BACKGROUND OF THE STUDY:

Adolescence is a transitional stage of physical and psychological development that generally occurs during the period from puberty to legal adulthood. The world health organization (WHO) defines an adolescent as any person between ages 10 and 19¹. It is a period in which an individual undergoes enormous physical and psychological changes. In addition, the adolescent experiences change in social expectations and perceptions.²Physical growth and development are accompanied by sexual maturation. Marked morphological changes in almost all organs and systems of body are responsible for the accelerated growth and changes in contours and sexual organs. In case of boys, active acceleration in growth of coarse pubic hair and fascial hair usually precede other signs of puberty such as voice changes. In girls, development of breasts, broadening of hips and rapid growth in height occurs and most importantly menarche (first menses) starts during this period. Hormonal changes are likely to result in thought pertaining to sex, irritability, restlessness, anger, and tension. Socially, adolescence consist in shifts from dependency to autonomy³.

Menstruation or period is normal vaginal bleeding that occurs as part of a woman’s monthly cycle. Every month, the women body prepares for pregnancy. If no pregnancy occurs, the uterus, or womb, sheds its lining. The menstrual blood is partly blood and partly tissue from inside the uterus. It passes out of the body through the vagina and is termed as menstruation.⁴The length of this cycle is 28 days from the start of one menstrual period to the start of next. Hormones are secreted in a Negative and positive feedback manner to control the menstrual.⁵

Menstrual cup is a feminine hygiene device which is inserted in to the vagina during menstruation to collect menstrual fluid and prevent it’s leaking on to clothes. Menstrual cups are usually made of flexible medical grade silicone. They are shaped like a bell with a stem.⁶Firstly the menstrual Cup was introduced in Kerala during the flood time in Alappuzha The Alappuzha Municipality in Kerala has launched “Project Thinkal” with the objective of encouraging the use of these cups instead of non-bio degradable sanitary pads. During the first phase of the program, 5,000 menstrual cups are distributed for free to female residents.⁷

NEED FOR THE STUDY:

Most of the girls and women in our country are using different methods of menstrual products for their menstrual protection. Majority of them are using sanitary pads, but they are unaware of the ill effects that happened due to continuous use of sanitary pads and due to faulty disposal technique of sanitary pads such as burning & dumping, that may contribute environmental pollution. The major ill effects that have occurring due to sanitary pads are urinary tract infections, cervical cancer, RTls etc. Because, pads are made up of innumerable chemicals including banned carcinogenic herbicides and also some absorbent gels, which absorbs all the moisture in our body and leaves the body dry and irritating. The sanitary pads also offer high long-term costs. Not only pads, disposable tampons have also cause environmental pollution vaginal dryness and risk of Toxic shock syndrome (TSS). Menstrual sponges cause leak on removal and period panties are very expensive.⁸ Female urethra is small so there is a risk of causing infections due to reusable sanitary pads. So to reduce the risk of infections can use a newly designed cup known as menstrual cup is a feminine hygiene device, greatly reduce the waste generated from menstrual cycles as it is reusable, unlike sanitary pads and tampons. Hence, it is more eco-friendly. Since it can be used for five or more years, it is more economical for an average family.

Menstrual Hygiene Management (MHM) is an integral part of the Swachh Bharat Mission Guidelines (SBM-G). The MHM Guideline (December 2015) is issued by the Ministry of Drinking Water and Sanitation to support all adolescent girls and women. According to it, the sanitary waste should be wrapped in leak proof pouches provided by producer and should be disposed with dry waste at the time of door-to-door collection.According to State of India’s Environment 2019 Survey, the Menstrual Hygiene Alliance of India (MHAI) has approximated that there are 336 million menstruating women in India, of which 36 per cent use disposable sanitary napkins — that totals to 121 million women. This implies that India has 12.3 billion disposable sanitary napkins to take care of every year, majority of which are not biodegradable/compostable.⁹

According to the Solid Waste Management (SWM) Rules 2016, the items contaminated with blood and body fluids, including cotton, dressings, soiled plaster casts, lines and bedding, are bio-medical waste and should be incinerated, autoclaved or microwaved to destroy pathogens. SWM Rules 2016 suggest that all menstrual waste should be sent to one of the 215 large scale common bio-medical waste incinerators that exist across the country.¹⁰ However, this requires organized segregation, collection and transportation of menstrual and other sanitary waste on a large scale. No viable models for this have been formulated or implemented till now. While incineration is being proposed as a solution, at present it is still not practiced^.

