Lost in transition: menstrual experiences of intellectually disabled school-going adolescents in Delhi, India
Issues around reproductive health of intellectually disabled adolescents have received limited attention in India. This study aimed to bring to light these issues to inform policy and practice surrounding reproductive health among intellectually disabled adolescents. The objectives of this study were to understand the problems encountered by intellectually disabled adolescents and their primary caretakers during management of the adolescent’s menstrual cycle, and to explore the strategies adopted to overcome them. Using qualitative methodology, in-depth interviews were carried out with 23 primary caretakers (all mothers) of adolescent girls in the age group of 11–19 years with IQ of 20–50 were interviewed using in-depth interviews. The mothers of adolescents were selected using purposive sampling and grounded theory methodology was followed for data analysis. The adolescents faced a whole range of issues; from not being able to change sanitary napkins due to physical constraints, to not being able to communicate their physical discomforts, such as stomach cramps, to their caretakers. Their caretakers adopted various strategies such as changing the sanitary napkins for the adolescent themselves, trying to train the adolescent to maintain hygiene, or in some cases even surgical removal of the adolescent’s uterus for the cessation of menstruation. Overall, the adolescents did not play a very significant role in the management of their own menstruation, which might prevent them from achieving reproductive health to the best of their potential.Alur, M. (2001) ‘Some cultural and moral implications of inclusive education in India: a personal view’, Journal of Moral Education 30(3): 287–92 <http://dx.doi.org/10.1080/03057240120077291>.
Bhartiya, A. (2013) ‘Menstruation, religion and society’, International Journal of Social Science and Humanity 3(6): 523–7 <http://dx.doi.org/10.7763/IJSSH.2013.V3.296>.
Chou, Y.-C. and Lu, Z.-Y.J. (2012) ‘Caring for a daughter with intellectual disabilities in managing menstruation: a mother’s perspective’, Journal of Intellectual and Developmental Disability 37(1): 1–10 <http://dx.doi.org/10.3109/13668250.2011.651615>.
Daley, T.C. (2004) ‘From symptom recognition to diagnosis: children with autism in urban India’, Social Science & Medicine 58(7): 1323–35 <https://doi.org/10.1016/S0277-9536(03)00330-7>.
Datta, K. (2017) ‘Noida schoolgirls learn about menstrual hygiene’, Hindustan Times [online], 1 April <www.hindustantimes.com/education/noida-schoolgirls-learn-about-menstrual-hygiene/story-8ve9CqSS7AyCeUFTVCYPUJ.html> [accessed 14 August 2017].
Diekema, D.S. (2003) ‘Involuntary sterilization of persons with mental retardation: an ethical analysis’, Mental Retardation and Developmental Disabilities 9(1): 21–6 <http://dx.doi.org/10.1002/mrdd.10053>.
Edwardraj, S., Mumtaj, K., Prasad, J.H., Kuruvilla, A. and Jacob, K.S. (2010) ‘Perceptions about intellectual disability: a qualitative study from Vellore, South India’, Journal of Intellectual Disability Research 54(8): 736–48 <http://dx.doi.org/10.1111/j.1365-2788.2010.01301.x> [accessed 14 August 2017].
Ellis, B.J., Giudice, M., Dishion, T.J., Figueredo, A.J., Gray, P., Griskevicius, V., Hawley, P.H., Jacobs, W.J., James, J., Volk, A.A. and Wilson, D.S. (2012) ‘The evolutionary basis of risky adolescent behavior: implications for science, policy, and practice’, Development Psychology 48(3): 598–623 <http://dx.doi.org/10.1037/a0026220>.
Garg, S. and Anand, T. (2015) ‘Menstruation related myths in India: strategies for combating it’, Journal of Family Medicine and Primary Care 4(2): 184–6 <http://dx.doi.org/10.4103/2249-4863.154627>.
Griffin, J., Carlson, G., Taylor, M. and Wilson, J. (1994) ‘Menstrual management and intellectual disability: new perspectives’, Occupational Therapy International 1: 141–57 <http://dx.doi.org/10.1002/oti.6150010303>.
Gomez, M.T., Carlson, G.M. and Dooren, K.V. (2012) ‘Practical approaches to supporting young women with intellectual disabilities and high support needs with their menstruation’, Health Care for Women International 33(8): 678–94 <http://dx.doi.org/10.1080/07399332.2012.684812>.
