Indian Journal of Community Medicine Vol. 31, No.

1, January - March, 2006

Place of Menstruation in the Reproductive

Lives of Women of Rural North India
A J Singh
Objective : To ascertain the perceptions and experiences of women regarding menstruation. Methods : An integrated qualitative
and quantitative study on reproductive health of Indian women was conducted in two primary health centre areas of rural north
India. Present article reports on the perceptions of 1205 women regarding various aspects of menstruation. Results : Major
source of information about menarche/menstruation was friends/relatives (72%). Mean age at menarche was ~ 15 years. Very
few women (0.4%) used sanitary napkins. Majority of women had strong beliefs about effect of diet on menstruation. Most of
them considered menstruation a dirty act and indulged in various taboo behaviours. Initial reaction was of fear/apprehension at
menarche in majority of girls. Conclusion: Women in rural north India still hold tranditional beliefs regarding menstruation.
Provision of a balanced and healthy family health education package to all girls is recommended.
Key words : Reproductive Health, Menstruation.
as the intervention area and the PHC-2 as a control area. The
recruited staff (an anthropologist and four field investigators)
were trained in survey techniques. Elementary knowledge on
reproductive health was also imparted to the project staff. Using
the probability proportionate to size (PPS) method 20 villages
in PHC-1 (population 20692) out of total 37 villages (population
29930) were randomly selected. Similarly, 13 villages
(population 27262) were selected randomly in PHC-2 area out
of total 28 villages (population 37365). A baseline survey was
conducted in both the areas. It was proposed to interview at
least 500 women aged 15-49 years and their husbands from
both the areas. A minimum of 10 interviews were held at each
village. A uniform pre-structured interview schedule was used
at all the centres. The schedule had details on - sociodemographic data, obstetric history, family planning and
abortion details, gynecological morbidity profile and menstrual
history.

Introduction
The occurrence of menses indicates the non-pregnant status
of a women. A missed period indicates the pregnancy. Every
woman, therefore, awaits her next menstrual bleeding episode
every month with a sense of expectation, anxiety or
apprehension depending on the fact whether the pregnancy is
wanted or unwanted. Moreover, because of the regimented
life of monthly waiting period a woman tends to plan her
activities of daily life and in particular the outdoor activities
1,2
and strenuous work accordingly . Thus, menstruation
becomes a central issue in her life. Her daily and monthly
routine revolves around menstruation.
The pattern and extent of bleeding during menses and
associated symptoms vary among different women e.g. the
number of days of bleeding, the periodicity of (bleeding) cycles,
the amount of bleeding and its association with pain or other
features like nausea/vomiting. This makes such monthly
episodes of bleeding individually unique for every woman.

Qualitative research on various aspects of reproductive health

was also conducted by anthropologist and the PI. Initially, 16
key informant interviews were done by the anthropologist in
some of the villages of the study areas. The first 2-3 interviews
were held with traditional birth attendants and health workers.
For the remaining interviews more key informants were selected
on the basis of the information obtained from the previous key
informants. These interviews provided the background material
and the framework for conducting the focus group discussions
(FGDs). Apart from 6 TBAs and 2 health workers, 2 local
medical practitioners, 2 teachers, 2 opinion leaders and
anganwadi workers were also used as key informants.
Repeated interviews (3-5 visits) were held with them to get the
relevant details. Information from various sources were pooled
to get a complete picture. These exploratory key informant
interviews also helped in developing appropriate vocabulary
and in identifying relevant questions for FGDs and for the
interview schedule.

However, the low social status of women in Indian society...

the culture of shame and silence associated with their
reproductive health matters make public discussion on these
topics a taboo. They are conditioned to hide everything related
to their private lives.
Thus, till recently this area has been relatively unexplored by
public health researchers. With this aspects in mind an ICMR
sponsored multicentric project was conducted to ascertain
the effect of utilization of mobile units on reproductive health
3,4
needs of women . Present article reports on the perceptions
of the women of rural north India regarding menstruation as
revealed during initial baseline qualitative and quantitative data
collection phase of the project.
Material & Methods
First, two primary health centre areas (PHC-1 and PHC-2)
were chosen purposively from a district in north India - 30-40
km from the parent institution (PGIMER). PHC-1 was taken

Four FGDs were then organized by the female anthropologist

(moderator) and the field workers (comoderators) to get insight
into the terms used locally for various reproductive health
problems and for menstruation before finalizing the interview

