There is a need to move away from a central focus on school attendance as the central outcome of menstrual hygiene management programs according to a new report, as the latter has no direct impact on school attendance.

“Addressing girls’ menstrual health challenges are important, but are better positioned as part of comprehensive sexuality education programs addressing stigma and shame associated with menstruation, access to menstrual products, inequitable gender norms and sexual and reproductive health knowledge gaps, as opposed to a girls education intervention, “the report says.

The study; Effects of sanitary pad distribution and reproductive health education on upper primary attendance and reproductive health knowledge and attitudes in Kenya: a cluster-randomised controlled trial’, sought out to assess if providing girls in grade 7 in a rural, coastal area of Kenya with sanitary pads and sex education would alleviate some of those challenges

According to the report neither sanitary pad distribution nor Reproductive Health education, on their own or together, were sufficient to improve primary school attendance. However, as the RH education intervention improved RH outcomes, the evidence suggests that sanitary pad distribution and RH education can be positioned in broader RH programming for girls.

The researchers however noted that even though, none of the three program packages had an impact on school attendance, those that participated in the sex education felt more positively about menstruation, knew more about sexual and reproductive health, had more equitable gender norms and were more self-confident at the end of the program.

The study assessed the effects of sanitary pad distribution and reproductive health education on girls in Std 7 aged around 14 years in three subcounties of Magarini, Kaloleni and Ganze in Kilifi to find out if providing them with sanitary pads would alleviate some of the challenges they face.

According to the report, adolescent girls face a range of challenges that may compromise their chances of completing school or their sexual and reproductive health.

“These challenges can be even further complicated by girls’ feelings of shame about their bodies, in particular about menstruation, or their lack of sanitary products to help them manage menstruation,”.

The report was co-authored by Karen Austrian, Beth Kangwana, Eunice Muthengi and Erica Soler- Hampejsek and published in the BioMed Central Research journal, an open-access journal publishing peer-reviewed contributions from across all scientific and clinical disciplines.

Methodology

The study enrolled 3489 randomly selected girls in primary grade 7, with a mean age of 14.4 and used a cluster randomized controlled trial design. Eligible clusters were all non-boarding schools in three sub-counties in Kilifi County that had a minimum of 25 girls enrolled in primary grade 7. 140 primary schools, 35 per arm, were randomly assigned to one of four study arms:

(1) control

 (2) sanitary pad distribution;

(3) RH education; or

(4) both sanitary pad distribution and RH education.

The Outcomes were school attendance, school engagement, Reproductive Health knowledge and attitudes, gender norms, and self-efficacy.

While several programs have previously been developed to address girls’ menstrual health management (MHM) needs in Kenya, as well as globally, the study observes that “few have been rigorously evaluated, and where evidence does exist on the effect of such programs on reproductive health (RH) and schooling outcomes, the results have been mixed”.