A study was conducted to assess the menstrual hygiene management and waste disposal in low and middle income countries. It is a structured search was performed to identify journal articles, reports and other grey literature related to menstrual hygiene management and disposal of absorbents. The result suggests that menstrual waste disposal may be more challenging in community settings than in institutional settings because the facilities are not as well managed further highlighting variations in disposal practices within urban areas, with slum based studies reporting inappropriate disposal more than urban focused studies.¹¹

As the commercially sold napkins and other menstrual products have many demerits so to overcome these problems a newer intervention named ‘menstrual cup’ was designed. Unlike tampons and pads, cups collect menstrual fluid rather than absorbing it. One cup may be reusable up to 10 years. The stem is used for insertion and removal. The bell-shaped cup seals against the vaginal wall just below the cervix. Every 4-12 hours (depending on the amount of flow), the cup is removed, emptied, rinsed and reinserted. After each period, the cup requires cleaning.⁶

As compared to other menstrual products like tampons and pads, menstrual cups are eco-friendly, reusable, economical, easy to clean, odorless, Free from infections, helps in tracking our menstrual blood loss, free from rashes, comfortable, lower the risk of cervical cancer and convenient also.¹²A cross sectional study was conducted to assess the adaptability and efficacy of menstrual cup in managing menstrual health and hygiene at Gujarat Medical Education and Research Society in 2017. The study shows that menstrual cups can replace the current methods of menstrual sanitation, due to lower cost and improved hygiene.¹³During the COVID-19 pandemic Healthcare workers in the hospital needs to wear personal protective equipment to treat the coronavirus safely healthcare workers on the front lines of the pandemic are reporting that they lack the resources to manage their periods between treating an overwhelming number of patient, not have menstrual products easily available, and following certain protocols for removing protective suits, changing sanitary pads and clothes aren’t always feasible. They have continuous duty hours from 7:00 AM to 8:00 PM so they cannot remove their pads during this time schedule in their menstrual periods. So, it may cause infection. Hence many of the health care workers use the menstrual Cup and have a good and comfortable feedback get from them by using it. Once it is properly inserted we have no thought of any fear regarding the menstrual Cup leakage or slipping it from the vagina.

Sanitary pad disposal in India is still a concern. Women and girls feel awkward if anybody sees them disposing a pad. So, they land up flushing them in toilet without knowing the consequences of choking. Hence, the researchers identified the felt need of the current problems and decided to conduct a research about knowledge and attitude regarding menstrual cup among adolescent girls.

OBJECTIVES:

· To assess the level of knowledge on menstrual cup among adolescent girls.

· To assess the attitude on menstrual cup among adolescent girls.

· To associate the level of knowledge on menstrual cup with their selected demographic variables.

· To associate the attitude on menstrual cup with their selected demographic variables.

MATERIALS AND METHODS:

A quantitative research approach and descriptive research design was adopted in the present study. The The study was conducted among adolescent girls in St. Sebastian High School, Nellikunnu. A total of 50 partipants who were early adolescent girls fulfilling the inclusion criteria were included in the study by purposive sampling. The instrument consisted of 3 parts; part 1 included the demographic data, part 2 consisted of questionnaire to assess knowledge regarding menstrual cup (score interpretation-Table 1) and part 3 consisted of an attitude scale to assess the attitude regarding menstrual cup (attitude scale score-Table-2). The instruments were validated with a content validity index each for the knowledge questionnaire and the attitude scale. An informed written consent was taken from each of the participants. Data was collected using structured questionnaire . Data analysis was done using descriptive and inferential statistics such as chi square test.

Table 1:

Score	Category	Percentage (%)
0-6	Inadequate knowledge	30
7-13	Moderate knowledge	65
14-20	Adequate knowledge	100

Table 2:

Category	Score range
Poor	10-20
Fair	21-30
Good	31-40
Excellent	41-50

RESULTS:

The first objective of the study was to assess the level of knowledge on menstrual cup among adolescent girls.

The analysis of the study shows that among 50 adolescent girls 43(86%) having moderate level of knowledge on menstrual cup and 5(10%) having adequate knowledge and 2(4%) having inadequate knowledge on menstrual cup.

Table: 3. Frequency and percentage distribution of the level of knowledge regarding the menstrual cup among adolescent girls. N = 50

SL No.

Level of knowledge

Frequency (n)

Percentage (%)

Inadequate knowledge

Moderate knowledge

Adequate knowledge

The second objective of the study was to assess the attitude on menstrual cup among adolescent girls.

The analysis of the study shows that among the 50 adolescent girls 43(86%) having good attitude on menstrual cup and 6(12%) having fair attitude and 1(2%) having excellent attitude and no one have poor attitude on menstrual cup.

The third objective of the study was to associate the knowledge on menstrual cup with selected demographic variables.

In the present study, is evident that there is no association between the level of knowledge on menstrual cup among adolescent girls with selected demographic variables such as age (χ2 = 0.779, which is not significant at 0.05 level), religion (χ2 = 0.56, which is not significant at 0.05 level), type of family (χ2 = 0.72, which is not significant at 0.05 level), area of residence (χ2 = 0.485, which is not significant at 0.05 level), educational status of father (χ2 = 2.78, which is not significant at 0.05 level), educational status of the mother (χ2 = 1.79, which is not significant at 0.05 level), family monthly income (χ2 = 1.41, which is not significant at 0. 05 level), usage of products other than sanitary pads (χ2 = 2.62, which is not significant at 0.05 level) and menstrual cycle (χ2 = 0.4, which is not significant at 0.05 level).