Government of India (2003) ‘Survey of disabled persons in India: NSS 58th round (July-Dec 2002)’ [database], National Sample Survey Office <www.ilo.org/surveydata/index.php/catalog/196/study-description> [accessed 21 November 2014].
Government of India (2015) Menstrual Hygiene Management: National Guidelines [pdf], Ministry of Drinking Water and Sanitation <www.mdws.gov.in/sites/default/files/Menstrual%20Hygiene%20Management%20-%20Guidelines.pdf> [accessed 1 August 2017].
Grover, S.R. (2002) ‘Menstrual and contraceptive management in women with an intellectual disability’, Medicine and the Community 176: 108–10.
Gupta, A. and Singhal, N. (2005) ‘Psychosocial support for families of children with autism’, Asia Pacific Disability Rehabilitation Journal 16(2): 62–83.
Hindustan Times (2016) ‘Laws on rights of persons with disabilities notified’, 30 December 2016 [online] <www.hindustantimes.com/india-news/law-on-rights-of-persons-with-disabilities-notified/story-E0Vpnt3r1v8sXNkxPdhvkL.html> [accessed 13 June 2017].
Holness, W. (2013) ‘Informed consent for sterilisation of women and girls with disabilities in the light of the Convention on the Rights of Persons with Disabilities’, Agenda: Empowering Women for Gender Equity 27(4): 35–54.
Kabra, M. and Gulati, S. (2003) ‘Mental retardation’, The Indian Journal of Pediatrics 70: 153–8.
Kamaruddin, K. and Mamat, N. (2015) ‘Stress among the parents of children with learning disabilities: a demographical analysis’, International Journal of Humanities Social Sciences and Education 2(9): 194–200.
Kishore, M.T. (2011) ‘Disability impact and coping in mothers of children with intellectual disabilities and multiple disabilities’, Journal of Intellectual Disabilities 15(4): 241–51.
Klett, L.S. and Turan, Y. (2012) ‘Generalized effects of social stories with task analysis for teaching menstrual care to three young girls with autism’, Sexuality and Disability 30(3): 319–36 <http://dx.doi.org/10.1007/s11195-011-9244-2>.
Lim, F., Downs, J., Li, J., Bao, X. and Leonard, H. (2013) ‘Caring for a child with severe intellectual disability in China: the example of Rett syndrome’, Disability and Rehabilitation 35(4): 343–51 <http://dx.doi.org/10.3109/09638288.2012.715720>.
Lin, L.P., Lin, P.Y., Hsu, S.W., Lin, J.D., Lai, C.I., Chien, W.C. and Lin, F.G. (2011) ‘Caregiver awareness of reproductive health issues for women with intellectual disabilities’, BMC Public Health 11: 1471–2458 <http://dx.doi.org/10.1186/1471-2458-11-59>.
Park, H.R. (2013) Menstrual Support for Females with Developmental Disabilities: Survey and Interview of Parents or Caretakers [pdf], PhD dissertation, University of Kansas <https://kuscholarworks.ku.edu/bitstream/handle/1808/15062/Park_ku_0099D_13173_DATA_1.pdf> [accessed 22 September 2017].
Patton, G.C., Hibbert, M.E., Carlin, J., Shao, Q., Rosier, M., Caust, J. and Bowes, G. (1996) ‘Menarche and the onset of depression and anxiety in Victoria, Australia’, Journal of Epidemiology and Community Health 50: 661–6.
Peters, S. (2007) ‘“Education for all?” A historical analysis of international inclusive education policy and individuals with disabilities’, Journal of Disability Policy Studies 18(2): 98–108.
Quint, E.H. (2008) ‘Menstrual issues in adolescents with physical and developmental disabilities’, Annals of the New York Academy of Sciences 1135: 230–6 <http://dx.doi.org/10.1196/annals.1429.020>.
Reddy, V.M. and Chandrashekar, C.R. (1998) ‘Prevalence of mental and behavioural disorders in India: a meta-analysis’, Indian Journal of Psychiatry 40: 149–57.
Rodgers, J. and Lipscombe, J. (2005) ‘The nature and extent of help given to women with intellectual disabilities to manage menstruation’, Journal of Intellectual and Developmental Disability 30(1): 45–52.
