The impact of menstruation on girls’ education in lower-income countries

Estimated read time: ~8 minutes


TL;DR  

There is typically a social stigma around menstruation in patriarchal societies. In lower-income countries, insufficient water and sanitation infrastructure and lack of access to sanitary materials exacerbates the negative psychosocial effects of menstruation. Qualitative studies have shown menstruation negatively affects girls’ education in lower-income countries. While some studies have shown improved educational outcomes when girls had access to sanitary materials and puberty education, infrastructure alone is not sufficient to achieve gender equality in education. The social taboo of menstruation must also be addressed.

For visual people, here’s an infographic I made on the topic (complete with images drawn by yours truly!)


Menstruation is a natural, biological process and not something women should be shamed for; but in many societies, they are.

Growing up in Texas, I learned about puberty and menstruation in grade 4, when the girls were taken out of class and told about the changes to expect as we “became women”. In the assembly, menstruation was presented as something to keep private.

When I started menstruating, I worried about inadvertently “announcing” my period to everyone by bringing a purse or backpack to the bathroom, so I hid pads and tampons in my pockets instead. I often lied to friends and classmates about my menstrual cramps, claiming I just had an “upset stomach” while I secretly popped Advil to numb the pain.

One time, a pad fell out of a girl’s backpack and a group of boys started pointing and laughing. Every month, I worried the same thing would happen to me.

What I just recounted is purely anecdotal, of course, but it is not a unique experience. Research has shown that societal taboos and the “silent” nature of menstruation rooted in patriarchal societies often have negative psychosocial impacts on girls and women around the world.

The fear and shame I felt around menstruation when I was younger occurred despite living in the upper-middle class of a well-developed country, where I never had to worry about access to sanitary materials or pain medication, the ability to clean myself at home with a nice hot shower, or privacy in a women’s restrooms.

Unfortunately, the negative psychosocial impact of menstruation is compounded by more entrenched stigmas and inadequate infrastructure for menstrual hygiene management (MHM) in many lower-income countries. 

This can impact everything from women’s feelings of safety to their ability to participate fully in daily activities.

This post focuses specifically on the impact of menstruation on girls education in lower-income countries. Most of this post is taken from a critical literature review I conducted for an international development course taught by Dr. Richard Carter at Cambridge University.


Intro

Globally, a majority of girls complete primary school, but girls’ enrolment rates “tend to fall when they reach lower secondary school age, which coincides with puberty”. In 2015, estimates indicated less than 50% of countries had achieved gender parity in secondary education. Menstruation has been recognised as one of many important gendered threats to girls’ educational success.

A critical literature review on the impact of menstruation on girls’ educational experiences and outcomes in lower income countries revealed three general conclusions: (1) qualitative evidence reveals a significant negative impact of menstruation on girls’ educational experiences, however (2) quantifying this impact on measurable educational outcomes is difficult, and (3) there are few rigorous, empirical studies to support the efficiency of means of intervention.

The next section will focus on conclusion (1), and the section following that will address conclusions (2) and (3).


The impact of menstruation on girls’ education

Much of the literature on the relationship between menstruation and girls’ educational experiences is qualitative, drawing on interviews rooted in participatory, feminist, and human rights methodologies. Collectively, studies identify many recurring sources of the negative impact of menstruation on educational experiences, including:

  • Inadequate access to sanitary materials
  • Poor WASH facilities, including latrines that are not private, inadequate water and soap for washing, and insufficient sanitary disposal facilities
  • Little or inaccurate education on menstruation
  • Negative psychosocial impacts including shame, embarrassment, and fear
  • Menstrual pain/discomfort
  • Limited spatial mobility due to cultural expectations or fears of sexual harassment

These factors may contribute to negative outcomes for girls’ education, including absenteeism, dropout, and difficulties concentrating or participating due to physical and psychosocial discomfort.

Qualitative, participatory studies capture snapshots of lived experiences through in-depth interviews, but they face several limitations. First, given the time and effort required, participatory studies often include only a small number of participants in distinct contexts. Their results offer insights into the experiences of those involved, but generalisability is limited. Additionally, given the sensitivity of discussing menstruation, there is a possibility that girls don’t reveal the truth of their experiences to researchers.

