Menstruation and School Absenteeism: Evidence from Rural Malawi
Open accessAbstract
The provision of toilets and menstrual supplies has emerged as a promising programmatic strategy to support adolescent girls' school attendance and performance in less developed countries. We use the first round of the Malawi Schooling and Adolescent Survey (MSAS) to examine the individual- and school-level factors associated with menstruation-related school absenteeism. The MSAS is a school-based longitudinal survey of adolescent students enrolled in coed public primary schools in the southern districts of Machinga and Balaka who were aged 14-16 in 2007. Although one-third of female students report missing at least one day of school at their last menstrual period, our data suggest that menstruation only accounts for a small proportion of all female absenteeism and does not create a gender gap in absenteeism. We find no evidence for school-level variance in menstruation-related absenteeism, suggesting that absenteeism is not sensitive to school environments. Rather, co-residence with a grandmother and spending time on school work at home reduce the odds of absence during the last menstrual period.
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Most quantitative studies have not found an association between menstruation and school attendance.
“Most quantitative studies have not found an association between menstruation and school attendance [12, 13, 20, 21]”
From Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study (2018) · cites this paper as [20]
The Menstruation and Schooling section says few studies have quantified the effect using attendance data, but the study it identifies found girls significantly more likely to be absent on menstrual days. The Discussion also reports that one-third of the Malawi sample missed at least one day during their last menstrual period. The paper describes a small effect, not a pattern of quantitative studies finding no association; page numbers were not available in our copy. (LLM, conf=0.78)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredBoth qualitative and quantitative work has suggested that poor menstrual hygiene management results in school absenteeism, distraction, and disengagement.
“Both qualitative and quantitative work has suggested that poor MHM results in school absenteeism, distraction, and disengagement.[6,7]”
From Do Menstrual Hygiene Management Interventions Improve Education and Psychosocial Outcomes for Women and Girls in Low and Middle Income Countries? A Systematic Review (2016) · cites this paper as [7]
The “Menstruation and Schooling” section reports qualitative accounts linking menstruation to attendance and classroom participation, alongside a quantitative study finding a small attendance effect. But this paper’s Results find no association between school sanitation facilities and menstruation-related absenteeism; its Discussion says a possible effect on concentration was not examined. It does not establish that poor menstrual hygiene management causes distraction or disengagement. (LLM, conf=0.86)
Experimental — accuracy not yet measuredQualitative studies in LMIC settings demonstrate that taboos and negative attitudes, including shame and secrecy, contribute to unhygienic practices and school absenteeism.
“This finding is consistent with those from qualitative studies in LMIC settings which demonstrate that taboos and negative attitudes, including shame and secrecy, contribute to unhygienic practices and school absenteeism [4,33]”
From Menstrual hygiene management and school absenteeism among adolescent students in Indonesia: evidence from a cross-sectional school-based survey (2018) · cites this paper as [33]
The “Menstruation and Schooling” section discusses girls’ fear that menstruation will be discovered and suggests that inadequate privacy and water may affect attendance and hygiene. But this paper analyzes survey data, not qualitative studies, and it does not demonstrate that taboos, shame, or secrecy cause unhygienic practices and absenteeism. The Discussion also says perceived toilet privacy appears to have little association with menstruation-related absenteeism. (LLM, conf=0.84)
Experimental — accuracy not yet measuredLimited studies to date have shown minimal effect of quantitative associations with school absence in relation to MHM, despite strong qualitative evidence from girls' narratives.
“Lastly, while policy makers have called for increased measurement of school attendance, dropout, and educational attainment in relation to MHM, demonstrating quantitative associations with school absence in limited studies to date has shown minimal effect [5,33,34], despite strong qualitative evidence from girls’ narratives [4,7,17,26,35].”
From A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools (2016) · cites this paper as [33]
Similar levels of absenteeism reported by boys and girls have been seen in other settings.
“and this has been seen in other settings [20, 22, 23].”
From Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study (2018) · cites this paper as [20]
Girls might be unwilling to mention menstruation as a reason they missed school because of stigma associated with menstruation.
“Girls might be unwilling to mention menstruation as a reason they missed school because of stigma associated with menstruation.6 29”
From Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey (2017) · cites this paper as [29]
Absenteeism due to menstruation among Indonesian girls is lower than has been reported in studies from African contexts but is still substantial.
“This is lower than has been reported in studies from African contexts but is still substantial [4,33,34].”
