last for period because of lack of sanitary pad disposal.
a few minutes;

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7.8 Emotional Impacts 8.1 Menstrual hygiene management prevailing

• More than half (57%) of the respondents • Around three-quarters (75.2%) of them
agreed that they get easily upset during pre- reported that they dry their clothe pads in
menstrual and menstrual periods than at other sunlight. Around one out of every ten (9.6%)
times. Close to two-third (63.4%) of the dry their cloth pads inside the house. Around 8
respondents agreed that menstruation is percent hide beneath another cloth and dry
something that they just have to tolerate with. them together.
• Little more than two-third (69.8%) of the • Close to two-third (62.9%) of the adolescent
adolescent schoolgirls agreed to the schoolgirls used papers as pad wraps for
statement, ‘men hae real advanatge of not disposing the kind of sanitary pads they used.
having monthly period.’ However, on the It is also revealed that more than one-quarter
contrary, around 13 percent of them (26.8%) of the adolescent girls reported that
contradicted the statement. It is also revealed they use plastic bag or polythene bag to wrap
that one out of every ten (10.1%) of the the sanitary pads and dispose it.
adolescent schoolgirls disagreed that a woman • Quite interestingly, the survey revealed that
who attributed her irritability to her more than half (52.4%) of the adolescent
approaching menstrual period as neurotic. schoolgirls changed their underwear twice a
• Surprisingly, more than two-third (69.8%) of day during menstruation.
the adolescent schoolgirls have agreed that • It has been also revealed that around 15
women complaining of menstrual distress are percent changed the underwear thrice a day
just using it as an excuse. Almost equal during menstruation. Around 20 percent
proportion (78.3%) of the respondents agreed changed only once a day. The survey has
that women are more tired than usual when revealed the two extreme situations whereby
they are menstruating (figure 48). about 2.1 percent of them changed the
underwear during the period between 5 to 7
7.9 Menstruation as taboo to adolescent school girls times in a day. On the other extreme, about 7.2
• One out of every ten (10.4%) still disagrees the percent did not change their underwear at all
statement that ‘it is important to talk about during menstruation.
menstrual period with men.’ There are still
8.2 Adolescents’ response to menstruation and
around 19 percent of the adolescent
schoolgirls who do not yield to the statement, practices developed as a result
‘it is important to discuss the topic of period at • Nine out of every ten (90.7%) of the
school with boys and girls.’ respondents reported that they come to
school despite menstruation. More than half
8.0 Type of menstrual absorbents used
(55.3%) of the adolescent schoolgirls reported
• The use of sanitary pad is commonly reported other categories of attendance counts.
both in urban and rural areas with a percentage However, about 44.7 percent of them reported
share of 52.1 percent and 47.9 percent that they missed school ranging from one day
respectively. It is revealed that every nine out to four days during every cycle.
of ten (91.9%) uses sanitary pad. Around 3 • More than half (52.5%) reported that they take
percent of the adolescent schoolgirls do not rest. It has been also revealed that close to
use any kind of absorbent material. one-quarter (21.1%) of them thoroughly
• Almost four in every ten (38.1%) reported that involve in activities to forget the pangs and
they use sanitary pad as an absorbent material discomforts while 6.4 percent of others resort
since it is easy to use. Almost by the same to medication followed by Yoga meditation
proportion (32.1%), the respondents reported (3.1%) and prayers (1.7%).
that they use sanitary pad since it is easily • Similarly, when asked whether they take bath
available. Around 11 percent of them reported during period, more than half (58.1%) reported
that sanitary pad could be used for longer that they do so. Around 13 percent of them
duration. have reported taking bath only on the second
• About 5.4 percent of the respondents reported day followed by 10 percent of them who
that they prefer sanitary pad to others since it bathed on the very first day. Around 4 percent
is affordable. However, about 4.4 percent of of them do not bath any time.
the respondents are of the take that they can’t
afford other good quality pads and use sanitary
pad as an absorbent.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

