A Research Report On Menstrual Restriction And Perceived Stress Among Adolescent Girls Among School Going Adolescent Girls, Kailali, Nepal

The practice has negatively influenced health, safety and human rights of women and has augmentedtheprocess of gender-basedviolence in Nepalisociety.(8) Though most study hav[r]

A RESEARCH REPORT ON

MENSTRUAL RESTRICTION AND PERCEIVED STRESS AMONG ADOLESCENT GIRLS AMONG

SCHOOL GOING ADOLESCENT GIRLS KAILALI, NEPAL

SUBMITTED BY ALISHA DAHAL

Fourth Year, 6TH BATCH

PU REGD NO 104-6-2-04882-2014

SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT IN THE SUBJECT OF THE PUBLIC HEALTH

RESEARCH REPORT (COURSE CODE PSD 408.4-PHRR) FOR DEGREE OF BACHELOR OF PUBLIC HEALTH

SUBMITTED TO

DEPARTMENT OF PUBLIC HEALTH KARNALI COLLEGE OF HEALTH SCIENCE

PURBANCHAL UNIVERSITY KATHMANDU, NEPAL

ii

Department of Public Health Karnali College of Health Science

Purbanchal University

CERTIFICATE

It is certified that this research entitled “Menstrual Restriction and Perceived Stress among school going adolescent girls, Kailali, Nepal” is the bona fide work of Ms Alisha Dahal conducted under our guidance and supervision as partial fulfillment of the requirement for the degree of Bachelor of Public Health from Karnali College of Health Science of Purbanchal University

Mrs Susmita Nepal

External Om Health Campus

Mr Krishna Prasad Sapkota Guide

Public Health Department Karnali College of Health Science

Mr Roshan Khadka

HOD

Public Health Department Karnali College of Health

Sciences, Battisputali, Kathmandu

_ Mr Annrodh Ghimire Campus Chief/ Principal Karnali College of Health

iii

DECLARATION

I hereby declare that this Research entitled “Menstrual Restriction and Perceived Stress among school going adolescent girls, Kailali, Nepal “has been prepared by me under the close guidance and supervision of Mr Krishna Prasad Sapkota as a guide in the partial fulfillment of the requirement for the degree of Bachelor of Public Health from Karnali College of Health Science of Purbanchal University, Nepal

_ Alisha Dahal

PU.REG.NO 104-6-2-04882-2014 BACHELOR OF PUBLIC HEALTH

2014, BATCH

iv

RECOMMENDATION

This is to recommend that Alisha Dahal has carried out the research report entitled “Menstrual Restriction and Perceived Stress among school going adolescent girls, Kailali, Nepal “for the partial fulfillment of curriculum of Bachelor of Public Health This original work was conducted under my supervision I would like to recommend keeping this research report for final evaluation

Mr Krishna Prasad Sapkota, Masters in Public Health (HSM) Guide

Public Health Department Karnali College of Health Science

Purbanchal University Biratnagar, Nepal

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ACKNOWLEDGEMENT

I am glad that I have come up with this report of research In addition, to come up with this success there is profound role of some of the good soul to whom I want to acknowledge It is my pleasure to get a platform for this research study, so initially my first thanks go to the Purbanchal University and to the Karnali College of Health Science I owe a great sense of indebtness to the supervisor of my dissertation, Mr Krishna Prasad Sapkota for his guidance and encouragement I offer my sincerest gratitude towards him for his kind assistance and support for the completion of this report Allowing me to grow and prosper, he has acted as a pillar this whole time I would also like to extend my gratitude to the Nepal Health Research Councils (NHRC) ethical review sub-committee A word of thanks goes to my family without whose support the success of this work has been impossible In addition, I cannot forget the appreciative role of all the library staffs for making the literature available

A word of thanks goes to the college administration I am very much thankful towards all the respondents without whose cooperation, completion of this research was not possible Last but not the least; I would like to thank all my colleagues, for the simulating discussion and I owe my gratitude to all those people who have made this research possible

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ABSTRACT

Fueled by ignorance and myth, menstrual restriction has had its root in Nepalese society since eras With various Hindu mythologies, it is forced upon women so as they are unable to perform daily works as usual with such restrictions The more severe form of restriction such as Chaupadi has killed many women and young child due to suffocation, snakebite, rape and other serious forms Although it has been criminalized by the law no visible impact of the law has been seen yet Excluding the hormonal imbalance and physical pain that women go through during such discriminatory practice, such hazardous practices also affect the mental health of the young girls which haven't been yet explored so for this reason this study is very important for the physical, social and psychological wellbeing of the adolescent girls and the community The aim of this study is toaccess the prevalence and perceived stress due to menstrual restriction among Adolescent girls of Lower secondary school in Kailali District, Nepal

The study carried out, was a descriptive, cross-sectional study conducted among 370 respondents, where proportionate random sampling technique was used to recruit study respondents The study was conducted at the secondary school of Godawari Municipality, Kailali, Nepal Pretesting of the questionnaire was done among 10% of the population in Kathmandu with a structured questionnaire and a Likert scale

TABLE OF CONTENTS

CERTIFICATE ii

DECLARATION iii

RECOMMENDATION iv

ACKNOWLEDGEMENT v

ABSTRACT vi

TABLE OF CONTENTS vii

LIST OF TABLES ix

LIST OF FIGURES x

LIST OF ABBREVIATIONS xi

CHAPTER I: INTRODUCTION

1.1 Background

1.2 Statement of Problem

1.3 Rationale of the study

1.4 Objective

1.5 Research Question

CHAPTER II: LITERATURE REVIEW

CHAPTER III: METHODOLOGY 12

3.1 Study Design 12

3.2 Study Variables 12

3.3 Study Area 13

3.4 Study Population 13

3.5 Sample Size 13

3.6 Sampling Technique 14

3.7 Tools and Technique of data collection 15

3.9 Validity and reliability of study 17

3.10 Inclusion and Exclusion criteria 17

CHAPTER IV: RESEARCH FINDINGS 19

CHAPTER V: DISCUSSION 27

CHAPTER VI: CONCLUSION AND RECOMMENDATION 31

REFERENCES xii

Annex Tools of Data Collection (English and Nepali Version) xiv Annex Mapping of study area Error! Bookmark not defined. Annex Approval Letter from College Error! Bookmark not defined. Annex Letter from College referring NHRC Error! Bookmark not defined. Annex Supervisors Recommendation Error! Bookmark not defined. Annex Approval Letter from Godawari MunicipalityError! Bookmark not

defined.

Annex Approval Letter from NHRC Error! Bookmark not defined. Annex Consent Letter Error! Bookmark not defined. Annex Data Collection Completion Letter from School No 1Error! Bookmark

not defined.

Annex 10 Data Collection Completion Letter from School No 2Error! Bookmark not defined.

Annex 11 Data Collection Completion Letter from School No 3Error! Bookmark not defined.

Annex 12 Collection Completion Letter from Ward OfficeError! Bookmark not defined.

ix

LIST OF TABLES

Table Perceived Stress Scale (10 items) - Cohen et al, 1994 Technique 15

Table Distribution according to socio-demographic characteristics 19

Table Level and Category of Menstrual Restriction 21

Table Mean score of an individual item of Perceived Stress 22

Table Table Perceived stress level 23

Table Association between Socio-demographic and PSS 24

LIST OF FIGURES

xi

LIST OF ABBREVIATIONS

HPS High Perceived Stress

KCHS Karnali College of Health Sciences

NDHS Nepal Demographic Health Survey

NHRC Nepal Health Research Council

PSL Perceived Stress Level

PSS Perceived Stress Level

PU Purbanchal University

SPSS Statistical Package for Social Sciences

1

CHAPTER I:INTRODUCTION

1.1.Background

WHO defines adolescence as the group of people from 10-19 years of age.(1)This being a period of transition from childhood to adulthood, most girls go through the first experience of their menstruation known as “Menarche”.(2)Along with this transition from childhood to adulthood, menstruation also indicate girls “sexual maturity”.(3)Generally, Menstrual cycle occurs every 28 days, where women bleeds from her uterus via vagina lastingfor three to seven days, if she does not become pregnant during a given cycle.(3) Coming from this critical time of identity formation and a transitional period from childhood to adulthood few communities consider it as being unclean or dirty although being a very natural, important and an inevitable phenomenon As it is a subject of myths and taboos in Nepal, secrecy and shame surrounds around the topic of menstruation.(2, 3) “Some Professional journals and popular magazines have placed an emphasis on menstrual pathology, with articles and studies about angry, depressed, unreasonable women and girls”.(2)Although various studies have been conducted on Mental Health and Sexual and Reproductive Health with ranges of literature on each topic but their interrelationship however have been under described Any problem related with Mental Health have the possibility to be the result of concurrent or past Sexual and Reproductive Health illness and vice versa.(4) Over last decades, stress and consequences of stress on health has been a major topic Psychological Stress is knownto be a crucial factor in the onset, course and exacerbation of various diseases, “e.g depression, cardio- vascular diseases, immune-related disorders”, which has been related to higher overall mortality reducing life satisfaction linked to Perceived Stress.(5)

