Tending the ‘monthly flower:’ a qualitative study of menstrual beliefs in Tigray, Ethiopia

Abstract

BackgroundMenstruation is a universal aspect of human female reproductive life. Management of menstrual flow presents hygiene challenges to girls and women in low-income countries, especially when they first start their periods. As part of a project to improve menstrual hygiene management in the Tigray Region of Ethiopia, we explored the local understanding of menstruation through focus-group discussions and individual interviews.MethodsA detailed ethnographic survey of menstrual beliefs was carried out through 40 focus group discussions, 64 in-depth key informant interviews, and 16 individual case histories in the Tigray Region of northern Ethiopia. A total of 240 individuals participated in six types of focus groups (pre-menarchal girls, menstruating adolescents, married women of reproductive age, post-menopausal women, adolescent males, and married men). In-depth interviews were also carried out with 80 individuals, including Orthodox Christian priests, imams from the Muslim community, principals of primary and secondary schools, teachers and nurses, as well as menstruating schoolgirls and women. Audio data were transcribed and translated, then broken down into discrete codes using Atlas Ti software (version 7.5.4, Atlas.ti Scientific Software Development Mnbh, Berlin) and further grouped into related families and sub-families based on their content. The results were then synthesized to produce a cohesive narrative concerning menstruation in Tigray.ResultsRecurrent themes identified by participants included descriptions of the biology of menstruation (which were sometimes fanciful); the general unpreparedness of girls for menarche; cultural restrictions imposed by menstruation on females (particularly the stigma of ritual uncleanliness in both Christian and Muslim religious traditions); the prevalence and challenges of unmet menstrual hygiene needs at schools (including lack of access to sanitary pads and the absence of acceptable toilet/washing facilities); and the stigma and shame associated with menstrual hygiene accidents in public.ConclusionsChanges in the educational system in northern Ethiopia are required to improve student understanding of the biology of menstruation, to foster gender equity, to overcome the barriers to school attendance presented by poor menstrual hygiene management, and to create a society that is more understanding and more accepting of menstruation.

Power, danger, and secrecy—A socio-cultural examination of menstrual waste management in urban Malawi

“…in Ancient Rome and Morocco) demonstrate these positive and negative poles of symbolic menstrual power [2]. Similarly, menstrual blood is also conceived of as a symbol of fertility and new life, despite being simultaneously seen as polluting [4,32]. Menstrual symbolism is therefore highly complex, and can mirror that of the post-menarche female body in general: concurrently reviled and revered, viewed as polluting but also life-giving, and requiring regulation and control [5].…”

“…Globally, there are substantial spatial and temporal variations in how menstruation is regarded and managed, and how menstruating women are expected to behave [3]. For example, in particular contexts, menstruation can affect women's participation in religious life [4,5] and can cause a degree of withdrawal from public life, ranging from the avoidance of crowded places [6] to total isolation [7]. Some menstruating women may be expected to abstain from cooking, washing, or household chores [3,7], whilst others do not refrain from anything at all [8].…”

Percepção das mulheres sobre o impacto da menstruação no cotidiano de vida

“…Sobre os mitos e crenças e o significado cultural do sangue menstrual, para as participantes do grupo 2 faz parte de um processo de limpeza do corpo, uma vez que para elas o fluxo menstrual é constituído de impurezas, desconhecendo o mecanismo da fisiologia menstrual e revelando uma explicação marcada pela influência religiosa, corroborando com estudo em que algumas mulheres acreditam que o banho no período menstrual está relacionado a enfermidades como, interrupção da menstruação, tontura, tumores, loucura e ainda embolia e paralisia 25,26 .…”

Girls’ attendance at school after a menstrual hygiene intervention in northern Ethiopia

“…These problems are common in Ethiopia, where the average age of menarche is 13–14 years . Particularly in rural areas, lack of accurate information about the biology of menstruation is widespread, access to menstrual hygiene supplies is difficult and unreliable, and significant social stigma still surrounds the topic of menstruation …”