Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia
Open accessAbstract
BACKGROUND: Adolescence in girls has been recognized as a special period marked with the onset of menarche. Even though menstruation is a natural process, it is associated with misconceptions, malpractices and challenges among girls in developing countries. However, much is not documented; school-absenteeism and dropout are a common problem among girls in rural Ethiopia. Focusing among school girls, this study has examined knowledge about menstruation, determinants of menstrual management and its influence on school-attendance in Northeast Ethiopia. METHODS: We conducted a mixed-method research combining quantitative and qualitative methods in Northeast Ethiopia. The quantitative study was conducted among 595 randomly selected adolescent school girls. Nine in-depth interviews; five school-dropout girls and four female teachers, and four focus group discussions among school girls were conducted in 2013. RESULTS: The mean age at menarche was 13.98 (±1.17) years. About 51% of girls had knowledge about menstruation and its management. Only a third of the girls used sanitary napkins as menstrual absorbent during their last menstruation. Girls from urban areas, had mothers of secondary and above education and, families of higher monthly expenditure had more chance of using sanitary napkins than their counterparts. More than half of the girls reported to have been absent from school during their menstruation period. Those who did not use sanitary napkins were more likely to be absent from school [AOR-95% C.I: 5.37 (3.02 - 9.55)]. Fifty eight percent of girls reported that their school-performance had declined after they had menarche. In addition, the qualitative study indicated that school-dropout was common among girls who experienced teasing and humiliation by classmates when their clothes were stained with blood as they do not use sanitary napkins. CONCLUSION: Though there is an effort to increase girls' school enrollment, lack of basic needs, like sanitary napkins that facilitate routine activates of girls at early adolescence are observed to deter girls' school-attendance in rural Ethiopia. Special support for girl students, especially when they have their first menstruation and separate functioning sanitary facilities are necessities that should be in school at all times if gender equality and girls empowerment is to be achieved.
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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 [21]
The Results section (page unavailable) reports that 54.51% of girls missed school during their last menstrual period. The Discussion (page unavailable) treats menstruation-related absenteeism as a finding of this study and describes lower absenteeism in other studies, not a general absence of association. (LLM, conf=0.83)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn an Ethiopian study, about 90% of girls stated that their academic performance or class rank declined after menarche.
“In an Ethiopian study, about 90% of girls stated that their academic performance or class rank declined after menarche.7”
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 [7]
The Results section, under “Influence of menstruation on girls academic performance,” says 57.80% perceived a decline in academic performance or rank after menarche, not about 90%. The 90.06% figure in that section refers to students who felt uncomfortable at school during menstruation. (LLM, conf=0.93)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn this study, school absence during menstruation was independently associated with negative attitudes and perceptions about menstruation, not having a gender-separated unlocked toilet for girls at schools, and being forbidden from activities during menstruation.
“In our study, school absence during menstruation was independently associated with negative attitudes and perceptions about menstruation, not having a gender-separated unlocked toilet for girls at schools and being forbidden from activities during menstruation, factors that are similar to other studies.7 9 10 21 24–27”
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 [7]
The Results section on school absenteeism reports shame or fear of leakage, lack of a private place, and lack of a separate bathroom for girls as reasons for missing school. These are similar to parts of the citing study’s findings, but the source does not report an independently adjusted association for negative attitudes, an unlocked gender-separated toilet, or being forbidden from activities during menstruation. (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 [4]
The Results (Menstruation and its hygienic management) include qualitative testimony that shame prevented a girl from buying sanitary napkins, and the Discussion links fear of mistreatment after menstrual leakage to school absenteeism. The Results also document reluctance to discuss menstruation, but do not establish that secrecy caused unhygienic practices or absenteeism; the Discussion presents taboos as a possible explanation rather than a demonstrated cause. No page numbers are provided in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe 41% absence rate during menstruation in this study was higher than that reported in a smaller-scale study in Maharashtra, India (561 girls, 14% absent), but similar to those reported in Habru, Ethiopia (595 girls, 55% absent) and West Bengal, India (190 girls, 39% absent).
“The 41% absence rate during menstruation in our study was higher than that reported in a smaller-scale study in Maharashtra, India, where data were collected using a pre-tested, self-administered structured questionnaire among girls aged 10–19 years (561 girls, 14% absent),11 but similar to those reported in Habru, Ethiopia (595 girls, 55% absent),7 and West Bengal, India (190 girls, 39% absent),”
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 [7]
A number of small-scale, mostly qualitative studies have found that many school-age girls do not attend school during menstruation due to shame, fear of visible stains, absence of a private place to manage menstruation in school, or dysmenorrhoea.
