Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls

Joyce Chinyama,Mercy Mwale,Jenala Chipungu,Lavuun Verstraete,Roma Chilengi,Charity Sikamo,Anjali Sharma,Cheryl Rudd,Wilbroad Mutale

doi:10.1186/s12889-018-6360-2

Abstract

IntroductionWhile in school, girls require an environment that is supportive of menstrual hygiene management (MHM) in order to ensure regular school attendance and participation. Little is known about schoolgirls access to and practice of MHM in rural Zambia. This study explores girls’ experiences of MHM in rural schools of Zambia from the perspectives of schoolgirls, schoolboys and community and school-based adults key to MHM for schoolgirls.MethodsIn July and August 2015, we conducted this qualitative exploratory study in six rural schools of Mumbwa and Rufunsa districts of Zambia. Twelve in-depth interviews (IDIs) and six focus group discussions (FGDs) were conducted among girls ages 14–18 who had begun menstruating. Two FGDs with boys ages 14–18 and 25 key informant interviews were also conducted with teachers, female guardians and traditional leaders to provide the context within which schoolgirls practice MHM.ResultsMost girls reported learning about menstruation only at menarche and did not know the physiological basis of menstruation. They reported MHM-related challenges, including: use of non-absorbent and uncomfortable menstrual cloth and inadequate provision of sanitary materials, water, hygiene and sanitation facilities (WASH) in schools. In particular, toilets did not have soap and water or doors and locks for privacy and had a bad odor. Girls’ school attendance and participation in physical activities was compromised when menstruating due to fear of teasing (especially by boys) and embarrassment from menstrual leakage. Boys said they could tell when girls were menstruating by the smell and their behaviour, for instance, moving less and isolating themselves from their peers. Girls complained of friction burns on their inner thighs during their long journey to school due to chaffing of wet non-absorbent material used to make menstrual cloth. Girls preferred to dispose used menstrual materials in pit latrines and not waste bins for fear that they could be retrieved for witchcraft against them. Though traditional leaders and female guardians played a pivotal role in teaching girls MHM, they have not resolved challenges to MHM among schoolgirls.ConclusionWhen menstruating, schoolgirls in rural Zambia would rather stay home than be uncomfortable, inactive and embarrassed due to inadequate MHM facilities at school. A friendly and supportive MHM environment that provides education, absorbent sanitary materials and adequate WASH facilities is essential to providing equal opportunity for all girls.

Highlights

While in school, girls require an environment that is supportive of menstrual hygiene management (MHM) in order to ensure regular school attendance and participation
This study was conducted to understand girls’ experiences of managing their menstruation and to further explore how the menstrual hygiene environment within schools may affect their attendance in school. This exploratory qualitative study draws on 12 in-depth interviews (IDIs) and 6 focus group discussions (FGDs) conducted among 14–18 years old girls who had already attained menarche and two Focus Group Discussion (FGD) with boys of the same age group
Seven key informant interviews (KIIs) were conducted with teachers serving as School Health Nutrition (SHN) coordinators who are focal persons for health-related issues including menstruation; 7 with female guardians of girls aged between 14 and 18 years; and 11 with traditional leaders in the communities surrounding the study schools

Summary

Introduction

Girls require an environment that is supportive of menstrual hygiene management (MHM) in order to ensure regular school attendance and participation. Most schools in developing countries, especially in rural areas, have inadequate facilities including water supply [13] for girls to wash hands, external genitalia and soiled clothes Nor do they have provision for privacy, soap, sanitary pads and disposal of soiled sanitary pads [14]. Girls’ participation and psychological well-being while in class is affected when they do not have access to sanitary pads or adequate alternatives because they fear staining their clothes and subsequently being teased and humiliated by their classmates [4, 7] It is not surprising that attendant hormonal disruptions notwithstanding, girls’ school performance has been noted to decline after they attain menarche in Africa [7]

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Conclusion