‘We Keep It Secret So No One Should Know’ – A Qualitative Study to Explore Young Schoolgirls Attitudes and Experiences with Menstruation in Rural Western Kenya

Linda Mason,Kelly Alexander,John Vulule,Penelope A Phillips-Howard,Kayla F Laserson,Aisha Mohammed,Frank O Odhiambo,Alie Eleveld,Elizabeth Nyothach,Richard Rheingans

doi:10.1371/journal.pone.0079132

Abstract

BackgroundKeeping girls in school offers them protection against early marriage, teen pregnancy, and sexual harms, and enhances social and economic equity. Studies report menstruation exacerbates school-drop out and poor attendance, although evidence is sparse. This study qualitatively examines the menstrual experiences of young adolescent schoolgirls.Methods and FindingsThe study was conducted in Siaya County in rural western Kenya. A sample of 120 girls aged 14–16 years took part in 11 focus group discussions, which were analysed thematically. The data gathered were supplemented by information from six FGDs with parents and community members. Emergent themes were: lack of preparation for menarche; maturation and sexual vulnerability; menstruation as an illness; secrecy, fear and shame of leaking; coping with inadequate alternatives; paying for pads with sex; and problems with menstrual hygiene. Girls were unprepared and demonstrated poor reproductive knowledge, but devised practical methods to cope with menstrual difficulties, often alone. Parental and school support of menstrual needs is limited, and information sparse or inaccurate. Girls’ physical changes prompt boys and adults to target and brand girls as ripe for sexual activity including coercion and marriage. Girls admitted ‘others’ rather than themselves were absent from school during menstruation, due to physical symptoms or inadequate sanitary protection. They described difficulties engaging in class, due to fear of smelling and leakage, and subsequent teasing. Sanitary pads were valued but resource and time constraints result in prolonged use causing chafing. Improvised alternatives, including rags and grass, were prone to leak, caused soreness, and were perceived as harmful. Girls reported ‘other girls’ but not themselves participated in transactional sex to buy pads, and received pads from boyfriends.ConclusionsIn the absence of parental and school support, girls cope, sometimes alone, with menarche in practical and sometimes hazardous ways. Emotional and physical support mechanisms need to be included within a package of measures to enable adolescent girls to reach their potential.

Highlights

Adolescence is a critical period of psychological and biological change, and emphasis has shifted in recent years to enhance interventions that protect young peoples’ lives [1]
Emotional and physical support mechanisms need to be included within a package of measures to enable adolescent girls to reach their potential
Staying in school potentially protects girls against early marriage, teen pregnancy, and other reproductive and sexual harms including HIV infection [4,5,6,7]. The burden of these harms among adolescent girls is disproportionately high in sub-Saharan Africa (SSA) [8,9,10]

Summary

Introduction

Adolescence is a critical period of psychological and biological change, and emphasis has shifted in recent years to enhance interventions that protect young peoples’ lives [1]. There are fewer studies on girls’ attitudes to menarche and menstruation in SSA [21], with recent studies reporting girls are shamed by stained clothing [11,22,23,24]. Such studies have suggested poor menstrual management causes girls to miss school [11,12,23], with calculations made that a girl will miss 10–20% of her school days [25]. This study qualitatively examines the menstrual experiences of young adolescent schoolgirls

Methods

Results

Discussion

Conclusion