“However, a number of small-scale, mostly qualitative studies have found that many school-age girls do not attend school during menstruation2 6–8 due to shame, fear of having visible stains on their clothing, absence of a private place to manage menstruation in school2 7 9 10 or dysmenorrhoea.11 12”
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 [7]
This finding contrasts with a similar study conducted in Ethiopia, where students who did not use disposable sanitary napkins were 5.4 times more likely to be absent from school, but supports a recent systematic review.
“This finding contrasts with a similar study conducted in Ethiopia, where students ‘who did not use disposable sanitary napkins were 5.4 times more likely to be absent from school than their counterparts’7 but supports a recent systematic review.47”
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 [7]
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 [4]
Girls expressed a strong desire for more practical information, including managing menses or pain relief.
“Girls expressed a strong desire for more practical information, including managing menses or pain relief”
From Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis (2019) · cites this paper as [93]
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 [9]
A higher proportion of girls (who did not use AFRIpads) reported using cloth compared with studies of girls in rural India (pooled prevalence: 63%) and single-study estimates from East Africa (24% in rural Kenya; 56% in Ethiopia).
“A higher proportion of girls (who did not use AFRIpads) reported using cloth compared with studies of girls in rural India (pooled prevalence: 63%12), and single-study estimates from East Africa (24% in rural Kenya;18 56% in Ethiopia9).”
From Measuring the prevalence and impact of poor menstrual hygiene management: A quantitative survey of schoolgirls in rural Uganda (2016) · cites this paper as [9]
In contrast to some past studies, most girls in this study were aware of menstruation prior to menarche.
“In contrast to some past studies (e.g., [3, 16, 23]), we found that most girls were aware of menstruation prior to menarche.”
From A qualitative understanding of the effects of reusable sanitary pads and puberty education: Implications for future research and practice (2017) · cites this paper as [16]
One in ten school-aged girls in low and middle income countries fail to attend school during menstruation or drop out of school at puberty due to absence of MHM facilities.
“others suggest that one in ten school-aged girls in low and middle income countries fail to attend school during menstruation or drop out of school at puberty due to the absence of menstrual hygiene management (MHM) facilities [4–7].”
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 [7]
Girls' school performance has been noted to decline after they attain menarche in Africa.
“girls’ school performance has been noted to decline after they attain menarche in Africa [7].”
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 [7]
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.
“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].”
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 [7]
Schoolgirls rely heavily on cloth due to household poverty, similar to findings in Northeast Ethiopia where girls used pieces of cloth and rags because of lack of money.
“With respect to menstrual material, schoolgirls rely heavily on cloth due to household poverty, which is similar to that found in Northeast Ethiopia where girls used pieces of cloth and rags because of lack of money [7].”
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 [7]
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- Authors
- Tegegne, T. K., & Sisay, M. M.
- Affiliations
- Debre Markos University (ET)
- Addis Ababa University (ET)
- Corresponding author
- Sisay, Mitike Molla
- Venue
- BMC Public Health
- Published
- 2014-10-29
- Volume
- 14
- Issue
- 1
- Pages
- 1118-1118
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC4232635
- OpenAlex
- W2092680858
- Cited by
- 342
- References
- 21
- Citations by year
- 2026: 29 · 2025: 37 · 2024: 45 · 2023: 37 · 2022: 49 · 2021: 43 · 2020: 35 · 2019: 23 · 2018: 17 · 2017: 16 · 2016: 6 · 2015: 3 · 2014: 2
- FWCI
- 8.92
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Deakin Research Online (Deakin University) (submittedVersion)
- Figshare (submittedVersion)
- Funders
- Addis Ababa University
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Health Sciences › Health Professions › General Health Professions › Adolescent Sexual and Reproductive Health
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- menstrual hygiene management, school absenteeism, adolescent girls, menarche, sanitary napkins, school dropout, menstrual knowledge, academic performance, peer teasing, rural Ethiopia, girls' empowerment
- MeSH terms
- Absenteeism, Adolescent, Adolescent Behavior, Ethiopia, Female, Humans, Hygiene, Menarche, Surveys and Questionnaires, School Health Services, Schools, Students, Health Behavior, Young Adult
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