Menstrual hygiene Management: A prominent cause of teenage girl school absenteeism in the state of Madhya Pradesh

In the Indian state of Madhya Pradesh, a multi- districtresearch was undertaken to better identify all major causes or obstructions to learning, especially for underprivileged girls. The project will not only look at the factors that prohibit females from enrolling in and finishing secondary school, but it will also determine the best combination of financial and non-financial incentives to increase girls' access to secondary school and preventing them from leaving. Several schemes to expand access to education have been developed by the Madhya Pradesh government over the last two decades. In 2011–2012, the state had almost 65,000 schools, the bulk of which were primary schools, with over 14 million students enrolled in grades 1–8 and over 2 million students in classes 9– 11. Thanks to the government's efforts, Madhya Pradesh's gross enrolment ratio at the secondary level (the proportion of eligible students who actually attend secondary school) is currently 71, in comparison with national average of 60. Despite this improvement, India's second most populous state still has enormous hurdles in providing comprehensive social and educational services to its inhabitants. Data is collected utilising both qualitative and quantitative approaches in the multi-district cross- sectional research study. The qualitative study's assessment of barriers will be used to inform a cross-sectional quantitative household survey of 750 homes from rural and urban disadvantaged subpopulations. The quantifiable household survey will validate the barriers while also assisting in establishing the perceived value of the optimum incentive package for enrolling and maintaining females in secondary school.

The purpose of this study was to determine the existing state ofMHM at schools in Bhopal's urban slums areas. The goal of the study was to determine the link among school absence and poor health, as well as the effects on schoolgirls' daily life and the problems they face in managing menstrual hygiene. It will assist health policymakers in developing effective interventions to address these problems.

Community-based cross-sectional research was conducted from January to June 2018 among menstruating teenage females (10-19 years) enrolled at Anganwadi in Raisen District, MP. Because this is the first study of its sort in this subject, a 50% prevalence of menstrual absenteeism was anticipated. s = Standarddeviation (SD) at 95 percent confidence interval (CI); (q=100p) and a margin of error of 10%, the projected minimum sample size was 393. The participants were chosen using a simple random sampling method and a line listing of the teenagers. A pre-designed, pre-tested, and a well-organized questionnaire was utilised to collect data from study participants during face-to-face interviews. Absenteeism in School of female students due to menstruation,the reasons for not attending school, and effect of menstruation on student‘s performance in school, affecting academic performance, Number of days absent per month (n=180)

Each study participant was told of the study's goal, benefits, hazards, and opportunity to withdraw or decline participation. Every participant provided written informed consent, and consent received from parents/guardians for responders under the age of 18 assured confidentiality, privacy, and anonymity.

The statistics package for Social Sciences (SPSS)version 16.0 was used to examine the data (IBM, SPSS Inc., Chicago, USA). Calculation of descriptive statistics to investigate the factors related with school absence, researchers used univariable and multivariable logistic regression with a 94%, CI (p0.05).

The average age (Standard Deviation) of research participants was 15.42, with 60.3 percent of individuals aged 15 to 18 years old. Around a third of the participants were in intermediate school (9-12 classes). Other backward and scheduled castes made up about half and a fourth of the participants. Approximately 77.6 percent of the respondents were poor. About a 1/4thof the participants' mothers were uneducated(table 1). At the age of 13, about half of the individuals had reached menarche. Menstruation was unknown to almost 63% of the subjects prior to menarche. Nearly a quarter of the participants (26%) are aware of the actual reason of menstruation.Even 3% of those polled believe it is a divine punishment. Only 3.6% of those polled correctly identified. Around eighty (80.2%) and seventy-five percent (75%) of the participants said their everyday activities were restricted at home because of health difficulties. Only

During menstruation, about half of the respondents (51.1 percent) miss school. Around three-quarters of students skip two to three days of school. Fear of leakage was the primary reason for missing school. More than half of the respondents (58%) and half of the respondents (50.4%) said they couldn't concentrate in class and couldn't participate in sports, respectively. Menstruation had a negative impact on academic achievement for almost 10% of the respondents as shows in table 4.

