An Integral Approach to Menstrual Hygiene Management - Understanding adolescent girls’ experiences of menstruation in Sri Puram, India

Background: Menstruation and menstrual hygiene management are central to the lived experiences of most girls and women around the world for much of their lives, yet is often under researched and ignored on the development agenda. Research objectives: This study sought to explore adolescent girls’ experiences of menstruation in Vellore, India, through looking at resources available, the use of these resources, coping strategies, and social and emotional wellbeing. Data materials and methods: This was a qualitative study. Photovoice and three individual indepth interviews with female adolescent students, one group in-depth interview with health experts, and one focus group discussion with female teachers were the methods of data gathering. The data were coded in Atlas.TI and analysed using thematic network analysis. Findings: This study found that the lived experiences of menstruation were complex and interconnected. Availability of, and access to resources such as sanitary pads plays a role in menstrual hygiene management, and is connected to structural and environmental factors. Access to such resources was not a problem for the participants in this study. Use of the resources and strategies developed by the participants were influenced both by personal motivations, and information and knowledge passed down through both formal and informal structures, such as school, health services, friends and mothers. Social wellbeing was found to be connected to the relationships of the participants with the people in the community. Relationships with women often act as a support, while relationships with men were found to be a source of stress. Social wellbeing was also found to be connected to the relationship to culture and traditions. Emotional wellbeing is connected to both individual and communal factors, and shaped by structures, environments and relationships. Conclusion: Emotional responses, actions and behaviours, social norms and relationships, and structures and environments all interact and influence one another, and must be understood together to form a complete picture of the complexity of the menstrual experience. As menstruation and MHM are central to women’s health, they are also central to health promotion and understanding these lived experiences is essential to moving forward, and promoting positive change