Key Social Norms Take-aways The GARIMA intervention reveals that breaking the culture of silence around menstruation can lead to improved menstrual health and hygiene management when social and behavioral change communication is grounded in interpersonal and community dialogue. The intervention successfully shifted gender norms and increased interpersonal communication, which were key mediators of improved menstrual health and hygiene management practices. However, entrenched norms around menstruation-related restrictions and absorbent use remained resistant to change. Future interventions should expand their focus to include family and community members to transform broader social norms.
Objectives This study aimed to evaluate whether encoded exposure (dose and recall) to the GARIMA intervention influenced adolescent girls’ knowledge, attitudes, interpersonal communication, menstruation-related restrictions, and menstrual health and hygiene management behaviors in rural Uttar Pradesh, India.
Methods Using a cross-sectional post-test only comparison group design, the study sampled 2,206 adolescent girls aged 12–18 from 240 villages (120 intervention and 120 comparison). Stratified random sampling and structured surveys assessed exposure to the intervention and outcomes. Multilevel logistic regression examined the relationship between encoded exposure, mediators (e.g., knowledge, attitudes), and menstrual health and hygiene management behaviors.
Intervention Details GARIMA was a community-based intervention implemented by UNICEF and partners across three districts. It included audio-visual materials, life-skills-based education, peer-led group meetings, and family engagement (e.g., mothers’ and fathers’ groups). Girls received storybooks, diaries, posters, and aprons, and participated in monthly sessions led by trained peer educators and frontline health workers. Content focused on menstruation knowledge, challenging taboos, and promoting healthy practices.
Results High levels of encoded exposure were significantly associated with improved knowledge of puberty and reproductive parts, positive gender attitudes, and greater interpersonal communication. These mediators, in turn, predicted better menstrual health and hygiene management behaviors, such as preparation, storage, disposal of absorbents, hygiene practices, and frequency of changing. However, the intervention had limited impact on knowledge about absorbent use and on attitudes toward menstruation-related restrictions, suggesting persistent cultural barriers.
Conclusions GARIMA demonstrated that social and behavior change interventions can positively affect adolescent girls’ menstrual health by targeting individual and interpersonal levels of social norm change. Still, entrenched restrictive norms require broader engagement with families and communities. Future programs should build on this model to more comprehensively dismantle harmful norms surrounding menstruation and expand social support networks for adolescent girls.