• Nine out of every ten (91.3%) of the the contrary, there are about 13.3 percent who
adolescent schoolgirls clean their genital area said ‘don’t know’.
during menstruation. Close to half (45.9%) of • About 2.2 percent of the nuns reporte'd that
the respondents agreed that they take half menstruation comes from the birth canal.
body bath during period due to lack of hot Around 36 percent of them also reported that
water. menarche begins at the age of 12 .
• More than two-thirds (73.8%) of the • Close to one-quarter (21.4%) of adolescent
respondents reported that they could afford nunsreported that menarche ranges from age
the sanitary pad during menstruation. On the 9 to 11. On the other extreme, more than one-
contrary, there are around 8 percent who quarter (26.9%) of the respondents reported
cannot afford and similarly, about 4.2 percent that menarche begins from the age of 14-18.
of them said that the sanitary pads are not
available. Sources of information on menarche
• More than two-thirds (68.6%) of the • Mothers are the first and main source of
respondents reported using water and soap for information for the nuns. More than half
cleaning genital area during menstruation (54.9%) of the nuns received information on
folowed by only water (27.6%). Less than one menstruation from their mothers. This is
percent have reported that they use towels. followed by about 35.3 percent who said
teachers as their source of information on
8.3 WASH facilities available at schools to combat
menarche. About 7.8 percent reported the
menstruation source as their sisters followed by 2 percent of
• More than half (55.1%) of the adolescent them who cited friends as their source.
school girls reported that they dispose the pad
8.6 Adolescent nuns’ knowledge on menstrual hygiene
into pad disposal bins followed by around 8
percent of them who dispose into pit. About • More than half (53.6%) of the nuns are aware
14.2 ercent of the respondents reported that of the menstruation hygiene. Similarly, more
they dispose off the pads in burning place. than one-third (67.9%) of them perceived it as
• However, around 9 percent of them reported unhygienic. Checked against the nuns’
that there is no disposal facilities at their knowhow on menstrual hygiene management,
disposal at schools. About 43.2 percent of the they reported the followings:
respondents reported that there are no place ✓ We need to clean our genital area with hot
for drying clothes. water;
• The study revealed that only about 64 percent ✓ We need to change our pad time to time;
of the respondents reported having adequate ✓ We have to take bath regularly;
toilet/bathing facilities enough for addressing ✓ We have to wash our hands with soap
issues related to menstruation. The survey after changing the pad;
also revelaed that close to half (45.9%) of the ✓ We need to keep our body clean during
respondents agreed that they take half body period;
bath during period due to lack of hot water. ✓ We need to change underwear regularly;
and
ii) Key findings of adolescent nuns: ✓ Apply perfume to avoid bad smell.
8.4 Awareness on menarche and its causes Awareness on menstrual related infections
• Only around 43 percent of the nuns reported • Only around 36 percent of them are aware of
correctly that the menstruation is a ‘natural the infections related to poor menstrual
shedding of blood on a monthly basis.’ hygiene management.
• About 7.1 percent of the nuns said that • Close to half (42.9%) don’t know at all about
menstruation is a curse followed by 5.4 infections resulting from poor menstrual
percent of them considering it as a disease. hygiene.
• Only about 41.1 percent of them reported that • More than half (53.6%) of the nuns are
it is the hormones that cause menstruation. A unaware about UTI. Only around two out of
substantial share of percentage (37.5%) of every ten (16.1%) are aware of the same.
nuns considered the cause as curse of God
followed by about 7.1 percent who considered Misconceptions and taboos
it as a disease. • One-quarter (25%) of the adolescent nuns
• A large majority (82.2%) of the nuns reported don’t know whether they must enter
that menstruation comes from the uterus. On shrines/temples while having periods.
However, about 21.5 percent of them agreed

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that they must not enter the shrine/temples • About 60.7 percent of the adolescent nuns
during period. have perceived menstruation as dirty and
• About 33.2 percent on a similar note reported annoying.
that women in menstruation are susceptible to • About 39.2 percent of them have wished that
possession by evil spirits. period would last for a few minutes in women.
• More than half (51.8%) of the adolescent nuns • More than two-thirds (76.8%) of the
agreed that they should not sleep with a man adolescent nuns reported that it is important to
during their periods since it will pass on the buy sanitary pad without being seen. On the
negative energy to man. other hand, around 60 percent wished that
• And one-quarter (25%) of them unanimously they did not have to menstruate.
believe that drinking tea will increase the • Around 35.7 percent of the respondents
menstrual flow. reported that it is uncomfortable for them to
talk about their periods. Close to half (42.8%)
8.9 Physical impacts of menstruation of the respondents reported that they miss
• Close to half (48.2%) of the adolescent nuns classes or other activities at nunneries for fear
agreed that repeated changing of clothes or that they would stain their clothes during
pads might aid the flow of blood. period.
• More than half (53.6%) agreed that women are • About half (50%) of the adolescent nuns
more tired than usual when they are reported that they miss classes or other
menstruating. activities lest they would be ridiculed by others
• Close to half (44.6%) of the adolescent nuns during period. About 41.1 percent of them
reported that menstruation does not affect missed classes or other forms of activities at
their usual activities. nunnery for fear of pain during menstruation.