Department of Community Medicine, PGIMER, Chandigarh 160012. E-mail : amarminhas56@rediffmail.com

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Place of Menstruation in North India

Indian Journal of Community Medicine Vol. 31, No. 1, January - March, 2006

schedule. These FGD participants were married women of

20-40 yrs age group. The FGDs helped in designing appropriate
questions for the interview schedule and in exploring the
prevailing range of beliefs and attitudes of the rural North Indian
women regarding reproductive health including menstruation.
Two of the FGDs were done in remote villages and the 2 in
PHC headquarter villages.

in this study are similar to the conceptual framework of rural

north Indian males pertaining to womens illnesses as reported
4
by the investigators earlier .
A women is considered dirty during her menses
Many restrictions are imposed on women during menstruation
in Indian rural setting. Many daily household chores which
1
5
are considered holy or sacred are proscribed . Garg et al
also reported that the subject of menstruation revolves round
notion of dirt, taboos and restrictions in various spheres of
womens lives in India.

Extensive notes were also taken during the session. Each

FGD had 4-6 participants who were invited to a common and
a neutral place in the village e.g. monthly meeting of local
women organization (mahila mandal) which are organized
regularly in rural areas of North India. Each FGD was analysed
immediately after the session through a meeting of the
moderator, comoderator and the investigators. Considerable
flexibility was given in the qualitative phase of the study for
data gathering and interviewing process. Emphasis was given
on recording verbatim responses.

In our study also many women said, During menstruation a

woman is considered impure or contaminated/dirty. So, all
kinds of restrictions are imposed on her.
One of them said, We do not go to the place of worship or
light the holy lamps during (during menses)... since it is a
holy place. It will be desecrated if a woman goes there during
menstruation. We do not offer food to Brahmins/Priests, do
not observe religious fasts, do not organize recitation of holy/
religious stories (katha) at our homes, and do not light incensesticks.

Based on the results of the key-informant interviews, and the

FGDs an interview schedule was prepared which was modified
after the pretesting. Then, after finalization of the interview
schedules a house to house survey was done in the selected
villages. All women aged 15-49 years, were contacted. Their
consent for the interview was taken. Each woman was
interviewed individually with emphasis on privacy.

Another woman said, if at all we have to go to temple (during

menses)... we first wash our hair... i.e. a purifying bath... then
go.

Results and Discussion

One woman told that she did not cook anything in kitchen
during menstruation. This is also linked to their belief regarding
their being impure/dirty during menses. Similar findings were
5
reported by Garg et al.

Profile of respondents :
Overall, 1205 women were interviewed (591 from the
experimental PHC and 614 from the control PHC). Of them,
10.8% were from a PHC village, 32,8% from a SC (subcentre)
village and 56.3% from a remote village. In all, 1056 households
were surveyed. Hindus were 79.5%, Sikhs 12.3%, Muslims
6.35% and rest were Christian/others. Lower/lower middle
class families were 85%. Rest were upper middle or higher
class. Nineteen percent of the respondents were unmarried.

Another one said, we do not lift heavy weights during

menses.... it leads to pain... such comments indicate that
women consider their bodies to be weakened during menses.
Another group of women said, we do not have sex during
menses... because if we do so... it leads to swelling inside...
and secondly, it feels all filthy to have sex during menses.

Mean age at marriage was 18.2 2.8 years. Eight percent

(98) women did not have any child. Of them, 33 were classifed
as infertile (primary infertility 3.4%; 33/976). Of them 14 (42%)
had consulted a doctor. Mean number of live birth, still birth,
and abortion per woman was 3.0, 0.2 and 1.5 respectively.
Mean number of living male and female children was 1.7 each.
Outcome of last pregnancy was a live birth in 96% cases, still
birth in 1.4% and abortion in 2.7% cases. Sex of the child in
the live birth was male in 66% cases and female in 34% cases.
Mean age of the last child was 53.1 36.1 months.

