Menstrual Health Index: A Novel Approach to Assess Safe Menstrual Practices in Adolescents and Young Adults.

Objective: To test the validity of the novel Menstrual Health Index (MHI) in order to assess safety of menstrual health and hygiene practices in adolescents and young adults.

Methods: This is a community-level prospective questionnaire-based study conducted in females between the age group of 11 and 23 years. The number of participants was 2860. The participants were asked to fill in the questionnaire pertaining to four components of menstrual health, viz., menstrual cycle, menstrual absorbents, psychosocial aspects and WASH component associated with menstruation. Based on the score assigned to each component, Menstrual Health Index was calculated. A score of 0-12 was considered poor, 12-24 was considered average, and 24-36 was considered good. Educational interventions were designed to improve the MHI in that particular population according to component analysis. After 3 months, MHI was rescored to see the improvement.

Results: A total of 3000 females were handed over the proforma and 2860 females participated.Among participants, 45.4% were from urban area, rest were from rural areas (35.6%) and slum areas (19%). Majority of the respondents were in the age group of 14-16 years (62%). Poor MHI (0-12 score) was seen in 48%, average score (13-24) was found in 37%, and good score was found in 15% participants. When individual components of MHI were assessed, it was found that, as high as 35% of the girls had limited accessibility to menstrual blood absorbents, 43% skipped school for more 4 times in a year, 26% suffered from severe dysmenorrhea, 32% reported difficulty in maintaining privacy while using WASH facilities and 54% were using clean sanitary pads as menstrual sanitation option. Best composite MHI was observed in urban areas, followed by rural and then slum area. In urban area and rural area, menstrual cycle component score was least. In rural area, sanitation component score was least and in slum area, WASH component scored the worst. Severe premenstrual dysphoric disorder was recorded in urban area, and maximum abstinence from school due to menstruation was seen in rural areas.An improvement in score was seen in 87% of the girls (93% individual and 87% composite), after 3 months of education and interventional strategies.

Conclusion: Menstrual health is not limited to cycle frequency and duration normalcy. It is a comprehensive subject, encompassing physical, social, psychological and geopolitical aspects. Assessing prevailing menstrual practices in a population, particularly in adolescents, is imperative to design IEC tools, and these objectives are aligned with SDG-M goals of Swachh Bharat Mission. MHI serves as a good screening tool to interrogate KAP in a particular area. Individual problems can also be addressed in a fruitful manner. Rights-based approach to provide essential infrastructure and provisions to promote safe and dignified practices to a vulnerable population like adolescents can be aided by using tools like MHI.