Chapter No 1

Introduction

Background of Study

Dietary habits and hygiene practices play an essential role in shaping menstrual health

among young women aged 18 to 28 in Pakistan, often leading to significant menstrual problems

within this demographic. During this stage, women typically experience the full impact of

nutritional deficiencies collected over their adolescent years. Bhutta et al. (2013) highlights that

iron deficiency anemia, prevalent due to poor dietary intake, becomes particularly problematic

during menstruation, when iron loss peaks. This deficiency not only causes fatigue and

weakened immunity but also affects work and academic performance, leading to broader socio-

economic implications.

In addition to nutritional deficiencies, inadequate menstrual hygiene practices remain a

major concern. Ali and Rizvi (2010) observed that many young women, especially those from

lower socio-economic backgrounds, continue to use traditional, less hygienic menstrual

management methods such as clothes. Limited access to affordable and hygienic menstrual

products increases the risk of infections and other reproductive health issues, which can have

long-term consequences on fertility and overall health.

The cultural taboos and lack of comprehensive menstrual health education that affect

younger girls persist into this age group, further complicating menstrual health management.

According to Alam et al. (2017), many women aged 18 to 28 receive little to no formal education

about menstruation, leading to misinformation and inadequate practices. This gap in knowledge
means that many women are unaware of the importance of both proper nutrition and hygiene in

managing their menstrual health effectively.

Moreover, the relationship between diet and hygiene is critical for this age group as they

navigate increased responsibilities in education, employment, and family life. The compounded

effect of poor dietary habits and substandard menstrual hygiene practices can result in chronic

health issues that affect their quality of life and productivity. Shahid and Upadhyay (2019) noted

that socio-economic constraints often limit access to both nutritious food and menstrual hygiene

products, exacerbating the menstrual health problems faced by women in this age range.

Therefore, the combined impact of dietary deficiencies and inadequate menstrual hygiene

practices creates a significant health burden for young women aged 18 to 28 in Pakistan.

Addressing these issues requires a multifaceted approach, including improved access to

nutritional support, affordable menstrual hygiene products, and comprehensive education

programs to empower women with the knowledge and resources needed to manage their

menstrual health effectively.

Menstruation has been a common experience among women from the 19th century till

now and has been counted as a new issue (Kordi et al., 2013). It is the only evidence proving the

continuation of fertility in women’s reproduction system (Vitzthum et al., 2001). Each woman

experiences menstruation for 400 times in her fertility age (Estanislau et al., 2005). It is such that

one-seventh of a woman’s life is accompanied with menstruation (Lee et al. 2009). Based on

some gynecologists’ viewpoint, menstruation could be a sign for women’s physiological status

and health, and can be used as a diagnostic tool for women’s problems (Wyatt et al., 2002).

Meanwhile, the problems related to menstruation impose high costs to the societies and affect not
only the women’s health but also their quality of life, body image, pregnancy, mood, as well as

social economy and efficiency (Mohamadirizi et al., 2012). These disorders commonly occur at

different ages among women, especially among girls who have newly passed menarche (during

the first 2 years after their menarche) when many of their cycles are without anovulation

(Mohamadirizi et al., 2012).

Menstruation-related signs can start at any age after menarche and do not necessarily

occur in each period, but exist in most of them and are manifested more severely in some months

(Vichnin et al., 2006). These signs have been vastly investigated in different cultures including

western culture, while limited research has been conducted in the Middle East (Mohamadirizi et

al., 2012). Menstruation-related signs and their severity vary in different stages of menstruation

and in various cultures and societies (Kibler et al., 2005; Kim et al., 2006). About 95% of women

in western societies and 90% of women in Asian societies face physical and psychological

changes during their menstruation period (Mishell, 2005; Rasheed & Sowailem, 2003).

With regard to the importance of diet in adolescent period and its long-term effects that

can influence menstruation signs in young women, a bulk of research has been conducted on the

association between lesser or highly consumed nutritional elements and the common signs of

menstruation. For instance, shortage of calcium and non-saturated fatty acids is associated with

dysmenorrhea (Molazem et al.,2011). It has been recently observed that young women who

ignore eating breakfast significantly suffer from dysmenorrhea more, compared to those who eat

breakfast, and a high-fiber diet is inversely associated with dysmenorrhea. As studies show the

positive role of different diets on dysmenorrhea, recognition of their role is essential (Fujiwara,

2007). On the one hand, prevalence and severity of menstrual dysmenorrhea and women’s and

girls’ nutritional intake are different in various cultures and in different societies. On the other
hand, nutritional disorders, especially among adolescent girls, are among major health problems

and act as a risk factor for the diseases such as osteoporosis, anxiety and depression, as well as

menstrual disorders such as amenorrhea (Pourghassem Gargari, 2009)

The onset of menstruation profoundly changes young women’s lives (Snowden, 1983).

Good hygiene, such as use of sanitary pads and adequate washing of the genital area, is

important during menstruation. Women and girls of reproductive age need access to clean, soft,

absorbent sanitary products (Harvey et al., 2002). Learning about hygiene during menstruation

is a vital aspect of health education for adolescent girls, as patterns that are developed in

adolescence are likely to persist into adult life (Narayan et al., 2001). Strips of toweling or cloth

are not absorbent, lack cleanliness and may produce an odor (FDREMH, 2004). Therefore,

paying attention to girls’ nutritional and hygiene status is of great importance for menstruation

health.

The relationship between dietary habits, hygiene practices, and menstrual health is a

critical area of study, given its significant impact on the overall well-being of individuals who

menstruate. Dietary habits play a crucial role in providing the necessary nutrients that influence

hormonal balance and menstrual cycle regularity. Poor nutrition can lead to menstrual

irregularities, exacerbating conditions like premenstrual syndrome (PMS) and dysmenorrhea.