Sapkota, D., Sharma, D., Pokharel, H.P., Budhathoki, S.S., Khanal, V.K. (2013) ‘Knowledge and practices regarding menstruation among school going adolescents of rural Nepal’, Journal of Kathmandu Medical College 2(3): 122–8 <http://dx.doi.org/10.3126/jkmc.v2i3.9962>.
Shastri, P.C. (2008) ‘Future perspective of planning child guidance services in India’, Indian Journal of Psychiatry 50: 241–3 <http://dx.doi.org/10.4103/0019-5545.44744>.
Sreeja, I., Sandhya, G., Rakesh, L. and Singh, M. (2008) ‘Comparison of burden between family caregivers of patients having schizophrenia and epilepsy’, The Internet Journal of Epidemiology 6: 2.
Swenson, I. and Havens, B. (1987) ‘Menarche and menstruation: a review of the literature’, Journal of Community Health Nursing 4(4): 199–210.
Tilley, E., Walmsley, J., Earle, S. and Atkinson, D. (2012) ‘The silence is roaring: sterilization, reproductive rights and women with intellectual disabilities’, Disability and Society 27(3): 413–26 <http://dx.doi.org/10.1080/09687599.2012.654991>.
Wikler, L. (1981) ‘Chronic stresses of families of mentally retarded children’, Family Relations 30(2): 281–8.
World Health Organization (WHO) (1985) Mental Retardation: Meeting the Challenge [pdf], WHO offset publication no. 86, Geneva: WHO <http://apps.who.int/iris/bitstream/10665/39691/1/WHO_OFFSET_86.pdf>
Alur, M. (2001) ‘Some cultural and moral implications of inclusive education in India: a personal view’, Journal of Moral Education 30(3): 287–92 <http://dx.doi.org/10.1080/03057240120077291>.
Bhartiya, A. (2013) ‘Menstruation, religion and society’, International Journal of Social Science and Humanity 3(6): 523–7 <http://dx.doi.org/10.7763/IJSSH.2013.V3.296>.
Chou, Y.-C. and Lu, Z.-Y.J. (2012) ‘Caring for a daughter with intellectual disabilities in managing menstruation: a mother’s perspective’, Journal of Intellectual and Developmental Disability 37(1): 1–10 <http://dx.doi.org/10.3109/13668250.2011.651615>.
Daley, T.C. (2004) ‘From symptom recognition to diagnosis: children with autism in urban India’, Social Science & Medicine 58(7): 1323–35 <https://doi.org/10.1016/S0277-9536(03)00330-7>.
Datta, K. (2017) ‘Noida schoolgirls learn about menstrual hygiene’, Hindustan Times [online], 1 April <www.hindustantimes.com/education/noida-schoolgirls-learn-about-menstrual-hygiene/story-8ve9CqSS7AyCeUFTVCYPUJ.html> [accessed 14 August 2017].
Diekema, D.S. (2003) ‘Involuntary sterilization of persons with mental retardation: an ethical analysis’, Mental Retardation and Developmental Disabilities 9(1): 21–6 <http://dx.doi.org/10.1002/mrdd.10053>.
Edwardraj, S., Mumtaj, K., Prasad, J.H., Kuruvilla, A. and Jacob, K.S. (2010) ‘Perceptions about intellectual disability: a qualitative study from Vellore, South India’, Journal of Intellectual Disability Research 54(8): 736–48 <http://dx.doi.org/10.1111/j.1365-2788.2010.01301.x> [accessed 14 August 2017].
Ellis, B.J., Giudice, M., Dishion, T.J., Figueredo, A.J., Gray, P., Griskevicius, V., Hawley, P.H., Jacobs, W.J., James, J., Volk, A.A. and Wilson, D.S. (2012) ‘The evolutionary basis of risky adolescent behavior: implications for science, policy, and practice’, Development Psychology 48(3): 598–623 <http://dx.doi.org/10.1037/a0026220>.
Garg, S. and Anand, T. (2015) ‘Menstruation related myths in India: strategies for combating it’, Journal of Family Medicine and Primary Care 4(2): 184–6 <http://dx.doi.org/10.4103/2249-4863.154627>.
Griffin, J., Carlson, G., Taylor, M. and Wilson, J. (1994) ‘Menstrual management and intellectual disability: new perspectives’, Occupational Therapy International 1: 141–57 <http://dx.doi.org/10.1002/oti.6150010303>.
