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Women & Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wwah20
Religious Influence on Menstrual Attitudes and Symptoms a
Barbara Olasov Rothbaum PhD & Joan Jackson PhD a
b
Medical College of Pennsylvania, [email protected]
b
University of Georgia, Athens, GA, 30602, [email protected] Published online: 02 Nov 2010.
To cite this article: Barbara Olasov Rothbaum PhD & Joan Jackson PhD (1990) Religious Influence on Menstrual Attitudes and Symptoms, Women & Health, 16:1, 63-78, DOI: 10.1300/ J013v16n01_05 To link to this article: http://dx.doi.org/10.1300/J013v16n01_05
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
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Religious Influence on Menstrual Attitudes and Symptoms Barbara Olasov Rothbaum, P h D
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Joan Jackson, PhD
ABSTRACT. Menstrual attitudes and symptoms of 18 Orthodox Jewish Mikvah attenders, 23 Orthodox Jewish Mikvah non-attenders, 35 Protestant women, and 45 Catholic women were compared. When age, education, number of pregnancies, and religiosity were controlled, Mikvah non-attenders and Protestants most strong1 enicant dorsed a view of menstruation as a bothersome event. No signi[ differences were found, however, in expected or retrospect~velyreported menstrual symptoms. Correlational analyses indicated that attitudes, expectancies, and symptoms were significantly correlated only for the Catholic women. Differences between groups in religiosity and socialization were found. The Jewish women endorsed doctrines such as "menstruation makes women unclean" more than Catholic or Protestant women. Results support the hypothesized differential religious training regarding menstruation, but only offer weak support for the effects of this training on menstrual attitudes, expectancies, and symptoms.
Many menstrual cycle researchers have discussed religious-cultural influ'ences as an important determinant of attitudes and reported experiences (Asso, 1983; Brooks-Gunn, 1985; Brooks-Gunn & Ruble, 1980a; Good & Smith, 1980; Moos, 1985; Most, Woods, Dery, & Most, 1981; Paige, 1973; Toth, Delaney, & Lupton, 1981). Barbara Olasov Rothbaum is affiliated with the Medical College of Pennsylvania. Joan Jackson is affiliated with the University of Georgia. Address requests for reprints to Barbara Olasov Rothbaum, Department of Psychiatry, Medical College of Pennsylvania at Eastern Pennsylvania Psychiatric Institute, 3200 Henry Avenue, Philadelphia, PA 19129. Women & Health, Vol. 16(1) 1990 O 1990 by The Haworth Press, Inc. All rights reserved.
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Brooks-Gunn (1985) found that Protestant women reported more regular cycles than Catholic or Jewish women and that the relationship between menstrual flow and menstrual distress was not as strong for Protestant women as it was for Catholic women. In addition, she found that for women with intense flows, the Catholics but not the Protestants were more likely to rate menstruation as bothersome and debilitating as measured by the Menstrual Attitude Questionnaire (MAQ, Brooks-Gunn & Ruble, 1980b). She concluded that "women's perceptions of menstrual characteristics are related to menstrual-related beliefs, and religious group membership mediates such perceptions" (p. 370). Good and Smith (1980) found that for Catholic women, sex-role attributes and anxiety were associated with menstrual distress. For Jewish women, only anxiety was related to menstrual distress, and neither sex-role attributes nor anxiety was associated with distress for Protestant women. They concluded that religion should be included as a "potentially important distress-mediating factor" (p. 490). Paige (1973) found that Jewish women who adhered to menstruation rituals and sexual taboos were the most likely to report menstrual problems as compared to Catholic and Protestant women, although only a small percentage of her participants were Jewish. She also found that menstrual distress was considered an important part of the traditional female role only for Catholics. These findings indicate that religion may be an important mediating variable in menstrual-related attitudes and experiences. However, all of these studies have only incidentally gathered information on religion. In addition, they have not examined Jewish women systematically, which would appear to be important, especially based on Paige's (1973) results. Only 10% of the Brooks-Gunn (1985) sample was Jewish (as compared to 55% Catholic and 24% Protestant), and Paige's (1973) two samples included only 7% and 6% Jews, respectively. Indeed, Orthodox Judaism contains laws and explicit teachings directly pertaining to menstruation and sexual activity. These restrictions are based on a passage from the Old Testament (i.e., Leviticus XV, 19) and dictate that women are not to touch their husbands, much less engage in sexual activity, for the duration of their menses plus seven days and then only after they have attended Mikvah, a ceremonial cleansing bath. Women in Orthodox Judaism
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Barbara Olasov Rorhbaum and Joan Jackson
65
are not allowed to become Rabbis or even sit with the men in synagogue because they are considered unclean and unholy. Thus, very overt messages are reinforced by required participation in a monthly ritual. .In the only study examining the effect of the Mikvah ritual, Siegel (1986) explored the hypothesis that Mikvah users were different from demographically matched Jewish non-Mikvah users in reported perimenstrual symptoms, but she did not find the expected differences. The present study examined the effects of religion generally, and Orthodox Judaism and the Mikvah ritual specifically, on menstrual attitudes and retrospectively reported symptoms. A group of Orthodox Jewish Mikvah attenders and a group of Orthodox Jewish Mikvah non-attenders were compared to each other and to a group of Protestant women and a group of Catholic women. It was predicted that Jewish Mikvah attenders would report the most negative attitudes, symptoms, and expectancies, followed closely by Jewish Mikvah non-attenders, Catholic women would fall in the middle, and Protestant women would respond the least negatively. This prediction resulted from the hypothesis that engaging in a monthly ritual with a very salient purpose-cleansing oneself of the uncleanliness and unholiness of menstruation in order that physical contact with one's husband may be reinstated-may serve to strenethen the neeative attitudes toward menstruation already instilled"by the teac{ings of the religion. This strengthening of attitudes could be conceptualized as a cognitive dissonance reduction phenomenon wherein attitudes change (i.e., are strengthened) in accord with overt behavior (i.e.; engaging in the ritual). Protestant women were predicted to report the most positive attitudes, expectancies, and symptoms, since their religious doctrine contains no specific menstrual teachings. Catholic women were predicted to be more negative than Protestant women as a result of their religious teachings, which, though not specifically menstmalrelated, would have implications for sexual activity during menstruation. These implications in Catholicism regarding sex during menstruation result from contraception-related taboos and doctrines stating sex should have the sole purpose of procreation. Since women are less likely to conceive during menstruation, it may be felt that women should refrain from sex during menstruation. It was also expected that attitudes, expectancies, and reports of symptoms
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would be significantly correlated within all groups (Brooks-Gunn, 1985; Brooks-Gunn & Ruble, 1980b; Menke, 1983; Woods, Dery, & Most, 1982). METHOD
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Participants Of 219 Orthodox Jewish, 178 Protestant, and 187 Catholic women invited to participate in the study, 72 Jewish women (32.9%), 60 Protestant women (33.7%), and 75 Catholic women (40.1%) agreed to participate and provided data. Excluded from this sample, however, were women who were not menstruating regularly for any reason (e.g., pregnancy, post-partum, hysterectomy, approaching menopause), as well as those who reported use of oral contraceptives or intrauterine devices. Thus, the final sample was comprised of 18 Orthodox Jewish women who reported regular attendance at Mikvah,23 Orthodox Jewish women who reported that they did not regularly attend Mikvah, 35 Protestant women, and 45 Roman Catholic women. All participants were members of organized religious congregations in cities in the Southeastern United States and were solicited to participate based on their membership. Participation in the study was endorsed by the leaders of the various congregations, but no other incentives were offered. Demographic characteristics of participants are shown in Table 1. All participants were married, Caucasian women of approximately the same age, however, there were some differences in demographics based on religious group membership. The two groups of Jewish women had more pregnancies and more children than Protestant women. Jewish Mikvah attenders had more formal education that the Mikvah non-attenders and Catholics, with Protestants intermediate and not significantly different from either. In addition, husbands of the Catholic women had somewhat less education and worked at jobs of somewhat lower status. Household incomes also varied across groups, the two groups of Jewish women reporting higher family incomes than the Protestants, with Catholics intermediate.
