Menstrual Hygiene Practices and Associated Factors among Post-Menarche Primary-School Girls in Semi-Rural Indonesia: A Mixed-Methods Study
Abstract
Introduction: Menstrual hygiene management (MHM) remains a significant public health issue, particularly among primary school girls in low- and middle-income countries. Poor menstrual hygiene is associated with an increased risk of reproductive tract infections and may increase vulnerability to sexually transmitted infections (STIs). In Indonesia, inadequate practices remain common, including in semi-rural areas such as Garut Regency, where limited sanitation and family dynamics influence menstrual health behaviors.
Methods: This study used a sequential explanatory mixed-methods design. A total of 83 primary school girls who had experienced menarche were included in the quantitative phase and analyzed using multivariate logistic regression. 21 informants were purposively selected for in-depth interviews based on school variation, knowledge level, maternal support level, and menstrual hygiene practice category. All selected informants completed the interviews, and all completed interviews were included in the thematic analysis
Results: High knowledge was strongly associated with good MHM practices (OR = 13.60; 95% CI: 3.38–54.71; p < 0.001 ). After adjusting for maternal support and sanitary pad availability, girls with adequate knowledge had 13.6 times higher odds of good menstrual hygiene practices . Qualitative findings suggested that maternal support may facilitate the application of menstrual hygiene knowledge through emotional guidance, practical assistance, and the normalization of menstruation.
Conclusion: High knowledge was the only statistically significant factor associated with good MHM practices in the adjusted quantitative model. Maternal support, although not statistically significant in the multivariable analysis, emerged in the qualitative findings as a contextual facilitator that may support the application of menstrual hygiene knowledge in daily practice.
References
Babbar K, Martin J, Ruiz J, Parray AA, Sommer M. Menstrual health is a public health and human rights issue. The Lancet Public Health. 2022;7(1):e10–e11. DOI: https://doi.org/10.1016/S2468-2667(21)00212-7
UNICEF. Guidance for Monitoring Menstrual Health and Hygiene (Version 1) [Internet]. Poirier P, editor. New York: UNICEF; 2020 [cited 2023 Mar 10]. Available from: https://www.unicef.org/media/85461/file/MHM-Monitoring-Resource.pdf
Hennegan J, Winkler IT, Bobel C, Keiser D, Hampton J, Larsson G, et al. Menstrual health: a definition for policy, practice, and research. Sexual and Reproductive Health Matters. 2021;29(1):1911618. DOI: https://doi.org/10.1080/26410397.2021.1911618
UNICEF, WHO. Progress on Drinking Water, Sanitation and Hygiene in Schools 2015–2023: Special Focus on Menstrual Health. New York: United Nations Children’s Fund and World Health Organization; 2024.
Daher A, Albaini O, Siff L, Farah S, Jallad K. Intimate hygiene practices and reproductive tract infections: A systematic review. Gynecology and Obstetrics Clinical Medicine. 2022;2(3):129–135. DOI: https://doi.org/10.1016/j.gocm.2022.06.001
Das P, Baker KK, Dutta A, Swain T, Sahoo S, Das BS, et al. Menstrual hygiene practices, WASH access and the risk of urogenital infection in women from Odisha, India. PLoS One. 2015;10(6):e0130777. DOI: https://doi.org/10.1371/journal.pone.0130777
Bhandari K, Dahal R, Paudel YR. Evaluating menstrual hygiene practices and school absenteeism among adolescent girls in Lumbini Province, Nepal. International Journal of Health Sciences and Research. 2024;14(5):144–154. DOI: https://doi.org/10.52403/ijhsr.20240516
Long JL, Haver J, Mendoza P, Kotasek SMV. The more you know, the less you stress: Menstrual health literacy in schools reduces menstruation-related stress and increases self-efficacy for very young adolescent girls in Mexico. Frontiers in Global Women's Health. 2022;3:859797. DOI: https://doi.org/10.3389/fgwh.2022.859797
