Menstruation and the Cycle of Poverty:Does the provision of sanitary pads improve the attendance and educational outcomes of girls in school?
Lead Research Organisation:
School of Oriental and African Studies
Department Name: Anthropology and Sociology
Abstract
Abstracts are not currently available in GtR for all funded research. This is normally because the abstract was not required at the time of proposal submission, but may be because it included sensitive information such as personal details.
Publications
Hennegan J
(2016)
Schoolgirls' experience and appraisal of menstrual absorbents in rural Uganda: a cross-sectional evaluation of reusable sanitary pads.
in Reproductive health
Hennegan J
(2017)
A qualitative understanding of the effects of reusable sanitary pads and puberty education: implications for future research and practice.
in Reproductive health
| Description | A randomised control trial (RCT) was conducted to assess the impact of providing sanitary pads and puberty education on school attendance and psychosocial outcomes for adolescent girls in rural Uganda. The project resulted in the following findings: School attendance Results of the study support the assertion that the management of menstruation presents a gender-specific barrier to education. The trial found that the provision of education and sanitary pad provision were both effective in improving school attendance in relation to the control group. Analysis of girls at follow-up found that while attendance declined substantially from the baseline for all girls in the study due to high levels of drop-out, those who received no intervention had a 17% greater drop in attendance. Where data was imputed for girls lost to follow-up, this effect was maintained, with a 25% greater drop in attendance for control schools in the worst-case scenario and 5% greater drop in the best case. Results suggest that providing puberty education is almost as effective in improving attendance as providing sanitary pads, suggesting that even in the absence of resources to provide sanitary pads, the inclusion of adequate and gender-sensitive puberty education in the school curriculum could improve attendance and target gender inequalities. Psychosocial outcomes The study found that neither the provision of sanitary pads nor puberty education produced significant differences in the psychosocial outcomes of adolescent girls. The reduction in shame and insecurity associated with the provision of sanitary pads in the pilot study was not replicated. Further, validated survey items capturing the psychosocial impacts of menstruation ¬such as shame, insecurity, and self-efficacy are needed. Effective Menstrual Management extends beyond the provision of sanitary care The effective and hygienic management of menstruation requires more than knowledge or reusable absorbents. The project did not address needs for adequate latrines, access to water for washing the body and absorbents, access to soap, access to privacy, or methods for disposal. Each of these factors contributes to dignity and enables adequate menstrual management. It is vital to take a holistic view of girls needs and consider how access to other requirements for menstrual management may further contribute to school attendance and their psychosocial wellbeing. Menstrual Hygiene Management (MHM) A secondary analysis of survey data was conducted to assess the prevalence of MHM, using the definition developed by the World Health Organization and UNICEF. It found that 90.5% of girls in the sample failed to meet the criteria for adequate MHM (including change frequency, washing, drying practices, and privacy), with no significant difference between those using reusable sanitary pads and those using traditional methods such as cloth. The work demonstrates an urgent need for improved assessment and reporting of MHM, and for primary research that tests the links between menstrual management and health, education, and psychosocial consequences. Formative Research is Essential Our findings support the need for RCTs to include a component of formative research to identify factors that may impede the effectiveness of the intervention. Though attrition is a challenge faced in most RCTs, it may be compounded in contexts of poverty, where economic constraints can prevent sustained participation in an intervention. Formative research in this project would have identified the high levels of school drop-out and enabled the development of a-priori analytic strategies to mitigates its effects. |
| Exploitation Route | We will be holding a scientific meeting at Oxford University in November 2016, which will bring together key international stakeholders engaged in menstrual hygiene management, from both Southern and Northern countries. The results of our research will be presented and a strategy for moving the issue forward in policy and programme circles will be developed. The study also formed the basis of an ESRC/DfID Impact Initiative case in Spring, 2018. |
| Sectors | Education,Healthcare,Other |
| Description | Poor menstrual knowledge and access to sanitary products have been proposed as barriers to menstrual health and school attendance. Previously there has been no research to support this assertion. This study, a randomised control trial that assessed the impact of providing reusable sanitary pads and puberty education on girls' school attendance and psychosocial wellbeing outcomes, was the first to investigate this issue. The results of the trial support the hypothesised positive impact of providing sanitary pads or puberty education for girls' school attendance in a developing country context. Though the findings emerged at the end of the research project, and have only recently been disseminated, we are already seeing an increase in coverage of the issue in both media and policy circles. Menstrual Health was not included n the Sustainable Development Goals and in October 2016, the project team convened members of academia, nongovernmental organizations, donor agencies, and practitioners to discuss ways forward. Six core themes emerged as actionable avenues to provide guidance and improve the inclusion of menstrual management on policy agendas of education, health and gender sectors. The research was the focus of the ESRC/DFID Impact Initiative Brief, 'Keeping African Girls in School with Better Sanitary Care' published in Marc 2018 (https://opendocs.ids.ac.uk/opendocs/bitstream/handle/123456789/13575/KeepingAfricanGirlsInSchool.pdf?sequence=1&isAllowed=y). It was also featured in