Gender as a social determinant of menstrual health: a mixed methods study among Indian adolescent girls and boys

Abstract

Gender bias in the patriarchal Indian society becomes evident in the form of worse sexual and reproductive health outcomes for girls than boys. While girls face menstrual taboos that affect their health, understanding of, and participation in the menstruation discourse remains limited among boys. We investigate how gender through its micro-interactional and macro-structural ways makes menstruation a gendered experience for adolescents; how various social determinants influence gendered menstruation experience among girls across social domains; and whether the lived gendered experience of menstruation harms their health. Using a sequential mixed-methods design semi-structured interviews of 21 boys and girls each; 12 adult key-respondent interviews; and a cross-sectional survey of 1421 adolescents from urban, rural and tribal settings of Nashik district, India, were conducted. Applying social constructivist theory and gender analysis framework, we thematically analysed the qualitative data. Multivariable regression analysis of survey data yielded risk ratios. Respondents reported a gendered experience of menstruation. Fewer boys (versus girls) reported receiving information in schools [Incidence Rate Ratio (IRR) at 95% CI: 0.34 (0.24, 0.49)]. Gendered menstrual experiences varied across social domains and various socioeconomic backgrounds. Menstrual health among girls was poorer among those with a lived experience of gendered menstruation [IRR: 0.22 (0.05, 0.90)]. Key respondents shared the need to engage boys in the menstruation discourse though apprehensive regarding its consequences. Gender bias along with other social factors negatively influence social construction regarding menstruation. Further, the discrimination is embodied by girls as poor health, thus perpetuating health inequalities across socioeconomic settings.