Thus, the routine life of women, in general, is profoundly

affected by the monthly phenomenon of bleeding during
menstruation.
The cloth-piece used as menstural pad-its disposal and
reuse
The concept of evil-eyes and magic is strong in India. The
piece of cloth/rag/pad used for menstrual bleeding is
considered by rural Indian women as one of the most vulnerable
object and a potent agent which might be used for casting evil
eyes/magic on some one. There is a belief prevalent in the
study area that women often throw their used rag/pad at road
crossing to cast evil eyes/magic on others. Anybody who steps
over this thrown rag/pad is said to become the victim of evil
eye/magic. This piece of cloth is considered a part and parcel
of the secret world of womens lives...so, all attempts are made
to hide/conceal the rag/pad... Thus, its disposal assumes a
special significance in the daily lives of Indian women.

Mean age at menarche was ~ 15 years. It was significant to

note that only 5 women (0.4%) used market-pads for
menstruation and that girls did not use any underwear in routine
6
before attaining menarche. Chatterjee et al had also reported
that use of market pad was low (2-8%) in an urban slum area
of North India. Majority of their respondents (70-76%) did not
even use any underwear in routine life.
The perceptions of women regarding menstruation as revealed
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Place of Menstruation in North India

Indian Journal of Community Medicine Vol. 31, No. 1, January - March, 2006

When our field-investigators asked the women if they reused

the cloth-piece used earlier for menstruation... many women
laughed at them... as if they had asked a very funny/ridiculous
question. Some of them reacted as if the investigators were
insulting the respondents. They said, it (the soiled rag) is a
disease... why to keep it inside the house... & Oh! who will
wash and reuse such a dirty thing... we throw it away on the
garbage heap... or bury it under the earth... (as told by a
Muslim woman). When they were asked... why do you bury
it, they told, it is shameful if anybody sees our dirty (stained
by menstrual blood) rags... suppose, some dog takes it
away... all private and secret/hidden things of women will come
out in the open... It will be very disgusting. If we casually
throw it away... all filth will spread and scatter around in the
whole village... so we bury it... so that nobody comes to know
about it.

modernization... it is Kalyug... nowadays, the girls know

everything soon after they are born... everyone has TV
nowadays... on which everthing is explained... all this (the early
menarche) ...is due to TV.
Dietary theory of early menarche
There is strong diet fixation among general population in India
about various aspects of health and disease. In our study
also, change in diet was told as a cause for early menarche...
as one of our respondent told - ... because of rising cost of
living, even villagers (who have milch animals) can not afford
to consume the milk... and they are forced to sell it... everyone
(including the girls) consumes more of tea... and even in that...
raw sugar is used (instead of jaggery)... which cause heat
inside... leading to early menarche. Another woman said, use
of English fertilizers/pesticides in fields/crops leads to early
menarche.

One of the women said, it is dirty blood... why should any

animal... child or a person touch it.

Continuing on the theory of changing times and change in

dietary pattern, one woman said, Earlier the girls never went
to school... now they study... it strains their minds... so, they
require nutritious diet... we give them eggs, meat etc... which
leads to heat inside... and girls start menstruating at an early
age. Another woman told, consumption of pickles and other
sour things like tamarind leads to early menarche.

Reuse of the cloth-pad was told by 4% respondents only in

our study. Their responses revealed that the cloth-pad used
for menstruation was considered a dirty thing and hence the
5
dislike for its reuse. Garg et al also report reuse of cloth by
only 6.5% of their respondents. However, their premise that
reuse was more common in villages could not be corroborated
in our study area where the women opined that such dirty
practices existed in cities only.

Many dietary restrictions were also told during menstruation...

as one women said, we dont take rice... curd, curd-milk
(lassi)... i.e. the cold things... during menses, since
consumption of such things leads to pain during menses.
Any items producing wind or vata are also not used... like
1
rice, radish, potato, sugarcane and onion. George and Joshi
2
et al also reported that women avoided hot-spicy food during
menses as they thought that these things increased the
menstrual flow.

One of the women even taunted the lady-interviewers of our

team... We in villages, do not display/exhibit the filth (as the
city dwellers do). We do not wash it (the dirty rags) for using it
again... there is no shortage here...plenty of rags are available...
This dirty act (of reusing the rags) is done in urban areas
only... because in cities there is no place to dispose off the
dirty rags... and the women have to wash the same (dirty)
cloth again and again.

Women in our study area also practiced their dietary theory

in the field of contraception... as one of them told... we
(deliberately) take some hot things (dry ginger powder, spices,
chillies, jaggery) every month... so that the period comes on
early and on time (and this coming of period implies that the
lady is not pregnant). Thus, a belief existed among them that
hot things hasten/facilitate the menstruation... and thus
prevent conception.

