The role of parental communication, gender norms, and adolescent menstrual health in Bangladesh: A secondary longitudinal analysis

Abstract

Background: Adolescent girls are a vulnerable group in terms of menstrual and reproductive health information and management. Around the world, many adolescent girls face social norms or stigma, taboo, gender norms, limited access to menstrual health information and negative attitudes from their family as well as the community. It directly affects their menstrual health and overall reproductive health, which shows a public health concern. Many research studies suggested that adolescent girls pursue their menstrual health-related education and training from their parents. Depending on their (guardians') knowledge, attitudes, and norms regarding menstruation, adolescent girls' perspectives can vary. As a result, this study aims to examine the changes in gender and social norms, menstrual knowledge and attitudes among guardians over time and how it changes the perception of their adolescent girls.

Objectives: The main objective of this study was to examine the changes in parental gender social norms, knowledge and attitudes about menstrual & reproductive health from 2023 to 2025 and how these changes affected girls' perceptions. The specific objectives were: 1) to assess the changes in the outcomes over the years, 2) to assess the association between the outcomes and the socio-demographic status of guardians, 3) to determine the changes in their adolescent girls' perspectives and to see whether parental communication mediates the relationship between guardians' menstrual knowledge and girls menstrual health literacy.

Methods: The study was conducted using secondary analysis of the Adolescent Menstrual Experiences and Health Cohort (AMEHC) study, a longitudinal research project currently being carried out in the sub-division of Khulna, Bangladesh. The AMEHC began with 2015 adolescent girls and their guardians in 2023 and continued till now (2026). This study focused on the baseline (2023) and wave 2 (2025) datasets of both guardians and girls. A longitudinal analysis was done using GSEM to examine how parental views on menstrual knowledge influence adolescent girls' perspectives. Additionally, a mediation analysis involving 1000 times bootstrapping iterations was performed to explore the pathways through which menstrual health information is transmitted from guardians to girls.

Results: The mean age of the adolescent girls was 11.95 years (± 0.0206) at baseline. The result showed positive changes over time with progressive gender norms perception, reduced negative menstrual attitudes among guardians, but over the years, menstrual knowledge shifted into a lower category and social restriction increased among guardians (from baseline to wave 2). There was a significant association observed between the socio-demographic status of guardians and reducing gender (p<0.05) and social norms restrictions (p<0.05), improving a high level of menstrual knowledge (p<0.05) and increasing positive attitudes (p<0.05) on menstruation, except for religion. The longitudinal analysis revealed that gender norms (β= -0.45, SE= 0.03, p <0.05) reduced in wave 2 by 0.45 times from baseline, menstrual knowledge (β= 1.86, SE= 0.07, p <0.05) increased by 1.86 times and social norms (restrictive) increased by 9.48 times from 2023 to 2025 among adolescent girls. The results also showed significant changes in guardians' perceptions regarding gender norms (β= 0.10, SE= 0.02, p <0.05), menstrual knowledge (β= 0.13, SE= 0.06, p <0.05) and social norms (OR= 1.37, p<0.05) in relation to their girls. Moreover, mediation analysis showed that parental communication did not function as a potential mediator (β= 0.11, SE= 0.08, p = 0.172), but also guardians' menstrual knowledge did not associate with girls' menstrual health literacy (OR= 1.11, p = 0.106).

Conclusions: Guardians are key individuals for the majority of adolescents to whom they can talk about their menstruation and reproductive health. And if mother-daughter communication is strong, it can impact on gaining better menstrual knowledge, attitudes and menstrual health management (MHM). When they can talk freely, this helps to reduce the gender norms restrictions and increase social acceptance by reducing stigma related to menstruation management. Policy makers and programme implementers should design programmes that emphasise parental involvement, address the root causes of stigma and promote an equitable society.