Menstrual Health and Inequities: Knowledge, Hygiene Practices, Socio-Cultural Restrictions, Health-Seeking Behavior, and Socio-Demographic Determinants Among School-Going Adolescent Girls in Shimla District, Himachal Pradesh

Background: Menstrual health is a critical but often neglected component of adolescent well-being. Despite increasing attention in India, knowledge gaps, unsafe practices, socio-cultural restrictions, and inequities persist. Evidence from Himachal Pradesh is limited, despite its high literacy rates and strong cultural traditions. This study aimed to assess menstrual knowledge, hygiene practices, socio-cultural restrictions, and health-seeking behavior among school-going adolescent girls in Shimla district, and to examine their associations with socio-demographic variables. Methods: A school-based cross-sectional survey was conducted by Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pardesh among 5,433 adolescent girls enrolled in government secondary and senior secondary schools in Shimla. Data were collected using a structured, pretested questionnaire administered via Google Forms, circulated to school principals by the Department of Education. Domains included socio-demographic profile, knowledge and awareness, hygiene practices, socio-cultural restrictions, and health-seeking behavior. Data were analyzed using descriptive statistics and chi-square tests to assess associations, with p<0.05 considered statistically significant. Results: Most girls (92.1%) had heard about menstruation before menarche, primarily from mothers (84.8%), but misconceptions persisted regarding the source of menstrual blood (uterus: 43.9%; bladder: 43.4%). Sanitary pad use was near-universal (94.3%), yet safe disposal practices varied, and 2.5% reported unsafe disposal (flushing/open). Socio-cultural restrictions were widespread, with 83.4% restricted from temples and 46.8% made to stay separately during menstruation. Health-seeking behavior was relatively high (81.3% consulted someone), but only half (50.6%) recognized all warning signs requiring medical attention. Across domains, better outcomes were consistently associated with older age, higher class, parental education, and family income (p<0.001 in most cases), while family type showed no significant effect. Conclusion: Although menstrual hygiene adoption was encouraging, significant knowledge deficits, unsafe disposal practices, entrenched cultural restrictions, and incomplete recognition of menstrual morbidities remain. Socio-economic and educational disparities strongly shape menstrual experiences. Targeted interventions—strengthening school-based education, engaging parents and communities, improving waste management, and promoting adolescent-friendly health services—are urgently needed. Addressing both informational and cultural dimensions of menstruation will advance adolescent health, gender equity, and dignity.