Gomez, M.T., Carlson, G.M. and Dooren, K.V. (2012) ‘Practical approaches to supporting young women with intellectual disabilities and high support needs with their menstruation’, Health Care for Women International 33(8): 678–94 <http://dx.doi.org/10.1080/07399332.2012.684812>.
Government of India (2003) ‘Survey of disabled persons in India: NSS 58th round (July-Dec 2002)’ [database], National Sample Survey Office <www.ilo.org/surveydata/index.php/catalog/196/study-description> [accessed 21 November 2014].
Government of India (2015) Menstrual Hygiene Management: National Guidelines [pdf], Ministry of Drinking Water and Sanitation <www.mdws.gov.in/sites/default/files/Menstrual%20Hygiene%20Management%20-%20Guidelines.pdf> [accessed 1 August 2017].
Grover, S.R. (2002) ‘Menstrual and contraceptive management in women with an intellectual disability’, Medicine and the Community 176: 108–10.
Gupta, A. and Singhal, N. (2005) ‘Psychosocial support for families of children with autism’, Asia Pacific Disability Rehabilitation Journal 16(2): 62–83.
Hindustan Times (2016) ‘Laws on rights of persons with disabilities notified’, 30 December 2016 [online] <www.hindustantimes.com/india-news/law-on-rights-of-persons-with-disabilities-notified/story-E0Vpnt3r1v8sXNkxPdhvkL.html> [accessed 13 June 2017].
Holness, W. (2013) ‘Informed consent for sterilisation of women and girls with disabilities in the light of the Convention on the Rights of Persons with Disabilities’, Agenda: Empowering Women for Gender Equity 27(4): 35–54.
Kabra, M. and Gulati, S. (2003) ‘Mental retardation’, The Indian Journal of Pediatrics 70: 153–8.
Kamaruddin, K. and Mamat, N. (2015) ‘Stress among the parents of children with learning disabilities: a demographical analysis’, International Journal of Humanities Social Sciences and Education 2(9): 194–200.
Kishore, M.T. (2011) ‘Disability impact and coping in mothers of children with intellectual disabilities and multiple disabilities’, Journal of Intellectual Disabilities 15(4): 241–51.
Klett, L.S. and Turan, Y. (2012) ‘Generalized effects of social stories with task analysis for teaching menstrual care to three young girls with autism’, Sexuality and Disability 30(3): 319–36 <http://dx.doi.org/10.1007/s11195-011-9244-2>.
Lim, F., Downs, J., Li, J., Bao, X. and Leonard, H. (2013) ‘Caring for a child with severe intellectual disability in China: the example of Rett syndrome’, Disability and Rehabilitation 35(4): 343–51 <http://dx.doi.org/10.3109/09638288.2012.715720>.
Lin, L.P., Lin, P.Y., Hsu, S.W., Lin, J.D., Lai, C.I., Chien, W.C. and Lin, F.G. (2011) ‘Caregiver awareness of reproductive health issues for women with intellectual disabilities’, BMC Public Health 11: 1471–2458 <http://dx.doi.org/10.1186/1471-2458-11-59>.
Park, H.R. (2013) Menstrual Support for Females with Developmental Disabilities: Survey and Interview of Parents or Caretakers [pdf], PhD dissertation, University of Kansas <https://kuscholarworks.ku.edu/bitstream/handle/1808/15062/Park_ku_0099D_13173_DATA_1.pdf> [accessed 22 September 2017].
Patton, G.C., Hibbert, M.E., Carlin, J., Shao, Q., Rosier, M., Caust, J. and Bowes, G. (1996) ‘Menarche and the onset of depression and anxiety in Victoria, Australia’, Journal of Epidemiology and Community Health 50: 661–6.
Peters, S. (2007) ‘“Education for all?” A historical analysis of international inclusive education policy and individuals with disabilities’, Journal of Disability Policy Studies 18(2): 98–108.
Quint, E.H. (2008) ‘Menstrual issues in adolescents with physical and developmental disabilities’, Annals of the New York Academy of Sciences 1135: 230–6 <http://dx.doi.org/10.1196/annals.1429.020>.
Reddy, V.M. and Chandrashekar, C.R. (1998) ‘Prevalence of mental and behavioural disorders in India: a meta-analysis’, Indian Journal of Psychiatry 40: 149–57.