2

Western setting but have become less Regardless, Menstruation is often perceived in negative light, as research on healthy menstruation in “normal: women is very less.(2)

1.2. Statement of Problem

3

Since, menstruation is considered as a polluting factor among Hindus, most girls feel unable to discuss or talk about the menstrual issues with their mothers and “certainly not with their fathers”.(2)Because it seems to be as something shameful and hideous, as a result this topic becomes unacknowledged among families, schools and communities restricting girls to be able to talk about their experiences openly as they now will have very limited information.(2)Being considered as untouchable in many places, girls learn from very early age as “early adolescence” that they will not be able to touch anything in the kitchen or visit a temple while menstruation even in families where strict untouchability is not perceived.(2)In many underdeveloped countries, school dropout rate of girls when they begin to menstruate is very high, including over 23% girls in India.(11) Women‟s and girls‟ emotional state, mentality, lifestyle and most importantly health have had an impactbecause of the taboos related to menstruation in many societies.(2)

According to the evolution of society, such menstrual taboo will disappear eventually, but by that time, many women and children will have died or suffered from health problem due to unsafe menstruation in those areas of Nepal.(12)Apart from all the cultural issues that have been discussedabove, lack of sanitation as poor protection and inadequate washing facilities, may increase the risk of being stigmatized, potential infection, and odor of menstrual blood which then later may have serious effect in their mental health.(2)

1.3.Rationale of the study

4

place in the monthly basis, overall improving the overall physical, mental and social status of adolescent girls in the area

1.4.Objective

1.4.1. General objective

To access the prevalence and perceived stress caused due to menstrual restriction among Adolescent girls of Lower Secondary School in Kailali District, Nepal

1.4.2.Specific objective

1 To measure the prevalence of different forms of menstrual restriction

2 To measure the Perceives Stress level of Adolescent girls due to menstrual restriction

3 To measure the association between menstrual restriction and perceived stress

1.5.Research Question

1 What is the prevalence of different forms of menstrual restriction? What is the level of perceived stress among the adolescent girls?

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1.6.Conceptual Framework

PerceivedSt

ress Socio-demographic

Factors:

1 Age

2 Ethnicity

3 Husbands

Education

4 Family

Structure

5 Fathers

Occupation

6 Mothers

Occupation

7 Fathers

support during menstruation

8 Mothers

support during menstruation

Menstrual Restriction

1 Restriction to enter or reside inside houses

2 Sent to Chau-Goth

3 Restriction to touch male

members

4 Restricted to interact with male members

5 Restricted to enter inside

temple

6 Restricted to cook food

7 Restriction to touch plants with holy belief

8 Restricted to touch livestock

or animals

9 Restricted to eat together

with family

10 Restricted to consume dairy products

11 Restricted to participate in cultural rituals

12 Restricted to go to school 13 Restricted to roam and play

with friends

14 Restricted to sleep in any bed

15 Restriction to use heavy

blankets and mattresses

16 Restriction to use packed

pads

17 Restricted to sundry cloth pad

18 Restriction to use common

toilet

19 Restricted to use common

Taps

Figure Conceptual Framework Independent

Variable

Independent Variable

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CHAPTER II: LITERATURE REVIEW

The literature reviews were done by reviewing the relevant published scientific articles based on Menstrual Restriction and Perceived stress directly or indirectly Online searching was the main source of literature review Web pages of Pub-Med via endnote, Google Scholar using Key Term as Menstruation and Taboo And Perceived Stress, Menstrual Restriction and NEPAL, Menstruation and South Asia, Menstruation and Nepal was used at first Later phrases like “Menstruation and Perceived Stress”, “Menstrual Restriction and Perceived Stress” for further reviewing the literature in depth

Id

en

tific

atio

n

Scr

ee

n

in

g

E

lig

ib

ilit

y

In

clu

d

ed

Records identified through database searching Pub Med in END Note (n=12288)

Additional records identified through other source including GoogleScholar and Google (n=77)

Record after duplicate removed (n=12181) + (n=77) =12258

Records Screened

(n=12258)

Records excluded due to relevance, study type, and inappropriate comparators or outcomes (n=1560)

Full-text articles assessed for eligibility(n=75)

Full-text articles excluded due to relevance, study type and inappropriate comparators or outcomes (n=51) Studies included in data synthesis (n=24)

7 Un-touchability and Social Restriction

One the study done in India reveals that only 9.7% adolescent girls did not practice any restriction Remaining 90.3% girls practiced different types of restrictions such as visit religious place, avoid eating certain food items and avoided doing kitchen work and restricted from physical activities during menstruation.(13) A study conducted in Indonesia showed that almost one third of girls in South Sulawesi (31.1%) and Papua (32.2%) believed that the community considers it shameful or a taboo to discuss menstruation, whereas this was less than one fifth in East Java (16.3%)and NTT(19.3%).(14)Approximately, one tenth or fewer girls reported that a menstruating girl is considered unclean by the community in Papua (10.9%), East Java (9.5%) and NTT (2.5%), but was reported by over a third of girls in South Sulawesi (34.1%) In contrast, in the self-reported menstrual knowledge questions, only one-fifth of girls answered that it was false that girls are unclean during menstruation (21.0%, 95% CI = 16.5–26.4) In addition, Questions that were most commonly answered incorrectly as mentioned in the research included: it is dangerous for a girl to physical activity while menstruating (26.0% responded correctly); menstrual blood contains harmful substances (21.2% responded correctly); and some foods should be avoided during menstruation (5.1% responded correctly) Attitudes to menarche varied Less than 5% of girls in most provinces reported that family and community celebrate a girl reaching menarche, except in South Sulawesi, where 37.5% of girls reported that community and family celebrate menarche (14)

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Similar study done in Western Nepal in 2018 showed that, Eighty-eight percent women said that they not attend any cultural ceremony as guest during menstruation Likewise, 12 percent respondents reported that only in urgent cases they attend secretly and return back immediately.(8)Same study showed that the women practicing Chaupadi can only bathe or wash clothes in a Chaupadi Dhara, which is a separate well, stream or small rivulets near the village Their access to water taps and wells is strictly restricted.(8) Restricted to enter or reside inside the house/ Abolishment to Chau-Goth

The Nepalese word Chaupadi refers to women in menstruation There is a series of rules applied to Chaupadi, although they vary slightly depending on the individual family, community, and region The core principles for the practice of Chaupadi exile women from their families and forbid them to participate in various daily activities during menstruation Most women spend their days and nights outside the house, in places such as cattle sheds Even so, women are expected to engage in hard labor outside their homes, such as digging collecting firewood and grasses, and farming Such rules are applied to women once they start their menstruation, up to 13 days for the first and the second period, seven days for the third period, and four days a month afterward (9)

Chaupadi sheds where menstruating women are subjected to the cold extremities (heavy blankets are restricted) and dangerous risk of various infectious diseases It was reported that out of 32 women, married women suffer from uterineprolapse.(15)The health implications of Chaupadi are severe There is neither registered physician nor medicine in the Health posts In the cases of snake and venomous scorpion bites, menstruating women have high chance of death because social taboo hinders their fast treatment keeping out them from people's touch.(8)

Restricted to enter inside Temple andtake part in cultural rituals

9 Food restrictions (different from Usual)

A study done in Western Nepal showed that menstruating women were restricted to drink milk or eat milk products They should only eat flatbread with salt, are deprived of nutritious food during periods and are not allowed to eat together with family members.(8)

In the same earlier mentioned study done in Doti, 45% of respondents were shown to have agreed that menstruating females can consume dairy and sour food items, meaning that 65% of them thought it to be not normal Also, the same study showed that 77% of respondents agreed that, increase in supplementation of nutrients/food as necessary during menstruation.(13)A cross-sectional study done in area around Bangalore city found that Food taboos were common during menstruation and 42.6% avoided certain food items common ones being sweets (21.6%) spicy food (3.9%) curd and milk products (9.1%).(16)In a Study in West Bengal Foods restricted during menstruation included milk and milk products, vegetables.(16)

Restricted to touch animals

Cows are regarded sacred and venerated in Hindu religion as the mother goddess hence menstruating women are prohibited to touch them.(8)

Restricted to go to school and Play

In a similar cross-sectional study in rural West Bengal More than 50% were restricted to play during menstruation Thirteen were restricted from attending school during menstruation Thirty-Eight, would rest more often during menstruation than at other times (16)

Perceived Stress and Menstruation

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natural phenomenononwhile 17% felt that menstruation occurred due to the curse of God Majority of them (56.8%) feltthat menstruation poses a huge physical and psychological burden on them.(16)

In the study done in Doti among a total of 141 female respondents, 39% responded „feeling shame to talk about menstrual status‟ followed by pain and then by leaks, stains, and menstruation related odor leading to teasing by boys as major challenges faced during menstruation Not surprisingly, only 29 respondents said they got psychological support from their family during menstruation (13) Of the respondents, 91 percent say that while practicing the Chaupadi, they experience the feelings of diffidence, insecurity, guilt and humiliation, as well as sadness and depression.(8)

