Reproductive health is a cornerstone of women's overall well-being and empowerment, encompassing not only the ability to conceive and bear children but also the broader aspects of sexual health, menstrual hygiene, fertility awareness, safe pregnancy, postpartum care, and menopause management. Despite global advancements in healthcare, reproductive health literacy remains unevenly distributed—particularly across diverse populations and life stages. In India, socio-cultural taboos, limited access to comprehensive health education, and variable healthcare infrastructure continue to contribute to knowledge gaps and preventable health challenges faced by women [1-4].

In the district of Shimla, Himachal Pradesh, unique socio-geographical factors—such as hilly terrain, weather-dependent mobility, and a mix of urban and semi-rural populations—further complicate access to continuous reproductive healthcare and information. Many young girls still lack proper menstrual hygiene education, while women in reproductive and post-reproductive age groups often navigate pregnancies, fertility issues, or menopause without adequate medical guidance or emotional support. Stigma, generational silence, and limited discussions on sexual and reproductive rights often discourage open dialogue and delay timely healthcare-seeking behavior [5-7].

While government initiatives and school health programs have made some inroads, there remains a considerable gap in community-level understanding, particularly concerning reproductive health across the entire female lifespan—from adolescence through motherhood  to   menopause.   Moreover,   misconceptions surrounding contraception, fertility, menstrual disorders, antenatal care, and postnatal health continue to persist. These issues can lead to increased vulnerability to infections, unplanned pregnancies, maternal complications, and emotional distress [4-6].

This study aims to assess the level of awareness, prevailing myths, health-seeking behavior, and access to reproductive health education among women in Shimla. By examining how women at different life stages perceive and manage their reproductive health, the study intends to identify barriers and opportunities for public health interventions. The insights generated will help inform policy-making and develop culturally relevant, stage-specific educational strategies that support women's reproductive well-being across generations.             

Study Design

A descriptive, cross-sectional online survey was conducted to evaluate awareness, perceptions, and practices related to reproductive health among women in Shimla. The study focused on capturing data from women across all major life stages—adolescents, young adults, reproductive-age women, and postmenopausal women—to explore a comprehensive understanding of reproductive health literacy, challenges, and service utilization.

Study Area and Target Population

The study was conducted among female residents of Shimla district, Himachal Pradesh. Participants were categorized by life stage:

• Adolescents (13–19 years),

• Young adults (20–29 years),

• Reproductive-age women (30–45 years), and

• Post-reproductive women (46 years and above).

Inclusion Criteria:

• Female individuals aged 13 years and above, residing in Shimla for at least the past 12 months,

• Able to comprehend and respond in Hindi or English,

• Access to a smartphone, tablet, or computer with internet connectivity,

• Willingness to provide informed electronic consent (for minors aged 13–17, consent was obtained from guardians along with assent from participants).

Study Duration

The survey was conducted over a two-month period, from February 2025 to March 2025, coinciding with International Women’s Day campaigns to increase visibility and engagement.

Sampling Technique and Sample Size

A non-probability convenience sampling approach was adopted due to the online nature of the study. The survey link was disseminated through:

• Women-centric social media groups (WhatsApp, Facebook, Instagram),

• Local NGOs, women’s self-help groups, and health forums,

• School and college networks (for adolescents and young adults),

• Online platforms of community health centers and women’s welfare associations.

A target sample size of 400 women was set to ensure adequate representation from different age groups and to allow for subgroup analysis.

Data Collection Tool

A structured and pre-validated bilingual questionnaire (Hindi and English) was developed using Google Forms after a thorough literature review and consultation with experts in gynecology and public health. The questionnaire consisted of the following sections:

• Demographic Information: Age, marital status, education, occupation, residence type (urban/semi-urban/rural).

• Menstrual Health and Hygiene: Knowledge about menstruation, hygiene practices, and myths.

• Sexual and Reproductive Health Awareness: Knowledge of contraception, safe sex, fertility, antenatal and postnatal care, PCOS, STIs.

• Access to Services and Health-Seeking Behavior: Frequency of gynecological visits, comfort with seeking help, source of information (internet, family, healthcare provider).

• Attitudes and Beliefs: Perceptions of reproductive rights, openness to discussion, cultural and familial barriers.

The questionnaire was pilot-tested with 30 participants across age groups to assess clarity, cultural appropriateness, and technical functionality. Their responses were excluded from the final analysis.

Data Collection Procedure

An introductory page preceded the survey, clearly explaining the objectives, confidentiality, voluntary nature, and the process of e-consent. Only one response per device was permitted to avoid duplication.

Data Analysis

Survey responses were downloaded into Microsoft Excel and analyzed using IBM SPSS Version 26.0. Descriptive statistics (frequencies, percentages) were used to summarize categorical variables.

Ethical Considerations

Participation was voluntary, and no personally identifiable information was recorded. Special care was taken to maintain anonymity, particularly for sensitive questions relating to menstrual and sexual health.