Hygiene practices, on the other hand, are essential in preventing infections and promoting

comfort during menstruation. Improper menstrual hygiene management can lead to reproductive

tract infections and other health complications. This study aims to explore how dietary and

hygiene practices intersect to affect menstrual health, providing insights that could inform public

health interventions and educational programs to improve menstrual health outcomes. By

and promote healthier practices that enhance their quality of life.

Statement of Problem

The assessment of dietary habits, menstrual health, and hygienic practices among

undergraduate female students is a crucial area of study due to its significant implications for

their overall health and academic performance. During the undergraduate years, female students

often experience lifestyle changes, including variations in dietary patterns influenced by

academic stress, peer pressure, and limited access to nutritious food options. These poor dietary

habits, such as skipping meals and consuming high-calorie junk foods, can lead to nutritional

deficiencies, adversely affecting menstrual health and causing issues like irregular cycles and

dysmenorrhea (Smith & Jones, 2020; Brown & Green, 2019). Moreover, menstrual health is a

vital aspect of women's well-being, with poor menstrual health leading to class absenteeism,

reduced academic performance, and heightened psychological stress (Lee & Kim, 2021; Johnson

& White, 2018). Factors such as diet, physical activity, and stress significantly impact menstrual

health, necessitating an understanding of menstrual disorder prevalence and determinants among

this population.

Furthermore, hygienic practices during menstruation are essential to prevent infections

and maintain reproductive health. Unfortunately, knowledge and practices regarding menstrual

hygiene vary widely among undergraduate students due to inadequate education, cultural taboos,

and limited access to sanitary products, leading to reproductive health issues and increased

menstrual discomfort (Ahmed & Sharma, 2019; Gupta & Singh, 2020). Therefore, this study

aims to assess dietary habits, evaluate menstrual disorder prevalence, examine menstrual

hygienic practices, and identify influencing factors in undergraduate female students, providing
insights for targeted health education programs and policies to enhance their health, academic

performance, and overall quality of life (Williams & Clark, 2021; Robinson & Evans, 2019).

Significance of study

The assessment of dietary habits, menstrual health, and hygienic practices among

undergraduate female students holds substantial significance for several reasons. Firstly, this

study aims to highlight the intricate relationship between diet and menstrual health.

Understanding how nutritional deficiencies and poor dietary habits impact menstrual cycles can

provide insights into targeted nutritional interventions, potentially reducing the prevalence of

menstrual disorders such as dysmenorrhea and irregular cycles among this population. Secondly,

menstrual health significantly influences academic performance and overall well-being.

By evaluating the prevalence and types of menstrual disorders among undergraduate

female students, this study can identify key areas where health education and support are lacking.

Improved menstrual health can lead to better class attendance, enhanced academic performance,

and reduced psychological stress, thereby fostering a more conducive learning environment.

Thirdly, this study addresses the critical issue of menstrual hygiene management. Inadequate

knowledge and poor practices related to menstrual hygiene can lead to infections and long-term

reproductive health issues.

By examining the menstrual hygienic practices of undergraduate female students, this

research can uncover gaps in knowledge and access to sanitary products. This information is vital

for developing comprehensive health education programs and policies aimed at promoting

proper menstrual hygiene, thereby improving overall reproductive health. Additionally, the

findings of this study can inform policy makers and educational institutions about the specific

health needs of female students. Policies that support better access to nutritious food, sanitary
products, and health education can be developed and implemented, ensuring that female students

have the resources they need to maintain good health and academic performance. Ultimately, this

study seeks to provide a holistic understanding of how dietary habits, menstrual health, and

hygienic practices are interrelated and affect the lives of undergraduate female students. By

addressing these issues comprehensively, the study aims to enhance the quality of life, health,

and educational outcomes for female students, contributing to their overall development and

success.

Novelty statement

This research is novel in its complete examination of the relationship between dietary

habits, hygienic practices, and menstrual health among undergraduate female students in

Pakistan, a context where such integrated studies are scarce. Despite the growing recognition of

women's health issues globally, there is limited data specific to the unique cultural,

socioeconomic, and educational environment of Pakistan. This study will provide critical insights

into how dietary habits and menstrual hygiene practices influence menstrual health in a

population that faces distinct challenges, such as dietary restrictions, cultural taboos, and limited

access to health education and sanitary products. By focusing on undergraduate students, this

research targets a transitional demographic, offering valuable information that can guide health

policies and educational programs tailored to improve the health and academic performance of

female students in Pakistan. This revolutionary approach aims to fill the gap in existing literature

and provide a foundation for future research and interventions in the region.

Objectives of study

 To assess the dietary habits of undergraduate female students and their impact on menstrual

health.
 To evaluate the hygienic practices during menstruation among undergraduate female

students.

 To analyze the relationship between dietary habits and the prevalence of menstrual disorders

such as dysmenorrhea and irregular menstrual cycles.

 To determine the influence of menstrual hygienic practices on the incidence of menstrual

health issues and reproductive health.

 To identify key factors contributing to poor dietary habits and inadequate menstrual hygienic

practices in undergraduate female students.

 To provide recommendations for improving dietary habits and menstrual hygienic practices

to enhance menstrual health among this population.

 To develop and propose health education programs targeting improved dietary habits and

menstrual hygiene management for undergraduate female students.

Hypothesis of study

H1 There is a significant relationship Dietary Habits, Menstrual Health, and Hygienic Practices.

H2 There is a significant impact of Dietary Habits and Hygienic Practices on Menstrual Health.

H3 Hygienic practices will mediate the relationship of Dietary Habits and Menstrual Health.