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CHAPTER III:METHODOLOGY

3.1.Study Design

A descriptive, cross-sectional study wasconducted

3.2.Study Variables

 Dependent variables  Perceived Stress  Independent variables

o Demographic Factors:

 Age

 Ethnicity

 Family Structure  Fathers Education  Mothers Education  Fathers occupation  Mothers occupation

 Fathers support during menstruation  Mothers support during menstruation o Menstrual Restriction

 Restricted to enter or reside inside houses  Sent to Chau-Goth

 Restriction to touch male members  Restricted to interact with male members  Restricted to enter inside the temple  Restricted to cook food

 Restriction to touch plants with holy belief  Restricted to touch livestock or animals  Restricted to eat together with a family  Restricted to consume dairy products  Restricted to participate in cultural rituals  Restricted to go to school

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 Restriction to use heavy blankets and mattresses  Restriction to use packed pads

 Restricted to sundry cloth pad  Restriction to use the common toilet  Restricted to use common Taps

3.3.Study Area

This study was conducted in Government Schools of State-7, Godawari Municipality 10, 11 of Kailali district, Nepal

3.4.Study Population

Populations of the study were the adolescent girls of age group 14-17 years from class 8, and 10

3.5.Sample Size

Sample size was calculated by using the following formula Sample size (n) = z2pq/d2(7)

= (

1.96)20.723*0.277/ (0.05)2

=

307.74~308(18)

Considering the non-response rate 20%, (n) = 20% of 308=61.6~62 Therefore, the total sample size was 370

Where,

z = 1.96, considering 95% confidence interval For this study,

p = 72.3 %=estimate at 0.723(7) q = 1-q

d = expected error (5%)

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3.6.Sampling Technique

Proportionate random sampling technique was adopted for this research as shown below To draw the samples, firstly three schools were randomly selected, and then total no of students was identified from the selected schools No of samples from each class (8, 9, and 10) from each school were calculated proportionately and students were selected randomly from each class

Figure Sampling Technique

Total no.of secondary schools

in godawari municipality =

Ward3 Shree Gwasi Secondary School,

N=324=50.86%, n= 188

Class (N=118) = 36.41%

n= 68 Class (N=100)

= 30.86% n= 58 Class 10 (N= 106)

=32.71% n= 62

Ward 11 Shree Saraswati Secondary School,

N=251=39.40%, n= 145

Class (N=77) =30.67%

n= 44 Class 10 (N=74)

=29.48% n= 43

Ward 12 Shree Janaki Secondary School, N=62=9.7%, n= 37

Class (N= 25) =40.32%

n= 15 Class (N=17)

=27.41% n= 10 Class 10 (N= 20)

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3.7.Tools and Technique of data collection

Tools:

1.Structured Questionnaire: A structured self-administered questionnaire was developed based on intensiveLiterature Review The whole questionnaire was translated in Nepali and back translation was done into English before pretesting

Perceived Stress Scale: The 10 items relevant to the Nepalese context was adopted and based on A Global Measure of Perceived Stress (PSS) by Sheldon Cohen, Tom Kamarck, and Robin Mermelstein, which are valid scales and have a high reliability(Coefficient batch alpha 0.84, 0.85, 0.86 respectively) A total of 10 item measure (Table 1)of the degree of which life situations are appraised in a five point Likert Scale (19) Respondents were asked to indicate about their experience in stress related feeling and thoughts on a 5-point scale as 0=never, 1=almost never, 2=sometimes, 3=fairly often, 4=very often (20)

Table Perceived Stress Scale (10 items) - Cohen et al, 1994 Technique

S.N Questions (The Perceived Stress Scale (10 items) - Cohen et al, 1994)

1. In the last month, how often have you been upset because of menstrual restriction?

2. In the last month, how often have you felt that you were unable to control important

things in your life because of menstrual restriction?

3. In the last month, how often have you felt nervous and “stressed” because of menstrual

restriction?

4. In the last month, how often have you felt confident about your ability to handle your

personal problems inspite of menstrual restriction?

5. In the last month, how often have you felt that things were going your way inspite of

menstrual restriction?

6. In the last month, how often have you found that you could not cope with all the things

that you had to because of menstrual restriction?

7. In the last month, how often have you been able to control irritations in your life inspite

of menstrual restriction?

8. In the last month, how often have you felt that you were on top of things?

9. In the last month, how often have you been angered because of menstrual restriction?

10. In the last month, how often have you felt difficulties were piling up so high that you

could not overcome them because of menstrual restriction?

Technique:

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3.8.Data management, analysis and interpretation procedure

Data Screening, Storage and Transfer

The received questionnaires were coded and filling was done before transfer of the data

Immediately following the data collection, prior to data entry, data was checked for completeness

The researcher managed and transferred the filled questionnaire own self to the destination

Researcher screened all the data for accuracy, assurance and completeness This promptness helped to address any omissions, errors or inaccuracies also helping to correct the data

Then finally, the responses were transferred into computer software Epi-Data to create a data set

Data were stored in specific folder of laptop and backup was stored in external hard disk for prevention from loss

Quality assurance of data

 EpiData v3.1 was used for data entry 10% raw data was entered after developing format for validating the data entry format

 At the end of the data entry 10% of filled questionnaires was selected randomly and crosschecked with the entered data

 The original data set was kept safely in a separate folder to prevent from manipulation and loss

 Recoding and analysis was conducted in a copy of the data set in a separate folder Data analysis

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based on p-value <0.05 being significantly associated and p-value >0.05 being not significant

Dissemination

After completion of the study presentation, dissemination program was conducted in KCHS, PU Two hard copies of the thesis and a soft copy was submitted to program coordinator, BPH, Godawari Municipality,PU and one hard copy was submitted to the NHRC One hard copy of the final report was submitted to the respective DHO and DPHO Finally, a manuscript will be developed and will be submitted in the international journal for publication

3.9.Validity and reliability of study

Validity of the instruments was ascertained Chronbatch alpha for both Perceived Stress Scale and Menstrual Restriction to measure the internal consistency The Chronbatch alpha for both was found to be 0.82 for PSS-10 Scale and 0.85 for menstrual restriction Expert consultation, literature review, and pretesting of the instrument on 10 % of total sample size in Kathmandu were done

3.10.Inclusion and Exclusion criteria

1 Inclusion: Adolescent age 14-17 years Exclusion:

 Adolescent above age 17 years

 Absentees

3.11.Expected outcome

Perceived stress among Adolescent girls as a result of Menstrual Restriction was found

3.12.Ethical Consideration

First written consent was obtained from the concerned authority Following that, Ethical clearance and approval from NHRC was obtained Similarly, respondents were made clear about the purpose of the study, confidentiality and privacy to safeguard their interests and that they could refuse to participate in the study, which shall be respected Furthermore, verbal and written consent was taken from both, respondents and their corresponding as;

 Informed Consent and Assent (for below 16 Years)

18  Absentees were excluded

3.14.Operational Definition

 Perceived Stress: Refers to the degree to which situations in one‟s life are appraisedas stressful due to menstrual restriction

 Adolescence:Refers to the age group of 14-17 in this study

 Menstruation: Refers to the periodic blood that flows as a discharge usually lasting for 5-7 days

 Menstrual Restriction:Refers to the limitation or control of someone or something, or the state of being restricted The state of being kept away from or stop oneself from doing (something) like touching male members, female members, cooking, using common bathrooms or a state of near complete or complete lack of contact between an individual and society so as treated to be untouchable or the punishment of being sent away to some other place just because of menstruation

 Chaupadi Goth: Chaupadi refers to a tradition practiced for centuries that banishes females during their menstruation period from the house Each month, women sleep outside their homes in sheds called “Goths,” in stables or in caves They are deemed impure and treated as untouchable They eat separately from their families, cannot enter their homes and often have to wash at a separate tap

 Minority Age Group:Adolescents below 16 years of age

 Age: Age of the respondent in completed years as stated by the respondent, adolescent girl (14-17 years old)

3.15.Time Frame of the study

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CHAPTER IV: RESEARCH FINDINGS

There were total of 370 Adolescent girls as respondents who participated in the study voluntarily The study was carried out in Kailali District, State of Nepal The respondents in the study were of Adolescent age group (14 – 17 yrs.) of Godawari Municipality in Kailali District, Nepal Results were divided into altogether sections as per the objectives as follows and answer following research questions

1 Prevalence of different forms of menstrual restriction PSL of Adolescent girls due to menstrual restriction

3 Association between menstrual restriction and perceived stress 4.1 Socio-demographic characteristics

The findings related to age, grade, ethnicity, religion, household size, father‟s education, mother‟s education, fathers view on menstrual restriction, mothers view on menstrual restriction, Mothers view on menstrual restriction, father's occupation and mother‟s occupation

Table Distribution according to socio-demographic characteristics

Characteristics Frequency (n) Percent (%)

Age (Completed Years)

