A Blind Spot in Girls' Education: Menarche and Its Webs of Exclusion in Ghana

Dolan, Catherine; Ryus, Caitlin R.; Dopson, Sue; Montgomery, Paul; Scott, Linda M.

doi:10.1002/jid.2917

Cited by 89 publications

(80 citation statements)

References 20 publications

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“…Among the key limitations of the pilot work were the environmental consequences of pad disposal. [22, 26] Further, the cost of monthly provision of disposable pads was substantial. A reusable product was believed to be more sustainable, both from a cost and environmental perspective.…”

Section: Methodsmentioning

confidence: 99%

“…[19–21] Taboos around the topic mean many adolescent girls are unprepared for menarche, and that management practices are not discussed openly. [19, 20, 22] In the confined school environment, with a lack of access to adequate latrines or separate latrines for males and females, menstrual management presents a significant challenge. Absorbents such as cloth are used and can often leak, soiling uniforms or outer garments.…”

Section: Introductionmentioning

confidence: 99%

“…Qualitative work indicated improvements in shame and self-confidence. [22] Whilst findings of the pilot were positive, they were limited by a lack of randomisation, small sample size, comparison of single clusters, and short study duration. In addition, the trial raised questions with regard to the effectiveness of providing sanitary pads in contrast (or addition to) education, and the need to identify the individual impact of these interventions.…”

Section: Introductionmentioning

confidence: 99%

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Menstruation and the Cycle of Poverty: A Cluster Quasi-Randomised Control Trial of Sanitary Pad and Puberty Education Provision in Uganda

et al. 2016

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BackgroundPoor menstrual knowledge and access to sanitary products have been proposed as barriers to menstrual health and school attendance. In response, interventions targeting these needs have seen increasing implementation in public and private sectors. However, there has been limited assessment of their effectiveness.ObjectivesAssess the impact of providing reusable sanitary pads and puberty education on girls’ school attendance and psychosocial wellbeing outcomes.MethodsA cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. Schools were allocated to one of four conditions: the provision of puberty education alone; reusable sanitary pads alone; puberty education and reusable sanitary pads; and a control (no intervention). The primary outcome was school attendance. Secondary outcomes reflected psychosocial wellbeing.ResultsAt follow-up, school attendance had worsened for girls across all conditions. Per-protocol analysis revealed that this decline was significantly greater for those in the control condition d = 0.52 (95%CI 0.26–0.77), with those in control schools having a 17.1% (95%CI: 8.7–25.5) greater drop in attendance than those in any intervention school. There were no differences between the intervention conditions. High rates of school drop-out and transfer meant the trial suffered from substantial participant drop-out. Intention-to-treat analyses using two different imputation strategies were consistent with the main results, with mean differences of 5.2% attendance in best-case and 24.5% in worst-case imputations. Results were robust to adjustments for clustering. There was no impact of the interventions on girls’ self-reported shame or insecurity during menstruation.ConclusionResults of the trial support the hypothesised positive impact of providing sanitary pads or puberty education for girls’ school attendance in a developing country context. Findings must be interpreted with caution in light of poor participant retention, intervention fidelity, and the attendance measures used.Trial RegistrationPan African Clinical Trials Registry PACTR201503001044408

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Menstruation and the Cycle of Poverty: A Cluster Quasi-Randomised Control Trial of Sanitary Pad and Puberty Education Provision in Uganda

et al. 2016

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“…Core items had been piloted in Ghana [10, 15]. Qualitative feasibility and acceptability work was undertaken prior to trial implementation, both in the local area, and similar regions (see [16]).…”

Section: Methodsmentioning

confidence: 99%

“…Past trials of menstrual product provision have addressed some of these questions with qualitative reports or field observations of product acceptability and uptake [9, 11, 15]. The Menstruation and the Cycle of Poverty trial [14] assessed here, conducted a pilot assessment of menstrual products.…”

Section: Introductionmentioning

confidence: 99%

Schoolgirls’ experience and appraisal of menstrual absorbents in rural Uganda: a cross-sectional evaluation of reusable sanitary pads

