Sanitation and Health-Seeking Behaviour among Adolescent Girls

Abstract

Background: Menstrual health is influenced not only by individual knowledge but also by school sanitation, privacy, product availability and access to appropriate health care. This study assessed school sanitation, menstrual health problems and health-seeking behaviour among adolescent girls in coastal Kozhikode, Kerala.

Methods: A descriptive cross-sectional study was conducted among 400 girls aged 13–19 years studying in Classes IX–XII in nine government schools. Stratified random sampling with proportional allocation was used. Data were collected using a structured interview schedule, non-participant observation and focused group discussions. Descriptive and inferential analyses were conducted using SPSS version 18 and MS Excel.

Results: The mean school sanitation score was 6.77±2.05 out of 15 (45.17% of maximum), while the menstrual health score was 6.07±2.45 out of 18 (33.73%). Only 7.5% reported that school toilets were cleaned at least once daily, while 52.8% reported weekly cleaning. Nearly one-third (29%) missed school during menstruation, 84% did not change menstrual pads at school, and 63.8% felt uncomfortable changing pads at school. Although 58% reported sanitary-pad vending machines, functionality was problematic. Only 16.3% reported functional incinerators, while 31% reported non-functional incinerators. Menstrual pain was reported by 84.5%, irregular periods by 27.5%, and only 3.0% visited a health worker for menstrual pain. Overall, 81.8% did not seek medical assistance for reported menstrual health problems because they considered them normal.

Conclusion: School sanitation and menstrual health remain important equity concerns even in a relatively developed state context. Functional WASH infrastructure, privacy, product availability, waste management and adolescent-responsive health services should be integrated into school menstrual health programmes.