14 118 31.89

15 105 28.38

16 78 21.08

17 69 18.65

Mean Age = 15.26 ± 1.099

Grade of students

Eight 139 37.57

Nine 132 35.68

Ten 99 26.76

Ethnicity

Dalits 180 48.65

Disadvantaged Janajati 36 9.73

Upper Caste Groups 154 41.62

Religion

Hindu 362 97.84

Muslim 0.27

Christian 1.35

Others 0.54

Household Sizes

Small Household Size 2.16

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Table continued…

Table illustrates that the sample had a mean age of 15.26 (SD = 1.099) The majority respondents were Hindu (97.84%) and approximately most of the respondents were Dalits (48.65%) and Upper caste groups (41.62) Larger household sizes were almost dominant in the study area (97.84%), literacy level on average was high for primary level with (42.16%) among

Characteristics Frequency

(n)

Percent (%)

Fathers Education

Illiterate 62 16.76

Literate 95 25.68

Primary Level (1-8) 156 42.16

Secondary or Above 57 15.41

Mothers Education

Illiterate 62 16.76

Literate 95 25.68

Primary Level (1-8) 156 42.16

Secondary Level or Above 20 5.41

Fathers View on Menstrual Restriction

Supports menstrual restriction 269 72.70

Against the menstrual restriction 101 27.29

Mothers View on Menstrual Restriction

Supports menstrual restriction 292 78.91

Against the menstrual restriction 78 21.08

Fathers Occupation

Does Not Wok or Earn Money 11 2.97

Governmental job 17 4.59

Non-Governmental job 14 3.78

Agriculture 215 58.11

Small Scale Business 24 6.49

Labor 18 4.86

Business 23 6.22

Others Foreign Employment 48 12.97

Mothers Occupation

Does Not Workor Earn Money 15 4.05

Governmental 1.89

Non-Governmental 0.54

Agriculture 322 87.03

Small Scale Transaction 2.16

Labor 0.81

Housewife 1.89

21

fathers, for same mothers had almost equal distribution as Literate (33.24%) followed by Primary Level (32.70%) Regarding the occupation of parents more than half of the respondents (58.11%) fathers were into agriculture and majority (87.03%) of the respondents' mothers were into agriculture

4.2 Level and category of menstrual restriction

This section consists of different categories of restriction with its frequency and percentage as shown in the Table

Table Level and Category of Menstrual Restriction

The findings in the table shows that half of the respondents 51.08% shared that they were sent to a Chau- Goth while they were menstruating, Majority of the respondents (80 27% were restricted to touch male members in their family, while in contrast among the same respondents 82.97% were however not restricted to interact with the male members Majority of the respondents 85.68% were restricted to enter inside the temple, followed by 82.97% were restricted to cook food, 79.19% were restricted to touch plants with holy belief Half of the

Restriction during the menstrual period Number (%)

Yes (%) No (%)

Restricted to enter or reside inside the house 214(57.84) 156(42.16)

Sent to Chau-Goth 189(51.08) 181(48.92)

Restricted to Touch Male members 297(80.27) 73(19.73)

Restricted to interact with male members 63(17.03) 307(82.97)

Restricted to enter inside Temple 317(85.68) 53(14.32)

Restricted to Cook food 307(82.97) 63(17.03)

Restricted to touch plants with holy belief 293(79.19) 77(20.81)

Restricted to touch livestock or animals 186(50.27) 184(49.73)

Restricted to eat together with Family 263(71.08) 107(28.92)

Restricted to consume dairy products 261(70.54) 109(29.46)

Restricted to participate in cultural rituals 120(32.43) 250(67.57)

Restricted to go to School 35(9.46) 335 (90.54)

Restricted to Roam and play around with friends 45(12.16) 325(87.84)

Restricted to sleep in any bed 167(45.14) 203(54.86)

Restricted to use heavy blankets and mattresses 92(24.86) 278(75.14)

Restricted to use packed pads 51(13.78) 319(86.22)

Restricted to sundry Cloth pad 71(19.2) 299(80.8)

Restricted to use the common toilet 141(38.1) 229(61.9)

22

respondents, 50.27% were restricted to touch livestock‟s or animals, 71.08% were restricted to eat together with family,70.54% were restricted to consume dairy products, while contrarily 67.57% were not restricted to participate in cultural rituals However, almost all the respondents 90.54% were not restricted to go to school during their menstrual period followed 87.84% not being restricted to roam and play around with friends 45.14% of the girls were restricted to sleep in any bed, along with 24.86% of them being restricted to use heavy blankets and mattresses Majority of the girls 86.22% were not restricted to use the packed pads (Sanitary napkins) duringtheir menstruation following 80.8% not be restricted to sundry the cloth pad 38.1% of the participant girls were restricted to use the common toilet but more than two third of the respondents 74.6% were restricted to use common taps

4.3Mean score of individual items of Perceived Stress

This section consists of table presenting the mean and standard deviation for each item of the perceived stress scale

Table Mean score of an individual item of Perceived Stress

Perceives Stress Questionnaire (10 Scale) Mean Std Deviation

1 In the last month, how often have you been upset because of menstrual restriction?

1.85 1.22

2 In the last month, how often have you felt that you were unable to control important things in your life because of menstrual restriction?

1.64 1.24

3 In the last month, how often have you felt nervous and “stressed” because of menstrual restriction?

1.83 1.24

4 In the last month, how often have you felt confident about your ability to handle your personal problems inspite of menstrual restriction?

1.88 1.310

5 In the last month, how often have you felt that things were going your way inspite of menstrual restriction?

2.34 1.25

6 In the last month, how often have you found that you could not cope with

all the things that you had to because of menstrual restriction?

1.92 1.30

7 In the last month, how often have you been able to control irritations in your life inspite of menstrual restriction?

1.84 1.25

8 In the last month, how often have you felt that you were on top of things? 2.17 1.30

9 In the last month, how often have you been angered because of menstrual

restriction?

2.02 1.36

10 In the last month, how often have you felt difficulties were piling up so high that you could not overcome them because of menstrual restriction?

2.11 1.57

23

Table shows that the mean score for different items in the scale varied form Mean ± SD of 1.85±1.22 for item no 1, in the last month, how often have you been upset because of menstrual restriction? For item no 2, in the last month, how often have you felt that you were unable to control important things in your life because of menstrual restriction? It was Mean ± SD of 1.64±1.24 Similarly, for item no 3, in the last month, how often have you felt nervous and “stressed” because of menstrual restriction? Mean ± SD was1.83±1.24 Respectively, for item no 4, in the last month, how often have you felt confident about your ability to handle your personal problems inspite of menstrual restriction? Mean ± SD was 1.88±1.31 In case of item no 5, in the last month, how often have you felt that things were going your way inspite of menstrual restriction? Mean ± SD was a bit higher 2.34±1.25 Also, for item no 6,In the last month, how often have you found that you could not cope with all the things that you had to because of menstrual restriction? Mean ± SD was 1.92±1.30.For item no 7,In the last month, how often have you been able to control irritations in your life inspite of menstrual restriction? Mean ± SD was 1.84±1.25.For item no 8, In the last month, how often have you felt that you were on top of things?, Mean ± SD was 2.17±1.30.For item no 9, In the last month, how often have you been angered because of menstrual restriction?, Mean ± SD was 2.02±1.36 and For item no 10, In the last month, how often have you felt difficulties were piling up so high that you could not overcome them because of menstrual restriction Mean ± SD was 2.11±1.57, making the Total Perceived Stress Scale Score as Mean ± SD = 19.59±5.51

Table Perceived stress level

The table shows that there was a high prevalence of perceived moderate stress, 79.2% among young adolescent's girls followed with 9.7% suffering from high perceives stress and 11.1% suffering from low perceived stress

Perceived stress level Number (%)

Low Stress 41 (11.1)

Moderate stress 293(79.2)

High Stress 36(9.7)

24 4.4Association between Socio-demographic and PS

This section consists of table showing the association of selected demographic variables like age, ethnicity, household size, father‟s and mother‟s education and their view regarding restriction which was tested using chi-square test as presented in the tables below

Table Association between Socio-demographic and PSS

Socio-demographic Characters tics

Total n (%)

High PS Moderate PS Low PS Value P-Value

Age (Completed years)

14 118 (31.9) 12 (33.3) 87 (29.7) 19 (46.3)

15 105 (28.4) (25) 83 (28.3) 13 (31.7)

7.977 0.240

16 78 (21.1) (25) 63 (21.4) (14.6)

17 69 (18.6) (16.7) 60 (20.5) (7.3)

Grade of the study

8 139 (37.6) 16(44.4) 110 (37.5) 13 (31.7)

9 132 (35.7) 9(25) 112 (38.2) 11 (26.8) 7.618 0.107

10 99 (26.8) 11(30.6) 71 (24.2) 17 (41.5)

Fathers Education

Illiterate 62 (16.8) 7(19.4) 47 (16) (19.5)

Literate 95 (25.7) 7(19.4) 80 (27.3) (19.5) 3.351 0.764

Primary level (1-8) 156 (42.2) 14 (38.9) 123 (42) 19 (46.3)