MacLean K, Hearle C, Ruwanpura KN. Stigma of staining? Negotiating menstrual taboos amongst young women in Kenya. Women's Studies International Forum. 2020;78:102290. DOI: https://doi.org/10.1016/j.wsif.2019.102290
Shah V, Phillips-Howard P, Hennegan J, Cavill S, Sonko B, Sinjanka E, et al. Puberty health intervention to improve menstrual health and school attendance among adolescent girls in The Gambia: Study methodology of a cluster-randomised controlled trial in rural Gambia (MEGAMBO Trial). Emerging Themes in Epidemiology. 2022;19(1):8. DOI: https://doi.org/10.1186/s12982-022-00114-x
Anbesu EW, Asgedom DK. Menstrual hygiene practice and associated factors among adolescent girls in sub-Saharan Africa: A systematic review and meta-analysis. BMC Public Health. 2023;23(1):33. DOI: https://doi.org/10.1186/s12889-022-14942-8
Sharma M, Sharma K, Bista AP, Subedi S, Lamichhane S. Knowledge on menstruation and menstrual hygiene practices among adolescent girls of selected schools, Chitwan. Journal of Chitwan Medical College. 2020;10(1):69–73. DOI: https://doi.org/10.54530/jcmc.151
Davis J, Macintyre A, Odagiri M, Suriastini W, Cordova A, Huggett C, et al. Menstrual hygiene management and school absenteeism among adolescent students in Indonesia: Evidence from a cross-sectional school-based survey. Tropical Medicine and International Health. 2018;23(12):1350–1363. DOI: https://doi.org/10.1111/tmi.13159
UNICEF. Menstrual Hygiene Management in Indonesia. Jakarta: UNICEF Indonesia; 2015.
Wihdaturrahmah, Chuemchit M. Determinants of menstrual hygiene among adolescent school girls in Indonesia. International Journal of Women's Health. 2023;15:943–954. DOI: https://doi.org/10.2147/IJWH.S400224
Badan Pusat Statistik (BPS). Survei Demografi dan Kesehatan Indonesia 2017. Jakarta: BPS; 2018.
Badan Pusat Statistik Kabupaten Garut. Kabupaten Garut Dalam Angka 2025. Garut: BPS Kabupaten Garut; 2025.
Kementerian Pendidikan Dasar dan Menengah Republik Indonesia. Profil Sanitasi Sekolah Dasar. Jakarta: Kemendikdasmen; 2025.
Solehati T, Trisyani M, Kosasih CE. Gambaran pengetahuan, sikap, dan keluhan tentang menstruasi di antara remaja puteri. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal). 2018;4(2):86–91. DOI: https://doi.org/10.33755/jkk.v4i2.110
Suazini ER. Persepsi remaja mengenai nasehat reproduksi pada saat mengalami menarche di Garut. Jurnal Medika Cendikia. 2019;6(1):9–20. DOI: https://doi.org/10.33482/medika.v6i01.97
Hussein J, Gobena T, Gashaw T. The practice of menstrual hygiene management and associated factors among secondary school girls in Eastern Ethiopia: The need for water, sanitation, and hygiene support. Women's Health. 2022;18:17455057221087871. DOI: https://doi.org/10.1177/17455057221087871
Uwadia RC, Oloruntoba EO, Wada OZ, Aluko OO. Menstrual hygiene management inequalities among school girls in Badagry, Nigeria. Tropical Medicine and International Health. 2022;27(11):970–980. DOI: https://doi.org/10.1111/tmi.13817
Ssemata AS, Ndekezi D, Kansiime C, Bakanoma R, Tanton C, Nelson KA, et al. Understanding the social and physical menstrual health environment of secondary schools in Uganda: A qualitative methods study. PLOS Global Public Health. 2023;3(11):e0002665. DOI: https://doi.org/10.1371/journal.pgph.0002665
Ene N, Bolarinwa OA, Adedigba C, Oyeleye J, Boboye I, Nwosu U, et al. “If I use pad, I feel comfortable and safe”: A mixed-method analysis of knowledge, attitude, and practice of menstrual hygiene management among in-school adolescent girls in a Nigerian city. BMC Public Health. 2024;24(1). DOI: https://doi.org/10.1186/s12889-024-19256-5
Mulugeta Demmu Y, Shifera GM, Ayana GM, Adare D, Yazew B, Damtew YT, et al. Menstrual hygiene management and associated factors among adolescent school girls in Gursum District, Eastern Ethiopia: Institution-based cross-sectional study. BMC Women's Health. 2023;23(1). DOI: https://doi.org/10.1186/s12905-023-02461-6
Kementerian Kesehatan Republik Indonesia. Survei Kesehatan Indonesia 2023. Jakarta: Kemenkes RI; 2023.