Barbara Olasov Rothbaum and Joan Jackson Table 1 Oenrma&ic characteristics of SarraJle
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Variable
Religiosity (experie n t i a l scale)
Religiosity (single item rat*) O t e n w m (single item ratirq)
Children
Household incrrne (3=$30,000-50,000; 4=$50,000-70,000 Husband's ocrupation
Husbad' s education
Grarp
M
SD
F
WOMEN & HEALTH
TABLE 1 (continued)
Hours work&
per week
M N P
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C
Variable Percent eIlpl0yed
Group M N
P C
Percent 88.9% 57.1% 61.8% 60.0%
-n
-X2
16
5.67
12 27 21
Note. Education and oxupation represent Hollingshead (1957) classification system. G r w p M = a t M e r s : N = Non-atten3ers: P Protestant; C = Catholic. Means with the same sukscript are not significantly different as determined by Cuman's Multiple Range Test.
=
Instruments Menstrual Attitude Questionnaire (MQ; Brooks-Gunn & Ruble, 1980b) The MAQ consists of 33 items that load onto five factors representing attitudes toward menstruation as debilitating, positive, predictable, bothersome, and as having neutral or no effects ("denial"). Internal consistency estimates (Cronbach's alpha) for the five factor-based scales comprising the instrument ranged from -90 to .97 in two samples of college women. Congruence between the same factors across two samples ranged from .77 to .91. The validity of the MAQ has been supported by the finding that MAQ scores are significantly correlated with reported menstrual distress as mea-
~ a r b a r Olasov i Rothbaurn and Joan Jackson
69
sured by Moos' (1968) Menstrual Distress Questionnaire. Each item is rated on a 7-point scale, such that scores can range from 12 to 84 for the menstruation as debilitating scale; six to 42 for the bothersome scale; five to 35 for both the positive and predictable subscales; and seven to 49 for the denial scale. Higher scores indicate more negative attitudes.
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Menstrual Distress Questionnaire- Form C (MDQ; Moos, 1968, 1977, 1985)
Form C of the MDQ rcquires the respondent to rate the severity of each of 47 symptoms as experienced during menstrual, intermenstrual, and premenstrual phases of the cycle. Eight factor-derived scales, including pain, water retention, autonomic reactions, negative affect, impaired concentration, behavior change, arousal, and control, comprise the instrument. Internal consistency estimates (KR-20) for the eight scales range from .53 to .89. The MDQ predicts treatment-seeking for perimenstrual problems (e.g., Clare, 1983) and is widely used in assessing perimenstrual symptomatology. Moos has compiled normative data based on assessment of over 2,000 women. Higher scores reflect worse symptomatologies. Expectancy Questionnaire (EQ; Olasov, 1984; Olasov & Jackson, 1987)
An adaptation of the instrument developed by Rossi and Rossi (1980), the EQ was designed to assess women's expectancies for their moods to be affected by the menstrual cycle. In the present study, women were asked to indicate how they expected to feel during their next premenstrual phase. Participants use a 1-6 Likert scale to respond to three questions and 16 adjectives describing mood states, yielding a total score ranging from 19 to 114.
Demographic Questionnaire (DQ) The DQ was developed for the present study to obtain demographic and medical/menstrual information, as well as to serve as an indicator of Mikvah attendance.