Rodgers, J. and Lipscombe, J. (2005) ‘The nature and extent of help given to women with intellectual disabilities to manage menstruation’, Journal of Intellectual and Developmental Disability 30(1): 45–52.
Sapkota, D., Sharma, D., Pokharel, H.P., Budhathoki, S.S., Khanal, V.K. (2013) ‘Knowledge and practices regarding menstruation among school going adolescents of rural Nepal’, Journal of Kathmandu Medical College 2(3): 122–8 <http://dx.doi.org/10.3126/jkmc.v2i3.9962>.
Shastri, P.C. (2008) ‘Future perspective of planning child guidance services in India’, Indian Journal of Psychiatry 50: 241–3 <http://dx.doi.org/10.4103/0019-5545.44744>.
Sreeja, I., Sandhya, G., Rakesh, L. and Singh, M. (2008) ‘Comparison of burden between family caregivers of patients having schizophrenia and epilepsy’, The Internet Journal of Epidemiology 6: 2.
Swenson, I. and Havens, B. (1987) ‘Menarche and menstruation: a review of the literature’, Journal of Community Health Nursing 4(4): 199–210.
Tilley, E., Walmsley, J., Earle, S. and Atkinson, D. (2012) ‘The silence is roaring: sterilization, reproductive rights and women with intellectual disabilities’, Disability and Society 27(3): 413–26 <http://dx.doi.org/10.1080/09687599.2012.654991>.
Wikler, L. (1981) ‘Chronic stresses of families of mentally retarded children’, Family Relations 30(2): 281–8.
World Health Organization (WHO) (1985) Mental Retardation: Meeting the Challenge [pdf], WHO offset publication no. 86, Geneva: WHO <http://apps.who.int/iris/bitstream/10665/39691/1/WHO_OFFSET_86.pdf>
Alur, M. (2001) ‘Some cultural and moral implications of inclusive education in India: a personal view’, Journal of Moral Education 30(3): 287–92 <http://dx.doi.org/10.1080/03057240120077291>.
Bhartiya, A. (2013) ‘Menstruation, religion and society’, International Journal of Social Science and Humanity 3(6): 523–7 <http://dx.doi.org/10.7763/IJSSH.2013.V3.296>.
Chou, Y.-C. and Lu, Z.-Y.J. (2012) ‘Caring for a daughter with intellectual disabilities in managing menstruation: a mother’s perspective’, Journal of Intellectual and Developmental Disability 37(1): 1–10 <http://dx.doi.org/10.3109/13668250.2011.651615>.
Daley, T.C. (2004) ‘From symptom recognition to diagnosis: children with autism in urban India’, Social Science & Medicine 58(7): 1323–35 <https://doi.org/10.1016/S0277-9536(03)00330-7>.
Datta, K. (2017) ‘Noida schoolgirls learn about menstrual hygiene’, Hindustan Times [online], 1 April <www.hindustantimes.com/education/noida-schoolgirls-learn-about-menstrual-hygiene/story-8ve9CqSS7AyCeUFTVCYPUJ.html> [accessed 14 August 2017].
Diekema, D.S. (2003) ‘Involuntary sterilization of persons with mental retardation: an ethical analysis’, Mental Retardation and Developmental Disabilities 9(1): 21–6 <http://dx.doi.org/10.1002/mrdd.10053>.
Edwardraj, S., Mumtaj, K., Prasad, J.H., Kuruvilla, A. and Jacob, K.S. (2010) ‘Perceptions about intellectual disability: a qualitative study from Vellore, South India’, Journal of Intellectual Disability Research 54(8): 736–48 <http://dx.doi.org/10.1111/j.1365-2788.2010.01301.x> [accessed 14 August 2017].
Ellis, B.J., Giudice, M., Dishion, T.J., Figueredo, A.J., Gray, P., Griskevicius, V., Hawley, P.H., Jacobs, W.J., James, J., Volk, A.A. and Wilson, D.S. (2012) ‘The evolutionary basis of risky adolescent behavior: implications for science, policy, and practice’, Development Psychology 48(3): 598–623 <http://dx.doi.org/10.1037/a0026220>.
Garg, S. and Anand, T. (2015) ‘Menstruation related myths in India: strategies for combating it’, Journal of Family Medicine and Primary Care 4(2): 184–6 <http://dx.doi.org/10.4103/2249-4863.154627>.
