What is the relationship between menstruation-related restrictions and menstrual health and hygiene management? A mixed method, community-based, cross-sectional study in rural India

The objective of the research was to test the relationship between restrictions and menstrual health and hygiene management (MHHM). A total of 2,212 adolescents in the structured questionnaire and 309 adolescent girls in the focus group discussions (FGDs) were selected using stratified random sampling in three districts of Uttar Pradesh. Overall, 96 per cent of the adolescent girls mentioned they faced some restriction in the structured questionnaire. Factors affecting adequate preparation of clean absorbent included having food restrictions and not having personal and structural restrictions. Factors affecting adequate storage of clean absorbent included not having social/religious restrictions and having structural restrictions. Factors affecting adequate frequency of changing included not having personal restrictions. Factors affecting adequate disposal included not having structural restrictions. The FGDs and structured questionnaire demonstrated that restrictions were ubiquitous, and adolescent girls followed restrictions because of personal and social beliefs, including considering menstruation impure. There was a blurry distinction between personal and social restrictions and most FGDs could not articulate actions to overcome social restrictions. These results highlight that restrictions matter and have a relationship with adequate MHHM. There is a need to combat restrictions using multifaceted approaches by designing programmes that are context specific.