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Religiosity Questionnaire (RQ) The RQ was developed for purposes of this study to assess participants' knowledge of religious doctrine concerning menstruation and the extent to which they were exposed while growing up to others who endorsed their religious doctrine concerning menstruation. Thus, they were asked to respond to the questions, "What is the official doctrine of your religion regarding menstruation?" and "What was your personal religious upbringing regarding menstruation?" Alternative responses that participants could endorse (or not) included "Menstruation is unclean," "Menstruation is something that makes women less holy than men," "Menstruation is sornething that men should be protected from, including not being touched by a menstruating woman." They were asked to "agree" or "disagree" with the statement "Women should not have sexual intercourse during menstruation or immediately afterwards" and (when applicable) indicate if endorsement of this belief is "Because my religion dictates it." Participants were also asked, "How religious do you consider yourself?" and "How observant are you (i.e., adhering to certain rules, attending place of worship, etc.)?" Both questions were answered using a 1 to 7 Likert scale with anchors of "not at all" (1) and "very" (7). Finally participants responded to the five items comprising Faulkner and DeJong's (1966) religiosity scale. Designed to measure the experiential dimension of religiosity, the items assess feelings of closeness to a divine being and beliefs that religion gives life purpose and meaning, that it provides security in the face of death, and that faith is essential to religious life. Total scores can range from 0 to 11, with higher scores indicating greater religiosity. Procedure
Leaders of two Orthodox Jewish, two Protestant (one Methodist, one nondenominational) and one Roman Catholic congregation gave the investigators permission to contact married women between the ages of 20 and 50 in their congregations. Women meeting these criteria were then mailed a packet of materials containing: a cover letter explaining the study, requesting participation, and men-
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71
tioning the endorsement of the religious leader; the MAQ, MDQ, EQ, DQ, and RQ in random order; and a pre-addressed, stamped envelope for return of completed materials. To ensure participants' anonymity, envelopes sent to participants were addressed and mailed by a member of the church or synagogue, and completed materials were then returned by mail directly to the investigators. RESULTS
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Due to the large number of variables examined relative to the sample size, a conservative significance level ofp < .O1 was incorporated to control for spurious differences. Religiosity
Whereas differences in menstrual attitudes and symptoms were hypothesized to be related to religious group membership, it was also hypothesized that degree of religiosity (independent of group membership) could influence reporting of attitudes and symptoms. Therefore, prior to the examination of group differences in attitudes and symptoms, the four groups of women were compared on the experiential dimension of religiosity as measured by the scale of Faulkner and DeJong (1966). An analysis of variance indicated a significant difference among groups, F(3,115) = 6.72, p < . O M . Duncan's Multiple Range Test further revealed that Jewish Mikvah non-attenders reported significantly lower degrees of religiosity (M = 6.43, SD = 1.78) than Mikvah attenders (M = 8.53, SD = 2.12), Protestants (M= 8.83, SD = 2.19), or Catholics (M = 7.68, SD = 2.15), who were not significantly different from each other. Similar differences were found in the single-item ratings of religiosity and religious observance. Knowledge o f Religious Doctrine and Socialization
Jewish women were, as expected, more likely than Protestants or Catholics to acknowledge that their religion dictates that "Menstruation makes women unclean." Forty-one percent of Mikvah attenders and 43.5% of non-attenders were aware of this doctrine, as
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compared to 2.2% of Catholics and 0% of Protestants. Jewish women also more frequently acknowledged a dictate that "Men should be protected from menstruating women." Non-Mikvah attenders, however, evidenced greater awareness of this dictate than Mikvah attenders, with 52.2%of the former and 17.7% of the latter responding positively. This belief was endorsed by 4.4% of Catholic women and 0% of Protestants. Virtually none of the participants believed that their religion holds that "Menstruation makes women less holy than men." Indeed, only one non-Mikvah attender (4.4%) and one Catholic woman (2.2%)endorsed this belief as part of their religious doctrine. Participants were also asked whether the three above-described religious dictates had been taught to them personally as they were growing up. Responses to these items indicated that very few women in any of the four religious groups had actually been taught these beliefs. In fact, frequency of endorsement of these items was so low as to preclude statistical analyses. Some evidence for differential socialization was apparent in that more Mikvah attenders (94.1%) than non-attenders (43.5%) endorsed the belief that "Women should refrain from sex during menstruation." Further, 88.2% of the former but only 13.0% of the latter cited religious dictates as a reason for abstinence. Only 20% of Protestants and 13.3%of Catholics believed that women should refrain from sex during menstruation, and no members of either group believed that their religion dictates abstinence from sex during menstruation. Menstrual Attitudes
Religiosity, age, education, and number of pregnancies, were used as covariates in analyses of covariance of the five subscales of the MAQ. These analyses (see Table 2) revealed significant (p < .01) group differences only on the scale reflecting an attitude toward menstruation as a "bothersome" event. Post hoc tests indicated that Mikvah non-attenders and Protestants viewed menstruation as significantly more bothersome than Mikvah attenders and Catholic women. These findings thus fail to support the hypothesis that Mikvah attenders would have the most negative attitudes to-
Barbara Olasov Rothbawn and Joan Jackson Table 2
Menstrual Attitude (XIestionnaire Mean Sm-
Debilitating
ard AN-
Results
M N
P C
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Predictable
M N P C
Positive
M N P C
Denial
M
N
Note. Higher score indicates nwre negative attihrdy. subscripts are mt significantly different as deta-mrd
with the same by D m m ' s Multiple P m p Test. M = Mi)Nah attenlers; N = non-atterders; P = Fmtestant: C = Catholic. Means
ward menstruation. Indeed, quite the contrary was found. Mikvah attenders viewed menstruation as less bothersome than any of the other three groups.
Expectancies for Premenstrual Moods Expectancies for premenstrual mood as measured by the EQ were also examined by means of ANCOVAs in which age, education, number of pregnancies, and religiosity were used as covariates.
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These analyses indicated no significant ( p < .01) group differences. Perimenstrual Symptoms
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Hypotheses regarding perimenstrual symptoms were tested by means of ANCOVAs of MDQ scores relevant to the premenstrual and menstrual phases of the cycle. As in previous analyses, covariates were age, education, number of pregnancies, and religiosity. The ANCOVAs indicated no significant (p < .01) group differences. Relationships Between Attitudes, Expectancies, and Symptoms
The hypothesis that attitudes, expectancies, and symptoms would be related within each group was examined by means of correlational analyses including total scores of the MAQ, EQ, MDQ-menstrual and MDQ-premenstrual. As can be seen in Table 3, statistically significant correlations ( p < .01) were found between all variables only for Catholic women. In the other three groups expectancies were related to both menstrual and premenstrual symptoms but attitudes were not, with the exception of Protestant women, whose attitudes were related to expectancies. These results thus point to the different relationships between attitudes, expectancies, and symptoms among these women of different religions: menstrual attitudes were predictive of expected and reported symptoms only for Catholic women. These attitudes predicted only expectancies for Protestant women, and had no predictive value for Jewish women.