Badan Kependudukan dan Keluarga Berencana Nasional (BKKBN). Survei Kinerja dan Akuntabilitas Program KKBPK (SKAP) Remaja Tahun 2019. Jakarta: BKKBN; 2019.
Coast E, Lattof SR, Strong J. Puberty and menstruation knowledge among young adolescents in low- and middle-income countries: A scoping review. International Journal of Public Health. 2019;64(2):293–304. DOI: https://doi.org/10.1007/s00038-019-01209-0
Plesons M, Patkar A, Babb J, Balapitiya A, Carson F, Caruso BA, et al. The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research. Reproductive Health. 2021;18(1):1. DOI: https://doi.org/10.1186/s12978-021-01082-2
Haider R. Mapping the expertise and understanding of menarche, menstrual hygiene, and menstrual health among adolescent girls in low- and middle-income countries. International Journal of Integrative Sciences. 2023;2(7):995–1014. DOI: https://doi.org/10.55927/ijis.v2i7.4395
Shah V, Nabwera HM, Sosseh F, Jallow Y, Comma E, Keita O, et al. A rite of passage: A mixed methodology study about knowledge, perceptions and practices of menstrual hygiene management in rural Gambia. BMC Public Health. 2019;19(1):277. DOI: https://doi.org/10.1186/S12889-019-6599-2
Uchino BN. Social support and health: A review of physiological processes potentially underlying links to disease outcomes. Journal of Behavioral Medicine. 2006;29(4):377–387. DOI: https://doi.org/10.1007/s10865-006-9056-5
Maimunah, Deviyanti WR. Faktor-faktor yang berhubungan dengan pengetahuan remaja putri kelas XI tentang personal hygiene saat menstruasi untuk mencegah keputihan. Jurnal Antara Kebidanan. 2019;2(1):10–15. DOI: https://doi.org/10.37063/ak.v2i1.31
Holmes K, Curry C, Sherry, Ferfolja T, Parry K, Smith C, et al. Adolescent menstrual health literacy in low-, middle- and high-income countries: A narrative review. International Journal of Environmental Research and Public Health. 2021;18(5):2260. DOI: https://doi.org/10.3390/ijerph18052260
Majeed J, Sharma P, Ajmera P, Dalal K. Menstrual hygiene practices and associated factors among Indian adolescent girls: A meta-analysis. Reproductive Health. 2022;19(1):148. DOI: https://doi.org/10.1186/s12978-022-01453-3
Khound M, Bhattacharyya H, Ghosh S. Menstruation and menstrual hygiene: Analyzing the gaps in knowledge, perception and practices in a rural area of North East India. Indian Journal of Community Medicine. 2025;50(5):849–853. DOI: https://doi.org/10.4103/ijcm.ijcm_513_24
Parle J, Khatoon Z. Knowledge, attitude, practice and perception about menstruation and menstrual hygiene among adolescent school girls in rural areas of Raigad District. International Journal of Community Medicine and Public Health. 2019;6(6):2490–2495. DOI: https://doi.org/10.18203/2394-6040.ijcmph20192310
Palgunadi NPGS, Wesnawa IGA, Sudiana IK. I bring home my used menstrual pad: Water, sanitation, hygiene, and menstrual hygiene management in middle schools with limited sanitation access. Edunity: Kajian Ilmu Sosial dan Pendidikan. 2024;3(11):1052–1063. DOI: https://doi.org/10.57096/edunity.v3i11.330
Barrington DJ, Robinson HJ, Wilson E, Hennegan J. Experiences of menstruation in high-income countries: A systematic review, qualitative evidence synthesis and comparison to low- and middle-income countries. PLoS One. 2021;16(7):e0255001. DOI: https://doi.org/10.1371/journal.pone.0255001
Njee RM, Imeda CP, Ali SM, Mushi AK, Mbata DD, Kapala AW, et al. Menstrual health and hygiene knowledge among post-menarche adolescent school girls in urban and rural Tanzania. PLoS One. 2024;19(3):e0284072. DOI: https://doi.org/10.1371/journal.pone.0284072
Yang YT, Chen DR. Effectiveness of a menstrual health education program on psychological well-being and behavioral change among adolescent girls in rural Uganda. Journal of Public Health in Africa. 2023;14(3). DOI: https://doi.org/10.4081/jphia.2023.1971
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