Breaking Barriers: A cross-sectional study on Menstrual Restrictions and Perceived Stress among adolescent girls in Kailali, Nepal

Menstrual restriction has persisted in Nepalese society for centuries, driven by ignorance and myth. This practice is imposed on women through various Hindu mythologies and leads to significant limitations in their daily activities. The most severe form of menstrual restriction, known as Chaupadi, has resulted in numerous deaths of women and young children due to suffocation, snakebite, rape, and other serious forms of harm. Despite its criminalization by law, there has been no visible impact on the practice of menstrual restriction. This discriminatory practice not only causes hormonal imbalance and physical pain but also has significant mental health implications for adolescent girls, which have yet to be fully explored. Therefore, this study aims to investigate the prevalence and perceived stress associated with menstrual restriction among adolescent girls attending lower secondary school in Far-Western Region, Kailali District, Nepal The study utilized a descriptive, cross-sectional design and recruited 370 respondents using a proportionate random sampling technique. The study was conducted at the secondary school of Godawari Municipality in Kailali, Nepal. Prior to the study, a structured questionnaire and a Likert scale were pretested among 10% of the population in Kathmandu. Data Analysis was done using Univariate Analysis, Bivariate Analysis (Chi-square) and Multi-variate Analysis (Logistic Regression). The findings revealed that perceived stress was comparatively higher among upper-caste groups and Dalits who followed menstrual restrictions religiously, as compared to disadvantaged Janajati from the hills. Moreover, the level of perceived stress was moderately high among households with larger family sizes. Significant associations were observed between menstrual restriction and perceived stress for each type of menstrual restriction studied, with more than 80% of the different measured levels of restrictions showing a significant association. Menstrual restriction-related practices, such as being restricted from entering inside the house, being sent to Chau-Goth, being restricted from touching male members, being restricted from touching livestock or animals, being restricted from eating together with the family, being restricted from consuming dairy products, being restricted from participating in cultural rituals, being restricted from sleeping in any bed, and being restricted from using heavy blankets and mattresses, were associated with perceived stress. The relationship between menstrual restrictions and perceived stress level was examined. Results showed that respondents with restrictions to enter or reside inside the house had 3.78 times higher odds of perceived stress (OR=3.78; CI=1.96-7.33), while those sent to Chhau Goth had 2.98 times higher odds (OR=2.98; CI=1.94-4.57). Respondents with restrictions on touching food, cooking food, plants with holy belief, livestock or animals, dairy products, eating together with family, participating in cultural rituals, having Prasad, sleeping in any bed, using packed pads, common toilet, or common taps during menstruation also had higher odds of perceived stress. Given the findings, further research is necessary to measure the level of perceived stress among adolescent girls in the population. This research has significant implications for the physical, social, and psychological well-being of adolescent girls and the community at large.