DISCUSSION All four religious groups appeared much more similar in their menstrual attitudes, symptoms, and expectancies than different. Where differences appeared (i.e., in attitudes), the Mikvah nonattenders, rather than the predicted Mikvah attenders, were the most negative. Thus, the first hypothesis was not supported. The second hypothesis received support from the Catholic women only. All
Barbara Olasov Rofhbaum and Joan Jackton
75
Mcment Correlation Coefficients for w i e s , Attitudes,
a d Wmtmq
-
Bikvah Attenders
m
Menstnlal .70*** .49
rn
.80*** .31
w .55
Mi)Nah Non-attenders Mcp
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MenstNal .72*** .27
rn
Premenstrual .54* .33
pmtestants
ma
Mcp
Menstrual
Premenstrual
.51** .39
.67*** .39
w .57***
Qtholics
ma
Mcp
rntrual
Premenstlual
.72***
.71*** .51**
.GI***
w .71***
Note. EQ = D p x b r q Questionnaire. K ~ Q = Menstrual Attitude Questionnaire. fCQ= Menstrual Distress Questionnaire.
groups' symptoms and expectancies were related, but the relationship between attitudes, symptoms, and expectancies were different for each religious group, with the Mikvah attenders and non-attenders appearing similar. Thus, these results are similar to Siegel's (1986) findings of no impact of the Mikvah ritual on menstrual symptoms, but discrepant from Siegel's in that differences in menstrual attitudes were found. The Mikvah ritual does not appear to have any adverse impact on
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menstrual attitudes or experiences. It could be that this group is denying the effects. Some support for this explanation comes from their low scores on the menstruation as bothersome scale of the MAQ. However, the other scales of the MAQ do not support this denial hypothesis. Another explanation involves the positive feelings that many religious individuals derive from adhering to their beliefs. Whether it results from cognitive dissonance ("I do this, so I must like it"), pleasure from carrying on an ancient tradition, reduction of feared consequences of noncompliance, approval from others, or some other process is difficult to determine at this time. Whatever the cause, it may be that the Mikvah ritual takes on an aspect of something special and treasured as other religious rites have done. The differences in knowledge of religious doctrine and socialization were expected and interesting. Most of the participants endorsed the beliefs espoused by their religion. It is interesting that although a sizeable percentage of the Jewish Mikvah non-attenders agreed that "Women should refrain from sex during menstruation," only a small percentage cited religious dictates as a reason for abstinence. It appears that these women may not have recognized the impact of their religious training. It appears that the most influence exerted by religious group membership in general is the impact on menstrual attitudes, but this influence is mild. In addition, the predictive value of these attitudes differed across groups. These findings do, therefore, support the notion that,religious group membership and training exert some influence on menstrual attitudes, although not on expectancies and experiences, and not in the predicted directions. The strong points of this study center around the sample selected: a "field" type study tapping naturally occurring groups and the rigor of demanding a "clean" sample of normally menstruating women free from contamination of the effects of contraception, gynecological problems, pregnancy, etc. Weaker areas of the study include the use of retrospective rather than prospective reporting of symptoms and the large numbers of variables examined relative to the sample size. Future cross-cultural research should focus on culturally "purer" groups, probably sampling from different countries.
Barbara Olasov Rothbaum and Joan Jackon
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REFERENCES Asso, D. (1983). Cause and effect 11: The mechanisms of learned influences on the individual's experience of the cycle. In D. Asso, The real menstrual cycle (pp. 150-164). New York: Wiley. Brooks-Gunn, J. (1985). The salience and timing of the menstrual flow. Psychosomatic Medicine, 47, 363-371. Brooks-Gunn, J., & Ruble, D. N. (1980a). Menarche: The interaction of physiological, cultural, and social factors. In A. J. Dan, E. A. Graham, & C. P. Bucher (Eds.), The menstrual cycle, volume I . A synthesis of interdisciplinary research (pp. 141-159). New York: Springer. Brooks-Gunn, J., & Ruble, D. N. (1980b). The Menstrual Attitude Questionnaire. Psychosomatic Medicine, 42, 503-512. Clare, A. W. (1983). Psychiatric and social aspects of premenstrual complaint. Psychological Medicine, Monograph Supplement 4. Faulkner, J., & DeJong, G. (1966). Religiosity in 5-D: An empirical analysis. Social Forces, 45, 246-254. Good, P. R., & Smith, B. D. (1980). Menstrual distress and sex-role attributes. Psychology of Women Quar?erly, 4 , 482-491. Hollingshead, A. B. (1957). Two-factor l n d a of Social Position. Unpublished manuscript, Yale University. Menke, E. M. (1983). Menstrual beliefs and experiences of mother-daughter dyads. In S. Golub (Ed.), Menarche: The transitionfromgirl to woman (pp. 133137). Lexington, MA: D. C. Heath. Moos, R. H. (1968). The development of a menstrual distress questionnaire. Psychosomatic Medicine, 30, 853-867. Moos, R. H. (1977). Menstrual distress questionnaire manual. Stanford, CT: University Social Ecology Laboratory. Moos, R. H. (1985). Penmenstrual symptoms: A manual and overview of research with the menstrual distress questionnaire. Palo Alto, CA: Social Ecology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University and Veterans Administration Medical Center. Most, A. F., Woods, N. F., Dery, G. K., &Most, B. M. (1981). Distress associated with menstruation among Israeli women. International Journal oJNursing Studies, 18, 61-71. Olasov, B. (1984). The effects of expectancies of women's reports oJpremenstrual tension. Unpublished master's thesis, University of Georgia. Olasov, B., & Jackson, J. (1987). Effects of expectancies on women's reports of moods during the menstrual cycle. Psychosomatic Medicine, 49, 65-78. Paige, K. E. (1973, September). Women learn to sing the menstrual blues. Psychology Today, 41-46. Rossi, A. S., & Rossi, P. E. (1980). Body time and social time: Mood patterns by menstrual cycle phase and day of week. In J. Parsons (Ed.), Thepsychobiology of sex differences and sex roles (pp. 269-304). New York: Hemisphere Publishing Corporation.
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Siege], S. J. (1986). The effect of culture on how women experience menstruation: Jewish women and Mikvah. Women & Health, 10, 63-74. Toth, E., Delaney, J., & Lupton, M. 1. (1981). The menstruating woman in popular imagination. In P. Komnenich, M. McSweeney, J. A. Noack, & N. Elder (Eds.), The menstrual cycle, volume 2: Research and implication. for women's health (pp. 8293). New York: Springer. Woods, N. F., Dery, G. K., & Most, A. (1982). Recollections of menarche, current menstrual attitudes, and perimenstrual symptoms. In S. Golub (Ed.), Menarche: The rransition from girl to woman, (pp. 87-97). Lexington, MA: D. C. Heath.