Some women were of the view that the same cloth should not
be used again, since.... it is a kind of disease... all types of
jaraseem (germs) are discharged from inside... if we reuse
the same cloth... we will get many illnesses. This reflected
that women in rural India also have their own scientific
justification of their reproductive behaviour.
Another woman told about her menstrual history... I considered
it a dirty thing... But if it does not happen (menses)... even
then it is not good... it will spread illness inside us... It used to
come every month... However, after the operation (tubectomy)
it comes every 20-22 days.

The first reaction to menstrual bleeding at menarche

Majority of our respondents said that they had no prior
knowledge about menstruation when they experienced their
first menstrual bleeding. Fear/panic was the dominant reaction
among many girls when they first had their menses. This is
1
true for majority of girls in rural and even in urban India . Garg
5
et al also reported that at menarche only 12% of their
respondents had any prior knowledge about menstruation.

Changing times and early menarche

People in villages wer aware that these days the girls are
having menarche at an early age as compared to previous
times. In fact, they had their own opinions regarding the reasons
for such a change. One of our respondents told, Nowadays
girls start menstruating at a very early age... even at 12 years
age... what can we say... the times are bad... it is the effect of

Responses of one of the women revealed the problems girls

face in rural Indian set up when they have their first menses...
as she told...
12
Place of Menstruation in North India

Indian Journal of Community Medicine Vol. 31, No. 1, January - March, 2006

I was in the school when it first happened. I noticed that my

salwar was stained/spoiled. I thought it (the bleeding) was
due to the boils... But one of my friends told me that I should
go back to my home (it was a co-educational school). My
teacher (female) also asked me to go home...saying that girls
have such problems every month. My friend escorted me to
my home.

distance from mother appeared to be due to the respect given

by the girls to their mothers. They did not seem to have intimate
friendly relations with their mothers. As one woman said, such
matters are not (supposed) to be discussed by the daughters
with their mothers.
However, women have an elaborate system of informal
consultation with their peer groups, female relatives (cousins
or aunts) regarding their reproductive health matters. Joshi et
2
5
al and Garg et al also reported that sisters, friends, sister-inlaw were the people consulted more frequently by their
respondents for problems related to menstruation. None of
them consulted their mothers.

My father asked, why have you come back to home (early) at

this hour. I told him (a lie) that I had forgotten a note-book at
home. My mother was not at home at that time. It was my
friend who told me how to use a menstrual pad. Before that I
had never used an underwear. So, I did not have any underwear
at that time. I had to borrow an underwear from my sister. She
asked if I had started menstruating. I said yes. My mother
came to know of this quite late.

At menarche, these people initiate the bewildered girl.... (who

experiences the sudden and shocking occurrence of her first
episode of menstrual bleeding and is often mentally not ready
or prepared for the event...) into an elaborate set of
prescriptions and proscriptions, taboos and rituals ralated to
menstruation. Gradually, after attaining maturity the women
develop various beliefs about different aspects of
menstruation... what causes early menses... what leads to
excessive menses... what to eat... what not to eat... what to
do and what not to do during the days of menstruation.

Thus, menarche... the heralding phenomenon for the initiation

of the girl in reproductive life i.e. the onset of menses is also
ridden with a lot of apprehension, fear, shame and..... disgust
on the part of the young girls.
One of the respondents in our study recounted her experience
of menarche... I told my cousin about the bleeding and told
her that I did not know what was happening to me. Probably it
is some ghost or spirit casting its evil shadow on me. Then
my cousin told me about it (the menses).

One of the women told about her views ragarding educating

her daughter about menstrual hygiene. For my daughter (aged
7 years)... this is not the appropriate time (to tell about
menses)... it is in the hands of Nature... whenever it will
happen... we will have to tell her.

Another women told about her reaction to the first episode of

menstrual bleeding My abdomen was aching and I was afraid... I panicked when
I saw blood stains on my salwar. I wondered if I had sustained
some injury. I could not comprehend the cause of this bleeding.
Then I told my sister-in-law (about the bleeding).

Health implications of menses

At the first time there was not much bleeding... there was, of
course, severe pain in abdomen 2-3 times... but I did not tell
anyone in my family... the pain in abdomen remained for 5-7
cycles... it got O.K. by itself... and now it does not pain during
menses anymore... my periods are regular... and always on
time... and never get delayed.

