Background: Menstruation is a natural biological process essential to female health, yet it remains enveloped in stigma, secrecy and misinformation, particularly in rural regions like Kangra. Poor menstrual health education, pervasive cultural myths and unhygienic practices contribute to adverse physical, emotional and social outcomes for adolescent girls. This study aimed to assess the awareness of menstrual hygiene practices and the prevalence of menstrual myths among adolescent girls in Kangra district, Himachal Pradesh. Materials and Methods: A descriptive, cross-sectional online survey was conducted between January and March 2025, targeting adolescent girls aged 13-19 years who had attained menarche. A structured, pre-validated bilingual questionnaire was disseminated via digital platforms, collecting information on socio-demographics, menstrual hygiene practices, product usage and menstrual myths. A total of 400 participants were included through convenience sampling. Responses were scored and categorized into Very Good (≥80%), Good (60-79%), Fair (40-59%) and Poor (<40%) awareness levels. Data were analyzed using descriptive statistics with IBM SPSS version 26.0. Results: Of the 400 respondents, 58.5% resided in rural areas and 56.0% were enrolled in secondary education. Knowledge regarding menstrual hygiene was generally high, with 83.5% correctly identifying menstruation as endometrial shedding and 87.8% recognizing the role of hygiene in infection prevention. However, awareness regarding modern menstrual products like menstrual cups (63.8%) and tampons (62.5%) was comparatively lower. Encouragingly, 75.0% of participants rejected the notion of ritual impurity and 82.0% disagreed with activity restrictions during menstruation. Overall, 32.5% demonstrated Very Good awareness, 44.0% had Good awareness, 19.0% had Fair awareness and 4.5% had Poor awareness levels. Conclusion: While adolescent girls in Kangra exhibited commendable awareness regarding basic menstrual hygiene, significant gaps remain concerning the use of modern products and persistent myths. Targeted, culturally sensitive educational initiatives integrated within schools and communities are essential to dismantle menstrual stigma, correct misinformation and empower girls to manage their menstrual health safely and confidently.
Menstruation is a natural and vital biological process marking a key transition in the lives of adolescent girls. Yet, despite its physiological normalcy, menstruation continues to be surrounded by stigma, secrecy and a host of pervasive myths, particularly in rural and semi-urban areas. Inadequate menstrual health education, cultural taboos and misinformation often leave adolescent girls ill-prepared to manage their menstrual health effectively, contributing to poor hygiene practices, emotional distress, school absenteeism and a broader impact on their physical and psychosocial well-being [1-4].
Across India and particularly in regions like Kangra, deeply rooted cultural norms shape how menstruation is perceived and discussed—or more commonly, avoided. Traditional beliefs labeling menstruating girls as impure or restricted in participation in daily activities can significantly harm self-esteem and limit access to accurate information. Furthermore, the choice and use of menstrual hygiene products remain largely influenced by factors such as affordability, availability, family norms and societal pressures, often leading to unhygienic practices that pose serious health risks [5-7].
The role of menstrual health education is critical in challenging these misconceptions, promoting hygienic practices and empowering girls with the knowledge and confidence to manage their menstruation safely. However, many adolescents still rely on informal sources of information such as peers or family members, which may perpetuate misinformation rather than correct it. Consequently, understanding the current awareness levels regarding menstrual hygiene and myths among adolescent girls is essential to identify educational gaps, address harmful practices and inform targeted interventions [8-10].
This study aims to explore the awareness of menstrual hygiene practices and the prevalence of menstrual myths among adolescent girls in Kangra. By highlighting existing knowledge gaps and cultural barriers, the research seeks to contribute to the development of culturally sensitive educational programs that promote safe menstrual practices, dismantle stigma and advance menstrual equity for adolescent girls in rural India.
A descriptive, cross-sectional online survey was conducted to assess awareness regarding menstrual hygiene practices and the prevalence of menstrual myths among adolescent girls in Kangra district, Himachal Pradesh.
The study targeted adolescent girls aged 13 to 19 years residing in Kangra district, who had experienced menarche. Eligible participants were able to read and understand Hindi or English, had access to an internet-enabled device and were willing to provide informed electronic assent along with parental consent where required.
Data collection was carried out over a three-month period, from January to March 2025.
Assuming a 50% prevalence of adequate menstrual hygiene awareness, with a 95% confidence interval and a 5% margin of error, the minimum calculated sample size was 384 participants. To compensate for potential incomplete submissions, a final sample size of 400 adolescent girls was targeted.
