Abstract
<p>Menstrual health advocacy often states that harmful social norms influence adolescents' menstrual health. However, there is a lack of specificity in identifying which social norms drive menstrual behaviors and how these norms operate and are sustained. We carried out a phased qualitative study with adolescent girls in Khulna, Bangladesh, guided by Bicchieri’s (2017) social norms theory. The research team identified initial candidate behaviors, which were refined through three FGDs with mothers and five FGDs with girls. Subsequent data collection involved five FGDs with girls and three with boys, along with in-depth individual interviews (IDIs) with girls (n=15), mothers (n=7), fathers (n=3), and male (n=2) and female (n=3) teachers. Our framework analysis blended deductive coding against social norms constructs, including empirical and normative expectations, reference groups and sanctions, with inductive analysis to understand experiences. We found that a privacy norm influenced the concealment of menstruation and restricted discussions, limiting learning and support. A second influential factor was the expectation that a “good mother” teaches her daughter how to care for herself at menarche. Other behaviors, such as school attendance or care-seeking, were primarily influenced by non-normative drivers, including beliefs. Our results provide evidence and an applied theoretical framework to guide interventions. We emphasize that both empirical and normative expectations and sanctions must be identified and addressed in interventions aimed at shifting social norms. Our findings emphasize mothers and families as key reference groups and suggest interventions targeting girls alone may be unable to shift norms.</p>