Source of information on menstruation

In only one case mother was the first person to explain her
daughter about menses My salwar had a (blood) stain on it...
my mother came to know of this. She asked if I knew about
it. I replied in negative. Then she told me about it. She said...
you are grown up now... it (the bleeding) is a sign of maturity
in girls....

I did not like it even at the first menses... even now I consider
it filthy... my heart feels unsettled... and I have a nauseating
feeling... The bleeding persists for 3 days... on the first day...
it is heavy... and for next two days it is average flow... Before
marriage it used to be for 5-6 days. Now, I often say that it is
better that this trouble gets over once for all. When I use rag/
cloth (for menses) I have gas formation in my stomach... and
I get the heat.

The communication between the mothers and the daughters

regarding menstruation or other such matters appears to be
minimal. In our study, friends (72%) or other female relatives
(17%) were the first people to tell the girls about the
menstruation i.e. how to use pads/cloth piece. Similar findings
1,2,5
were reported by others . The code of silence and secrecy
pertaining to these issues implies that the girls hide/conceal
these events from their male relatives i.e. brothers/fathers and
even their mothers initially... who get to know of it sooner or
later.

Marriage and menstruation

Intimate relation of the day of marriage and the date of
menstruation was revealed by the narrative of one of our
respondent - When I got married I has started menstruating
the day before. It was my second day of bleeding. But my
husband did not spare me... we had sex on the first night
itself... My sisters, sisters-in-law and my husbands sister
everybody had asked me not to have sex during menses...
i.e. on the first night... but, do men ever spare women?... so

The women told that they felt shy to discuss such things with
their mothers. Even the mothers did not talk about these things
with their daughters. In some cases the women relatives asked
the girls not to discuss these things with their mothers. This
13

Place of Menstruation in North India

Indian Journal of Community Medicine Vol. 31, No. 1, January - March, 2006

we had it (the sex)... he said (why) should I spare you on the

first day (of the marriage) itself? However, thereafter he never
troubled me during menstruation days.

Mandals/Anganwadi centres. Mass media may also be utilized

to encourage menstrual hygiene among adolescents. These
aspects should be kept in mind while planning any intervention,
educational or otherwise, regarding reproductive health of
women.

Conclusion
Thus, our study results (both from qualitative research data
and quantitative survey revealed that prior to menarche,
knowledge about menstruation was deficient among the
respondents. There was a strong belief among the women
respondents of our study area about the effect of diet on
menstruation age at menarche, date of bleeding and amount
of bleeding. Ten percent of the women reported observance of
various taboo-behaviours related to menstruation. Regular
monthly bleeding episodes during menstruation was
considered as purifying process which cleansed the womens
body of the dirty blood.

References
1.

George A. It happens to us. In. Listening to women talk about

their health - issues and evidence from India. J. Gittelsohn
et al (Eds.) New Delhi, Har Anand Publications, 1994.

2.

Joshi A, Kurien E, Misra A, Rajeshwari M and Biswas S.

Socio-cultural implications of menstruation and menstrual
problems on rural womens lives and treatment seeking
behaviour. Operations Research Group, Baroda.
(Unpublished Ford Foundation supported study) 1998.

3.

Singh AJ. Mobile clinic approach to tackle reproductive health

problem of women in north India. Bull PGI. 2004; 38: 66-70.
Singh AJ. Womens illness - the Indian male perspective : A
search for linkage with Vedic concept of health and Hindu
mythology. Bull Ind Inst Hist Med. 2001; 31: 39-56.

4.

Initial reaction of majority of girls to the first episode of bleeding

was of a sense of fear/apprehension. Such fear needs to be
tactfully dispelled from the mind of adolescent girls so that
they develop a balanced and healthy outlook towards their
prospective reproductive lives. Thus, there is a need to provide
healthy family life education to the women of our study area...
particularly the young girls. Appropriate educational package
may be developed for school going girls. Non-school going
girls may be educated through meetings held at Mahila

5.

Garg S, Sharma N and Sahay R. Socio-cultural aspects of

menstruation in an urban slum in Delhi, India. Reproductive
Health Matters, 2001; 9: 15-25.

6.

Chatterjee J, Walia IJ and Singh AJ. Case control study on

vaginal discharge in an urban slum of Chandigarh. Indian
Medical Gazette, 1995: 129; 166-171.

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Place of Menstruation in North India