Our study displays that more than two-thirds of the older adolescent girls did not have prior knowledge of menstruation while experiencing menarche. This finding is consistent with others [13–14]. Traditionally, parents think that pubertal changes, including menstruation, are a natural phase of human development that should be remained a secret to adolescents before experiencing physical and psychological changes. However, adolescents may suffer from fear, depression, and anxiety after experiencing the rapid development of significant biological changes as s/he has no prior knowledge regarding SRH. For example, research showed that the number of students without prior knowledge got scared while having first menstruation was much higher (p < .001) than those who had prior information .
The present study explores that 65% of older adolescent girls considered mothers as their key informants of SRH issues. Mothers also appeared as the primary source of SRH information in some other studies [13–14, 16–18].
As it is observed, about half of the adolescent girls neither read nor watch any SRH-related content on the media. Lack of perceived importance of the adolescent girls of the rural area may result in low media exposure of SRH issues. Moreover, less than one-third of the students ever consulted with health care providers regarding the SRH problem. Inadequate health care services across the country and the tendency of concealing SRH-related problem because of the perception of taboo may contribute to this low percentage of access to health care.
This study found that more or less one-third of the older adolescent girls had inaccurate knowledge regarding puberty health. The absence of open and frequent discussion on this important topic within the family, the classroom and social network, lack of SRH health campaign and inadequate program and content of SRH on mass media due to perceived taboo of the issues lead to the restriction of a steady flow of SRH information and ignorance about adolescence health among the college-going girls. This observation was attested by our study findings, which reported a significant relationship (p < .001) between the variables in bivariate analysis. Furthermore, a portion of the study participants was also unaware of family planning and maternal health issues. According to social perception, whatever is the age, less or more, women are considered to be matured after their marriage. Therefore, SRH discussion is forbidden to unmarried girls, and significant numbers of female students are uninformed at their most crucial transitional phase of life .
Discussions on sexuality and sexually transmitted diseases are prohibited in social space in the country. Ideas about HIV/AIDS have been given in an elementary form on textbooks prescribed by educational institutions as these matters are considered as taboos. In general, ideas that have been given are HIV/AIDS could occur if anyone uses a syringe used by a HIV-infected person, use untested blood, or when a child was born by an infected mother. Most important messages, such as unsafe sexual intercourse, are often out of discussion. Besides, empirical evidence revealed that content delivery in the school education continues to remain inefficient, with teachers often skipping the chapters, or asking students to study them at home . Teachers never utter the word ‘sex’ or avoid it while teaching in the classroom. Because of cultural impediments, everyone has an adverse attitude towards comprehensive sex education.
Different myths are common in the rural area as regards menstruation existing religious dogma and cultural orthodox that impose some restrictions on adolescent girls and adult women as well. These restrictions prohibit adolescents from going outside even to the school, entering into the kitchen, touching any male, brushing hair, and see oneself in the mirror. Some respondents, most of them from rural areas, believe that they should follow these restrictions. In Bangladesh, the conventional practice rooted inside the conservative socio-cultural structure has taught the women that their desires, dreams, pains, aspirations, sorrows, joys can never be expressed outside the home or in public. Discussions about the menstruation process of women are thought to be a matter of shame, so the unrealistic, unscientific, superstitious thoughts of this very natural matter take root in the society to a greater extent. It creates a myth. However, our findings are supported by some studies conducted in Bangladesh, India and other countries [14–16, 18–20].
Our study findings reported that about half of the adolescent girls feel shy and timid of puberty issues; consequently, they are reluctant to reveal SRH-related problems. In our society, mothers still feel uncomfortable discussing SRH-related matters with their daughters due to traditional values and conservative attitudes. So, it is not a particular matter for female students to feel discomfort about reproductive health, whereas a very dear one like a mother feels uncomfortable to discuss regarding period. Our study depicts that 62% of adolescent girls used clean cloth during the menstrual cycle that is very unhealthy because it can cause fungal infections and urine infections. In Bangladesh, the use of sanitary napkins is a very recent trend. As a result of publishing advertisements on media, currently, the level of awareness is increasing gradually. Purchasing capacity also influences the use of a sanitary napkin. Though it is more convenient for a female student who lives in a city, the use of napkins depends on the financial well-being and availability of a student living in the village. However, irrespective of the area of residence, the average use rate of the sanitary pad is higher than the findings of many studies conducted in India [14, 18].
This study also examined the factors predicting better the KAP of SRH of the study participant. We found that being a student of science group, urban residence, regular SRH discussion, prior knowledge on SRH, mother as the source of SRH information, and ever reading or watching RH contents on the mass media and ever talking with a health professional regarding SRH Problem are the significant factors associated with the better status of SRH knowledge, attitude, and practice. Some of these factors were also supported by other studies [21–22].