Prevalence and Impact of Dysmenorrhea on Adolescent Girls in India Across Income Levels

Abstract

Dysmenorrhea is a highly prevalent condition among menstruating women, characterized by painful abdominal cramps. The incidence and severity of this disease in developing countries such as India has been understudied, particularly in lower socio-economic levels where healthcare is sought only for acute issues, and menstruation is associated with religious/social stigma. We hypothesized that dysmenorrhea adversely impacts attendance, academic performance and participation in sports and social activities, and that economic status is an important modifier of menstrual health literacy. A comprehensive survey was conducted across 2 groups of adolescent schoolgirls in Bengaluru, stratified according to household incomes: 211 schoolgirls from low income (<$3000/year), and a sample of 58 schoolgirls from high income (>$25,000/year). We found a high prevalence and intensity of dysmenorrhea in Indian adolescent girls, with 40-50% of girls reporting a pain level of 8,9 or 10. 30% of respondents in both income segments were moderately to severely limited in their daily activities by period pain. However, 46% of girls from the lower income households were affected by religious taboos vs 12% from the high income, and had fewer confidantes accompanied by worse access to healthcare. Collectively, we find that dysmenorrhea is a highly disruptive and painful condition causing significant loss of productivity and performance of adolescent girls. Interestingly, even though the girls from lower income families suffer higher levels of social and emotional distress, they attend school regularly – providing a unique opportunity for an interventional support from adequately trained teachers within a safe environment.