Secondary Level or above(>8) 57 (15.4) (22.2) 43 (14.7) (14.6)

Mothers Education

Illiterate 106 (28.6) 17 (47.2) 76 (25.9) 13 (31.7)

Literate 123 (33.2) (22.2) 100 (34.1) 15 (36.6) 10.417 0.108

Primary level (1-8) 121 (32.7) (22.2) 103 (35.2) 10 (24.4)

Secondary Level or above(>8) 20 (5.4) (8.3) 14 (4.8) (7.3)

Fathers view on restriction

0.623

0.732

Supports Menstrual Restriction 269 (72.7) 35 (71.4 216 (73.5) 18 (66.7)

Against Menstrual restriction 101 (27.3) 14 (28.6) 78 (26.5) (33.3)

Mothers view on restriction

1.422

0.491

Supports Menstrual Restriction 292 (78.9) 38 (77.6) 235 (79.9) 19 (70.4)

Against Menstrual restriction 78 (21.1) 11 (22.4) 59 (20.1) (29.6)

25

Mothers view on restriction p-value (0.49) was not found to be associated with PS as well

4.5 Association between Menstrual Restriction and PS

This section consists of results showing association between different forms of restrictions and level of the perceived stress level in the represented table below

Table Association between Menstrual Restriction and PS

Types of Restrictions Total n (%) High PS Mild PS Low PS

Value

P-Value

Restricted to enter the inside house

Yes 214 (57.8) 33 (91.7) 161 (54.9) 20 (48.8)

19.276 <0.001*

No 156 (42.2) (8.3) 132(45.1) 21 (51.2)

Sent to Chau Goth

Yes 189 (51.1) 30 (83.3) 141 (48.1) 18 (43.9)

16.858 <0.001*

No 181 (48.9) (16.7) 152 (51.9) 23 (56.1)

Restricted to touch male members

Yes 73 (19.7) 12 (33.3) 50 (171) 11 (26.8)

6.825 0.033*

No 297 (80.3) 24 (66.7) 243 (82.9) 30 (73.2)

Restricted to touch livestock or animals

Yes 186 (50.3) 27 (75) 146 (49.8) 13 (31.7)

14.481 <0.001*

No 184 (49.7) (25) 147(50.2) 28 (68.3)

Restricted to eat together with a family

Yes 263 (71.1) 31 (86.1) 211 (72) 21 (51.2)

11.948 0.003*

No 107 (28.9) (13.9) 82 (28) 20 (48.8)

Restricted to Consume dairy Products

Yes 261 (70.5) 35 (97.2) 204 (69.6) 22 (53.7)

18.074 <0.001*

No 109 (29.5) (2.8) 89 (30.4) 19 (46.3)

Restricted to participate in cultural rituals

Yes 120 (32.4) 20 (55.6) 88 (30) 12 (29.3)

9.740 0.008*

No 250 (67.6) 16 (44.4) 205 (70) 29 (70.7)

Restricted to go to school

Yes 35 (9.5) (16.7) 26 (8.9) (7.3)

2.520 0.284

No 335 (90.5) 30 (83.3) 267 (91.1) 38 (92.7)

Restricted to roam around and play with friends

Yes 45 (12.2) (22.2) 33 (11.3) (9.8)

3.854 0.146

26

Table continued…

Table7 explains and highlights that there was association between restricted to enter inside the house (<0.001*), sent to Chau-goth(<0.001*), restricted to touch male members (<0.033*), restricted to touch livestock or animals(<0.001*), restricted to eat together with family(<0.003*), restricted to consume dairy products(<0.001*), restricted to participate in cultural rituals (<0.001*), restricted to go to school(<0.284), restricted to roam and play around with friends (<0.146),restricted to sleep in any bed(<0.003) restricted to use heavy blanket and mattresses(<0.001*), restricted to use packed pads (0.005*), restricted to sundry cloth pad(0.002*), restricted to use common toilets(<0.001*) and restricted to use common taps (<0.001*)respectively

Types of Restrictions Total n (%)

High PSS

Mild PSS Low PSS

Value

P-Value

Restricted to sleep in any bed

Yes 167 (45.1) 25 (69.4) 129 (44) 13 (31.7)

11.721 0.003*

No 203 (54.9) 11 (30.6) 164 (56) 28 (68.3)

Restricted to use heavy blankets and mattresses

Yes 92 (24.9) 18 (50) 64 (21.8) 10 (24.4)

13.611 <0.001*

No 278 (75.1) 18 (50) 229 (78.2) 31 (75.6)

Restricted to use packed pads

Yes 51 (13.8) 11 (30.6) 33 (11.3) (17.1)

10.461

0.005*

No 319 (86.2) 25 (69.4) 260 (88.1) 34 (82.9)

Restricted to sundry cloth pad

Yes 71 (19.2) 15 (41.7) 49 (16.7) (17.1)

12.996 0.002*

No 299 (80.8) 21 (58.3) 244 (83.3) 34 (82.9)

Restricted to use the common toilet

Yes 141 (38.1) 27 (75) 103 (35.2) 11 (26.8) 24.069 <0.001*

No 229 (61.9) (25) 190 (64.8) 30 (73.2)

Restricted to use common taps

Yes 276 (74.6) 35 (97.2) 221 (75.4) 20 (48.8)

24.250 0.001*

27

CHAPTER V: DISCUSSION

28

and the ways in which a person reacts to it can be influenced by a various number of factors such as personal characteristics, lifestyle, social support, and appraisal of the stressor(s), life events, socio-demographic and occupational variables In thestudy, it was found that with age the level of perceived stress was significantly lower, with being Highest among the age group of 14 to lowest in the age group of 17 Similar findings were found when the grade of the adolescent girls increased from being highest in the grade to lowest among grade 10 Among different ethnic groups present perceived stress was found to be comparatively high among Upper caste groups and Dalits since they religiously follow menstrual restriction in contrast to disadvantaged Janajati of hills In addition, larger the household sizes the level of perceived stress was moderately high among them Menstrual restriction and perceived stress were measured with regards to each type of menstrual restriction showing significant association between more that 80% of the measured level of menstrual restrictions

International studies showed that the perception of psychological stress in the adolescent population tends to be higher among girls,regardless of age, in contrast this study showed low level of stress among adolescents which may be due to increasing maturity among adolescents with age.In Korea,the prevalence of perceived stress was observed in 30.5% of female participants In England, of the adolescents who perceived themselves with high level of stress, 54.5% were female In Brazil, the studies conducted with adolescents are leading to the same direction as international investigations, with prevalence of 30.1% among girls In Rio Grande Sul, among the adolescents who perceived themselves as stressed, 61.5% were female.(23)The results of current research suggested that in a developing society with high prevalence of stress, interventions targeted toward promoting financial and social equalities, social skills training, and healthy lifestyle may have the potential benefits for large parts of the population, most notably female and lower educated people.(24)

29

surprising, participants were restricted from eating dairy products (22)The researchers were impressed to see that most of our participants were permitted to attend school and read books while menstruating In the past, menstruating girls were expected to halt school attendance, since one Hindu belief is that „Sarashwoti,‟ the goddess of education, will become angry if a girl or woman reads, writes or touches books during her menstrual cycle.(22) Agreeably, 90.54% of our participants were not restricted to go to school either with 9.46% being restricted for the same

The findings of this study showed that there is a significant relationship between menstrual restriction and perceived stress among adolescent girls of Godawari Municipality, Kailali District.Adolescent age being highly crucial phase of life is difficult for those born in under developed countries since topics of sexual and reproductive health are yet to be freely spoken and normalized With such taboos going on regarding restrictions during menstruation lead them to various form of mental trauma including perceived stress which has significant association with other mental hazards Since this population is in school, it would be extremely important that educational public policies could consider the possibility of inserting psychologists and nutritionists in the school context, in the sense of working directly with problems related with stress associated with menstrual restriction If it is not possible to respond to this suggestion, we reinforce the need for teachers of Physical Education, Mental Health and Nutrition in their classes focusing on health education, to approach the theme using videos, seminars and scientific lectures addressed to the importance of avoiding such harmful practice and to reduce the levels of stress For that reason, to mitigate such hazards extension of advocacy on normalizing m around menstruation, sexual and reproductive health issues should be in community level, also sharing of the experiences and proper mental health counseling should be done specified to the adolescent age group with maximum support Dreadful practices such as Chaupadi must be very punishable and all the discriminatory practices should be ruled out from its root to prevent further consequences in young girl's psychosocial well-being and life.For further research this type of study can be conducted among the larger population in community and institutional basis View of men shall also be explored and factors associated with Chaupadi practice and other forms of menstrual restrictions can be studied as well