*multipleresponse

Up until adolescence, females are on level with boys; but, once puberty sets in, girls experience increasing constraints to their activities and mobility, affecting female education, resulting in different menstrual health promotion is still a problem. This study contributes to the field by concentrating on slum residents. Few research look at school absenteeism as a result. As a result, the purpose of this study is to investigate how adolescents' inability to attend school affects their academic performance. In this study, the age at menarche of adolescent schoolgirls varied from 10 to 18 years, with the majority of the girls reaching the age of 13. The present study found that 61.8% of women were unaware of menstruation before menarche, which is similar to prior findings and even higher (73.3%) in a rural Indore study (9-12). Which is comparable to previous study in the Bhopal urban area, where 71% of girls were made aware by their mothers (12). Teachers were the first informants for 82% of the girls in Bhopal and 51.3 percent of the girls in India, according to studies (9, 14). Sisters (54%) had a big role in delivering knowledge to children, according to a study in rural Indore(13). Around a third of the respondents (29.3%) in this survey used sanitary pads, and comparable proportions were found in rural Indore and Raisen(13, 15). According to a study done in Bhopal, just 22% of women utilised sanitary napkins as absorbents, while 62% used ordinary fabrics (12).

Around half of the participants in this study (51.1%) had missed school during their periods in the previous year, which is greater than studies in Delhi (39 percent), rural Pune (42 percent), West Bengal (38 percent), and Bangladesh (42 percent). All of these studies took place in economically stable areas with access to sanitary facilities and menstruation awareness (9,16-18). Because to the differences in research areas, studies in Ghaziabad (62%) found higher prevalence than the current study (14,15). Another survey in three Indian states found lower absenteeism rates than the current study: Maharashtra (11.2%), Chhattisgarh (21.1%), and Madhya Pradesh(2.9%),(19). A survey of nursing students in Madhya Pradesh indicated that 66% of respondents were not interested in attending college during their period(20). Similar to a research in Bangladesh, 64 percent of women missed two to three days of school during their period, whereas during their most recent period, 20.1 percent of Ugandan women missed at least one day of school. Aresearch in Delhi indicated that the average number of days missed was 1.20 (7), significantly lower than the current study of slum females(9, 18, 21).

Pain was shown to be the greatest predictor of school absence during menstruation in this study (Ro=2.2), similar to study conducted in Uganda (Ro=1.8) and a finding that was not significant in the current study or comparable findings in Jabalpur (15). The current study found no link between parents' socioeconomic position and their schooling; socioeconomic was an important parameter (17). According to the poll, roughly 45% of girls said there weren't enough facilitiesand just 36% said they were only for girls, despite government recommendations. (19). Menstruation is perceived as unhealthy, embarrassing, or obstructive to learning by females who lack awareness about it before to menarche. Other primary factors in school absenteeism included family restrictions, which contradicts the findings of the current study (20,28-30).

Menstruation is perceived to interfere with school performance and activities by 72.8% of girls in our survey, indicating that menstruation affects not just attendance but also the quality of time spent in school. Fear of humiliation made it difficult for the girls to stay in school and also prevented them from participating in outside activities, according to studies in Bhopal, where 69 % of girls said menstruation had an impact on their academic life(9).According to the current study, over 60% of participants claimed to have lost focus during study hours, which is similar to a survey in three states (50%) and a study in Madhya Pradesh, where a greater proportion (71%) claimed to have lost concentration during study hours (20). These issues were influenced by the type of menstruation item used, cloth users having greater problems than disposable sanitary pad (18).A finding in Iraqi schools found that caused them to miss exams, while 57 percent said it interfered with their participation in academic activities and class presentations. The current study found that around 11% of students observed weak performance (32). This study uses a large sample size to gain a better understanding of menstruation management, which is especially important in the most underserved group. Because kids may not want to disclose school absence or identify menstruation as a reason, quantitative surveys used to monitor school attendance may result in under-reporting.Qualitative research will provide a deeper understanding of many level elements, challenges associated with MHM, and practical solutions to this problem.

CONCLUSION

According to the findings, about half of adolescent girls (50.6 percent) miss school during their period. Around 75% believe that menstruation affects their academic performance. It means that if MHM facilities are accessible at school, school absence can be reduced.As a result, it is necessary to millions of women, subsidized sanitary napkins and improved sanitation facilities for school students should be made available through different programmes such as the ―Menstrual Hygiene Schem (MHS)‖ and ―Swacch Bharat Mission‖.

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LNCT University, Bhopal