Participants were recruited through convenience sampling by distributing the survey link widely across digital platforms, including WhatsApp groups, school WhatsApp channels, Instagram pages, Facebook adolescent health groups and local community forums.
Inclusion Criteria
Adolescent girls aged 13-19 years
Residents of Kangra district
Attained menarche
Ability to comprehend Hindi or English
Access to a smartphone, tablet, or computer with internet connectivity
Willingness to participate and provide informed electronic assent (and parental consent where required)
Exclusion Criteria
Girls who had not attained menarche
Participants with a known diagnosed menstrual disorder (e.g., PCOS, clotting disorders)
Inability or unwillingness to complete the online survey
A structured, pre-validated questionnaire was developed and hosted on Google Forms, available in both Hindi and English. The questionnaire comprised four sections:
Socio-Demographic Information: Age, education level, place of residence (rural/urban) and family background
Menstrual Hygiene Knowledge: Awareness regarding menstrual biology, hygienic practices, use of products and disposal methods
Menstrual Product Use: Types of absorbents used (cloth, sanitary pads, menstrual cups), frequency of change and bathing habits
Beliefs and Myths: Awareness of and attitudes toward prevalent menstrual myths (e.g., food restrictions, religious taboos, isolation practices)
The questionnaire was pilot-tested among 30 adolescent girls not included in the final study, to ensure clarity, cultural appropriateness and ease of online administration. Modifications were made based on feedback
Participants accessed the Google Form survey link, which was accompanied by an introductory page explaining the study objectives, ensuring voluntary participation, guaranteeing confidentiality and including an electronic assent checkbox (and parental consent section where necessary). Only one response per participant was allowed and no personal identifiers were collected to maintain anonymity.
Responses to knowledge and myth-identification questions were scored as follows:
One point awarded for each correct response
Total scores were categorized as:
Very Good Awareness: ≥80% correct answers
Good Awareness: 60-79% correct answers
Fair Awareness: 40-59% correct answers
Poor Awareness: <40% correct answers
Separate analyses were conducted for menstrual hygiene awareness and belief in myths.
Survey data were exported from Google Forms into Microsoft Excel and analyzed using IBM SPSS version 26.0. Descriptive statistics (frequencies, means, percentages) were used to summarize socio-demographic data and awareness levels.
Informed electronic assent was obtained from all participants and parental consent was obtained where necessary. Participation was voluntary and strict confidentiality and anonymity of all survey responses were maintained throughout the study.
The socio-demographic profile of the 400 adolescent girls who participated in the study revealed that the majority were aged between 13-15 years (35.5%) and 16-17 years (34.5%), with a smaller proportion aged 18-19 years (30.0%). Regarding educational attainment, most girls were enrolled in secondary school (56.0%), followed by higher secondary education (30.0%) and a smaller number in primary schooling (14.0%). In terms of residence, a greater proportion of respondents resided in rural areas (58.5%) compared to urban settings (41.5%). Family structure analysis showed that 58.0% of the participants belonged to nuclear families, while 42.0% were from joint families. Notably, school attendance was predominantly regular among participants (89.3%), with only 10.8% reporting irregular attendance (Table 1).
Awareness and knowledge regarding menstrual hygiene and myths among participants demonstrated a generally positive trend, with several critical insights. A high percentage of girls correctly identified menstruation as a result of endometrial shedding (83.5%) and recognized the importance of maintaining hygiene to prevent infections such as urinary tract infections (87.8%). Knowledge about optimal absorbent change frequency (77.0%) and the health risks of unhygienic practices (80.8%) was relatively strong. Additionally, most participants understood the necessity of daily bathing during menstruation (84.8%) and hygienic disposal of menstrual waste (86.0%). However, only 63.8% were aware of menstrual cups being a viable hygiene option and 62.5% acknowledged the safe use of tampons, indicating room for improvement in knowledge of modern menstrual products. Regarding myths, 75.0% rejected the notion of ritual impurity, 82.0% disagreed with activity restrictions during menstruation and 79.0% debunked the myth that cooking during menstruation harms food purity. Awareness about the benefits of exercise, the irrelevance of dietary restrictions and the importance of open discussions also reflected moderate to high knowledge levels. Overall, 88.8% recognized schools’ vital role in menstrual health education, emphasizing the need for structured educational interventions (Table 2).