30

31

CHAPTER VI: CONCLUSION AND RECOMMENDATION

6.1Conclusion

This study represents initial evidence that perceived stress among young girls of adolescent age group was significantly present in the Godawari Municipality, Kailali district This descriptive, cross-sectional, study found that various forms of restriction practiced during menstruations were significantly related with the Perceived stress level among them.Furthermore, researches should be conducted to assess the prevalence of the Perceived Stress among adolescent girls in larger population in different places and to eliminate such practices from root, via Awareness regarding the issue.In addition, factors associated with restriction and Perceived stress can be explored

6.2 Recommendation

1 Keeping in mind of the situation regarding the Perceived stress as a result of menstrual restriction, extension on advocacy regarding the harmful practice and Chaupadi should be done in the community level

2 To further prevent the stress in coming generation, early knowledge about menstruation should be provided to the adolescent girls

3 Counseling should also be provided form municipal level in the community involving parents, local representatives, health professionals, teachers and others Education Ministry should manage the mental health related curriculum in the

schools

xii

REFERENCES

1 WHO Adolescent health Available from: www.who.int/topics/adolescent_health Kirk J, Sommer M Menstruation and body awareness: linking girls‟ health with

girls‟ education Royal Tropical Institute (KIT), Special on Gender and Health 2006:1-22

3 Hamal M, Susma K Hygiene, Health Problems and Socio-cultural practices: what school girls during menstruation Age 2014;12(13):14

4 Timilsina A Intersecting Mental Health and Sexual and Reproductive Health Health Prospect.17(1):18-20

5 Klein EM, Brahler E, Dreier M, Reinecke L, Muller KW, Schmutzer G, et al The German version of the Perceived Stress Scale - psychometric characteristics in a representative German community sample BMC Psychiatry 2016;16:159

6 Nemade D, Anjenaya S, Gujar R Impact of health education on knowledge and practices about menstruation among adolescent school girls of Kalamboli, Navi-Mumbai Health Popul Perspect Issues 2009;32(4):167-75

7 Cardoso LF, Clark CJ, Rivers K, Ferguson G, Shrestha B, Gupta J Menstrual restriction prevalence and association with intimate partner violence among Nepali women BMJ Sex Reprod Health 2018

8 Upadhyay P Menstruation pollution taboos and gender based violence in western Nepal 2018

9 Jun M, Jang I The Role of Social Capital in Shaping Policy Non-compliance for Chhaupadi Practice in Nepal Asian Women 2018;34(3):47-70

10 NFCC Assessment Study on Chhaupadi in Nepal: Towards a Harm Reduction Strategy Nepal: 2015 March, 2015 Report No

11 Garg S, Sharma N, Sahay R Socio-cultural aspects of menstruation in an urban slum in Delhi, India Reproductive health matters 2001;9(17):16-25

12 Ranabhat C, Kim C-B, Choi EH, Aryal A, Park MB, Doh YA Chhaupadi culture and reproductive health of women in Nepal Asia Pacific Journal of Public Health 2015;27(7):785-95

13 Yadav RN, Joshi S, Poudel R, Pandeya P Knowledge, Attitude, and Practice on Menstrual Hygiene Management among School Adolescents Journal of Nepal Health Research Council 2018;15(3):212-6

14 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 Trop Med Int Health 2018

15 Robinson H Chaupadi: the affliction of menses in Nepal International journal of women's dermatology 2015;1(4):193-4

16 Shanbhag D, Shilpa R, D'Souza N, Josephine P, Singh J, Goud B Perceptions regarding menstruation and practices during menstrual cycles among high school going adolescent girls in resource limited settings around Bangalore city, Karnataka, India International Journal of Collaborative Research on Internal Medicine & Public Health 2012;4(7):1353

xiii

18 Cardoso LF, Clark CJ, Rivers K, Ferguson G, Shrestha B, Gupta J Menstrual restriction prevalence and association with intimate partner violence among Nepali women BMJ sexual & reproductive health 2018:bmjsrh-2017-101908 19 Cohen S, Kamarck T, Mermelstein R A global measure of perceived stress

Journal of health and social behavior 1983:385-96

20 Eller LS, Mahat G Psychological factors in Nepali former commercial sex workers with HIV Journal of Nursing Scholarship 2003;35(1):53-60

21 Parajuli SB, Heera K, Mishra A, Bhattarai P, Shrestha M, Srivastav K Chaupadi during menstruation still a major community health challenge: perspective from Mid-Western Nepal BIBECHANA 2019;16:228-35

22 Amatya P, Ghimire S, Callahan KE, Baral BK, Poudel KC Practice and lived experience of menstrual exiles (Chhaupadi) among adolescent girls in far-western Nepal PloS one 2018;13(12):e0208260

23 Pinto AdA, Claumann GS, Medeiros Pd, Barbosa RMdSP, Nahas MV, Pelegrini A Association between perceived stress in adolescence, body weight and romantic relationships Revista Paulista de Pediatria 2017;35(4):422-8

xiv

Annex Tools of Data Collection (English and Nepali Version)

Purbanchal University

Faculty of Medical and Allied Science Karnali college of Health Science

Department of Public Health Battisputali, Kathmandu, Nepal

For the researchers purpose only

Ref

Please circle the appropriate single option as response and fill the appropriate information‟s in the blank dotted areas as applicable

1

1

Have your Menstruation started?

2 (If end the survey)

Yes No

2 Age (Completed Years) ………

3 Which grade you study in?

2

Class Class Class 10 Permanent residence (Ward only)

5 Ethnicity Dalit

2 Disadvantaged Janajatis

3 Disadvantaged non Dalit Terai caste groups Religious minorities

5 Relatively advantaged Janajatis Upper caste groups

6 Religion

2

Hindu Buddhist Muslim Kirat Christians Others (specify) How many members are there in your

family?

1

Male………… Female…………

8 Marital status

2

Married Unmarried

Others (Divorced, widower)

9 Fathers Education

2

Illiterate Literate

Basic Level (1-8) Secondary Level (9-12) Bachelors Level Masters Level Section: A

xv

10 Mothers Education

2 Illiterate Literate

Basic Level (1-8) Secondary Level (9-12) Bachelors Level Masters Level 11 If married Husbands Education

(If not married skip this question)

1 Illiterate Literate

Basic Level (1-8) Secondary Level (9-12) Bachelors Level Masters Level 12 Is your Father against Menstrual Restriction

or supports it?

1

Against menstrual restriction Supports menstrual restriction 13 If your father is against restriction what kind

of support you receive from his side?

1

Support to break all taboos and restrictions

Do not restrict you during menstruation Emotional support

14 Is your Mother against Menstrual Restriction or supports it?

1

Against menstrual restriction Supports menstrual restriction 15 If your mother is against restriction what kind

of support you receive from his side?

1

3

Support to break all taboos and restrictions Do not restrict you during menstruation Emotional support

Other……… 16 Is your Husband against Menstrual Restriction

or supports it? (If not married skip this question

1

Against menstrual restriction Supports menstrual restriction 17 If your husband is against restriction what

kind of support you receive from his side? (If not married skip this question

1

3

Support to break all taboos and restrictions Do not restrict you during menstruation Emotional support

Other………

18 What is your fathers occupation?

2

Does not work (Does not earn money) Governmental

Non- governmental Agriculture

Small scale transaction Labor

Student Business

Other (Specify)………

19 What is your mothers occupation?

2 10

Does not work (Does not earn money) Governmental

Non- governmental Agriculture

Small scale transaction Labor

Student House wife Business

Other (Specify)……… 20 What is your husband‟s occupation?

2

Does not work (Does not earn money) Governmental

Non- governmental Agriculture

Small scale transaction Labor

Student Business

xvi Section B

Menstrual Restriction

How often you face the following circumstances during menstruation please mention your response with a tick in the appropriate box

SN

Statements Never

0

Sometimes 1

Always 2 Are you restricted to enter inside the house

while menstruating

2 Are you restricted to reside inside house (not sent to chau goth) while menstruating Are you restricted to reside inside

house?(Sent to a chau- goth) while menstruating Are you restricted to see male members

while menstruating

5 Are you restricted to touch male members while menstruating

6 Are you restricted to interact with male members while menstruating

7 Are you restricted to enter inside temple while menstruating

8 Are you restricted to touch food to be eaten by others while menstruating

9 Are you restricted to cook food while menstruating

10 Are you restricted to touch plants with holy beliefs like Tulsi, Pipal, Bel etc while

menstruating

11 Are you restricted to consume Vegetables while menstruating

12 Are you restricted to consume Fruits while menstruating

13 Are you restricted to eat together with family while menstruating

14 Are you restricted to touch livestock while menstruating

15 Are you restricted to eat together with family while menstruating

16 Are you restricted to consume Dairy Products like milk, curd, ghee while menstruating

17 Are you restricted to consume Animal Products like meat, fish, eggs

18 Are you restricted to get involved in cultural rituals or family functions during menstruation

19 Are you restricted to go to school during menstruation

20 Are you restricted from playing or roam with your friends during menstruation 21 Are you restricted to sleep in your usual

bed while menstruating

22 Are you restricted to sleep in any bed while menstruating

xvii 24 Are you restricted to use packed pads and

forced to wear strained unwashed cloths during menstruation

25 Are you restricted to sundry the clot pad you used while menstruating?

26 Are you restricted to use the common toilet during menstruation

27 Are you restricted to touch or use water taps and wells during menstruation

Section C

Perceived Stress

Thank You for your Support

Please tick your response in the appropriate box SN

Statements Never

0

Almost Never

1

Sometimes 2

Fairly Often

3 Very Often

4 28 In the last month, how often have you been

upset because of menstrual restriction? 29 In the last month, how often have you felt

that you were unable to control important things in your life because of menstrual restriction?

