American Indian Adolescent Girls' Experiences with Menstruation

Although menstruation is a universal biological experience for women, American Indian (AI) adolescent girls in the United States (US) face multifaceted, culturally distinct challenges that contribute to disproportionate health disparities. Despite the public health implications of adolescent menstruation experiences, a critical knowledge gap about menstruation experiences and their impact on education persists in the US. The aim of this study was to describe the menstruation-related experiences of AI adolescent girls living in rural, reservation communities in the upper Midwest.

Using a qualitative, community-engaged approach, focus groups were conducted with middle and high school students in 3 reservation communities in North Dakota and South Dakota. Using a semi-structured interview guide, participants were asked about experiences with menstruation, learning about menstruation, menstruation at school, limitations due to menstruation, and cultural beliefs/teachings related to menstruation. Following data collection, transcripts were analyzed using descriptive content analysis.

One hundred and ten girls participated in a total of thirteen focus groups (middle school n = 6; high school n = 7) equally distributed across 3 reservation communities. Four main themes were identified in the data: 1) learning about menstruation-often mistimed and inadequate, 2) menstruation at school,-challenges related to management, school performance and participation, 3) experiencing menstruation,-emotional and physical symptoms, and 4) making meaning of menstruation-becoming more confident and positive associations with age.

This study provides a critical understanding of the menstruation experiences of AI adolescent girls living in rural reservation communities in the upper Midwest. Findings reveal that menstruation is a complex experience shaped by familial, cultural, educational, and institutional factors. These findings underscore the urgent need for early, culturally responsive menstrual health education and school policies that affirm and support menstruating students.