9. Emotional impacts produced by menstruation 11. Sanitary facilities to counter menstruation hygiene
management
• More than two-thirds (69.8%) of the
respondents agreed that they are more easily • More than a quarter (26.8%) of the adolescent
upset during pre-menstrual periods than at nuns reported that they missed classes or
other times of the month. activities since there isn’t privacy anywhere for
• More than two-thirds (82.2%) of the girls to wash and change at nunnery.
respondents reported that they just have to • More than half (53.6%) of the respondents
tolerate menstruation. again reported that they missed classes or
• Close to half (44.7%) of them reported that activities during menstruation since there is no
men have real advantage of not having place to dispose-off sanitary pad.
monthly period. On the other hand, more than • Around close to one-quarter (21.5%) of the
two-thirds (76.8%) of the adolescent nuns adolescent nuns reported that they missed
reported that the only good thing with classes or activities because of lack of sanitary
menstruation is that they come to know that pad. More than two-thirds (78.6%) of the
they are not pregnant. respondents agreed that they missed classes
• Contrary to earlier assertions by the or activities during period since the toilets are
adolescent nuns, close to half (47.2%) of them too dirty and discourages them to change.
reported that menstruation allows them to be
more aware of their body followed by 67.8 Practices on menstrual hygiene by adolescent nuns
percent of them who said that the recurrent • Almost nine out of every ten (87.5%) use
monthly flow of menstruation is an external sanitary pad followed by around 11 percent
indications of women’s general good health. who used napkin/cloth or towel.
• Close to two-third (64.3%) of the nuns are • On an equal proportion, about 33.9% of them
aware of the pre-menstrual phenomena preferred tampon and sanitary pad. Around 14
through physical symptoms like breast percent of them preferred napkin/cloth or
tenderness, backache, cramps or other towel and about 3.6 percent preferred
physical signs. menstrual cup. Around 13 percent preferred
reusable sanitary pad.
10. Social impacts produced by menstruation
• More than two-thirds (71.4%) cited that they
• Close to half (46.4%) of the adolescent nuns are affordable.
reported that women complaining of • Around one in every ten (10.7%) of them
menstrual distress are just using that as an reported that those absorbent materials they
excuse. preferred are easy to use.

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• About 7.1 percent of the adolescent nuns reported that they have toilet/bathing facilities
reported that it is easily available and hence for addressing issues related to menstruation.
they preferred it. • More than half (50.8%) of the respondents
• More than half (55.4%) of the adolescent nuns reported that they take half body bath during
reported that they use water alone to clean the period due to lack of hot water.
cloth pad followed by one-quarter (25%) of • About 33.3 percent of them reported that they
them who used both water and soap. can afford pads followed by equal proportions
• Around 18 percent of the adolescent nuns hide of them (20%) who reported that they cannot
and dry the cloth pad beneath other clothes. afford and at the same time not available to
• About two-thirds (66.1%) of the respondents buy.
reported that they dry it inside the house
followed by one-quarter (25%) of them who Empirical Findings
dried them in the sun. • On an average, if an adolescent girl grows
• Again, quite a sizable proportion of adolescent older by one more year, there is a probability
nuns have dried the cloth pad by hiding that her knowledge on menstrual hygiene
beneath another cloth (7.1%). would be enhanced by 18.8 percent, holding
• More than two-thirds (71.4%) of them other factors constant. However, it has been
changed their pads only once a day. The also revealed that as the age keeps increasing,
remaining 28.6 percent of them changed twice there is a probability that the knowhow on
a day. menstrual hygiene amongst adolescent girls
would keep growing till the tangency (point of
WASH facilities at nunneries no change) point and then starts declining by
• Close to half (46.4%) of them reported that 0.52 percent on an average, holding other
they dispose pads into pad disposal bin factors constant. Similarly, if an adolescent girl
followed by equal proportions (23.2%) of them lives in a boarding school, on an average, there
who reported that they dispose it into toilet is a probability of declining, by 25 percent, of
and drain. not learning menstrual hygiene management
• Around 2 percent of them reported that they holding other factors constant. The main
disposed the absorbent material into routine factors like an adolescent girl’s own education
waste and an equal proportion of them and her parental education have no effect at all
reported to have thrown in the open. in menstrual hygiene management. The
• Close to half (48.2%) of the respondents regression result also revealed that, on an
reported that they used papers as pad wraps average, if an adolescent girl receives pocket
followed by 35.7 percent of them who used money from their parents, there is a probability
plastic bag. enhancing the menstrual hygiene
• About 16.1 percent of them have not used pad management knowledge by 0.8 percent.
wrap at all.

Practice of Menstrual Hygiene at nunneries

• Eight out of every ten (80.4%) took bath on a
daily basis during menstruation.
• Around 4 percent of the adolescent nuns took
bath only on the first day. About 1.8 percent
reported that they do not bath at all.
• More than two-thirds (67.9%) of the
adolescent nuns clean their genital area during
menstruation.
• Close to two-third (63.6%) cleaned the genital
area with only water followed by about 18.2
percent who used water and soap.
• Around 13 percent used towel. About 67.9
percent of the adolescent nuns reported of
having burning place for sanitary pad followed
by pit (23.2%) and pad disposal bins (8.9%).
• About 85.7 percent of the adolescent nuns
reported that they have place for drying
clothes. Similarly, about 78.6 percent of them

