Menstruation is a natural and essential part of a woman's reproductive health cycle. It signifies the ability to bear children and is thus a crucial aspect of a woman's life. However, despite its significance, menstruation continues to be surrounded by stigma, myths, and misconceptions in many parts of the world, including Himachal Pradesh, India. The lack of accurate information and hygienic practices related to menstruation can have profound implications for the health and well-being of women [1-3].

Himachal Pradesh, nestled in the northern region of India, is known for its scenic beauty and rich cultural heritage. However, the state, like many others in India, grapples with challenges related to menstrual hygiene management (MHM) among its female population. Ensuring proper menstrual hygiene is crucial to prevent menstrual disorders, reproductive tract infections (RTIs), and other health issues that can affect women's quality of life [4-6].

The outpatient department (OPD) of Zonal Hospital in Dharamshala, Himachal Pradesh, serves as a vital healthcare facility catering to a diverse population of reproductive age group females. These women seek healthcare services for various reasons, making the OPD a potential gateway for addressing issues related to menstrual hygiene. Understanding the level of knowledge and practices related to menstrual hygiene among this specific group of women attending the Zonal Hospital OPD is pivotal for designing targeted interventions and improving women's overall reproductive health [7-9].          

Several studies have highlighted the gaps in menstrual hygiene knowledge and practices among women in India [1-3]

These studies emphasize the need for educational interventions that promote awareness and dispel myths surrounding menstruation. However, to our knowledge, there is limited research focusing on menstrual hygiene knowledge among women seeking healthcare services in the Himachal Pradesh region, particularly in the context of Zonal Hospital's OPD.

This study aims to assess the level of menstrual hygiene knowledge among reproductive age group females attending the outpatient department of Zonal Hospital, Dharamshala, Himachal Pradesh. By identifying gaps and potential areas for targeted educational interventions, this research endeavors to contribute to improved menstrual hygiene practices and, subsequently, the overall reproductive health of women in the region.

Through this investigation, we seek to shed light on the existing knowledge gaps and challenges that women in Himachal Pradesh face concerning menstrual hygiene, ultimately advocating for comprehensive and informed approaches to menstrual health education and management in the region.

Objectives of the Study

To assess the level of Menstrual Hygiene knowledge among reproductive age group females attending the outpatient department of Zonal Hospital, Dharmshala, Himachal Pradesh, with the objective of identifying gaps and potential areas for targeted educational interventions.

Research Methodology

• Research Approach: Descriptive

• Research Design: Hospital based cross-sectional survey design

• Setting of the Study-OPD in Zonal Hospital, Dharmshala, Himachal Pradesh

• Study Duration: Between January 2023- March 2023

• Study Population: Women aged between 15-45 years came to OPD

• Sample Size- 400 women, assuming 50% have adequate knowledge regarding Menstrual Hygiene, 5% absolute error, 95% confidence level, and 5% non-response rate.

• Sampling Technique: convenience Sampling technique

• Sampling Criteria: First five female patients who came to OPD were selected everyday till the completion of sample size after explaining the purpose of the study. Informed consent was taken from them and confidentiality of the selected participants was also maintained 

• Inclusive Criteria: Female patients who were willing to participate in the study.

• Exclusion Criteria: Female patients who were not willing to participate in the study

Description of Tool

• Demographic Data Survey Instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education, family’s monthly income etc.

• Questionnaire: The questionnaire contains 20 structured Menstrual Hygiene knowledge related questions. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20) = very good, 60-79% (12-15) = Good, 41-59% (811) = Fair, <40% (< 8) = poor

• Validity of Tool: By the experts in this field

• Data Collection: By under the guidance of supervisors and patients were given 30 minutes time to complete that questionnaire and collected at the end of the prescribed time

• Data Analysis: With Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage.

The goal of the current study was to assess the level of Menstrual Hygiene knowledge among women attending the outpatient department of Zonal Hospital, Dharmshala, Himachal Pradesh. A total of 400 respondents including 133 (33.25%) from urban area and 267 (66.75%) from rural area were participated in the study (Table 1).

Table 1: Knowledge Regarding Menstrual Hygiene among Study Participants

In the present study 26.5% (106) participants had very good knowledge (16-20 marks) towards Menstrual Hygiene, 49.5% (198) had good knowledge (12-15 marks), 16.25% (65) had fair knowledge (8-11 marks) and 7.75% (31) having poor knowledge (<8 marks).

Table 2: Knowledge Score RegardingMenstrual Hygiene among Study Participants

The present study aimed to assess the level of menstrual hygiene knowledge among women attending the outpatient department of Zonal Hospital in Dharmshala, Himachal Pradesh. The findings reveal a range of knowledge levels among the participants, with a substantial portion exhibiting good to very good knowledge regarding menstrual hygiene. This discussion will analyze and interpret the study results, compare them with existing literature, and highlight the implications for menstrual hygiene education and awareness in the region.

