Although sexual issues are openly discussed in the media, sexuality and reproductive functions are treated as taboo. Menstruation is a normal physiologic process, but carries various meanings within cultures and is rarely discussed amongst families and communities.
This study sought to assess the knowledge and practices of secondary school girls towards menstruation in the Thulamela municipality of Limpopo Province, South Africa.
A quantitative descriptive study design was used and respondents were selected by means of convenience sampling from a population of secondary school girls. The sample consisted of 273 secondary school girls doing Grades 10–12. A self-administered questionnaire was used to collect data, which was analysed by computing frequencies and percentages using the Statistical Package for Social Sciences (SPSS version 12).
The findings revealed that respondents experienced menarche at 13 years and that menstruation is a monthly bleeding (80%) that happens to every female; it is a sign of adulthood (91%). 15% reported that it is the removal of dirt from the stomach and abdomen, 67% indicated the source of menstruation being the uterus, 65% the vagina and 13% from the abdomen. 73% reported having fear and anxiety at the first experience of bleeding and that they could not maintain adequate hygienic practices due to a lack of privacy and sanitary towels.
Interventions are needed to increase girls’ opportunities to discuss menstruation and access information from adults including mothers, parents and guardians. School-based sexuality education should be comprehensive, begin early and be regularly repeated.
The menstrual cycle is the cycle of natural changes that occurs in the uterus and ovary as an essential part of making sexual reproduction possible. In human females, the menstrual cycle occurs repeatedly between the ages of menarche, when cycling begins, until menopause. Amongst girls, the first signs of puberty may emerge as early as 8 or 9 years and terminate at 15 or 16 years, with menarche. The average age of menarche of 12–13 years in most developing countries has been well established, with surveys showing that urban, educated, middle-class girls in many countries are now starting their periods on average at 12.5 years or earlier (World Health Organization [WHO] 2011). South Africa has also reported a similar mean age of menarche, and according to HIV & AIDS and STI National Strategic Plan (NSP 2007–2011), 6% of adolescent girls (15–24 years) reported having had sex by age 15 years. According to the SADHS (
that mothers, teachers, friends, relatives, television and books are the main source of providing information about menstruation to the adolescent girls. However, it is also seen that information received from these sources is often inaccurate and partial. (p. 44)
The way in which adolescent girls are prepared for their first menstruation may influence their reaction to it as well as the way they see themselves as young women. Amaral, Hardy and Hebling (
Menstruation and the menstrual cycle create a psychological discomfort for adolescents. Although menstruation is a natural process, it is often linked with several misconceptions and cultural practices. However, this depends upon knowledge and awareness of the subject which has an impact on the female adolescent in the event of menarche. Usually amongst black ethnic communities such discussions or information are not open, they are private and very discreet. Information given at this stage is generalised, and pertains to issues of how to behave and not ‘playing’ with boys without discussing the critical issues relating to menarche, conception, contraception, menstrual hygiene and reproductive health. Lack of menstrual information was observed in the same study, where adolescent girls could not specify the natural method of contraception as they could not relate the menstrual cycle with conception.
The aim of the study was to assess and describe menstrual knowledge and practices amongst female adolescents in the Vhembe district of Limpopo Province.
Assess menstrual knowledge of female adolescents in the Vhembe district of Limpopo Province.
Describe menstrual practices of female adolescents in the Vhembe district of Limpopo Province.
A quantitative, explorative, descriptive design was used to assess menstrual knowledge and practices of secondary schools female adolescents at the Thulamela municipality, Limpopo Province. Explorative and descriptive studies were used to gain more information about menstrual knowledge and practices, as it provided a contextual picture of the situation. The target population included female adolescents aged 14–19 years in Grades 10–12 at six secondary schools. Non-probability convenience sampling was used to obtain a sample of 273 female adolescents, with 148 within the age range of 14–17 years and 98 being 18–19 years, whilst 27 had not specified their ages. The criteria for selection were all adolescent females who were already experiencing menstruation and were nulliparous. Systemic sampling of education circuits was conducted and six circuits were sampled and one secondary school randomly selected, which resulted to six secondary schools surveyed. Data was collected through self-report questionnaires that were distributed to female adolescents. Respondents in a survey answered the questions based on demography, knowledge of menstruation, attitudes, source of information and practices towards menstruation. Data was then manipulated by the Statistical Package of Social Science version 17, in order to describe the phenomenon (Polit & B.P. Beck 2008). Ethical approval was obtained from the provincial Department of Education, school principals and school governing bodies. The purpose of the study was given to the study respondents in their local languages. Female respondents were approached for their verbal and written consent. The confidentiality of the information was maintained by assigning identification numbers to each questionnaire. The respondents were informed that participation was voluntary, and that they could withdraw from the study at any time. Anonymity was maintained by ensuring that the names and identity would not be recorded. Participation in the study included informed consent from school governing bodies of the respective schools and written consent from the participants’ parents/guardians. A consent form was attached to the covering letter for parents/guardians to sign prior the distribution of questionnaires.
A pilot study is a small-scale trail run on a limited sample from the same population as that of the final study before the main/final study is done (Polit & B.P. Beck 2008). A pilot study was carried out at Vhumbedzi circuit, where questionnaires were distributed to twenty female adolescents to determine the feasibility of the proposed study and to detect flaws in the questionnaire. No corrections emanated from the pilot study, and all questions were found to be clear.
