*Dept. of Community Medicine, Mahatma Gandhi Medical College & Research institute, Pondicherry
**Geetanjali Medical College and Hospital, Udaipur, Rajasthan
#Department of Community Medicine, A.V. Medical College, Pondicherry

Corresponding Author: Dr. Rajkumar Patil, Department of Community Medicine, Mahatma Gandhi Medical College & Research Institute,
Pondicherry. Email : ddrraj49@gmail.com

Abstract Background: Menstruation is a normal physiological process but people have many misconceptions. Objectives: To identify various myths and misconceptions about menstruation and ascertain if there is a difference between illiterates and literates. Methods: A cross-sectional study was carried out among the villagers under the catchment area of Community Medicine Department of A. V. Medical College, Pondicherry. Total 339 consecutive households were included and one adult respondent from each household was interviewed using a pre-structured questionnaire. Data were analysed using SPSS software. Proportions and Chi square test were used. Results: Nearly two third of the respondents (65.4% illiterates as well as 62.1% literates) believed that menstruating blood is dirty. Regarding myths, “Placing broom stick, neem leaves & footwear around the girl prevents intrusion of evil spirits” and “woman after menstruation must have a purifying bath”; there was very significant (p < 0.01) difference between literates and illiterates. When it was asked whether any activity of daily life (e.g. entry to kitchen, temple, sleeping on bed etc.) should be prohibited, most of the respondents (illiterates 97.8% and literates 90.2%) said “yes”. Almost all (100%) who said “yes”, believe that women should not enter a temple during menstruation. Conclusion: Most of the people lack awareness; they still believe in old sayings. Literates are also having myths indicating that there is a strong need for creating awareness among literates also. Females had more misconceptions as compared to males. Key words: Behavior; attitudes; practice; awareness; literacy.

Introduction

Many traditional practices and myths surround normal physiological processes such as menarche, and when young people are not given scientific explanations of such phenomena, they are left puzzled and are unable to differentiate between myth and reality [1]. Still one can find a woman sitting in neglected corner of a house in any village because of her menstrual period. In India even mere mention of the topic has been a taboo in the past and even to this date the cultural and social influences appear to be a hurdle for advancement of knowledge on the subject [2].

Menstruation is a normal physiological process which has many associated myths and misconceptions. Health behaviours and practices vary from culture to culture, and ignorance of culturally divergent beliefs and practices may lead to failure in health care delivery, thereby complicating various reproductive health problems [3]. Literacy is one of the important factors associated with various social stigmas and myths regarding menstruation.

There are many studies among adolescents about perception towards menstruation, but studies in adults are lacking. In fact, the adults are going to influence the thinking and beliefs of the adolescents which is of significant importance for the community. The present study attempted to outline the various myths and misconceptions prevalent about menstruation and to ascertain the difference between literates and illiterates.

Methods

This community-based cross-sectional study was conducted by the Department of Community Medicine, A. V. Medical College, Pondicherry, to know the beliefs about menstruation in rural area of Pondicherry. No data could be found out from past literature about proportion of illiterate and literate
having misconceptions about menstruation. To determine sample size, P was taken as 0.5, considering the theory of probability 50% (which gives the maximum sample size), thus sample comprised 339 villagers, considering 95% confidence interval and allowing 10% error. One village was selected by simple random sampling method, out of 4 villages (each village was having more than 350 families) under the catchment area of RHTC, Manapet. After proper training and orientation, Compulsory Rotatory Resident Interns (CRRIs) conducted door to door survey in the village during their Community Medicine posting (1st January 08-15th February 08). Consecutive 339 households (exclusion criteria: door locked and no consent) were covered. A pre-tested semi-structured questionnaire was used to interview 339 respondents aged ≥ 18 years (one adult from each household). Before interview, villagers were informed about the purpose of the study and consent was taken. A person who can read and write with understanding in any language was considered as literate [4] in the study.

Besides demographic information, questions related with restriction of daily life activities (e.g. entry to kitchen, temple, sleeping on bed etc.) and various beliefs about menstruation (menstrual blood is dirty blood, excessive sweets lead to excessive menstruation, purifying bath is must after menses etc.) were included in questionnaire.

