Girls drop out of school because of menstruation

Silence about menstruation

In many countries in the Global South menstruation is still perceived as taboo. During the time of menstruation girls and women must face many challenges, discrimination, harassment, social exclusion, and perceptions such as describing menstruation as shameful and dirty. Taboo, silence, and stigma that still exists in many countries in the Global South continue to disempower girls and women, harmfully affecting their life, education and health.

Menstruation restricts mobility, girls tend to stay home because there is no other option. It affects their freedom and their choices, excludes them from school attendance, social and community life and among others, health-related issues cause stress and anxiety. 

What is Menstruation hygiene management?

Menstruation hygiene management (MHM) means that women and adolescent girls use a clean material to absorb or collect menstrual blood and that this material can be changed in privacy as often as necessary for the duration of the menstrual period. MHM includes soap and water for washing the body as required, and access to facilities to dispose of used menstrual management materials.

School is not a place to menstruate

Lack of basic services such as access to toilets, clean water or sanitary pads are having an impact on daily life and also causes many health issues. Toilets in the schools are mostly without doors and there is no place where to throw out used materials. That means that very often girls are forced to put the used pads into the plastic sacs and then to burn them in secret when they arrive home. Often, they do so with that plastic as well, which makes it even more dangerous for them and the environment.

“I used to miss one week of school every month,” says one of the schoolgirls in Tanzania. “I didn’t want to shame myself in front of my peers.”

“It’s difficult to talk about menstruation and sanitary pads openly because it’s not something we do. I try to save money for pads, but if it runs out, I use pieces of cloth,”- says a school girl in Tanzania

“We always ask them to go home… to go home and take care of themselves at home, since we don’t have any facilities in the school“- school female teacher, rural area of Nigeria

Period teasing – “periods are unnatural”

According to a research article about period teasing of adolescent boys and girls in Northern Tanzania 13% of girls have experienced period teasing, and more than 80% fear being teased, mainly by male classmates. Furthermore, 47% of girls left school early during their last period, 31% did not participate in class as much as usual, and 33% of them concentrated less in school while having a period.

Boys and men also often including the teachers tend to perceive periods as embarrassing and strongly inappropriate for a girl to talk about a period with males. 20% of boys reported “periods are unnatural” as one of the reasons for teasing. 79% of boys answered that girls would be ashamed to reveal their menstruation to male classmates. 66% of boys answered that women and girls in their homes, while being on their period, are restricted from daily activities such as cooking (50% of households), touching water sources and animals, touching plants, passing through planted farms, washing dishes and attending public gatherings.

“When I started my own menstruation, I was asked to not even touch a man because if I touch any man, I will be pregnant. So, when my junior brother touched me, I went out crying and I said that, my brother touched me. So, I will be pregnant, they said no, if it is your blood brother. But if somebody touches you outside. Since you have started menstruation, you have to be very careful don’t allow any man to touch you.” – says the mother of a schoolgirl. Fear, shame, cramps and pain, are common reasons to be absent in the classroom. Students are required to stand up when answering questions that potentially reveal that they are menstruating. 9% of girls report being afraid to stand up. “Sometimes when I am seeing my menstruation. I can’t even sit down because my mind will be like if I sit down, it will touch that cloth I am wearing.” – says one of the schoolgirls. “Sometimes, they don’t sit down properly. They don’t want to sit down because they don’t like staining their cloth, they don’t feel comfortable. They used to sit halfway.’’ – school teacher

Transactional sex for a pad and other health-related issues

In some traditional households, girls are discouraged from bathing or touching their genitals during menstruation, which makes menstrual hygiene and the universal approach to personal hygiene during menstruation quite challenging and can lead to higher levels of urogenital infection. Regarding stigmatization of menstruation itself, drying and washing reusable sanitary pads in secret, in girls rooms under unhygienic conditions result in higher infection rates.