the UKFIET blog in April 2018 (https://www.ukfiet.org/2018/can-better-sanitary-care-help-keep-african-girls-in-school/). Based on the publicity from this piece, the research was highlighted in a Project Syndicate article, 'Demystifying Menstruation' on Apr 17, 2018, and Dolan was subsequently contacted to feature in a short film (https://www.project-syndicate.org/videos/the-easy-solution-to-help-keep-girls-in-school), in which I described the impact of menstruation on girls' economic opportunities and self-esteem. On November 7, 2018 Dolan was part of the Festival of Social Science Event @IDS, centered on how we can improve life choices for women, and demystify menstruation. The panel formed the basis for a blog published in the New Statesmen, 'Why tackling period poverty is an issue for everyone' (https://www.newstatesman.com/spotlight/healthcare/2019/02/why-tackling-period-poverty-issue-everyone). Period poverty has now become a highly visible issue in public discourse, with several social enterprises springing up to provide girls living in low-income environments with adequate sanitary care. Our ESRC-funded project, which was the first to provide evidence on the link between sanitary care and educational outcomes, has been foundational in subsequent efforts to end period poverty. |
| First Year Of Impact | 2018 |
| Sector | Communities and Social Services/Policy,Education,Healthcare |
| Impact Types | Societal |
| Description | Green Templeton Academic Initiatives, Small Grant |
| Amount | £5,000 (GBP) |
| Organisation | Green Templeton College |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 10/2016 |
| End | 09/2017 |
| Description | Plan Uganda |
| Organisation | Plan International |
| Department | Plan Uganda |
| Country | United States |
| Sector | Charity/Non Profit |
| PI Contribution | This ESRC/DfID funded project, Menstruation and the Cycle of Poverty, is based on a partnership between Plan Uganda, Oxford University, and SOAS, University of London. SOAS and Oxford University were responsible for the initial design and conceptualisation of the project, data analysis, and stakeholder engagement in the UK and Europe. |
| Collaborator Contribution | Plan Uganda is the implementing partner and has been responsible for the roll out of the randomised control trial, data collection and stakeholder engagement in Uganda. |
| Impact | * All outcomes are multi-disciplinary [Anthropology, Management Studies, Social Policy, Marketing, Sociology] * Outcomes:(1) stakeholder consultation meetings, workshops and dissemination events in Uganda (2011-2014); (2) Capacity building: trained Plan staff on data collection for RCTs. * Outputs: journal papers, academic presentations, media |
| Start Year | 2013 |
| Description | Media Coverage of research |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | The research has been covered in the following media: Gunawan, Imana. (Jan 25, 2017). Menstruation can hinder girls' education, but it's more complicated than that. Humanosphere, Global Health. http://www.humanosphere.org/global-health/2017/01/menstruation-can-hinder-girls-education-but-its-more-complicated-than-that/ Aizenman, Nurith. (Dec 28, 2016). Does handing out sanitary pads really get girls to stay in school? NPR, All Things Considered. http://www.npr.org/sections/goatsandsoda/2016/12/28/506472549/does-handing-out-sanitary-pads-really-get-girls-to-stay-in-school Bagri, Neha Thirani. (Dec 22, 2016). Oxford researchers say African girls need just two things to stay in school. Quartz. https://qz.com/869519/to-boost-girls-secondary-school-attendance-in-africa-give-them-sanitary-pads-and-lessons-on-puberty/ University of Oxford News (Dec 22, 2016). Ugandan schoolgirls stay in lessons when helped with periods. http://www.ox.ac.uk/news/2016-12-22-ugandan-schoolgirls-stay-lessons-when-helped-periods Leach, Anna. (Oct 19, 2016). 11 ways to stop periods from disrupting girls' education. The Guardian. www.theguardian.com/global-development-professionals-network/2016/oct/19/11-ways-to-stop-periods-from-disrupting-girls-education Hennegan, Julie. (May 9, 2016). Women and water: Menstrual hygiene management and current evidence for interventions. Global Water Forum: www.globalwaterforum.org/ Gathura, Gatonye. (March 30, 2016). No evidence free sanitary products improve schooling for girls. Rocket Science: Development News. http://rocketscience.co.ke/2016/03/30/no-evidence-free-sanitary-products-improve-schooling-for-girls/ Medical Brief. (Feb 17, 2016). More research needed into periods' stigma. Africa's Medical Media Digest. http://www.medicalbrief.co.za/archives/more-research-needed-into-periods-stigma/ Hodel, Kate. (Feb 10, 2016). Disruption to women's lives caused by periods needs more research. The Guardian. www.theguardian.com/global-development/2016/feb/10/disruption-women-girls-periods-menstruating-oxford-university?CMP=share_btn_tw University of Oxford News (Feb 10, 2016). How best to tackle the stigma of menstruation? www.ox.ac.uk/news/2016-02-10-how-best-tackle-stigma-menstruation |
| Year(s) Of Engagement Activity | 2016,2017 |
| Description | Scientific Meeting |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | We held a Scientific Meeting on Priorities for primary research of menstrual management in low and middle income countries. The meeting was attended by a diverse range of stakeholders from around the world, including practitioners, policy makers and academics. A draft scientific report was produced at the conclusion of the workshop that identified preliminary recomendations. Each participant has subsequently contributed to refining these recommendations and we have finalised six core themes as actionable avenues to provide guidance and improve menstrual management. We are currently developing a strategy for taking them forward in education, gender, and health policy. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Stakeholder Dissemination and Consultation |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Approximately 50 government officials, teachers and representatives of civil society organisations attended this dissemination and consultation event in Kamuli, Kamuli District, Uganda. It was the first time participants had come together to discuss how menstruation and sanitary care were impacting on girls education in the district. Based on the event, participants agreed to form a consultative group to advocate for the provision of adequate sanitary care for girls in primary and upper primary schools. |
| Year(s) Of Engagement Activity | 2014 |