Women & Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wwah20
Religious Influence on Menstrual Attitudes and Symptoms a
Barbara Olasov Rothbaum PhD & Joan Jackson PhD a
b
Medical College of Pennsylvania, [email protected]
b
University of Georgia, Athens, GA, 30602, [email protected] Published online: 02 Nov 2010.
To cite this article: Barbara Olasov Rothbaum PhD & Joan Jackson PhD (1990) Religious Influence on Menstrual Attitudes and Symptoms, Women & Health, 16:1, 63-78, DOI: 10.1300/ J013v16n01_05 To link to this article: http://dx.doi.org/10.1300/J013v16n01_05
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
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systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
Religious Influence on Menstrual Attitudes and Symptoms Barbara Olasov Rothbaum, P h D
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Joan Jackson, PhD
ABSTRACT. Menstrual attitudes and symptoms of 18 Orthodox Jewish Mikvah attenders, 23 Orthodox Jewish Mikvah non-attenders, 35 Protestant women, and 45 Catholic women were compared. When age, education, number of pregnancies, and religiosity were controlled, Mikvah non-attenders and Protestants most strong1 enicant dorsed a view of menstruation as a bothersome event. No signi[ differences were found, however, in expected or retrospect~velyreported menstrual symptoms. Correlational analyses indicated that attitudes, expectancies, and symptoms were significantly correlated only for the Catholic women. Differences between groups in religiosity and socialization were found. The Jewish women endorsed doctrines such as "menstruation makes women unclean" more than Catholic or Protestant women. Results support the hypothesized differential religious training regarding menstruation, but only offer weak support for the effects of this training on menstrual attitudes, expectancies, and symptoms.
Many menstrual cycle researchers have discussed religious-cultural influ'ences as an important determinant of attitudes and reported experiences (Asso, 1983; Brooks-Gunn, 1985; Brooks-Gunn & Ruble, 1980a; Good & Smith, 1980; Moos, 1985; Most, Woods, Dery, & Most, 1981; Paige, 1973; Toth, Delaney, & Lupton, 1981). Barbara Olasov Rothbaum is affiliated with the Medical College of Pennsylvania. Joan Jackson is affiliated with the University of Georgia. Address requests for reprints to Barbara Olasov Rothbaum, Department of Psychiatry, Medical College of Pennsylvania at Eastern Pennsylvania Psychiatric Institute, 3200 Henry Avenue, Philadelphia, PA 19129. Women & Health, Vol. 16(1) 1990 O 1990 by The Haworth Press, Inc. All rights reserved.
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Brooks-Gunn (1985) found that Protestant women reported more regular cycles than Catholic or Jewish women and that the relationship between menstrual flow and menstrual distress was not as strong for Protestant women as it was for Catholic women. In addition, she found that for women with intense flows, the Catholics but not the Protestants were more likely to rate menstruation as bothersome and debilitating as measured by the Menstrual Attitude Questionnaire (MAQ, Brooks-Gunn & Ruble, 1980b). She concluded that "women's perceptions of menstrual characteristics are related to menstrual-related beliefs, and religious group membership mediates such perceptions" (p. 370). Good and Smith (1980) found that for Catholic women, sex-role attributes and anxiety were associated with menstrual distress. For Jewish women, only anxiety was related to menstrual distress, and neither sex-role attributes nor anxiety was associated with distress for Protestant women. They concluded that religion should be included as a "potentially important distress-mediating factor" (p. 490). Paige (1973) found that Jewish women who adhered to menstruation rituals and sexual taboos were the most likely to report menstrual problems as compared to Catholic and Protestant women, although only a small percentage of her participants were Jewish. She also found that menstrual distress was considered an important part of the traditional female role only for Catholics. These findings indicate that religion may be an important mediating variable in menstrual-related attitudes and experiences. However, all of these studies have only incidentally gathered information on religion. In addition, they have not examined Jewish women systematically, which would appear to be important, especially based on Paige's (1973) results. Only 10% of the Brooks-Gunn (1985) sample was Jewish (as compared to 55% Catholic and 24% Protestant), and Paige's (1973) two samples included only 7% and 6% Jews, respectively. Indeed, Orthodox Judaism contains laws and explicit teachings directly pertaining to menstruation and sexual activity. These restrictions are based on a passage from the Old Testament (i.e., Leviticus XV, 19) and dictate that women are not to touch their husbands, much less engage in sexual activity, for the duration of their menses plus seven days and then only after they have attended Mikvah, a ceremonial cleansing bath. Women in Orthodox Judaism
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are not allowed to become Rabbis or even sit with the men in synagogue because they are considered unclean and unholy. Thus, very overt messages are reinforced by required participation in a monthly ritual. .In the only study examining the effect of the Mikvah ritual, Siegel (1986) explored the hypothesis that Mikvah users were different from demographically matched Jewish non-Mikvah users in reported perimenstrual symptoms, but she did not find the expected differences. The present study examined the effects of religion generally, and Orthodox Judaism and the Mikvah ritual specifically, on menstrual attitudes and retrospectively reported symptoms. A group of Orthodox Jewish Mikvah attenders and a group of Orthodox Jewish Mikvah non-attenders were compared to each other and to a group of Protestant women and a group of Catholic women. It was predicted that Jewish Mikvah attenders would report the most negative attitudes, symptoms, and expectancies, followed closely by Jewish Mikvah non-attenders, Catholic women would fall in the middle, and Protestant women would respond the least negatively. This prediction resulted from the hypothesis that engaging in a monthly ritual with a very salient purpose-cleansing oneself of the uncleanliness and unholiness of menstruation in order that physical contact with one's husband may be reinstated-may serve to strenethen the neeative attitudes toward menstruation already instilled"by the teac{ings of the religion. This strengthening of attitudes could be conceptualized as a cognitive dissonance reduction phenomenon wherein attitudes change (i.e., are strengthened) in accord with overt behavior (i.e.; engaging in the ritual). Protestant women were predicted to report the most positive attitudes, expectancies, and symptoms, since their religious doctrine contains no specific menstrual teachings. Catholic women were predicted to be more negative than Protestant women as a result of their religious teachings, which, though not specifically menstmalrelated, would have implications for sexual activity during menstruation. These implications in Catholicism regarding sex during menstruation result from contraception-related taboos and doctrines stating sex should have the sole purpose of procreation. Since women are less likely to conceive during menstruation, it may be felt that women should refrain from sex during menstruation. It was also expected that attitudes, expectancies, and reports of symptoms
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would be significantly correlated within all groups (Brooks-Gunn, 1985; Brooks-Gunn & Ruble, 1980b; Menke, 1983; Woods, Dery, & Most, 1982). METHOD
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Participants Of 219 Orthodox Jewish, 178 Protestant, and 187 Catholic women invited to participate in the study, 72 Jewish women (32.9%), 60 Protestant women (33.7%), and 75 Catholic women (40.1%) agreed to participate and provided data. Excluded from this sample, however, were women who were not menstruating regularly for any reason (e.g., pregnancy, post-partum, hysterectomy, approaching menopause), as well as those who reported use of oral contraceptives or intrauterine devices. Thus, the final sample was comprised of 18 Orthodox Jewish women who reported regular attendance at Mikvah,23 Orthodox Jewish women who reported that they did not regularly attend Mikvah, 35 Protestant women, and 45 Roman Catholic women. All participants were members of organized religious congregations in cities in the Southeastern United States and were solicited to participate based on their membership. Participation in the study was endorsed by the leaders of the various congregations, but no other incentives were offered. Demographic characteristics of participants are shown in Table 1. All participants were married, Caucasian women of approximately the same age, however, there were some differences in demographics based on religious group membership. The two groups of Jewish women had more pregnancies and more children than Protestant women. Jewish Mikvah attenders had more formal education that the Mikvah non-attenders and Catholics, with Protestants intermediate and not significantly different from either. In addition, husbands of the Catholic women had somewhat less education and worked at jobs of somewhat lower status. Household incomes also varied across groups, the two groups of Jewish women reporting higher family incomes than the Protestants, with Catholics intermediate.