The alarming fact is that in some cases girls offering transactional sex to be able to buy sanitary pads, especially younger, economically dependent girls and women. Regarding women’s health, this rapidly increases the risk of HIV and other sexually transmitted diseases as well as unintended pregnancy and school dropout.

A pilot study in Tanzania

Sara Gabrielsson is an Associate senior lecturer and researcher in Sustainability Science at Lund University (LUSCUS) in Sweden. Her research is mainly focusing on Water, Sanitation and Hygiene (WASH) delivery and services and sustainable development in Africa. Together with the cooperation of a local Tanzanian organisation she has decided to find out what menstrual product would be the most effective and suitable for girls in Tanzania to make  life for them easier. This type of research was very unique and the first of its kind and Menstrual cups were perceived as the best suitable option for the local girls. “I can even play football, I can go to school, I can go outside, I feel free.” Those were some of the reactions of girls starting to use the menstrual cup.

This pilot study was focusing on many cultural and management challenges of different menstrual products in the rural area of the Mara region, Tanzania.  Together with the cooperation of local organisation Maji Safi this research was based on a comparison of three menstrual products: disposable sanitary pads, washable fabric and the menstrual cup. The testing period was 30 days for a single product each and it was tested by three groups of girls in age 11 to 18. In every group, there were 30 girls in total. Before the actual pilot, girls were also educated about how to correctly use the different products. There was a survey done between 175 schoolgirls, discussions and interviews with teachers and practitioners.

Menstrual cups can collect blood safely for up to 8 hrs., so it enables girls to stay in school during menstruation, it also increases mobility and participation, reduces shaming, the risks of vaginal infections, produces no waste and lasts for up to 10 years. Although the initial price of the cup could be quite high, even unaffordable for some girls. The study also pointed out that the inefficient state of the school’s Water, Sanitation and Hygiene (WASH) facilities is one of the main reasons why girls stay home during their period. It was also found that the menstrual cup was seen as the most preferred option for how to handle menstruation. Sara also made a short film about this study in Tanzania – Break the silence

How to Improve MHM:

The study also mentions the suggestions for improvement: Such as preventing and stopping menstrual shaming by talking about menstruation with both boys, girls, men and women. Access and availability to clean toilets with doors and bins in schools and public areas for disposal of menstrual products and access to clean water and soap. Provide information about menstruation in school curriculums. Increased distribution of menstrual products in rural and urban areas and make them more affordable.

MHM is having an impact on:

• Education: MHM has a negative impact on girls’ educational performance. On average girls stay home 2-4 days during their period. More than 98 million girls are missing school across the world.
• Economics: Menstrual Health Management has impacts on economic growth and development. According to the World Bank, 30 trillion dollars are lost in productivity and earnings due to limited educational opportunities for girls.
• Health risks: Inefficient sanitation in schools and public areas, lack of water and soap and bins makes it difficult for girls to manage their period and higher the risk of vaginal infections. When water is not available, and I am menstruating and when I change the thing and my hand is stained with blood and will not see water to wash my hands, I will now use the toilet tissue and clean up my hands. We normally wash our hands with sand on the ground” – says a schoolgirl in Nigeria
• Environmental pollution: Poor waste management, clogging of sanitation systems, unsafe disposal methods put extra pressure on the environment.

MHM in the SDGs

MHM is now considered as one of the burning development issues. Over the last 15 years, the awareness of MHM has been increasing, especially the attention to HMH in human rights. The discussion is taking its part in international development frameworks, national policies and also in public in general. What it seems to be missing is a clear given and more comprehensive goal and cross sectoral collaboration opportunities and straightforward policy.

Menstrual hygiene management is touching and connecting with many of Sustainable Development Goals (SDGs) MHM is indirectly included under goal number 6 (Clean Water and sanitation), 5 (Gender Equality), 4 (Quality Education), 3 (Good Health and well-being), 8 (Decent Work and Economic Growth) and 12 (Responsible consumption and production).

Anna Pokorná is a MSC student in Development Studies at Lund University, Sweden 

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