On the prevalence of stress, the study showed that more adolescent girls experienced high stress associated with menstruation. This is in contrary to what [18] found in a study on assessing stress experiences during the menstruation among school going adolescent girls in selected schools of Pune city in which fewer adolescent school going girls showed severe/high level of stress (physiological & psychological) experiences. Another study by [7] on stress experience during menstrual cycle among adolescents at selected schools, Nellore, Andhra Pradesh found that regarding the level of stress majority of the respondents had moderate stress due to menstruation cycle.
Unlike the current study which was conducted in a typical rural community, most studies that found low percentages on high/low stress were conducted in cities where majority of the population is working or doing good businesses. Accordingly, many adolescent girls have parents or guardians who are able to support them with appropriate menstrual materials to use during menstruation. Unlike in typical rural area, most of the parents are not working and businesses are rare. This makes it difficult for the parents to support their adolescent girls with appropriate menstrual materials like sanitary pads. In addition, schools in the cities are well constructed and there is high probability of finding good menstrual facilities in most of the schools while in remote areas schools are poorly constructed with challenges in accessing appropriate menstrual facilities.
In addition, [19] makes a comparison on cultural restrictions in rural and urban settings. They observed that it is rare to find cultural restrictions on menstruation in cities compared to rural areas. The adolescent girls in many rural areas are not allowed to talk to their parents or anyone except their grandmothers that they are menstruating. This creates unconducive environment for the adolescent girls because not all grandmothers are capable of finding proper solutions to address their problems and the consequences worsen where a girl child has no any granny.
Furthermore, the study found that most adolescent girls were feeling ashamed and embarrassed with menstruation. This finding was in line with the finding of a study done by [20]. The study observed that concerns about privacy for washing absorbents were associated with many consequences including shame, insecurity and disengagement at school. The privacy item captured worry about privacy for washing absorbents, as such, such associations may have been driven by girls’ trait anxiety. Therefore, the absent of the proper washing rooms at schools for the adolescents who are menstruating contributes much on the shame and embarrassment.
The study found that the school which the girls were attending, distance to school, worrying about being observed washing menstrual absorbent and the signs and symptoms of menstruation significantly contributed to stress among adolescent girls. In a similar study, [21] found that long distances to school were seen as a challenge faced by many learners, and affected dropout rates, attendance and academic performance. Some participants identified that they felt unsafe travelling long distances to school and many also felt that the long distances travelled affected their academic performance due to arriving at school tired, and such challenges worsen on the side of female learners. Long walking distances to school make it even more challenging to attend school when experiencing pain.
Also, the study found that learners experienced one or more symptom, respectively, in the premenstrual phase. Abdominal pain (menstrual cramps or dysmenorrhea) and back pain were most common symptoms related to menstruation in learners, and these findings were concordant with other studies. Learners reported that premenstrual symptoms made them excruciate and exhausted physically, mentally, and emotionally and counting days to end. Due to the high prevalence of these symptoms among students which increases long resting hours, negatively affected students daily living activities, disturbed social life and absenteeism from institutions. Early diagnosis and knowledge about menstrual disturbances are essential because they help choose appropriate treatments, minimizing the disruptions or adverse effects on students' lives.
Further, menstruation can cause menstrual cramps, headache, backache, nausea, and diarrhoea. Most girls in low-income settings do not have the economic means to afford medication to manage these symptoms. The physical discomforts and a lack of means by which to deal with them may cause girls to stay home when menstruating [22]. [23] also found that menstruation is mostly considered as dirty and shameful. As such, menstrual flow is seen as dirty, polluting, and shameful, hence women hide menstrual cloths for fear of being cursed. As a result, the exposure of menstruation brings shame and stress to the girls.
The study has shown that majority of adolescent girls pretended to be sick in order to cope up with stress associated with menstruation. In order to avoid embarrassment due to leaking, the adolescents pretended to be sick and stayed away from school and limited their social participation. Literature has shown that most schools have poor and inadequate sanitary facilities and materials. In their study, [24] on menstrual hygiene, management, and waste disposal: practices and challenges faced by girls/women of developing countries found that one of the biggest obstacles faced by adolescent girls was the lack of basic facilities for WASH in almost all the government schools studied. Many of the schools did not have basic WASH facilities or dumping stations, changing rooms, or emergency sanitary pads. Consequently, many girls usually threw their used pads on the roadsides, into toilets, rubbish pits, and/or buried them, if convenient. Only 4 out of 10 schools studied had some form of WASH facilities such as water and soap in their toilets [24]. As such most girls do not feel comfortable when menstruating at school and some prefer to be home until menstruation is over.
A study by [25] observed that high percentage girls reported the use of bad words, terms or phrases to describe them while menstruating. The explanation for this could be that boys find menstruating girls smelly and objectionable [25]. In line [20] revealed that menstruation could lead to misunderstanding, confusion and prejudice. This means that the girls’ right to non-discrimination, bodily integrity, equality, privacy, health and the right to freedom from inhumane and degrading treatment from abuse and violence is not observed.
Limitations
Since this study is quantitative, the outcomes may be limited. This is due to the structured pattern of the questionnaire. In our case, the questionnaire had closed ended questions which did not give respondents an opportunity of explanations. As a result, we might have run the risk of missing big-picture information that could have benefited the study. Also, as indicated on measurement, the outcome variable in our study was proxy, this was due to unavailability of a tool to measure stress from menstruation. As such, we used the adolescent’s perceived stress based on their feelings, after the questionnaire was pretested several times and validated through expert opinion.