Barbara Olasov Rothbaum and Joan Jackson Table 1 Oenrma&ic characteristics of SarraJle
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Variable
Religiosity (experie n t i a l scale)
Religiosity (single item rat*) O t e n w m (single item ratirq)
Children
Household incrrne (3=$30,000-50,000; 4=$50,000-70,000 Husband's ocrupation
Husbad' s education
Grarp
M
SD
F
WOMEN & HEALTH
TABLE 1 (continued)
Hours work&
per week
M N P
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C
Variable Percent eIlpl0yed
Group M N
P C
Percent 88.9% 57.1% 61.8% 60.0%
-n
-X2
16
5.67
12 27 21
Note. Education and oxupation represent Hollingshead (1957) classification system. G r w p M = a t M e r s : N = Non-atten3ers: P Protestant; C = Catholic. Means with the same sukscript are not significantly different as determined by Cuman's Multiple Range Test.
=
Instruments Menstrual Attitude Questionnaire (MQ; Brooks-Gunn & Ruble, 1980b) The MAQ consists of 33 items that load onto five factors representing attitudes toward menstruation as debilitating, positive, predictable, bothersome, and as having neutral or no effects ("denial"). Internal consistency estimates (Cronbach's alpha) for the five factor-based scales comprising the instrument ranged from -90 to .97 in two samples of college women. Congruence between the same factors across two samples ranged from .77 to .91. The validity of the MAQ has been supported by the finding that MAQ scores are significantly correlated with reported menstrual distress as mea-
~ a r b a r Olasov i Rothbaurn and Joan Jackson
69
sured by Moos' (1968) Menstrual Distress Questionnaire. Each item is rated on a 7-point scale, such that scores can range from 12 to 84 for the menstruation as debilitating scale; six to 42 for the bothersome scale; five to 35 for both the positive and predictable subscales; and seven to 49 for the denial scale. Higher scores indicate more negative attitudes.
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Menstrual Distress Questionnaire- Form C (MDQ; Moos, 1968, 1977, 1985)
Form C of the MDQ rcquires the respondent to rate the severity of each of 47 symptoms as experienced during menstrual, intermenstrual, and premenstrual phases of the cycle. Eight factor-derived scales, including pain, water retention, autonomic reactions, negative affect, impaired concentration, behavior change, arousal, and control, comprise the instrument. Internal consistency estimates (KR-20) for the eight scales range from .53 to .89. The MDQ predicts treatment-seeking for perimenstrual problems (e.g., Clare, 1983) and is widely used in assessing perimenstrual symptomatology. Moos has compiled normative data based on assessment of over 2,000 women. Higher scores reflect worse symptomatologies. Expectancy Questionnaire (EQ; Olasov, 1984; Olasov & Jackson, 1987)
An adaptation of the instrument developed by Rossi and Rossi (1980), the EQ was designed to assess women's expectancies for their moods to be affected by the menstrual cycle. In the present study, women were asked to indicate how they expected to feel during their next premenstrual phase. Participants use a 1-6 Likert scale to respond to three questions and 16 adjectives describing mood states, yielding a total score ranging from 19 to 114.
Demographic Questionnaire (DQ) The DQ was developed for the present study to obtain demographic and medical/menstrual information, as well as to serve as an indicator of Mikvah attendance.
