Key Social Norms Take-aways This study demonstrates that social and behavior change interventions can effectively shift social norms surrounding menstruation when these norms are conceptualized as multidimensional constructs—encompassing personal beliefs, perceived peer approval (injunctive norms), and perceptions of others’ behaviors (descriptive norms). The GARIMA initiative revealed that increased exposure to positive messaging significantly aligned personal and collective beliefs, thereby enhancing menstrual health and hygiene management practices. However, entrenched socially imposed restrictions—like prohibitions on food, clothing, or participation in religious activities—remained challenging to overcome, though girls exposed to the intervention were more likely to question and challenge these norms.
Objectives The study aimed to (1) test two methods for measuring social norms—composite approval-based norms versus restriction-based norms—and (2) assess how exposure to the GARIMA SBCC intervention impacted social norms and menstrual health and hygiene management practices among adolescent girls in rural Uttar Pradesh, India.
Methods A cross-sectional, case-comparison design was used with a population-based sample of 2,212 post-menarche adolescent girls aged 12–19. Structured quantitative interviews assessed intervention exposure, social norms, and menstrual health and hygiene management behaviors. Multivariate and multilevel logistic regressions examined the association between exposure, social norms, and adequate MHM, adjusting for demographic factors.
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 Girls exposed to GARIMA reported significantly more positive social norms (44% vs. 21% in controls) and were more likely to practice adequate menstrual health and hygiene management (40% vs. 14%). Those with positive composite social norms had 1.66 times higher odds of high menstrual health and hygiene management behavior. Though social restrictions remained prevalent, girls in the intervention group more often reported recognizing and resisting these restrictions. The composite social norms measure had a better fit in predicting menstrual health and hygiene management outcomes than restriction-based norms.
Conclusions The study validates a robust, multidimensional approach to measuring social norms and underscores the potential of social and behavior change to improve menstrual health outcomes by shifting these norms. Interventions should continue to focus on aligning personal beliefs with peer norms while explicitly addressing and enabling the challenge of restrictive social expectations to foster long-term norm change.