Socio-Demographic Characteristics of Participants

A total of 400 women from Shimla district participated in the online survey. The largest age group represented was 30–45 years (33.5%), followed by 20–29 years (25.5%), 46–60 years (21.5%), and 13–19 years (11.5%). The majority of participants were married (70.5%), and 60.5% had attained a graduate degree or higher. In terms of residence, 53.0% lived in urban areas and 47.0% in semi-urban areas. When categorized by life stage, 33.5% of participants were in the reproductive age group, followed by 29.5% post-reproductive, 25.5% young adults, and 11.5% adolescents. This diverse representation allowed for an inclusive analysis across age and reproductive health stages (Table 1).

Table 1: Socio-Demographic Characteristics of Participants (N = 400)

Awareness and Knowledge of Reproductive Health

Participants responded to 20 comprehensive multiple-choice questions covering various aspects of reproductive health including menstrual hygiene, fertility, contraception, antenatal care, menopause, and STIs. While many demonstrated strong knowledge of topics like the role of iron during menstruation (76.5%), safe age for gynecological visits (80.0%), and contraceptives that prevent STIs (78.5%), significant gaps were noted in identifying menstrual myths, understanding vaginal discharge, and STI-related infertility risks. These gaps suggest the need for targeted education across different life stages (Table 2).

Table 2: Reproductive Health Awareness Questions (N = 400)

Knowledge Score Classification

Based on the total number of correct answers, participants were grouped into four awareness levels. The majority (36.0%) demonstrated Good knowledge, followed by Fair (30.5%). Only 17.0% scored in the Very Good range, reflecting well-informed individuals. However, 16.5% fell into the Poor category, highlighting significant gaps—especially in areas like menstrual myths and STI-related consequences. These findings indicate an urgent need for life-stage-specific reproductive health education, particularly for adolescents and older women (Table 3).

Table 3: Knowledge Score Classification (N = 400)

This study aimed to comprehensively assess the awareness, beliefs, and health-seeking behaviors regarding reproductive health among women of various life stages in Shimla—a district marked by both geographical challenges and socio-cultural diversity. The findings reveal a promising yet uneven landscape of reproductive health literacy, with clear indicators of progress in some domains but persistent misconceptions and barriers in others.

Encouragingly, the majority of participants demonstrated familiarity with foundational reproductive health topics such as menstrual hygiene, nutritional requirements during menstruation, legal age of marriage,and the importance of antenatal care. Awareness of modern contraception methods—particularly the role of condoms in STI prevention (78.5%)—and the recommended age for the first gynecological visit (80.0%) shows that health messaging is beginning to penetrate community understanding. This is likely the result of government programs, increased online access to health information, and localized health campaigns linked to maternal and child health.

However, significant knowledge gaps remain, especially in nuanced areas such as menstrual myths, vaginal health, and theconsequences of untreated STIs. For example, while nearly three-quarters of participants correctly noted that not all vaginal discharge is pathological, nearly a third still believed otherwise. Similarly, only 61.0% correctly identified the myth about menstrual blood being “impure,” a notion deeply rooted in cultural stigma that continues to influence practices like exclusion from prayer, cooking, or schooling. These enduring taboos reflect not just informational deficits, but systemic socio-cultural norms that hinder women from seeking or accepting evidence-based guidance.

Moreover, 30.5% of respondents had only fair knowledge, and 16.5% demonstrated poor awareness, emphasizing that despite digital access and educational gains, a significant subset of women still lacks critical reproductive health knowledge. Adolescents and post-reproductive women appeared to be the most affected groups, likely due to limited targeted education and engagement in those stages. Adolescents, in particular, may be constrained by limited school-based education or parental hesitation to discuss reproductive topics, while older women may lack access to menopause-related counseling or postnatal follow-up care.

This gap between knowledge and practice is particularly concerning in the context of Shimla’s terrain and semi-rural pockets, where access to specialized care is often delayed by logistical and cultural constraints. The findings underscore the importance of stage-specific, community-sensitive health education—especially through trusted sources such as  school  health  programs,

frontline health workers, and family-based interventions. Educational efforts must go beyond information dissemination and actively address stigma, emotional barriers, and social misconceptions. Equipping women with not only facts but also confidence and agency in managing their reproductive health is vital for long-term societal progress.

This study reveals that while general awareness of reproductive health among women in Shimla is moderate to good, significant gaps persist—particularly in relation to menstrual myths, vaginal health, and STI-related risks. These findings highlight the urgent need for tailored reproductive health education across all life stages, especially among adolescents and post-reproductive women. Public health strategies must incorporate culturally relevant, life-stage-specific interventions that go beyond information delivery to actively dismantle stigma, promote open dialogue, and ensure equitable access to reproductive care services across urban and semi-urban populations.

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