Griffin, J., Carlson, G., Taylor, M. and Wilson, J. (1994) ‘Menstrual management and intellectual disability: new perspectives’, Occupational Therapy International 1: 141–57 <http://dx.doi.org/10.1002/oti.6150010303>.
Gomez, M.T., Carlson, G.M. and Dooren, K.V. (2012) ‘Practical approaches to supporting young women with intellectual disabilities and high support needs with their menstruation’, Health Care for Women International 33(8): 678–94 <http://dx.doi.org/10.1080/07399332.2012.684812>.
Government of India (2003) ‘Survey of disabled persons in India: NSS 58th round (July-Dec 2002)’ [database], National Sample Survey Office <www.ilo.org/surveydata/index.php/catalog/196/study-description> [accessed 21 November 2014].
Government of India (2015) Menstrual Hygiene Management: National Guidelines [pdf], Ministry of Drinking Water and Sanitation <www.mdws.gov.in/sites/default/files/Menstrual%20Hygiene%20Management%20-%20Guidelines.pdf> [accessed 1 August 2017].
Grover, S.R. (2002) ‘Menstrual and contraceptive management in women with an intellectual disability’, Medicine and the Community 176: 108–10.
Gupta, A. and Singhal, N. (2005) ‘Psychosocial support for families of children with autism’, Asia Pacific Disability Rehabilitation Journal 16(2): 62–83.
Hindustan Times (2016) ‘Laws on rights of persons with disabilities notified’, 30 December 2016 [online] <www.hindustantimes.com/india-news/law-on-rights-of-persons-with-disabilities-notified/story-E0Vpnt3r1v8sXNkxPdhvkL.html> [accessed 13 June 2017].
Holness, W. (2013) ‘Informed consent for sterilisation of women and girls with disabilities in the light of the Convention on the Rights of Persons with Disabilities’, Agenda: Empowering Women for Gender Equity 27(4): 35–54.
Kabra, M. and Gulati, S. (2003) ‘Mental retardation’, The Indian Journal of Pediatrics 70: 153–8.
Kamaruddin, K. and Mamat, N. (2015) ‘Stress among the parents of children with learning disabilities: a demographical analysis’, International Journal of Humanities Social Sciences and Education 2(9): 194–200.
Kishore, M.T. (2011) ‘Disability impact and coping in mothers of children with intellectual disabilities and multiple disabilities’, Journal of Intellectual Disabilities 15(4): 241–51.
Klett, L.S. and Turan, Y. (2012) ‘Generalized effects of social stories with task analysis for teaching menstrual care to three young girls with autism’, Sexuality and Disability 30(3): 319–36 <http://dx.doi.org/10.1007/s11195-011-9244-2>.
Lim, F., Downs, J., Li, J., Bao, X. and Leonard, H. (2013) ‘Caring for a child with severe intellectual disability in China: the example of Rett syndrome’, Disability and Rehabilitation 35(4): 343–51 <http://dx.doi.org/10.3109/09638288.2012.715720>.
Lin, L.P., Lin, P.Y., Hsu, S.W., Lin, J.D., Lai, C.I., Chien, W.C. and Lin, F.G. (2011) ‘Caregiver awareness of reproductive health issues for women with intellectual disabilities’, BMC Public Health 11: 1471–2458 <http://dx.doi.org/10.1186/1471-2458-11-59>.
Park, H.R. (2013) Menstrual Support for Females with Developmental Disabilities: Survey and Interview of Parents or Caretakers [pdf], PhD dissertation, University of Kansas <https://kuscholarworks.ku.edu/bitstream/handle/1808/15062/Park_ku_0099D_13173_DATA_1.pdf> [accessed 22 September 2017].
Patton, G.C., Hibbert, M.E., Carlin, J., Shao, Q., Rosier, M., Caust, J. and Bowes, G. (1996) ‘Menarche and the onset of depression and anxiety in Victoria, Australia’, Journal of Epidemiology and Community Health 50: 661–6.
Peters, S. (2007) ‘“Education for all?” A historical analysis of international inclusive education policy and individuals with disabilities’, Journal of Disability Policy Studies 18(2): 98–108.
Quint, E.H. (2008) ‘Menstrual issues in adolescents with physical and developmental disabilities’, Annals of the New York Academy of Sciences 1135: 230–6 <http://dx.doi.org/10.1196/annals.1429.020>.