30 In the last month, how often have you felt nervous and “stressed” because of menstrual restriction? 31 In the last month, how often have you felt

confident about your ability to handle your personal problems inspite of menstrual restriction?

32 In the last month, how often have you felt that things were going your way inspite of menstrual restriction?

33 In the last month, how often have you found that you could not cope with all the things that you had to because of menstrual restriction?

34 In the last month, how often have you been able to control irritations in your life inspite of menstrual restriction?

35 In the last month, how often have you felt that you were on top of things?

xviii

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= lxGb'

@

= a'l4i6

#

= d'l:nd

$

= ls/fFt

%

= ls|:rLog

^

= cGo -pNn]v ug'{xf;\_===============================

& ==

tkfO{sf ] kl/jf/df slt hgf ;b:o x'g'x'G 5<

!

= Dlxnf =======================

@

= k'?if =========================

* = tkfO{sf] a}jflxs l:ytL pNn]v ug'{xf]; !

= lajflxt

@

= cljaflxt

#

= cGo -kf/kfr's], Psn dlxnf_

( = tkfO{sf ] a'afsf] z}lIfs of]Uotf pNn]v ug'{xf]; !

= ;fdfGo n]vk9 ug{{ ghfGg]

@

= ;fIf/

#

= k|fydLs tx -!–*_

$

= dfWodLs tx -(–!@_

%

= :gftstx

^

= :gftsf]Q/ tx

&

= cGo -pNn]v ug'{xf;\_============================

! )= = tkfO{sf ] cfdfsf] z}lIfs of]Uotf pNn]v ug'{xf]; !

= ;fdfGo n]vk9 ug{{ ghfGg]

@

= ;fIf/

#

= k|fydLs tx -!–*_

$

= dfWodLs tx-(–!@_

%

= :gftstx

^

= :gftsf]Q/ tx

xx = ! != olbljjfl xt x'g'x'G

5 eg]

tkfO{sf ] >Ldfgs f] z}lIfs of]Uotf pNn]v ug'{xf]; !

= ;fdfGo n]vk9 ug{{ ghfGg]

-olbcljjf lxt x'g'x'G

5 eg]

k|Zg g+ !@ df hfg'xf]; \_ @

= ;fIf/

#

= k|fydLs tx -!–*_

$

= dfWodLs tx-(–!@_

%

= :gftstx

^

= :gftsf]Q/ tx

&

= cGo -pNn]v ug'{xf;\_============================

! @ =

tkfO{sf ] a'af /h:jnfsf ] j]nf x'g] k|ltaG wsf] lj/f]w ug'{ x'G5 jf ;dy{g ug{'x'G <

!

= ;dy{g ug{'x'G5

-

olb !

pQ/ /f]Hg'x' G5 eg] k|=g+

!$ df

hfg'xf]; \ _ @

= lj/f]w ug'{x'G5

! #= =

olb tkfO{sf ] a'af /h:jnfsf ] a]nf x'g] k|ltaG wsf] lj/f]wL xf] eg] jxfF af6 tkfO{n ] s:tf] ;dy{g kfpg'eP sf] <

!

= ;a} cGwljZjf; tf]8\g ;d{yg / xf};nf lbg'x'G5

@

= ;a} aGb]hx? Tf]8\g ;d{yg / xf};nf lbg'x'G5

#

= efjgfTds ;dy{g ug'{x'G5

$ = cGo============================================ =========== !$= = tkfO{sf ] cfdf /h:jnfsf ] j]nf x'g] k|ltaG wsf] lj/f]w ug'{ x'G5 jf ;dy{g ug{'x'G <

!

= ;dy{g ug{'x'G5

-

olb !

pQ/ /f]Hg'x' G5 eg] k|=g+

!^ df

hfg'xf]; \ _ @

xxi ! %= olb tkfO{sf] cfdf /h:jnfsf] a]nfx'g] k|ltaGw sf] lj/f]wL xf] eg] jxfF af6 tkfO{n] s:tf] ;dy{g kfpg'ePs f] <

!

= ;a} cGwljZjf; tf]8\g ;d{yg / xf};nf lbg'x'G5 @

= ;a} aGb]hx? Tf]8\g ;d{yg / xf};nf lbg'x'G5

#

= efjgfTds ;dy{g ug'{x'G5

$ = cGo============================================ ============= ! ^= tkfO{sf ] >Ldfg /h:jnfsf ] j]nfx'g] k|ltaG wsf] lj/f]w ug'{ x'G5 jf ;dy{g ug{'x'G <

!

= ;dy{g ug{'x'G5

-olbcljjfl xt x'g'x'G5 eg] k|Zg g+ !* df hfg'xf];\ _ @

= lj/f]w ug'{x'G5

! &= olb tkfO{sf ] >Ldfg\ /h:jnfsf ] a]nf x'g] k|ltaG wsf] lj/f]wL xf] eg] jxfF af6 tkfO{n ] s:tf] ;dy{g kfpg'eP sf] <

!

= ;a} cGwljZjf; tf]8\g ;d{yg / xf};nf lbg'x'G5

@

= ;a} aGb]hx? Tf]8\g ;d{yg / xf};nf lbg'x'G5

#

= efjgfTds ;dy{g ug'{x'G5

$ = cGo============================================ ==================== ! *= = tkfO{sf] a'afsf] k]zf s] xf] < ! = @ = # = $ = % = ^ = &

sfd gu/]sf] -k};f gsdfpg]_ ;/sf/L u}/ ;/sf/L s[ifL ;fgf] sf/f]af/ Hofnfbf/L >lds ljBfyL{ u[lx0fL Jofkf/

cGo

xxii = * = ( = ! )= !(= \ tkf O{sf] cfdfsf] k]zf s] xf] < ! = @ = # = $ = % = ^ = & = * = ( = ! )=

sfd gu/]sf] -k};f gsdfpg]_ ;/sf/L u}/ ;/sf/L s[ifL ;fgf] sf/f]af/ Hofnfbf/L >lds ljBfyL{ u[lx0fL Jofkf/

cGo

-v'nfpg'xf];\_======================================= @ )= tkfO{sf ] >Ldfgs f] k]zf s] xf] <

! = @ = # = $ = % = ^ = & = * = ( = ! )=

sfd gu/]sf] -k};f gsdfpg]_ ;/sf/L u}/ ;/sf/L s[ifL ;fgf] sf/f]af/ Hofnfbf/L >lds ljBfyL{ u[lx0fL Jofkf/

cGo

-v'nfpg'xf];\_=======================================

-olb cljjflxt x'g'x'G

5 eg]

k|Zg g+ !* ;d'x v

df hfg'xf]; \_

;d'x M v

xxiii

Dlxgfjf/Lsf] ;dodf tkfO{n] lgDg kl/l:yltx? ;fdgf ug'{ePsf] eg] pko'QmaS;df -√ _ lrGxnufO{ tkfO{sf] k|ltls|of lbg'xf];\

qm=

;= k|:g

slxNo} klg 5}g

slxn]

sfFxL ;w}

@@ =

/h:jnf ePsf] a]nf tkfO{nfO{ 3/ leq k|a]; /f]s jf aGb]h <

@#= /h:jnf ePsf] a]nf tkfO{nfO{ 3/ leq jf;

j:g /f]s jf aGb]h < - t/ 5fpuf]7df k7fpg'x'Gg _

@$= /h:jnf ePsf] a]nf tkfO{nfO{ 3/ leq jf;

j:g /f]s jf aGb]h < - 5fpuf]7df k7fpg'x'G5 _

@% =

/h:jnf ePsf] a]nf tkfO{nfO{

k'?ifx?nfO{ x]g{ /f]s jf aGb]h <

@^= /h:jnf ePsf] a]nf tkfO{nfO{

k'?ifx?nfO{ 5'g /f]s jf aGb]h < @&

=

/h:jnf ePsf] a]nf tkfO{nfO{ k'?ifx? ;Fu s'/fsfgLug{ /f]s jf aGb]h <

@*= /h:jnf ePsf] a]nf tkfO{nfO{ dlGb/ hfg

/f]s jf aGb]h <

@(= /h:jnf ePsf] a]nf tkfO{nfO{ c?n] vfg]

vfgf 5'gdf /f]s jf aGb]h <

#)= /h:jnf ePsf] a]nf tkfO{nfO{ vfgf ksfpg

/f]s jf aGb]h <

#!= /h:jnf ePsf] a]nf tkfO{nfO{ wfdL{s

cf:yf af]s]sf af]6 lj?jf jf ?v h:t} t'n;L, lkknjf j]n cflb 5'g /f]s jf aGb]h <

#@= /h:jnf ePsf] a]nf tkfO{nfO{ xl/of]