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Regional situation of MHM other participants that they do so since the

school does not have capabilities to render
Nepal (n=150 adolescent girls)1 help to special children;
✓ The teacher participants also asserted that
• 6.0% of girls knew that menstruation is a
there is no emotional and social impact for the
physiologic process.
special children since they are oblivious of the
• 14.7% of girls think menstruation is caused
menstrual process;
by curse.
✓ Upon moderated and probed on the prevailing
• 36.7% knew that it is caused by hormones.
knowledge on menstruation amongst those
• 94% of them use pads during the period but
adolescent girls, participants unanimously
only 11.3% dispose it.
asserted that they carry out practical teaching
• Overall knowledge and practice were 40.6%
on menstruation with demonstration on use of
and 12.9% respectively.
pad, how to dump it into the pad disposal bin
• 24.0% of girls were taught about with the help of bamboo clip. Later the
menstruation by their guardian's friends and collected pad is disposed into the waste
teachers. collector vehicle by one of the girls’ captains
• 98.0% of girls have a view that they are not on a rotational basis. However, practical
taught properly on ???. teaching is dented since some of the
• Only 18.0% of girls clean their genitalia area. participants have no hands-on experience
• 72.0% does not clean genitalia area. regarding menstruation;
• Only 11.3% use soap and water to clean. ✓ The participants also revealed that girls who
• 88.7% clean with water. experience period at school and without
Bangladesh (n=2,332 adolescent school going sanitary pads are issued absorbent materials
girls)1 procured by the school through collection of
Ngultrum 100 from each student annually as a
• 6.5% were aware of menstruation health contribution and make them replace the
• 37.5% first received information from material later;
mother, 28.75% girls received from others ✓ The participants also revealed that they have
like friend relatives and teachers. even extra uniforms (school dress) for the girls
• 86.25% believed menstruation as in case they stain theirs with unexpected or
physiological process. forgotten onset of the next cycle of
• 48.75% use sanitary pads, 6.25% use cloth menstruation;
pieces, 40% use both cloth and pad. ✓ One of the participants suggested the Ministry
• 73.5% reuse cloth pieces and 57.5% dispose of Education to come up with standard manual
cloth and pad properly. on menstruation to be taught uniformly across
• 97.5% clean genital area with soap and all the schools to the adolescent girls;
water. ✓ Participants quantified the packets of
menstrual pads required per each cycle. On an
India (n=387 adolescent school going girls) 3
average, three packets containing eight pieces
• 36.95% are aware of menstruation. of menstrual pads are usually used by the girls,
• The sanitary pads were used by 49.35% which amount to Ngultrum 105 per each cycle;
• 45.74% practice the used of old clothes. ✓ All the participants have unanimously agreed
• Satisfactory cleaning of the external genitalia that they don’t have enough WASH facilities to
was practiced by 33.85% of the girls manage menstruation in their schools;
✓ The discussion also revealed that the girls to
Qualitative Findings toilet ratio stands at 66:1 and it has been
A Focused Group Discussion (FGD) had been discovered that the special children do not
conducted in Changangkha Middle Secondary have separate toilet;
School, Thimphu. The discussions comprised of ✓ Participants asserted that there is no social
two phases: first with regard to the special taboo related to menstruation health and
students; and second regarding general hygiene;
adolescent school girls. The following were the key ✓ The participants anticipated from this survey to
findings of the discussion: get good toilet in schools with constant water
supply, facilities for managing MHM and etc;
✓ One of the teacher participants said that they and
advise concerned parents of special children to ✓ The participants agreed together to support
keep them at home and take care till the the installation of an incinerator to burn the
menstruation is over. This was augmented by pads.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

CHAPTER 8: CONCLUSION AND RECOMMENDATIONS

This chapter deals with the conclusion drawn out 8.2 Recommendations & way forwards
of the findings of this survey and presents the list
of recommendation and way forwars for future The study recommends the following:
research. The Knowledge, Attitude and Practices ✓ Every school and nunnery need to enhance
(KAP) of the adolescent schoolgirls and nuns had their WASH facilities;
been quite glaring that they need various ✓ Every school and nunnery need to enhance
interventions from both the Ministry of Education their sanitary facilities viz. sanitary pad disposal
and parents and as well society at large. To bin, facility to dry improvised sanitary pad,
augment the quantitative findings, a Focused renewable materials to wrap disposable pads
Group Discussion (FGD) amongst teachers and etc;
especially who are taking care of children with ✓ Enhance sexuality education programs in
special needs were conducted. every school and nunneries;
✓ Some portion of School Development Fund
8.1 Conclusion (SDF) to sponsor buying sanitary pads and
The phenomenal increased in the budget support distribute to adolescent school girls on a
by the government to the education sector has monthly basis;
made us witness tremendous improvement in ✓ Enhance parenting education on Life Skills and
students’ wellbeing both in terms of educational Sexuality Education;
resources and school facilities over the past ✓ Student boys too need to be educated through
decade, according to the annual education Life Skills Education on the empathy they need
statistics. This by and large had contributed to the to show to girls regarding menstrual health and
tremendous growth of human capital. However, hygiene and social, emotional and
there is more to well-being and development of physiological impacts related to the same
students, especially adolescent student girls. This faced by girls;
study also included adolescent nuns in the ✓ Education Ministry to bring the adolescent
nunneries. To this effect, this study excavated fact nuns into mainstream in terms of sexuality
that despite the overall improvements realized by education and any other forms of education
the Ministry of Education, there still lacks adequate imparted to the mainstream adolescent girls
WASH facilities in the schools for managing for their overall development;
menstrual health and hygiene in many schools and ✓ The School Health and Nutrition Division needs
nunneries. to spearhead the development of spot-check
and Observation checklist to account the
Also, besides catering various forms of sexuality
existing WASH facilities for each school
education as part of Life Skills Education to
(inclusive of nunneries) and compute ratio of
students, there still remains a huge vacuum in
users to WASH facilities;
terms of knowhow on menstrual health and
✓ Ministry of Education to closely liaise with
hygiene and its management both amongst
Ministry of Health on their public health
adolescent schoolgirls and nuns. This study has
development facilities and endeavor to realize
also revealed a daunting fact, which is closely
WASH facilities in schools and nunneries;
related to poverty of the students’ parents. The
✓ Schools need to enhance the capacity of MHM
yearly pocket money received by the individual
service providers in their schools ;
student is so minimal to afford all those sanitary
✓ Ministry of Education to establish disable-
facilities. This study has as well revealed that most
friendly WASH facilities in each school and
of the school-going girls and nuns’ parents have no
duplicate this process in nunneries as well;
education and their livelihoods depend on
✓ Ministry of Education to support the
subsistence farming.
installation of incinerator to burn sanitary pads
On the attitude towards menstruation, the study in each school;
revealed that menstruation is still a taboo amongst ✓ School Health and Nutrition Division in
adolescent school-going girls and nuns. This collaboration with UNICEF to enhance the
survey has also found the negative health, social MHM programs in schools and nunneries; and
and emotional effects experienced by adolescent ✓ Ministry of Education to liaise with the Ministry
schoolgirls and nuns. of Health to reach out MHM programs to each
household of Bhutan apart from schools and
nunneries.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