Reddy, V.M. and Chandrashekar, C.R. (1998) ‘Prevalence of mental and behavioural disorders in India: a meta-analysis’, Indian Journal of Psychiatry 40: 149–57.
Rodgers, J. and Lipscombe, J. (2005) ‘The nature and extent of help given to women with intellectual disabilities to manage menstruation’, Journal of Intellectual and Developmental Disability 30(1): 45–52.
Sapkota, D., Sharma, D., Pokharel, H.P., Budhathoki, S.S., Khanal, V.K. (2013) ‘Knowledge and practices regarding menstruation among school going adolescents of rural Nepal’, Journal of Kathmandu Medical College 2(3): 122–8 <http://dx.doi.org/10.3126/jkmc.v2i3.9962>.
Shastri, P.C. (2008) ‘Future perspective of planning child guidance services in India’, Indian Journal of Psychiatry 50: 241–3 <http://dx.doi.org/10.4103/0019-5545.44744>.
Sreeja, I., Sandhya, G., Rakesh, L. and Singh, M. (2008) ‘Comparison of burden between family caregivers of patients having schizophrenia and epilepsy’, The Internet Journal of Epidemiology 6: 2.
Swenson, I. and Havens, B. (1987) ‘Menarche and menstruation: a review of the literature’, Journal of Community Health Nursing 4(4): 199–210.
Tilley, E., Walmsley, J., Earle, S. and Atkinson, D. (2012) ‘The silence is roaring: sterilization, reproductive rights and women with intellectual disabilities’, Disability and Society 27(3): 413–26 <http://dx.doi.org/10.1080/09687599.2012.654991>.
Wikler, L. (1981) ‘Chronic stresses of families of mentally retarded children’, Family Relations 30(2): 281–8.
World Health Organization (WHO) (1985) Mental Retardation: Meeting the Challenge [pdf], WHO offset publication no. 86, Geneva: WHO <http://apps.who.int/iris/bitstream/10665/39691/1/WHO_OFFSET_86.pdf>
Alur, M. (2001) ‘Some cultural and moral implications of inclusive education in India: a personal view’, Journal of Moral Education 30(3): 287–92 <http://dx.doi.org/10.1080/03057240120077291>.
Bhartiya, A. (2013) ‘Menstruation, religion and society’, International Journal of Social Science and Humanity 3(6): 523–7 <http://dx.doi.org/10.7763/IJSSH.2013.V3.296>.
Chou, Y.-C. and Lu, Z.-Y.J. (2012) ‘Caring for a daughter with intellectual disabilities in managing menstruation: a mother’s perspective’, Journal of Intellectual and Developmental Disability 37(1): 1–10 <http://dx.doi.org/10.3109/13668250.2011.651615>.
Daley, T.C. (2004) ‘From symptom recognition to diagnosis: children with autism in urban India’, Social Science & Medicine 58(7): 1323–35 <https://doi.org/10.1016/S0277-9536(03)00330-7>.
Datta, K. (2017) ‘Noida schoolgirls learn about menstrual hygiene’, Hindustan Times [online], 1 April <www.hindustantimes.com/education/noida-schoolgirls-learn-about-menstrual-hygiene/story-8ve9CqSS7AyCeUFTVCYPUJ.html> [accessed 14 August 2017].
Diekema, D.S. (2003) ‘Involuntary sterilization of persons with mental retardation: an ethical analysis’, Mental Retardation and Developmental Disabilities 9(1): 21–6 <http://dx.doi.org/10.1002/mrdd.10053>.
Edwardraj, S., Mumtaj, K., Prasad, J.H., Kuruvilla, A. and Jacob, K.S. (2010) ‘Perceptions about intellectual disability: a qualitative study from Vellore, South India’, Journal of Intellectual Disability Research 54(8): 736–48 <http://dx.doi.org/10.1111/j.1365-2788.2010.01301.x> [accessed 14 August 2017].
Ellis, B.J., Giudice, M., Dishion, T.J., Figueredo, A.J., Gray, P., Griskevicius, V., Hawley, P.H., Jacobs, W.J., James, J., Volk, A.A. and Wilson, D.S. (2012) ‘The evolutionary basis of risky adolescent behavior: implications for science, policy, and practice’, Development Psychology 48(3): 598–623 <http://dx.doi.org/10.1037/a0026220>.
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