The data collected was analysed using SPSS software. Simple proportions and Chi-square test were used to compare the differences between literates and illiterates.

Results

Literacy is an important determinant for individual as well as community health. Out of 339 study subjects, 136 (40.1%) were illiterates and female to male ratio was 1.8:1 (as most of the men were at work in the field).

Most of the respondents were housewives (37.8%) followed by farmers (33.3%). Out of 339 respondents, 44.2% belonged to socio-economic class V (according to Modified Prasad’s classification), 31.6% belonged to class IV, 15.3% to class III and 7.1% to class II and only 1.8% were in class I.

The misconceptions were more prevalent in the females viz. menstrual blood is dirty blood (72.5% vs 2 47.1%, χ² value-21.59, p < 0.001), broom sticks prevents intrusion of evil spirits (60.1% vs 47.1%, χ² value-5.31, p = 0.02), excessive sweets lead to excessive menstruation (70.6% vs 42.1%, χ² value-26.43, p < 0.001) and purifying bath is must after menses (86.2% vs 61.9%, χ² value-26.32, p < 0.001).

The observations among literates and illiterates regarding various misconceptions have been tabulated in Table 1.

Table 1- Myths and beliefs about menstruation among illiterates and literates

The beliefs that “evil spirits entry in body of menstruating girl can be prevented by placing broom sticks or footwears or neem leaves around the girl” and “a woman must have a purifying bath after menstruation” were significantly more prevalent among illiterates.

When it was asked whether any activity of daily life (e.g. entry to kitchen, temple, sleeping on bed etc.) should be prohibited, most of the respondents (illiterates 97.8% and literates 90.2%) said “yes”. Almost all (100%) who said “yes” told that women should not enter the temple during menstruation (Table 2).There was significant difference between illiterates and literates regarding two prohibited practices: “entry to kitchen” and “touching a holy book” (Table 2).

Table 2- Prohibited practices during menstruation among illiterates and literates

Discussion

Menstruation is a normal physiological process that is viewed differently according to various social and cultural understandings [5]. In an age when research is sweeping away many long-held medical misconceptions, the body of knowledge surrounding women's menstrual cycle remains tainted by age-old myths and taboos [6]. In India, menstruation blood is considered as dirty and polluting [7]. 63.4% of respondents had this misconception in the present study. Subject of menstruation revolves round the notion of dirt, taboos and restrictions in various spheres of women's lives in India [8]. Misconceptions were widely prevalent in the present study group ranging from 55% to 77%.

Many restrictions are imposed on women during menstruation in Indian rural setting. Many daily household chores which are considered 'holy' or 'sacred' are prohibited [9]. In India there is one very strong belief “a menstruating woman can’t take part in religious ceremony”. “Entry to temple” was the most common restricted activity and almost all illiterates as well as literates are having this belief. It shows that even literacy can’t change the religious and social stigmas associated with menstruation. In a recent study [10], 41.5% of adolescent girls told that pooja room entry is forbidden, in the present study 93.8% adults believed that during menstruation woman should not go to a temple. The difference may be due to the area and age group involved in the study. A study conducted by Singh A J showed similar findings [11]. In the present study it was found that illiterates were having more misconceptions as compared to literates when some misconceptions are considered but overall the situation didn’t differ much. Awareness is lacking about menstruation. Although it is a normal physiological process and a common indication of non-pregnant state, people consider it dirty and unholy, which may lead to some psychological problems in adolescence. There is a need for creating awareness regarding physiology of menstruation, more among females since the misconceptions are much more prevalent among the females. The present study reveals that literacy does not make a person more aware about menstruation. Here lies the difference between literacy and education. Education about menstruation needs to be imparted to all adults to increase the awareness among them so that misconceptions can be removed and unnecessary ostracisation of the menstruating female is avoided.

Key Points IEC (Information Education Communication) activities should be directed not only towards illiterates but also for literates. Females are having more misconceptions as compared to males. Reproductive health education should be targeted not only to young ones but also to adult population and specifically among the females. In villages even if adolescent girls want to avoid these myths, middle aged people tend to impose their customs on them without knowing the truth.

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