8.3 Future Research

The future studies like Rapid Assessment of
WASH Facilities in schools, Process Impact of
WASH and LSE related to Menstrual Hygiene
Management needs to be carried out. A
household-based MHM survey needs to be carried
out across all 20 districts of Bhutan.

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

REFERENCS
1. Sommer M, Sahin M. Overcoming the taboo: advancing the global agenda for menstrual hygiene
management for schoolgirls. Am J Public Health 2013;103:1556–9.
2. [Link]
3. [Link]
709x&year=2011&month=October&volume=5&issue=5&page=1027-1033&id=1522
4. [Link]
b#q=Nepal+menstrual+hygiene+management+study

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Annexure I: Questionnaires
KAP Survey on Menstrual Hygiene Management in Schools of Bhutan
2016

Dear Respondents,

The School Health and Nutrition Division of Ministry of Education would like to request for your kind
cooperation to smoothly execute this survey assigned to M/S Bhutan A2Z Statistics, Economics and
Environmental Consultancy to collect information from you to assess the level of knowledge, attitute
and practices related to menstrual hygienic management amongst the girls in your school.

Chief Program Officer

School Health and Nutrition Division
Ministry of Education: Thimphu.

Questionnaire Form: Circle the responses or write the corresponding code

A: GEOGRAPHICAL IDENTIFICATION: Q10. Religion: 1. Buddhist
Q1. Dzongkhag:………………………………… 2. Christain
Q2. Name of the school: ………………………………. 3. Hindu
Q3. Level of the school: 4. Others (Specify):…………………………..
1. PS
2. LSS Q11. Whom do you live with back at home?
3. MSS 1. With mother and father
4. HSS 2. With mother only
5. Central School (specify Level)……….. 3. With father only
4. With stepmother and father
Q4. Area: 1. Rural 5. With relatives
2. Urban 6. Others (Specify):………………………………

Q4.1. Type of school: Q12. What is your parents'/Guardian Highest Educational level?:
1. Govt. Father Mother Guardine
2. Private 00. No education
Classes 1-12 ……….. ……. ………..
Q5. Status of school: 13. Diploma
1. Boarding 14. College & above
2. Day school 15. Monastic/shedra
3. Both 16. NFE

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Q13. Occupation of your parents: Father Mother Guardine

Q6. Total female teachers: 1. Farmer
B. SOCIO-DEMOGRAPHIC CHARACTERISTICS: 2. Govt. employee
Q7. Age (in completed years): ………………… 3. Corp. employee
[Link]: …………………… 4. Pvt. Employee
5. Business/trade
Q9. Mother Tongue 6. Others (Specify):………………………..
1. Ngalop Q14. Do you get pocket money regularly from your parents?
2. Sharchop 1. Yes
3. Lhotsam 2. No (>> Q16)
4. Khengpa
5. Others (Specify): ……………………… Q15. Yearly pocket money received (Nu.):…………………...
C. KNOWLEDGE Q21. What is the interval between two menstural cycles?
Q16. What is menstruation? 1.………………(days)
1. Natural shedding of blood on 2. Don't know
monthly basis.
2. Disease Q22. Did anyone tell you about menstruation before your
3. Curse onset of menstruation? 1. Yes 2. No
4. Others (specify):………………………
5. Don't know Q23. From whom you got information regarding menstruation?
1. Mother
Q17. What is the cause of menstruation? 2. Teacher
1. Hormones 3. Friends
2. Curse of God 4. Books
3. Caused by disease 5. Media (TV, Radio etc)
4. Others (Specify): ………………….. 6. Others (Specify):…………………….
5. Don’t know
Q24. Do you know about menstrual hygiene?
Q18. From which organ does menstrual blood come 1. Yes
from? 1. Uterus [Link]
2. Birth canal
3. Bladder Q25. If 'Yes'in Q24, what do you know about menstural hygiene?
4. Abdomen
5. Others (specify):……………………..
6. Don't know
Q26.1. Do you think menstrual blood is unhygenic?
Q19. At what age do you think most girls usually 1. Yes
get their first period? [Link]
1.……….. (years)
2. Don't know Q26.2 Are you aware of the following infection due to poor menstrual
Hygiene: [1=Yes, 2=No, 3=Don’t know]
Q20. What is the duration of normal menstruation [Link] Infection
for normal person? 2. Reproductive Track Infection (RTI)
1.…………(days) 3. Urinary Track Infection (UTI)
2. Don't know [Link] to infertility