Hennegan

Dolan

et al. 2016

Reprod Health

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BackgroundGovernments, multinational organisations, and charities have commenced the distribution of sanitary products to address current deficits in girls’ menstrual management. The few effectiveness studies conducted have focused on health and education outcomes but have failed to provide quantitative assessment of girls’ preferences, experiences of absorbents, and comfort. Objectives of the study were, first, to quantitatively describe girls’ experiences with, and ratings of reliability and acceptability of different menstrual absorbents. Second, to compare ratings of freely-provided reusable pads (AFRIpads) to other existing methods of menstrual management. Finally, to assess differences in self-reported freedom of activity during menses according to menstrual absorbent.MethodsCross-sectional, secondary analysis of data from the final survey of a controlled trial of reusable sanitary padand puberty education provision was undertaken. Participants were 205 menstruating schoolgirls from eight schools in rural Uganda. 72 girls who reported using the intervention-provided reusable pads were compared to those using existing improvised methods (predominately new or old cloth).ResultsSchoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities, less difficulties changing absorbents, and less disgust with cleaning absorbents. There were no significant differences in reports of outside garment soiling (OR 1.00 95%CI 0.51–1.99), or odour (0.84 95%CI 0.40–1.74) during the last menstrual period. When girls were asked if menstruation caused them to miss daily activities there were no differences between those using reusable pads and those using other existing methods. However, when asked about activities avoided during menstruation, those using reusable pads participated less in physical sports, working in the field, fetching water, and cooking.ConclusionsReusable pads were rated favourably. This translated into some benefits for self-reported involvement in daily activities, although reports of actual soiling and missing activities due to menstruation did not differ. More research is needed comparing the impact of menstrual absorbents on girls’ daily activities, and validating outcome measures for menstrual management research.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0260-7) contains supplementary material, which is available to authorized users.

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The sexual and reproductive health covariates of early menarche among adolescent girls

Ibitoye,

Sandfort,

Bingenheimer

et al. 2024

Journal of Adolescence

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IntroductionResearch suggests that girls who reach menarche at an early age are at greater risk for negative sexual and reproductive health (SRH) outcomes than their later‐maturing counterparts, but very little research has examined this issue in sub‐Saharan Africa, especially in West Africa. The goal of the current study was to determine whether early menarche was associated with any SRH outcomes in a sample of Ghanaian girls.MethodsThe study data were drawn from the baseline assessment of a longitudinal study involving two age cohorts (13–14 and 18–19 years) of 700 adolescent girls from Ghana. Logistic regressions were used to assess the association between early menarche (before age 13) and seven SRH outcomes (adolescent sexual activity, early sexual initiation, inconsistent condom use, transactional sex, sexual violence, multiple sexual partners, and adolescent pregnancy).ResultsEarly menarche was significantly associated with adolescent sexual activity (odds ratio [OR] = 6.4; 95% confidence interval [CI] 2.1–19.7), and sexual violence (OR = 3.2; 95% CI 1.6–6.2) in the younger cohort and early sexual initiation (OR = 3.2; 95% CI 1.19–8.61) and multiple sexual partners (OR = 3.7; 95% CI 1.39–9.87) in the older cohort. Early menarche was also associated with transactional sex and teen pregnancy in the full sample.ConclusionsThese findings suggest the need for special attention to the needs of early‐maturing girls in SRH programming. Interventions are needed to delay adolescent sexual activity in girls with early menarche. Efforts to prevent sexual violence among adolescent girls in Ghana may benefit from targeting and addressing the specific needs of early‐maturing girls.

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A Blind Spot in Girls' Education: Menarche and Its Webs of Exclusion in Ghana

Cited by 89 publications

References 20 publications

Menstruation and the Cycle of Poverty: A Cluster Quasi-Randomised Control Trial of Sanitary Pad and Puberty Education Provision in Uganda

Menstruation and the Cycle of Poverty: A Cluster Quasi-Randomised Control Trial of Sanitary Pad and Puberty Education Provision in Uganda

Schoolgirls’ experience and appraisal of menstrual absorbents in rural Uganda: a cross-sectional evaluation of reusable sanitary pads

The sexual and reproductive health covariates of early menarche among adolescent girls

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