The distribution of knowledge scores among participants revealed that 44.0% of the girls demonstrated a "Good" level of awareness (60-79% correct responses), while 32.5% achieved a "Very Good" level (≥80%), indicating that over three-fourths of respondents possessed a commendable understanding of menstrual hygiene and myth-related issues. Meanwhile, 19.0% exhibited "Fair" knowledge (40-59%) and a small segment (4.5%) had "Poor" knowledge (<40%). These findings suggest a strong baseline of menstrual health awareness among adolescent girls in Kangra, although they also highlight a significant minority that could benefit from intensified, targeted educational initiatives to eliminate persistent myths and reinforce safe menstrual hygiene practices (Table 3).
This study provides valuable insights into the awareness and knowledge of menstrual hygiene practices and prevailing menstrual myths among adolescent girls in Kangra district. Despite menstruation being a fundamental biological process, it remains shrouded in stigma and misinformation, particularly in rural and semi-urban communities. The findings of this study highlight both encouraging progress in menstrual health education and critical areas requiring further intervention.
Table 1: Socio-demographic characteristics of participants
Variable | Category | Frequency (n) | Percentage (%) |
Age Group (Years) | 13-15 | 142 | 35.5 |
16-17 | 138 | 34.5 | |
18-19 | 120 | 30.0 | |
Education Level | Primary school | 56 | 14.0 |
Secondary school | 224 | 56.0 | |
Higher secondary | 120 | 30.0 | |
Residence | Urban | 166 | 41.5 |
Rural | 234 | 58.5 | |
Family Type | Nuclear | 232 | 58.0 |
Joint | 168 | 42.0 | |
School Attendance | Regular | 357 | 89.3 |
Irregular | 43 | 10.8 |
Table 2: Awareness and knowledge of menstrual hygiene and myths among participants
No. | Question | Options | Correct Responses (n) | Percentage (%) |
1 | What physiological process underlies menstruation? | a) Digestive cycle, b) Endometrial shedding, c) Hormonal imbalance, d) Blood purification | 334 | 83.5 |
2 | How does maintaining menstrual hygiene prevent health risks? | a) Reduces infections like UTIs, b) Improves mood, c) Only aids comfort, d) No health impact | 351 | 87.8 |
3 | What is the optimal frequency for changing menstrual absorbents? | a) Every 12 hours, b) Every 4-6 hours, c) Once daily, d) Only when full | 308 | 77.0 |
4 | How do unhygienic menstrual practices contribute to reproductive health issues? | a) Increase risk of bacterial vaginosis, b) Cause weight gain, c) Only affect mood, d) No impact | 323 | 80.8 |
5 | Are properly sanitized reusable menstrual cloths safe for use? | a) Yes, b) No, c) Only with chemical disinfectants, d) Only in urban settings | 286 | 71.5 |
6 | Why is daily bathing during menstruation recommended? | a) Prevents odor and infections, b) Only for comfort, c) Only in warm climates, d) No need | 339 | 84.8 |
7 | What makes menstrual cups a viable hygiene option? | a) Safe with proper sterilization, b) Unsafe due to leakage, c) Only for heavy flow, d) Only for adults | 255 | 63.8 |
8 | Why is hygienic disposal of menstrual waste critical? | a) Prevents environmental contamination, b) Only for aesthetics, c) Only in urban areas, d) No impact | 344 | 86.0 |
9 | Does menstruation confer ritual impurity on girls? | a) Yes, b) No, c) Only in religious contexts, d) Only in rural traditions | 300 | 75.0 |
10 | Are restrictions on daily activities during menstruation justified? | a) No, b) Yes, c) Only for strenuous tasks, d) Only during heavy flow | 328 | 82.0 |
11 | How does menstruation impact educational attendance? | a) No inherent impact, b) Causes unavoidable absence, c) Only in rural schools, d) Only with pain | 273 | 68.3 |
12 | Is cooking during menstruation harmful to food purity? | a) Yes, b) No, c) Only for sacred meals, d) Only in traditional kitchens | 316 | 79.0 |
13 | What is the impact of moderate exercise during menstruation? | a) Generally safe and beneficial, b) Always harmful, c) Only for light flow, d) Only in urban areas | 290 | 72.5 |
14 | Are dietary restrictions during menstruation scientifically supported? | a) Yes, b) No, c) Only for certain foods, d) Only in traditional diets | 265 | 66.3 |
15 | When does menstrual pain warrant medical evaluation? | a) If severe or persistent, b) Always normal, c) Only in young girls, d) Only with heavy bleeding | 278 | 69.5 |
16 | Why is open discussion of menstruation important? | a) Reduces stigma and misinformation, b) No benefit, c) Only in schools, d) Only with family | 261 | 65.3 |
17 | What is the role of schools in menstrual health education? | a) Provide comprehensive awareness, b) No role, c) Only for older students, d) Only in urban schools | 355 | 88.8 |
18 | Which practice is least relevant to menstrual hygiene? | a) Frequent absorbent change, b) Proper waste disposal, c) Regular hygiene, d) Avoiding social gatherings | 269 | 67.3 |
19 | Are tampons a safe menstrual hygiene option with proper use? | a) Yes, b) No, c) Only for heavy flow, d) Only in urban settings | 250 | 62.5 |