Q27. There are four phases of menstrual cycle namely menstrual phase, Proliferative/ follicular phase, ovuluyary phase
and luteal phase. Of which phase the chances of getting pregnancy is high?
1. Menstrual phase (day 1-5)
2. Follicular/proliferative phase ( day 6-13)
3. Ovulutary phase (day 14)
4. Luteal phase (day 15-28)
5. Don’t know

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

D. ATTITUDE
Don't Strongly
Sl# Strongly Know Disagree disagree
Item agree (1) Agree (2) (3) (4) (5)
28 Women must not enter shrines/temples while having periods
29 Women in menstruation are susceptible to get possessed by evil spirits
30 Women are more tired than usual when they are menstruating
31 Menstruation does not affect my usual activities
I am more easily upset during pre-menstrual and menstrual periods than at
32 other times of the month

33 Menstruation is something that I just have to put up (tolerate) with

34 Men have real advantage of not having monthly period
The only thing good with menstruation is that I come to know that am not
35 pregnant

36 Menstruation allows women to be more aware of their body

The recurrent monthly flow of menstruation is an extranal indication of women's
37
general good health
I can tell my period is approaching because of the breast tenderness, backache,
38 cramps or other physical signs

A woman who attributes her irritability to her approaching menstrual period is

39
neurotic

40
I barely notice the minor physiological effect outof my menstrual periods

41
Women complaining of menstrual distress are just using that as an excuse
42 It is important to talk about menstrual period with men
43 It is important to discuss the topic of period at school with boys and girls
44 The period is dirty and annoying
Don't Strongly
Sl# Strongly Know Disagree disagree
Item agree (1) Agree (2) (3) (4) (5)
45 We women wish that the period would last for a few minutes
46 It is important to buy sanitary pad without being seen
47 Women wish that we do not have our period

48
It is uncomfortable for us women to talk about our periods

49
I miss school during my period because am afraid of staining my clothes
50 I miss school during my period because am afraid of others making fun of me
51 I miss school during period because it can cause pain

52
I miss school during my period can make me feel uncomfortable or tired
I miss school during my period because there isn't anywhere for girls to wash
53 and change at school

I miss school during my period because there inowhere to dispose off sanitary
54
pad
55 I miss school during my period because I don't have sanitary pad
Q56 Are there any other reasons your period makes you miss school?

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

E: PRACTICES Q57.1 Which one of the above do you perferred most?

[Link] is the main absorbent material do you use (Enter Corresponding SL#)
during period/menstruation?
1. Sanitary pad
2. Napkin/cloth or towel Q57.2 Why do you perfer?
3. Reusable sanitary pad 1. Easiiy available
4. Tampon 2. Affordable
5. Mentrual cup 3. Can't afford the good quality ones
6. Cotton 4. Easy to use
7. Tissue paper 5. Can be used longer
8. Others (Specify):………….……….. [Link](specity)………………………
9. None of the above

Q58. If you are using cloth as pad, how do you clean it? Q65. If 'No' in Q64, cite at least three reasons:
1. Water
2. Water and soap
3. Others (Specify):…………………….
Q66. If your menstrual problem interferes with
Q59. If you are using cloth, how do you dry the cloth? attendance, how often does it so?
1. Sunlight 1. One day every cycle
2. Inside the house 2. Two days every cycle
3. Others (Specify): ……………………. 3. Three days every cycle
4. Four days every cycle
Q60. How many times do you change cloth or pad in a day? 5. Others (Specify): …………..…………………
1. Once
2. Two and more Q67. What remedies do you take duriong menstruation?
1. Medication
Q61. Where do you dispose your pads? 2. Yoga/Meditation
1. Pad disposal bin 3. Prayers
2. Drain 4. Thoroughly involve in activities
3. Toilet 5. Take rest
4. Open field 6. Others (Specify)………………………..
5. Routine waste
6. Others (Specify): ……………….. Q68. How often do you bath during period?
Q62. Types of pad wraps used for disposing it: 1. Daily
1. Papers 2. Only on first day
2. Plastic bag 3. Only on second day
3. No wrap 4. Do not bath any time
4. Others (Specify): ………………………. 5. Others (Specify): ……………………..

