Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis

Abstract

Objectives

To assess the status of menstrual hygiene management (MHM) among adolescent girls in India to determine unmet needs.

Design

Systematic review and meta-analysis. We searched PubMed, The Global Health Database, Google Scholar and references for studies published from 2000 to September 2015 on girls’ MHM.

Setting

India.

Participants

Adolescent girls.

Outcome measures

Information on menarche awareness, type of absorbent used, disposal, hygiene, restrictions and school absenteeism was extracted from eligible materials; a quality score was applied. Meta-analysis was used to estimate pooled prevalence (PP), and meta-regression to examine the effect of setting, region and time.

Results

Data from 138 studies involving 193 subpopulations and 97 070 girls were extracted. In 88 studies, half of the girls reported being informed prior to menarche (PP 48%, 95% CI 43% to 53%, I ² 98.6%). Commercial pad use was more common among urban (PP 67%, 57% to 76%, I ² 99.3%, n=38) than rural girls (PP 32%, 25% to 38%, I ² 98.6%, n=56, p<0.0001), with use increasing over time (p<0.0001). Inappropriate disposal was common (PP 23%, 16% to 31%, I ² 99.0%, n=34). Menstruating girls experienced many restrictions, especially for religious activities (PP 0.77, 0.71 to 0.83, I ² 99.1%, n=67). A quarter (PP 24%, 19% to 30%, I ² 98.5%, n=64) reported missing school during periods. A lower prevalence of absenteeism was associated with higher commercial pad use in univariate (p=0.023) but not in multivariate analysis when adjusted for region (p=0.232, n=53). Approximately a third of girls changed their absorbents in school facilities (PP 37%, 29% to 46%, I ² 97.8%, n=17). Half of the girls’ homes had a toilet (PP 51%, 36% to 67%, I ² 99.4%, n=21). The quality of studies imposed limitations on analyses and the interpretation of results (mean score 3 on a scale of 0–7).

Conclusions

Strengthening of MHM programmes in India is needed. Education on awareness, access to hygienic absorbents and disposal of MHM items need to be addressed.

Trial registration number

CRD42015019197.