t/sfl/†;AhL vfg /f]s jf aGb]h <

##= /h:jnf ePsf] a]nf tkfO{nfO{ kmnkm'n

vfg /f]s jf aGb]h <

#$= /h:jnf ePsf] a]nf tkfO{nfO{ 3/kfn'jf

kz'klG5 jf hgfj/ 5'g /f]s jf aGb]h <

#%= /h:jnf ePsf] a]nf tkfO{nfO{ kl/jf/ ;Fu

a;]/ vfgf vfg /f]s jf aGb]h <

#^= /h:jnf ePsf] a]nf tkfO{nfO{ b'w, blx,

£o" nufot cGo b'Uw ;fdfu|L vfg /f]s jf aGb]h <

#&= /h:jnf ePsf] a]nf tkfO{nfO{ df5f, df;', c08f cflb vfg /f]s jf jGb]h <

#(= /h:jnf ePsf] a]nf tkfO{nfO{ ;+f:s[tLs

sfo{s|d jf kfl/jfl/s e]63f6df ;+DnUg x'g /f]s jf jGb]h <

$)= /h:jnf ePsf] a]nf tkfO{nfO{ ljBfno hfg

/f]s jf aGb]h <

$@= /h:jnf ePsf] a]nf tkfO{nfO{ ;fyLx? ;Fu

v]Ng†w'Dg /f]s jf aGb]h <

$#= /h:jnf ePsf] a]nf tkfO{nfO{ cfˆgf]

vf6df ;'Tg /f]s jf aGb]h <

$$= /h:jnf ePsf] a]nf tkfO{nfO{ s'g} klg

vf6df ;'Tg /f]s jf aGb]h <

$%= /h:jnf ePsf] a]nf tkfO{nfO{ ef/L l;/s,

8Zgf cf]9\g cf]5\ofpg /f]s jf aGb]h <

$&= /h:jnf ePsf] a]nf tkfO{nfO{ ahf/df lsGg

kfOg] l8ikf]h]jn Kof8sf] k|of]u ug{ /f]s jf aGb]h <

xxiv

k|of]u u/]sf] sk8f wf]P/ 3fddf ;'sfpg /f]s jf aGb]h <

$(= /h:jnf ePsf] a]nf tkfO{nfO{ cfˆgf] 3/sf]

;a}n] k|of]u ug]{ rkL{ k|of]u ug{ /f]s jf aGb]h <

%)= /h:jnf ePsf] a]nf tkfO{nfO{ s'g} klg

wf/f jf kfgLsf] d'xfg 5'g / k|of]u ug{ /f]s jf aGb]h <

;d'x M u

cg'e't tgfj

s[kof x/]s k|:gsf] nflu pko'Qm ljsNkdf uf]nf] nufpg' xf]; olb tkfO{nfO{ /h:jnf ePsf] a]nf s'g}kgL s'/fdf k|ltaGw 5}g eg] s'g}kgL ljsNkdf uf]nf] gnufpg'xf];

% @=

utdlxgfdf, /h:jnfsf] ;dodf ePsf] k|ltaGwsf] sf/0fn] tkfOF k|fo slt lg/f; x'g' eof] < slxN o} eO{g ) nueu slxNo} eO{g ! slxn]s fxLF x'Gy]F @ k|fo e}/fv]sf] x'Gy]F # ;w} h;f] uyF]{ $ %# =

utdlxgfdf tkfO{nfO{

/h:jnfsf] ;dodf ePsf]

k|ltaGwsf sf/0f s]xL

dxTjk'0f{ s'/fx? lgoGq0f ug{ c;dy{ lyP eGg] k|fo sltsf] dx;'; ug{'eof]<

slxN o} ul/g ) nueu slxNo} ul/g ! slxn]s fxLF uyF]{ @ k|fo ul//fv]sf] x'Gy]F # ;w} h;f] uyF]{ $ %$ =

utdlxgfdf tkfO{nfO{

/h:jnfsf] ;dodf ePsf]

k|ltaGwsf sf/0f

eoft'/(nervous) / tgfj k|fo sltsf] dx;'; ug{'eof]<

slxN o} ul/g ) nueu slxNo} ul/g ! slxn]s fxLF uyF]{ @ k|fo ul//fv]sf] x'Gy]F # ;w} h;f] uyF]{ $ % %=

utdlxgfdf tkfO{nfO{

/h:jnfsf] ;dodf ePsf]

k|ltaGwsf sf/0f ef]u]sf]

k/]zfgL;Fu k|fo sltsf]

;kmntfk'j{s ;fdgf ug'{eof] < slxN o} ul/g ) nueu slxNo} ul/g ! slxn]s fxLF uyF]{ @ k|fo ul//fv]sf] x'Gy]F # ;w} h;f] uyF]{ $ %^ =

utdlxgfdf /h:jnfsf] a]nfdf ePsf] k|ltaGwsf afah'b cfˆgf] hLjgsf dxQjk'0f{

kl/jt{gx?nfO{ k|efjsf/L

9+un] ;fdgf ul//x]sL5' eg]/ stLsf] dx;'; ug'{ePsf] < slxN o} ul/g ) nueu slxNo} ul/g ! slxn]s fxLF uyF]{ @ k|fo ul//fv]sf] x'Gy]F # ;w} h;f] uyF]{ $ % &=

utdlxgfdf /h:jnfsf] a]nfdf ePsf] k|ltaGwsf afah'b tkfO{n] cfˆgf JolQmut ;d:ofx? 9'Ss;+u ;Dxfn]sL

5' eGg] stLsf] dx;';

ug'{eof] < slxN o} ul/g ) nueu slxNo} ul/g ! slxn]s fxLF uyF]{ @ k|fo ul//fv]sf] x'Gy]F # ;w} h;f] uyF]{ $ %* =

utdlxgfdf tkfO{n] sltsf] dx;'; ug'{eof] sL /h:jnfsf]

j]nf ePsf] k|ltaGwsf

afah'b d]/f sfdx? d}n] ;f]r]sf] h:t} e}/fv]sf 5g\ <

slxN o} ul/g ) nueu slxNo} ul/g ! slxn]s fxLF uyF]{ @ k|fo ul//fv]sf] x'Gy]F # ;w} h;f] uyF]{ $ %( =

utdlxgfdf tkfO{n] sltsf] dx;'; ug'{eof] sL tkfOFn]

/h:jnfsf] a]nf ePsf]

k|tLaGwsf sf/0fn] ubf{

tkfO{n] ug'{kg]{ ;a}

xxv

sfdx?sf] ;fdgf ug{

;Sg'ePg <

^) =

utdlxgfdf /h:jnfsf] a]nf

ePsf] k|ltaGwsf sf/0f

pTkGg k/]zfgLx?

lgoGq0f ug{ tkfO{

slQsf] ;Ifd x'g'eof] <

slxN o} eO{g ) nueu slxNo} eO{g ! slxn]s fxLF ePF @ k|fo e}/fv]sf] x'Gy]F # ;w} h;f] x'Gy]F $ ^! =

utdlxgfdf tkfO{nfO{

sQLsf] dx;'; eof] ls

/h:jnfsf] ;dodf ePsf]

k|ltaGwsf afah't d d]/f ;a} sfddf cufl8 lyPF<

slxN o} ePg ) nueu slxNo} ePg ! slxn]s fxLF uyF]{ @ k|fo ul//fv]sf] x'Gy]F # ;w} h;f] uyF]{ $ ^ @=

utdlxgfdf tkfO{nfO{

/h:jnfsf] ;dodf ePsf]

k|ltaGwsf sf/0f sltko

s'/fx? cfˆgf] lgoGq0f aflx/ /x]sf] / ug{ gkfPsfn] l/; p7\of] <

slxN o} p7]g ) nueu slxNo} p7]g ! slxn]s fxLF p7\Yof] @ k|fo pl7/fv]sf] x'GYof] # ;w} h;f] p7\Yof] $ ^# =

utdlxgfdf /h:jnfsf] ;dodf ePsf] k|ltaGwsf sf/0f d}n] cfkm'n] rfx]sf] s'/f ug{ kfOg eg]/ sQLsf] dx;'; ug'{eof] <

slxN o} ul/g ) nueu slxNo} ul/g ! slxn]s fxLF uy]{F @ k|fo ul//fv]sf] x'Gy]F # ;w} h;f] uy]{F $ ^$ =

utdlxgfdf /h:jnfsf] ;dodf ePsf] k|ltaGwsf afah'b cfˆgf] ;do lgoGq0f ug{ sQLsf] ;Ifd x'g'ePsf] <

slxN o} ;lsg ) nueu slxNo} ;lsg ! slxn]s fxLF uy]{F @ k|fo ul//fv]sf] x'Gy]F # ;w} h;f] uy]{F $ ^% =

utdlxgfdf tkfO{nfO{

slQsf] dx;'; eof] sL