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Religiosity Questionnaire (RQ) The RQ was developed for purposes of this study to assess participants' knowledge of religious doctrine concerning menstruation and the extent to which they were exposed while growing up to others who endorsed their religious doctrine concerning menstruation. Thus, they were asked to respond to the questions, "What is the official doctrine of your religion regarding menstruation?" and "What was your personal religious upbringing regarding menstruation?" Alternative responses that participants could endorse (or not) included "Menstruation is unclean," "Menstruation is something that makes women less holy than men," "Menstruation is sornething that men should be protected from, including not being touched by a menstruating woman." They were asked to "agree" or "disagree" with the statement "Women should not have sexual intercourse during menstruation or immediately afterwards" and (when applicable) indicate if endorsement of this belief is "Because my religion dictates it." Participants were also asked, "How religious do you consider yourself?" and "How observant are you (i.e., adhering to certain rules, attending place of worship, etc.)?" Both questions were answered using a 1 to 7 Likert scale with anchors of "not at all" (1) and "very" (7). Finally participants responded to the five items comprising Faulkner and DeJong's (1966) religiosity scale. Designed to measure the experiential dimension of religiosity, the items assess feelings of closeness to a divine being and beliefs that religion gives life purpose and meaning, that it provides security in the face of death, and that faith is essential to religious life. Total scores can range from 0 to 11, with higher scores indicating greater religiosity. Procedure
Leaders of two Orthodox Jewish, two Protestant (one Methodist, one nondenominational) and one Roman Catholic congregation gave the investigators permission to contact married women between the ages of 20 and 50 in their congregations. Women meeting these criteria were then mailed a packet of materials containing: a cover letter explaining the study, requesting participation, and men-
Barbara Olasov Rothbaum and Joan Jackson
71
tioning the endorsement of the religious leader; the MAQ, MDQ, EQ, DQ, and RQ in random order; and a pre-addressed, stamped envelope for return of completed materials. To ensure participants' anonymity, envelopes sent to participants were addressed and mailed by a member of the church or synagogue, and completed materials were then returned by mail directly to the investigators. RESULTS
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Due to the large number of variables examined relative to the sample size, a conservative significance level ofp < .O1 was incorporated to control for spurious differences. Religiosity
Whereas differences in menstrual attitudes and symptoms were hypothesized to be related to religious group membership, it was also hypothesized that degree of religiosity (independent of group membership) could influence reporting of attitudes and symptoms. Therefore, prior to the examination of group differences in attitudes and symptoms, the four groups of women were compared on the experiential dimension of religiosity as measured by the scale of Faulkner and DeJong (1966). An analysis of variance indicated a significant difference among groups, F(3,115) = 6.72, p < . O M . Duncan's Multiple Range Test further revealed that Jewish Mikvah non-attenders reported significantly lower degrees of religiosity (M = 6.43, SD = 1.78) than Mikvah attenders (M = 8.53, SD = 2.12), Protestants (M= 8.83, SD = 2.19), or Catholics (M = 7.68, SD = 2.15), who were not significantly different from each other. Similar differences were found in the single-item ratings of religiosity and religious observance. Knowledge o f Religious Doctrine and Socialization
Jewish women were, as expected, more likely than Protestants or Catholics to acknowledge that their religion dictates that "Menstruation makes women unclean." Forty-one percent of Mikvah attenders and 43.5% of non-attenders were aware of this doctrine, as
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compared to 2.2% of Catholics and 0% of Protestants. Jewish women also more frequently acknowledged a dictate that "Men should be protected from menstruating women." Non-Mikvah attenders, however, evidenced greater awareness of this dictate than Mikvah attenders, with 52.2%of the former and 17.7% of the latter responding positively. This belief was endorsed by 4.4% of Catholic women and 0% of Protestants. Virtually none of the participants believed that their religion holds that "Menstruation makes women less holy than men." Indeed, only one non-Mikvah attender (4.4%) and one Catholic woman (2.2%)endorsed this belief as part of their religious doctrine. Participants were also asked whether the three above-described religious dictates had been taught to them personally as they were growing up. Responses to these items indicated that very few women in any of the four religious groups had actually been taught these beliefs. In fact, frequency of endorsement of these items was so low as to preclude statistical analyses. Some evidence for differential socialization was apparent in that more Mikvah attenders (94.1%) than non-attenders (43.5%) endorsed the belief that "Women should refrain from sex during menstruation." Further, 88.2% of the former but only 13.0% of the latter cited religious dictates as a reason for abstinence. Only 20% of Protestants and 13.3%of Catholics believed that women should refrain from sex during menstruation, and no members of either group believed that their religion dictates abstinence from sex during menstruation. Menstrual Attitudes
Religiosity, age, education, and number of pregnancies, were used as covariates in analyses of covariance of the five subscales of the MAQ. These analyses (see Table 2) revealed significant (p < .01) group differences only on the scale reflecting an attitude toward menstruation as a "bothersome" event. Post hoc tests indicated that Mikvah non-attenders and Protestants viewed menstruation as significantly more bothersome than Mikvah attenders and Catholic women. These findings thus fail to support the hypothesis that Mikvah attenders would have the most negative attitudes to-
Barbara Olasov Rothbawn and Joan Jackson Table 2
Menstrual Attitude (XIestionnaire Mean Sm-
Debilitating
ard AN-
Results
M N
P C
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Predictable
M N P C
Positive
M N P C
Denial
M
N
Note. Higher score indicates nwre negative attihrdy. subscripts are mt significantly different as deta-mrd
with the same by D m m ' s Multiple P m p Test. M = Mi)Nah attenlers; N = non-atterders; P = Fmtestant: C = Catholic. Means
ward menstruation. Indeed, quite the contrary was found. Mikvah attenders viewed menstruation as less bothersome than any of the other three groups.
Expectancies for Premenstrual Moods Expectancies for premenstrual mood as measured by the EQ were also examined by means of ANCOVAs in which age, education, number of pregnancies, and religiosity were used as covariates.
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These analyses indicated no significant ( p < .01) group differences. Perimenstrual Symptoms
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Hypotheses regarding perimenstrual symptoms were tested by means of ANCOVAs of MDQ scores relevant to the premenstrual and menstrual phases of the cycle. As in previous analyses, covariates were age, education, number of pregnancies, and religiosity. The ANCOVAs indicated no significant (p < .01) group differences. Relationships Between Attitudes, Expectancies, and Symptoms
The hypothesis that attitudes, expectancies, and symptoms would be related within each group was examined by means of correlational analyses including total scores of the MAQ, EQ, MDQ-menstrual and MDQ-premenstrual. As can be seen in Table 3, statistically significant correlations ( p < .01) were found between all variables only for Catholic women. In the other three groups expectancies were related to both menstrual and premenstrual symptoms but attitudes were not, with the exception of Protestant women, whose attitudes were related to expectancies. These results thus point to the different relationships between attitudes, expectancies, and symptoms among these women of different religions: menstrual attitudes were predictive of expected and reported symptoms only for Catholic women. These attitudes predicted only expectancies for Protestant women, and had no predictive value for Jewish women.