20 | Who is best suited to deliver menstrual health education? | a) Peers, b) Trained educators/health professionals, c) Religious leaders, d) Parents | 341 | 85.3 |
Table 3: Knowledge score classification
Knowledge Category | Score Range | Frequency (n) | Percentage (%) |
Very Good | ≥80% | 130 | 32.5 |
Good | 60%-79% | 176 | 44.0 |
Fair | 40%-59% | 76 | 19.0 |
Poor | <40% | 18 | 4.5 |
The socio-demographic profile of the participants showed that a majority of the girls were aged between 13 and 17 years, with more than half enrolled in secondary education. Notably, a significant proportion (58.5%) resided in rural areas, where access to menstrual health resources and information is typically more limited compared to urban settings. Regular school attendance among 89.3% of the participants suggests an important opportunity for integrating structured menstrual health education into school curricula to reach a broad audience during their formative years.
In terms of menstrual hygiene awareness, the results are promising. Most participants demonstrated good knowledge regarding the physiological basis of menstruation, the importance of hygiene practices, the optimal frequency for changing absorbents and the significance of proper waste disposal. Awareness about daily bathing during menstruation and the environmental impacts of menstrual waste was high, indicating a positive shift towards the adoption of safe menstrual practices. Such findings are encouraging and suggest the impact of increasing discussions around menstrual hygiene in recent years, propelled by school programs, non-governmental initiatives and media campaigns [6,8].
However, notable gaps remain. Awareness about newer menstrual hygiene options like menstrual cups and tampons was relatively low, with only 63.8% and 62.5% of participants, respectively, recognizing their safe use. This highlights a continued reliance on traditional menstrual products, potentially due to lack of exposure, cultural hesitations, or misinformation. Efforts must therefore be made to improve adolescent girls' access to comprehensive information about a range of menstrual hygiene options, allowing informed personal choice and reducing reliance on unsafe or unhygienic practices.
Importantly, the study sheds light on the persistence of menstrual myths, though there are encouraging signs of change. A significant majority of girls rejected the notion of ritual impurity (75.0%) and disagreed with restrictions on daily activities during menstruation (82.0%). Nevertheless, approximately one-third of participants still endorsed some form of traditional misconceptions, such as believing in food restrictions or associating menstruation with loss of purity. These findings mirror broader trends observed in rural India, where traditional beliefs remain deeply ingrained and often hinder open discussions about menstrual health [5,7,9].
The knowledge score classification further substantiates the need for ongoing educational initiatives. Although over three-fourths of participants demonstrated Good to Very Good awareness, about 23.5% of girls fell into the Fair or Poor categories, indicating a vulnerable subgroup still lacking adequate knowledge. Targeted interventions, particularly focused on dismantling myths and promoting scientifically accurate information, are crucial to reaching these adolescents and ensuring that no girl is left behind due to misinformation or stigma.
The strong recognition among participants (88.8%) of schools’ role in menstrual health education underscores the importance of institutional involvement in menstrual literacy programs. Schools, along with trained educators and healthcare professionals, must be empowered to deliver accurate, culturally sensitive and age-appropriate information. Additionally, involving families and community leaders in awareness campaigns can facilitate a supportive environment where adolescent girls feel comfortable discussing menstruation without fear or shame.
This study, however, is not without limitations. Being an online survey, it may have preferentially included adolescents with better access to digital resources, potentially excluding more marginalized groups who might have even lower levels of awareness. Moreover, self-reported responses may be influenced by social desirability bias. Future research should consider mixed-method approaches, including in-depth interviews or focus groups, to gain a more nuanced understanding of beliefs and practices.
In conclusion, while the study highlights encouraging levels of menstrual hygiene awareness among adolescent girls in Kangra, the persistence of certain myths and knowledge gaps calls for continued, multi-faceted educational efforts. A holistic, community-supported approach emphasizing factual menstrual education, open dialogue and the normalization of menstruation is essential to empower adolescent girls, safeguard their health and foster menstrual dignity and equity.
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