Q63. Number of times you change your underwear during Q69. Do you clean genital area during menstruation?
menstruation in a day: ……………………………… 1. Yes
2. No (>> Q70)
Q64. Do you come to school during menstruation?
1. Yes
2. No
Q70. If 'Yes' in Q70, by what? Q73.1. I have a half body bath during my period due to lack of hot water
1. Water and soap facilities at school?
2. Only with water 1. Strongly agree
4. Towels 2. Agree
5. Others (Specify): …………………………. [Link]'t know
[Link]
Q71. Which one of the following sanitary pad disposal 5. Strong disagree
facilities does your school have?
1. Burning place Q74. Do you afforf to buy sanitary pad or any other substitues to
2. Pit be used as sanitary pad during menstruation?
3. Pad disposal bins 1. Can afford
4. Others (Specify): …………………….. [Link] afford
3. Not available to buy
Q72. Does your school have place for drying clothes? [Link]'t know
1. yes
2. No Q75. Any other comments:

Q73. Does your school have toilet/bathing facilities

enough for addressing issues related to menstruation?
1. Yes
2. No

Thank you for your cooperation and time!

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Questionnaire Form: Circle the responses or write the corresponding code

A: GEOGRAPHICAL IDENTIFICATION: Q9. Occupation of your parents: Father Mother Guardine
Q1. Dzongkhag:………………………………… 1. Farmer
Q2. Name of the Nunnary: …………………………………………. 2. Govt. employee
3. Corp. employee ……… ………. …………
Q3. Region: 4. Pvt. Employee
1. Eastern 5. Business/trade
2. Central 6. Others (Specify):………………………..
3. Western
B. SOCIO-DEMOGRAPHIC CHARACTERISTICS: ……. Q10. Do you get pocket money regularly from your parents?
Q4. Age (in completed years): ………………… 1. Yes
2. No (>> Q11)
[Link]: ……………………
Q11. Yearly pocket money received (Nu.):…………………...
Q6. Mother Tongue
1. Ngalop C. KNOWLEDGE
2. Sharchop Q12. What is menstruation?
3. Lhotsam 1. Natural shedding of blood on
4. Khengpa monthly basis.
5. Others (Specify): ……………………… 2. Disease
3. Curse
Q7. Highest Education level completed, if any 4. Others (specify):………………………
[Mention classes or Degree] ………………….. 5. Don't know
Q13. What is the cause of menstruation?
Q8. What is your parents'/Guardian Highest Educational
level? Father Mother Guardine 1. Hormones
00. No education 2. Curse of God
Classes 1-12 ……….. ……. ……….. 3. Caused by disease
13. Diploma 4. Others (Specify): …………………..
14. College & above 5. Don’t know
15. Monastic/shedra
16. NFE

Q14. From which organ does menstrual blood come from? Q20. Do you know about menstrual hygiene?
1. Uterus 1. Yes
2. Birth canal [Link]
3. Bladder
4. Abdomen Q21. If 'Yes' in Q20, what do you know about menstural hygiene?
5. Others (specify):……………………..
6. Don't know

Q15. At what age do you think most girls usually get their Q21.1. Do you think menstrual blood is unhygenic?
first period? 1. Yes
1.……….. (years) [Link]
2. Don't know
Q21.2 Are you aware of the following infection due to poor menstrual
Q216. What is the duration of normal menstruation for Hygiene: [1=Yes, 2=No, 3=Don’t know]
normal person? [Link] Infection
1.…………(days) 2. Reproductive Track Infection (RTI)
2. Don't know 3. Urinary Track Infection (UTI)
[Link] to infertility
Q17. What is the interval between two menstural cycles?
1.………………(days) Q22. There are four phrase of menstrual cycle nsmely menstrual
2. Don't know phase, Proliferative/follicular phase, ovuluyary phase and leutral
phaes. Of which phase the chances of getting pregnancy is high?
Q18. Did anyone tell you about menstruation before your 1. Menstrual phase (day 1-5)
onset of menstruation? 1. Yes 2. No 2. Follicular/proliferative phase ( day 6-13)
3. Ovulutary phase (day 14)
Q19. From whom you got information regarding menstruation? 4. Leutral phase (day 15-28)
1. Mother 5. Don’t know
2. Teacher
3. Friends
4. Books
5. Media (TV, Radio etc)
6. Others (Specify):…………………….