Validity refers to the degree to which the instrument measures what it is supposed to measure (Polit & C.T. Beck 2008). Content validity was achieved through a logical analysis of items, and was supported by literature review. Face validity involves the analysis of the questionnaire in view of face and content validity; to this end, the statistician endorsed the questionnaire for validity. Reliability was ensured by the test-retest method and internal consistency. The questionnaire was piloted to twenty female adolescents. The results of the pilot study were compared with those of the actual research. No discrepancies were observed, confirming the reliability of the instrument.
The results section attempted to obtain personal information about the respondents in order to contextualise the responses concerning sexuality issues against the knowledge of menstruation and practices by female adolescents.
Respondents’ age at menarche and knowledge of menstruation (
Variables | Frequency | Percentage |
---|---|---|
9–10 | 2 | 2 |
11–12 | 33 | 12 |
13–14 | 196 | 73 |
Others | 37 | 13 |
Yes | 200 | 73 |
No | 73 | 27 |
Regarding the knowledge of the participants prior to menarche, 27% reported knowledge of the physical changes that relate to menarche, 94% were aware of the social and religious restrictions, whilst (48%) were aware of hygienic practices and 98% were informed about the use of absorptive materials. Participants indicated that menstruation is a monthly bleeding (80%) that happens to every female; it is a sign of adulthood (91%). Fifteen percent reported that it is the removal of dirt from the stomach and abdomen. Regarding the source of menstruation, 67% indicated the uterus, 65% the vagina, whilst 11% indicated that it is from the abdomen, with 5% agreeing that it is from the stomach. Lack of sexuality information can have a detrimental effect on the sexual decisions in the reproductive life of the adolescent as it can affect sexual behaviour.
Respondents’ source of menstrual information.
Participants reported various practices related to menstruation: 37% reported to be using sanitary pads, 55% used cloths, 2% used newspaper and 26% used hand towels. Regarding the frequency of changing the absorptive material, 0.7% reported once, 95% twice and 7% thrice. Those who bathed once during menstruation were 58%, whilst 48% bathed twice. Method of disposing: 63% used the pit toilet; whilst 33% used refuse bins and 3% flushed the sanitary pads. Regarding caring for underwear, 7% washed and exposed these to sunlight, whilst 90% washed and hid the underwear, and 2% washed and discarded the underwear. When it came to the storage of underwear, 66% kept them clean and covered, whilst 29% kept them unclean and covered.
The age of the study participants ranged from 12 to 19 years. A similar study conducted by Ali and Rizvi (
that sexuality education should be available to all youth, at school and out of school, to address their sexuality health needs. They should have knowledge and an understanding of sexual development, human reproduction and healthy sexual behaviour. As puberty rites already address some aspects of sexual health, having more information on the sexuality education in the rites would strengthen the sexuality education given there and limit sexual problems that young girls experience. (p. 62)
Menstrual practices.
Variables | Frequency | Percentage |
---|---|---|
Use of sanitary pads | 100 | 37 |
Pieces of cloths | 150 | 55 |
Newspapers | 5 | 2 |
Hand towels | 70 | 26 |
Once | 2 | 0.7 |
Twice | 260 | 95 |
Thrice | 10 | 7 |
Once | 158 | 58 |
Twice | 110 | 40 |
Yes | 105 | 38 |
No | 168 | 62 |
Pit toilet | 173 | 63 |
Refuse bin | 90 | 33 |
Flush in toilet | 8 | 3 |
Wash and expose to sun | 20 | 7 |
Wash and hide | 247 | 90 |
Hide and discard | 5 | 2 |
Clean and covered | 190 | 66 |
Unclean and covered | 80 | 29 |
Regarding caring for underwear, 7% washed and exposed these to sunlight, whilst 90% washed and hid and 2% hid and/or discarded the underwear. The hygienic practice related to menstruation is also affected by the socio-economic factors. Since most of the adolescents live with extended family members, they are forced not to bath, or when bathing, it has to be very early in the morning or late in the evening in order to maintain privacy. This arrangement results in the situation that they can therefore not wash their underwear and dry them appropriately. Shah
According to McPherson and Korfine (
The study was limited by the quantitative data collection method; if triangulated with focus group discussions, more in-depth information might have been sought.
Mothers should be supportive to decrease their daughters’ negative reactions to menarche and to dispel their negative and secretive attitudes towards menstruation.
Maintaining good hygienic practices should be taught to maturing girls so that they understand the implications of their state of maturity.
Maturing girls should be empowered to view menstruation as a normal physiological process and not to shy away or keep it a secret for fear of embarrassment amongst peers if they matured early.
School health nurses should be made available to assist in enforcing sexuality education amongst female students with regard to menstruation, sex, teenage pregnancy, conception and contraception.
Involving premenarcheal girls in discussions about menstruation will help these girls to have a positive psychological and social mind-set about menstruation and dispelling the myths related to menstruation will assist young girls to positively embrace womanhood.
Most adolescents lack scientific knowledge about menstruation and puberty. Parents often are reluctant to discuss this topic with their adolescent girls. Socio-cultural beliefs that accompany menarche and hygienic practices greatly impact negatively at the health of adolescents, and it is from this perspective that reproductive health education campaigns target puberty education so that young women may start adopting healthy lifestyles and develop adequate skills for sexual and reproductive health in future so as to achieve the millennium development goal of improving and reducing maternal mortality.
The author would like to thank the female adolescents, school governing bodies, principals and the Vhembe district educational circuit for making the study a success.
The author declares that she has no financial or personal relationship(s) that may have inappropriately influenced her in writing this article.