Menstrual hygiene attitudes, practices, and lived experiences among school-going adolescents in a tribal-predominant block of Jharkhand, India: a convergent parallel mixed-methods study

Menstrual hygiene management (MHM) remains a major public health concern for adolescent girls in rural and tribal-predominant settings. This study assessed menstrual hygiene attitudes, practices, and lived experiences among school-going adolescent girls in Palojori block, Jharkhand, India. A convergent parallel mixed-methods study was conducted in October 2025 in two randomly selected government high schools (one non-residential co-educational and one residential girls’ school). Quantitative data were collected from 500 participants using paper-based questionnaires. Qualitative data were obtained through four focus group discussions (n=48) and thematically analysed. The median age was 15 years (interquartile range: 14–16), and 32.8% belonged to Scheduled Tribes. Most participants had attained menarche (89.4%) and received menstrual hygiene sensitization at school (86.6%). Among menstruating girls (n=447), 67.6% used both cloth and sanitary pads, 23.3% used pads only, and 9.2% used cloth only. Absorbents were changed every 4–6 hours by 73.2%. Among cloth users, 87.2% washed cloth with soap and water, while 59.8% practiced sun-drying. School absenteeism during menstruation was reported by 85.9%, with a median of 3 missed days per cycle. Disposal methods included dustbin disposal at school (36.9%) and burial in soil at home (34.9%). Menstrual restrictions were reported by 60.4%, and practice scores were negatively associated with restrictions (Spearman’s rho = −0.376, p<0.001). Qualitative findings highlighted fear at menarche, secrecy, mixed absorbent use, and the need for improved school sanitation facilities. Favourable menstrual hygiene attitudes and practices were positively linked with older age, higher education, parental schooling, school‑based menstrual education and longer post‑menarche experience, whereas cultural restrictions and school absence predicted poorer menstrual health outcomes. These findings call for reinforced school‑centred menstrual health interventions, improved access to menstrual products and water, sanitation, and hygiene (WASH) infrastructure, alongside community‑led efforts to dismantle harmful norms and support girls’ safe, dignified menstrual management.