From Menstrual hygiene management and school absenteeism among adolescent students in Indonesia: evidence from a cross-sectional school-based survey (2018) · cites this paper as [33]
Ascertainment of intermediate outcomes such as school absence has been mixed.
“Ascertainment of intermediate outcomes such as school absence (i.e. which may contribute to dropout or failure to achieve) has been mixed (14, 31)”
From Menstrual hygiene management among adolescent schoolgirls in low- and middle-income countries: research priorities (2016) · cites this paper as [31]
Studies to date, predominantly using school registers, have not shown a strong association between absence and menstrual intervention with varying duration of follow-up ranging between 1-month and 1-year.
“Studies to date, predominantly using school registers, have not shown a strong association between absence and menstrual intervention with varying duration of follow-up ranging between 1-month and 1-year.10 12–16”
Attendance data may be a poor measure of menstrual intervention effectiveness in SSA where girls report multiple reasons for absenteeism.
“Attendance data may be a poor measure of menstrual intervention effectiveness in SSA where girls report multiple reasons for absenteeism.15”
Menstrual hygiene management can be a challenge for women and girls, especially in low and middle-income settings, though there have been few large-scale studies of the impacts on health, education and gender equality.
“The current literature suggests that menstrual hygiene management (MHM) can be a challenge for women and girls, especially in low and middle-income settings though there have been few large-scale studies of the impacts on health, education and gender equality [16–19].”
Quantitative evidence for links between MHM and attendance have been mixed, although studies have almost exclusively looked at absorbent type, rather than all MHM practices.
“Quantitative evidence for links between MHM and attendance have been mixed, although studies have almost exclusively looked at absorbent type, rather than all MHM practices discussed below.9–12”
From Measuring the prevalence and impact of poor menstrual hygiene management: A quantitative survey of schoolgirls in rural Uganda (2016) · cites this paper as [10]
Quantitative studies in Ghana and Malawi found moderate to non-significant improvements to school attendance associated with MHM interventions.
“Quantitative studies in Ghana and Malawi found moderate to non-significant improvements to school attendance associated with MHM interventions [8, 9].”
From Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls (2019) · cites this paper as [9]
Inadequate MHM affected girls' confidence, psychological wellbeing and ability to perform physical activities.
“As also shown elsewhere, inadequate MHM affected girls’ confidence, psychological wellbeing and ability to perform physical activities [9, 30].”
From Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls (2019) · cites this paper as [9]
In rural Malawi, cost of commercial pads was identified as one of the barriers to school attendance.
“In rural Malawi, cost of commercial pads was identified as one of the barriers to school attendance [9, 31].”
From Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls (2019) · cites this paper as [9]
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“Lastly, while policy makers have called for increased measurement of school attendance, dropout, and educational attainment in relation to MHM, demonstrating quantitative associations with school absence in limited studies to date has shown minimal effect [5,33,34], despite strong qualitative evidence from girls’ narr…”
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“It is notable that our study found similar levels of absenteeism reported by boys and girls, and this has been seen in other settings [20, 22, 23].”
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“This finding is consistent with those from qualitative studies in LMIC settings which demonstrate that taboos and negative attitudes, including shame and secrecy, contribute to unhygienic practices and school absenteeism [4, 33], and reinforce harmful norms and gender inequality [27, 37, 38].”
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- Authors
- Grant, M., Lloyd, C., & Mensch, B.
- Affiliations
- University of Wisconsin–Madison (US)
- Population Council (IN)
- Venue
- Comparative Education Review
- Publisher
- University of Chicago Press
- Published
- 2013-05
- Volume
- 57
- Issue
- 2
- Pages
- 260-284
- ISSN
- 0010-4086 (ISSN-L)
- 1545-701X
- PMC
- PMC4286891
- OpenAlex
- W2066959016
- Cited by
- 201
- References
- 35
- Citations by year
- 2026: 4 · 2025: 15 · 2024: 15 · 2023: 10 · 2022: 23 · 2021: 19 · 2020: 63 · 2019: 8 · 2018: 14 · 2017: 12 · 2016: 9 · 2015: 5 · 2014: 3 · 2013: 1
- FWCI
- 6.14
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Comparative Education Review (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD062155, R24HD047873)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Social Sciences › Education › Youth Substance Use and School Attendance
- Social Sciences › Safety Research › Poverty, Education, and Child Welfare
- Keywords
- menstruation, school absenteeism, adolescent girls, menstrual hygiene management, school toilets, rural Malawi, elementary school students
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