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

D. ATTITUDE
Don't Strongly
Sl# Strongly Know Disagree disagree
Item agree (1) Agree (2) (3) (4) (5)
23 Women must not enter shrines/temples while having periods
24 Women in menstruation are susceptible to get possessed by evil spirits
25 Sleeping with a man during your periods will pass on the "drip" to man
26 Drinking tea will increase the blood flow
27 Changing often/ staying clean will increase the blood flow
28 Women are more tired than usual when they are menstruating
29 Menstruation does not affect my usual activities
I am more easily upset during pre-menstrual and menstrual periods than at
30
other times of the month
31 Menstruation is something that I just have to put up (tolerate) with
32 Men have real advantage of not having monthly period
The only thing good with menstruation is that I come to know that am not
33 pregnant

34 Menstruation allows women to be more aware of their body

The recurrent monthly flow of menstruation is an extranal indication of women's
35
general good health
I can tell my period is approaching because of the breast tenderness, backache,
36 cramps or other physical signs

A woman who attributes her irritability to her approaching menstrual period is

37
neurotic

38
I barely notice the minor physiological effect outof my menstrual periods

39
Women complaining of menstrual distress are just using that as an excuse
40 The period is dirty and annoying
41 We women wish that the period would last for a few minutes
42 It is important to buy sanitary pad without being seen
43 Women wish that we do not have our period
44 It is uncomfortable for us women to talk about our periods

I miss classes/activities during my period because am afraid of staining my

45
clothes

Don't Strongly
Sl# Strongly Know Disagree disagree
Item agree (1) Agree (2) (3) (4) (5)
I miss classes/activities during my period because am afraid of others making
46
fun of me
47 I miss classses/activities during period because it can cause pain
I miss classes/activities during my period can make me feel uncomfortable or
45 tired

I miss classes/activities during my period because there isn't privacy anywhere

46
for girls to wash and change at school
I miss classes/activities during my period because there inowhere to dispose off
47
sanitary pad

48 I missclasses/activities during my period because I don't have sanitary pad

I miss classes during my period since toilets are too dirty and don't feel like to
49 change
Q49 Are there any other reasons your period makes you miss classes or activities of nunnary?

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

E: PRACTICES Q50.1 Which one of the above do you perferred most?

[Link] is the main absorbent material do you use [ Enter corresponding Sl#]
during period/menstruation?
1. Sanitary pad
2. Napkin/cloth or towel Q50.2 Why do you perfer?
3. Reusable sanitary pad 1. Easiiy available
4. Tampon 2. Affordable
5. Mentrual cup 3. Can't afford the good quality ones
6. Cotton 4. Easy to use
7. Tissue paper 5. Can be used longer
8. Others (Specify):………….……….. [Link](specity)………………………
9. None of the above

Q51 If you are using cloth as pad, how do you clean it? Q57. If 'No' in Q8, cite at least three reasons:
1. Water
2. Water and soap
3. Others (Specify):…………………….

Q52. If you are using cloth, how do you dry the cloth? Q58. If your menstrual problem interferes with
1. Sunlight attendance, how often does it so?
2. Inside the house 1. One day every cycle
3. Hide and dry it beneath other clothes 2. Two days every cycle
4. Others (Specify): ……………………. 3. Three days every cycle
4. Four days every cycle
Q53. How many times do you change cloth or pad in a day? 5. Others (Specify): …………..…………………
1. Once
2. Two and more Q59. What remedies do you take duriong menstruation?
1. Medication
Q54. Where do you dispose your pads? 2. Yoga/Meditation
1. Pad disposal bin 3. Prayers
2. Drain 4. Thoroughly involve in activities
3. Toilet 5. Take rest
4. Open field 6. Others (Specify)………………………..
5. Routine waste
6. Others (Specify): ……………….. Q60. How often do you bath during period?
1. Daily
Q55. Types of pad wraps used for disposing it: 2. Only on first day
1. Papers 3. Only on second day
2. Plastic bag 4. Do not bath any time
3. No wrap 5. Half-body bath everyday
4. Others (Specify): ………………………. 6. Others (Specify): ……………………..

Q56. Number of times you change your underwear during Q61 Do you clean genital area during menstruation?
menstruation in a day: ……………………………… 1. Yes
Q58. Do you come to school during menstruation? 2. No (>> Q64)
1. Yes
2. No
Q62. If 'Yes' in Q70, by what? Q66. Do you afforf to buy sanitary pad or any other substitues to
1. Water and soap be used as sanitary pad during menstruation?
2. Only with water 1. Can afford
4. Towels [Link] afford
5. Others (Specify): …………………………. 3. Not available to buy
[Link]'t know
Q.63Which one of the following sanitary pad disposal
facilities does your nunnary have? Q67. I have a half body bath during my period due to lack of hot water
1. Burning place facilities at nunneries?
2. Pit 1. Strongly agree
3. Pad disposal bins 2. Agree
4. Others (Specify): …………………….. 3. Don't know
4. Disagree
Q64. Does your nunnary have place for drying clothes? 5. Strongly disagree
1. yes
2. No Q68. Any other comments:

Q65. Does your nunnary have toilet/ bathing facilities

enough for addressing issues related to menstruation?
1. yes
2. No

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 MENSTRUAL HYGIENE MANAGEMENT OF ADOLESCENT SCHOOL GIRLS AND NUNS

Annexure II: REBH Approval Letter

Page | 64
 x

United Nations Children’s Fund (UNICEF)

Bhutan Country Office, UN House
Peling Lam, Kawajangsa
Thimphu, Bhutan
Tel: +975 2 322424
[Link]

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