DISCUSSION All four religious groups appeared much more similar in their menstrual attitudes, symptoms, and expectancies than different. Where differences appeared (i.e., in attitudes), the Mikvah nonattenders, rather than the predicted Mikvah attenders, were the most negative. Thus, the first hypothesis was not supported. The second hypothesis received support from the Catholic women only. All
Barbara Olasov Rofhbaum and Joan Jackton
75
Mcment Correlation Coefficients for w i e s , Attitudes,
a d Wmtmq
-
Bikvah Attenders
m
Menstnlal .70*** .49
rn
.80*** .31
w .55
Mi)Nah Non-attenders Mcp
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MenstNal .72*** .27
rn
Premenstrual .54* .33
pmtestants
ma
Mcp
Menstrual
Premenstrual
.51** .39
.67*** .39
w .57***
Qtholics
ma
Mcp
rntrual
Premenstlual
.72***
.71*** .51**
.GI***
w .71***
Note. EQ = D p x b r q Questionnaire. K ~ Q = Menstrual Attitude Questionnaire. fCQ= Menstrual Distress Questionnaire.
groups' symptoms and expectancies were related, but the relationship between attitudes, symptoms, and expectancies were different for each religious group, with the Mikvah attenders and non-attenders appearing similar. Thus, these results are similar to Siegel's (1986) findings of no impact of the Mikvah ritual on menstrual symptoms, but discrepant from Siegel's in that differences in menstrual attitudes were found. The Mikvah ritual does not appear to have any adverse impact on
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menstrual attitudes or experiences. It could be that this group is denying the effects. Some support for this explanation comes from their low scores on the menstruation as bothersome scale of the MAQ. However, the other scales of the MAQ do not support this denial hypothesis. Another explanation involves the positive feelings that many religious individuals derive from adhering to their beliefs. Whether it results from cognitive dissonance ("I do this, so I must like it"), pleasure from carrying on an ancient tradition, reduction of feared consequences of noncompliance, approval from others, or some other process is difficult to determine at this time. Whatever the cause, it may be that the Mikvah ritual takes on an aspect of something special and treasured as other religious rites have done. The differences in knowledge of religious doctrine and socialization were expected and interesting. Most of the participants endorsed the beliefs espoused by their religion. It is interesting that although a sizeable percentage of the Jewish Mikvah non-attenders agreed that "Women should refrain from sex during menstruation," only a small percentage cited religious dictates as a reason for abstinence. It appears that these women may not have recognized the impact of their religious training. It appears that the most influence exerted by religious group membership in general is the impact on menstrual attitudes, but this influence is mild. In addition, the predictive value of these attitudes differed across groups. These findings do, therefore, support the notion that,religious group membership and training exert some influence on menstrual attitudes, although not on expectancies and experiences, and not in the predicted directions. The strong points of this study center around the sample selected: a "field" type study tapping naturally occurring groups and the rigor of demanding a "clean" sample of normally menstruating women free from contamination of the effects of contraception, gynecological problems, pregnancy, etc. Weaker areas of the study include the use of retrospective rather than prospective reporting of symptoms and the large numbers of variables examined relative to the sample size. Future cross-cultural research should focus on culturally "purer" groups, probably sampling from different countries.
Barbara Olasov Rothbaum and Joan Jackon
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REFERENCES Asso, D. (1983). Cause and effect 11: The mechanisms of learned influences on the individual's experience of the cycle. In D. Asso, The real menstrual cycle (pp. 150-164). New York: Wiley. Brooks-Gunn, J. (1985). The salience and timing of the menstrual flow. Psychosomatic Medicine, 47, 363-371. Brooks-Gunn, J., & Ruble, D. N. (1980a). Menarche: The interaction of physiological, cultural, and social factors. In A. J. Dan, E. A. Graham, & C. P. Bucher (Eds.), The menstrual cycle, volume I . A synthesis of interdisciplinary research (pp. 141-159). New York: Springer. Brooks-Gunn, J., & Ruble, D. N. (1980b). The Menstrual Attitude Questionnaire. Psychosomatic Medicine, 42, 503-512. Clare, A. W. (1983). Psychiatric and social aspects of premenstrual complaint. Psychological Medicine, Monograph Supplement 4. Faulkner, J., & DeJong, G. (1966). Religiosity in 5-D: An empirical analysis. Social Forces, 45, 246-254. Good, P. R., & Smith, B. D. (1980). Menstrual distress and sex-role attributes. Psychology of Women Quar?erly, 4 , 482-491. Hollingshead, A. B. (1957). Two-factor l n d a of Social Position. Unpublished manuscript, Yale University. Menke, E. M. (1983). Menstrual beliefs and experiences of mother-daughter dyads. In S. Golub (Ed.), Menarche: The transitionfromgirl to woman (pp. 133137). Lexington, MA: D. C. Heath. Moos, R. H. (1968). The development of a menstrual distress questionnaire. Psychosomatic Medicine, 30, 853-867. Moos, R. H. (1977). Menstrual distress questionnaire manual. Stanford, CT: University Social Ecology Laboratory. Moos, R. H. (1985). Penmenstrual symptoms: A manual and overview of research with the menstrual distress questionnaire. Palo Alto, CA: Social Ecology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University and Veterans Administration Medical Center. Most, A. F., Woods, N. F., Dery, G. K., &Most, B. M. (1981). Distress associated with menstruation among Israeli women. International Journal oJNursing Studies, 18, 61-71. Olasov, B. (1984). The effects of expectancies of women's reports oJpremenstrual tension. Unpublished master's thesis, University of Georgia. Olasov, B., & Jackson, J. (1987). Effects of expectancies on women's reports of moods during the menstrual cycle. Psychosomatic Medicine, 49, 65-78. Paige, K. E. (1973, September). Women learn to sing the menstrual blues. Psychology Today, 41-46. Rossi, A. S., & Rossi, P. E. (1980). Body time and social time: Mood patterns by menstrual cycle phase and day of week. In J. Parsons (Ed.), Thepsychobiology of sex differences and sex roles (pp. 269-304). New York: Hemisphere Publishing Corporation.
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Siege], S. J. (1986). The effect of culture on how women experience menstruation: Jewish women and Mikvah. Women & Health, 10, 63-74. Toth, E., Delaney, J., & Lupton, M. 1. (1981). The menstruating woman in popular imagination. In P. Komnenich, M. McSweeney, J. A. Noack, & N. Elder (Eds.), The menstrual cycle, volume 2: Research and implication. for women's health (pp. 8293). New York: Springer. Woods, N. F., Dery, G. K., & Most, A. (1982). Recollections of menarche, current menstrual attitudes, and perimenstrual symptoms. In S. Golub (Ed.), Menarche: The rransition from girl to woman, (pp. 87-97). Lexington, MA: D. C. Heath.