Despite these challenges, qualitative research consistently shows significant negative psychosocial impacts associated with menstruation across many cultural contexts. Patriarchal societies have constructed taboos and a culture of silence around menstruation that “makes menstruation a non-issue”. Cultural beliefs and myths about menstruation vary across contexts, but many cultures associate menstruation with being “dirty”, “impure”, or “contaminated”; negative feelings which are often internalised by women.

The stigma around menstruation creates feelings of shame, embarrassment, anxiety, and fear that can impose mental distress on girls and negatively impact their educational experiences. Interviews with girls across Sub-Saharan Africa revealed a hesitancy to participate in class when menstruating for fear of leaks being visible when they stood to respond to questions. In Tanzania, girls were given curfews due to fears of sexual assault after menarche, limiting their ability to study and do work with other students. Similarly, in Nepal, menstruating girls’ mobility is limited because of a belief that menstruation is “ritually dangerous” , and in India 85% of adolescent girls practiced various restrictions during menstruation, including 16% who reported missing school.

These psychosocial challenges are exacerbated by limited access to comfortable sanitary products, sufficient WASH infrastructure, and proper puberty education. Insufficient access to means to manage their menstruation in a safe, private, comfortable manner threatens girls’ dignity and basic human rights, and poor WASH facilities have been cited as a driving factor in girls abandoning their education in lower-income communities.

Given the challenges revealed from participatory research, studies have attempted to quantify the impact menstruation on measurable educational outcomes, namely absenteeism and dropout. However, accurately quantifying these outcomes is dubious. The culture of silence around menstruation limits the ability to rely on self-reporting. In one study only 14 schoolgirls out of a total of 835 volunteered they had missed school because of menstruation. However, in a computer-based version of the study, 32 percent of menstruating schoolgirls reported missing at least one day of class since starting their period. This suggests menstrual-related absences may be highly underreported in interviews. Further, using school records may be inaccurate since researchers have noted menstrual-related absences may be reported as “illness”, calling into question results from studies that rely solely on school records.

Finally, menstruation is likely just one of many compounding factors leading to girls’ absenteeism or dropout, therefore quantifying a direct effect of menstruation on measurable educational outcomes is questionable.


The impact of proposed interventions

Despite the challenges in directly quantifying the impact of menstruation on educational outcomes, the literature shows menstruation has negative impacts on girls’ experiences in schools. Thus, improving access to sanitary materials, creating gender-conscious WASH infrastructure, and providing puberty education are promoted as methods of improving menstruating girls’ educational experiences and achieving educational gender parity.

Quantitative research on the effects of sanitary pads on education are limited, but one study conducted in rural Uganda from 2012 to 2014 concluded the provision of sanitary pads and puberty education were equally effective in improving attendance of schoolgirls. Girls tend to prefer commercial, disposable sanitary pads to commonly used reusable pads, but the accessibility, disposability, and sustainability of supply of these products must be addressed. Results of the study suggest the provision of “adequate and gender-sensitive puberty education” in school curriculum can significantly improve school attendance when providing accessible sanitary materials is infeasible.

In addition to inadequate sanitary materials, WASH infrastructure is often inadequate for girls to manage their menstruation with privacy and dignity. Schools may not have access to private latrines, means for disposal of sanitary materials, or sufficient water and soap necessary for girls to be comfortable. The systematic literature review conducted in 2011 highlights the clear gap of research addressing the impact of improved WASH facilities on girls’ education.


Summary

Due to the sensitivity of discussing menstruation, particularly in patriarchal cultures where social norms limit such discussions, it is difficult to accurately quantify the impacts of menstruation and proposed interventions on educational success. While there are limits to gathering evidence on the direct links between menstruation and quantifiable outcomes of absenteeism and dropout, studies universally acknowledge the importance of adequate MHM in improving girls’ quality of life and experiences in education.

The societal taboos and “silent” nature of menstruation rooted in patriarchal assumptions have established negative psychosocial impacts on girls that are unlikely to be solved by improvements in MHM infrastructure alone. Although research identifies a positive correlation between provision of sanitary pads and puberty education on girls’ attendance, there is no noted difference in the negative psychological outcomes associated with menstruation. Similarly, others acknowledge “the provision of separate-sex toilets is probably necessary but not sufficient to impact on girls’ educational outcomes”.

Although rigorous, empirical studies offer value in quantifying correlations and causations between variables, the impact of menstruation on education should be addressed holistically, drawing on feminist and human rights methodologies to capture nuances of the problem and create long-term solutions that address complex cultural challenges and empower girls.

 

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