Menstrual hygiene management programs aim to provide education and/or materials in order to help students manage menstruation and remove any associated stigma and as a result, increase attendance, thereby increasing educational attainment outcomes. While menstrual hygiene management programs have many benefits, this evidence summary focuses on the evidence for impact on attainment outcomes.
A distinction can be drawn between hardware and software interventions, but these approaches are often combined. There has also been a more recent focus on providing WASH facilities that are ‘girl-friendly’ spaces; safe, secure and private environments to encourage usage.
Hardware interventions refer to the provision of materials (e.g. absorbents, underwear) or improvement of facilities (e.g. WASH, ‘girl-friendly’ spaces) to manage menstruation. Absorbents can be commercial (bought pre-made from a supplier) or home-made, disposable or reusable. WASH interventions may include increasing the number of available toilets, providing clean water, washing or disposal facilities. ‘Girl-friendly’ interventions may include provision of single-sex toilets, locks on toilet doors, lights in toilets etc.
Software interventions refers to educational efforts to teach about menstruation (understanding) and/or how to use menstrual hygiene products (usage). Education can be delivered by either educational or health/social professionals.
1. More research is required on the impact of menstrual hygiene management programmes on academic outcomes. Of 12 studies identified in the review, only one reported attainment data. The majority report of studies focus on attendance data. The limited evidence base means that an impact in months progress is not communicated.
2. A low positive impact was found on attendance outcomes from menstrual hygiene management programs. The theory of change for menstrual hygiene management programmes increasing attainment is through increases in attendance leading to additional learning.
3. Menstrual hygiene management programs are likely to be valuable for teaching children about their reproductive health or for advancing gender equality within education, outside of any impact on academic learning outcomes. This evidence summary focuses on attainment – but schools should consider the other potential benefits when deciding on whether to implement a menstrual health management program.
This evidence summary focuses primarily on academic outcomes. The review, however, only identified one study that examined the impact of menstrual hygiene interventions on attainment. Given that the likely leaver to improving attainment through menstrual hygiene interventions is by improving school attendance, analysis was also conducted to determine the impact of menstrual hygiene management programs on pupil attendance. The impact of menstrual hygiene management programs on pupil attendance is (+0.090). This is low impact based on very limited evidence.
The results of rigorous evaluations, such as those with experimental trials or with well-controlled groups, suggest that the average impact of menstrual hygiene management programs on attendance has typically been positive but low. Whilst impact on attendance is generally positive, there is a lack of evidence to determine whether effects are mediated by intervention type or the effect on additional outcomes such as enrolment, absence, drop-out and grade repetition/progression.
Most evaluations of menstrual hygiene management programs are conducted in Low and Middle Income countries (LMICs). There is a lack of evidence regarding their use and effectiveness in High Income Countries.
Studies are typically conducted in LMIC countries where these programs are most prevalent. There were four countries as the setting for studies included in this analysis, with the majority of studies undertaken in Sub-Saharan Africa (Kenya, Ghana, Uganda) and two studies undertaken in Nepal.
There are several different approaches to menstrual hygiene management including the use of hardware or software interventions, and the inclusion of WASH components and/or girl-friendly facilities. Common characteristics of software interventions may include:
- One-off or regular educational sessions.
- Education on the menstrual cycle and hygiene (understanding).
- Education/demonstrations on how to make and/or use menstrual hygiene products (usage).
- Education delivered by teachers, peers, nurses, midwives or other social/health workers to students (female only or mixed sex groups) and sometimes their mothers or other women in the community.
- Training and professional development for teachers may be included in interventions.
- Education may also be delivered via print or electronic media.
Common characteristics of hardware interventions may include:
- A material component where commercial sanitary products (underwear or absorbents such as disposable sanitary pads or reusable cups/pads) or materials and instructions to make homemade sanitary products are provided.
- A WASH component to improve sanitation and existing facilities at schools through increasing number of toilets or provision of menstural hygiene products, soap/disinfectant, clean water, handwashing facilities, absorbent washing facilities and absorbent disposal facilities.
- A ‘girl-friendly’ component to encourage use of facilities such as single-sex toilets, toilets with doors, lockable toilets, and toilets with lighting.
- Provision of a calendar and pencil to track menstrual cycle.
- Cash transfer component to support the purchase of sanitary products.
The cost of menstrual hygiene interventions vary from very low cost interventions (the provision of low cost sanitory pads) to more expensive interventions such as support delivered by external experts or projects to improve sanitation facilities, which have high start-up cost but a lower ongoing per pupil cost. As a result, the average cost has been rated as low.
The security of the evidence around menstrual hygiene management is rated as very limited. Whilst 12 studies were identified as meeting the inclusion criteria for the Toolkit, only one study reported attainment data and only six reported data on attendance. As a result, a months progress figure has not been communicated.
As with any evidence review, the Toolkit summarises the average impact of approaches when researched in academic studies. It is important to consider your context and apply your professional judgement when implementing an approach in your setting.