Menstrual Hygiene Management in Schools in South Africa: Knowledge, experience and impact on school attendance

Abstract

Abstract Background In many countries, girls face significant challenges when it comes to managing menstruation, particularly in school settings. Lack of access to adequate menstrual hygiene products, sanitation facilities, and information about menstruation can lead to absenteeism, poor academic performance, and ultimately impact dropout rates among school-age girls. Methods The study was conducted in senior primary schools in three districts of three provinces in South Africa. A mixed method study design included– in-depth interviews (IDIs), focus group discussions (FGDs), an anonymous survey and a sanitation audit of female learner toilet facilities in a sample of schools in each participating district. Participants included male and female learners, parents and key stakeholders. Questions focused on source of water and sanitation facilities, education, knowledge and experience of the menstrual cycle including impact on school attendance. Descriptive analysis was conducted for the anonymous survey and sanitation audit. FGDs and IDIs were audio recorded, transcribed and translated and thematically coded. Deductive and inductive coding was done. Results A total of 332 anonymous surveys were completed by learners (241 females, 91 males). The survey found that fewer than two thirds of learners (61.1%; n = 203) had been educated on their menstrual cycle and a third of those who had started menstruation did not know which passage the blood passes through. Almost half of participants (44.8%; n = 34) had no menstrual product available at first menses. Half of female learners (50%, n = 38) reported they had “ever missed school” for reasons relating to their menstrual cycle, with the main reason relating to pain. Qualitative data from the FGDs and IDIs confirmed and supported the survey data. Results of the school sanitation survey demonstrated that condition and type of toilet facilities varied considerably between provinces. The school free sanitary pad distribution programme was also implemented in different ways and often supply was inconsistent. Conclusions Findings suggest a lack of knowledge relating to menstruation, and a lack of access to menstrual products among senior primary learners. Absenteeism from school was common during mensus. This study highlights the need for more consistent implementation of existing school life skills education and sanitary product programmes.