The study findings indicate that a significant percentage of the participants demonstrated good knowledge on several aspects of menstrual hygiene. Notably, a high percentage of respondents correctly understood the basics of menstruation, such as its purpose and the typical menstrual cycle length. This suggests that foundational knowledge about menstruation is relatively well-established among the study population.

Furthermore, a majority of participants correctly recognized the importance of washing hands before and after handling menstrual hygiene products and understood the health risks associated with unclean or unsanitary menstrual hygiene practices. These findings underscore the awareness of the crucial role of hygiene in menstrual health and the potential health consequences of neglecting it.

In addition, a substantial proportion of respondents acknowledged the significance of menstrual hygiene education in schools and communities, demonstrating an understanding of the importance of comprehensive menstrual health education beyond individual knowledge.

However, the study also revealed areas where knowledge gaps exist. For instance, fewer participants could name the primary components of menstrual blood or common menstrual disorders. This suggests a need for enhanced knowledge dissemination on these topics. Similarly, questions related to the environmental impact of disposable menstrual hygiene products received lower correct response rates, emphasizing the necessity of educating women about sustainable menstrual hygiene options.

The findings regarding cultural or social taboos around menstruation are noteworthy. While a majority of participants recognized the existence of such taboos in their community, this highlights the importance of addressing cultural sensitivities and promoting open discussions to challenge and overcome stigma associated with menstruation.

Moreover, a substantial proportion of respondents understood the positive impact of a healthy diet and lifestyle on menstrual health. This finding aligns with the growing recognition of the holistic relationship between overall health and menstrual well-being.

Overall, the study results provide valuable insights into the level of menstrual hygiene knowledge among women in the Himachal Pradesh region. While there is a solid foundation of understanding, particularly concerning hygiene practices, there are clear opportunities for improvement in areas such as environmental awareness, menstrual disorders, and cultural sensitivities.

Comparing these findings with previous studies in India, such as those by Thakre et al [1], Dasgupta et al [2] and Oster et al [3], it is evident that the menstrual hygiene knowledge levels in this study's population are generally consistent with or even exceed the levels reported in these earlier studies. However, these studies vary in scope and geographical locations, making it crucial to consider regional variations in knowledge and practices.

In conclusion, this study provides valuable insights into the knowledge of menstrual hygiene among women attending the Zonal Hospital OPD in Himachal Pradesh. The findings underscore the importance of ongoing educational interventions tailored to the specific needs of this population. Addressing knowledge gaps and promoting open dialogue about menstrual health can contribute to improved menstrual hygiene practices, reduced health risks, and enhanced overall well-being for women in the region.

1. Thakre, S.B. et al. “Menstrual hygiene: knowledge and practice among adolescent school girls of Saoner, Nagpur district.” Journal of Clinical and Diagnostic Research vol. 5, no. 5, 2011, pp. 1027–1033.

2. Dasgupta, A. and Sarkar, M. “Menstrual hygiene: how hygienic is the adolescent girl?” Indian Journal of Community Medicine vol. 39, no. 2, 2014, pp. 143–147.

3. Oster, E. et al. “Menstruation, sanitary products, and school attendance: evidence from a randomized evaluation.” American Economic Journal: Applied Economics vol. 7, no. 1, 2015, pp. 1–26.

4. Kumar, A. et al. “Cultural and social practices regarding menstruation among adolescent girls.” Indian Journal of Community Health vol. 29, no. 1, 2017, pp. 46–53.

5. Tegegne, T.K. and Sisay, M.M. “Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia.” BMC Public Health vol. 14, no. 1, 2014, p. 1118.

6. Hennegan, J. et al. “A qualitative understanding of the effects of reusable sanitary pads and puberty education: implications for girls’ education and reproductive health in rural Uganda.” Reproductive Health vol. 13, no. 1, 2016, p. 143.

7. Sommer, M. et al. “Comfortably, safely, and without shame: defining menstrual hygiene management as a public health issue.” American Journal of Public Health vol. 105, no. 7, 2015, pp. 1302–1311.

8. Mason, L. et al. “‘We keep it secret so no one should know’: a qualitative study to explore young schoolgirls’ attitudes and experiences with menstruation in rural western Kenya.” PLoS ONE vol. 8, no. 11, 2013, e79132.

9. Kuhlmann, A.S. et al. “Menstrual hygiene management in resource-poor countries.” Obstetrics and Gynecology vol. 129, no. 5, 2017, pp. 957–966.