The research hypothesis of the above stated objective was “there is significant association between levels of knowledge on menstrual cup among adolescent girls with their selected demographic variables” but the study reveals that there is no significant association between levels of knowledge on menstrual cup among adolescent girls with their demographic variables, the research hypothesis is rejected.

Table 4: Association between level of knowledge on menstrual cup among adolescent girls with selected demographic variables

Sl. No	Demographic Variables	Chi square	Table value (TV)	Level of significance
1	Age	0.779	3.841	Non-significant
2	Religion	0.56	3.841	Non-significant
3	Type of family	0.72	3.841	Non- significant
4	Area of residence	0.485	3.841	Non-significant
5	Educational status of father	2.78	3.841	Non-significant
6	Educational status of mother	1.79	3.841	Non-significant
7	Family monthly income	1.41	3.841	Non-significant
8	Usage of products other than sanitary pads	2.62	3.841	Non-significant
9	Menstrual cycle	0.4	3.841	Non- significant

The fourth objective of the study was to associate the attitude on menstrual cup with their demographic variables.

The present study reveals that, there is significant association between attitude on menstrual cup among adolescent girls with age (χ2 = 4.90, which is significant at 0.05 level), area of residence (χ2 = 4.57, which is significant at 0.05 level) and educational status of mother (χ2 = 4.57, which is significant at 0.05 level). But there is no significant association between the attitude of menstrual cup among adolescent girls with demographic variables such as religion (χ2 =0.104, which is not significant at 0.05 level), type of family (χ2 =0.03, which is not significant at 0.05 level),educational status of the father (χ2 = 2.55, which is not significant at 0.05 level),family monthly income (χ2 =0.0062, which is not significant at 0.05 level), usage of products other than sanitary pads (χ2 =0.035, which is not significant at 0.05 level) and menstrual cycle (χ2 =0.93, which is not significant at 0.05 level).

In this study there is significant association between age, area of residence and educational status of mother with attitude on menstrual cup among adolescent girls. So, the research hypothesis is accepted. With reference to other demographic variables such as religion, type of family, educational status of father, family monthly income, usage of products other than sanitary pad and menstrual cycle there is no significant association with attitude. So, the null hypothesis is accepted.

Table 5: Association between the attitude on menstrual cup among adolescent girls with selected demographic variables

SI. No	Demographic variables	Chi square	Table value (TV)	Level of significance
1	Age	4.90	3.841	Significant
2	Religion	0.10	3.841	Non- significant
3	Type of family	0.03	3.841	Non- significant
4	Area of residence	4.57	3.841	Significant
5	Educational status of father	8.32	9.48	Non- significant
6	Educational status of mother	4.57	3.841	Significant
7	Family monthly income	0.006	3.841	Non- significant
8	Usage of products other than sanitary pads	0.035	3.841	Non- significant
9	Menstrual cycle	0.93	3.841	Non- significant

The Table (5) depicts that, there is significant association between attitude on menstrual cup among adolescent girls with age (χ2 = 4.90, which is significant at 0.05 level), area of residence (χ2 = 4.57, which is significant at 0.05 level) and educational status of mother (χ2 = 4.57, which is significant at 0.05 level). But there is no significant association between the attitude of menstrual cup among adolescent girls with demographic variables such as religion (χ2 =0.104, which is not significant at 0.05 level), type of family (χ2 =0.03, which is not significant at 0.05 level),educational status of the father (χ2 = 2.55, which is not significant at 0.05 level),family monthly income (χ2 =0.0062, which is not significant at 0.05 level), usage of products other than sanitary pads (χ2 =0.03, which is not significant at 0.05 level) and menstrual cycle (χ2 =0.93, which is not significant at 0.05 level).

DISCUSSION:

The present study focus on the assessment of knowledge and attitude on menstrual cup among adolescent girls in selected school, Thrissur. The study was conducted among 50 adolescent girls (13-14 years) at St. Sebastian School, Nellikkunnu, Thrissur. The data was collected by means of structured questionnaire. Purposive sampling technique was used for the selection of the sample for the study. The study findings shows that among 50 adolescent girls 86% have moderate knowledge,10% have adequate knowledge and 4 % have inadequate knowledge on menstrual cup. The present study also shows 86% have good attitude,12% have fair attitude and 2% have poor attitude regarding menstrual cup. And also there is significant association between attitude on menstrual cup among adolescent girls with age, area of residence and educational status of mother.

CONCLUSION:

The findings of present study shows that knowledge and attitude regarding menstrual cup among adolescent girls has to be improved. There is a need to improve knowledge regarding menstrual cup among girls in managing menstruation with lesser side effects. So at the end of the study we have distributed an information pamphlet on menstrual cup- its method of insertion and its benefits. Through this we can improve menstrual hygiene among girls and can create an awareness regarding an innovative method for managing menstruation.

CONFLICT OF INTEREST:

The authors have no conflict of interest regarding this research.

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Received on 21.02.2022 Modified on 22.04.2022

Research J. Science and Tech. 2022; 14(3):139-144.

DOI: 10.52711/2349-2988.2022.00023