Evaluation of a menstrual hygiene intervention in urban and rural schools in Bangladesh: a pilot study

Abstract

Girls’ menstrual experiences impact their social and educational participation, physical and psychological health. We conducted a pilot study to assess the acceptability and feasibility of a multi-component intervention intended to support menstruating girls; improve menstrual care knowledge, practices, and comfort; and increase school attendance.We conducted a pre/post evaluation of a 6-month pilot intervention in four schools (2 urban, 2 rural) in Dhaka, Bangladesh. We selected 527 schoolgirls (grades 5 to 10; aged 10 to 17 years) for a baseline survey and 528 girls at endline. The intervention included: 1) Menstrual Hygiene Management (MHM) packs– reusable cloth pads, underwear, carry bags and menstrual cycle tracking calendars, 2) education curriculum- pictorial flipcharts, puberty related-booklets, and teachers’ training to deliver puberty and MHM sessions, 3) maintenance- improvements to school sanitation, provision of disposable pads in the school office, provision of chute disposal systems for disposable pads, and gender committees to promote a gender-friendly school environment and maintenance of intervention facilities. We estimated intervention uptake and intervention effect by calculating prevalence differences and 95% confidence intervals using fixed-effects logistic regression.The intervention uptake was more than 85% for most indicators; 100% reported receiving puberty education, 85% received MHM packs, and 92% received booklets. Reusable cloth pads uptake was 34% by endline compared with 0% at baseline. Knowledge about menstrual physiology and knowledge of recommended menstrual management practices significantly improved from baseline to endline. Reported improvements included more frequent changing of menstrual materials (4.2 times/day at endline vs. 3.4 times/day at baseline), increased use of recommended disposal methods (prevalence difference (PD): 8%; 95% Confidence Interval: 1, 14), and fewer staining incidents (PD: − 12%; 95% CI: − 22, − 1). More girls reported being satisfied with their menstrual materials (59% at endline vs. 46% at baseline, p < 0.005) and thought school facilities were adequate for menstrual management at endline compared to baseline (54% vs. 8%, p < 0.001). At endline, 64% girls disagreed/strongly disagreed that they felt anxious at school due to menstruation, compared to 33% at baseline (p < 0.001). Sixty-five percent girls disagreed/strongly disagreed about feeling distracted or trouble concentrating in class at endline, compared to 41% at baseline (p < 0.001). Self-reported absences decreased slightly (PD: − 8%; 95% CI: − 14, − 2).Uptake of cloth pads, improved maintenance and disposal of menstrual materials, and reduced anxiety at school suggest acceptability and feasibility of the intervention aiming to create a supportive school environment.

Development and validation of the Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26) in Bangladeshi schools: A measure of girls’ menstrual care confidence

“…Intervention components included provision of schoolteacher-led puberty and menstruation education, improved waste disposal facilities, and distribution of menstrual materials and menstrual cycle tracking calendars (among other activities). Details about the study context, school selection and characteristics, and the main study’s intervention activities and evaluation methods have been presented separately [ 15 , 16 ].…”

Changes in the menstrual hygiene management facilities and usage among Bangladeshi school girls and its effect on school absenteeism from 2014 to 2018

“…Menstrual hygiene management (MHM) in schools is subpar due to limited access to menstrual hygiene knowledge and facilities [ 1 , 2 ]. Adolescents must manage their menstruation at home and at school, as it is a vital part of their lives [ 3–5 ]. Worldwide studies conducted over the last ten years have demonstrated the difficulties schoolgirls encounter in managing their menstruation [ 6 ].…”

“…Adolescents are frequently misled and unprepared for menstruation due to a lack of knowledge and MHM facilities and practices and social stigma [ 11 , 12 ]. Since they spend six hours in school, it’s critical that they have access to gender-specific sanitation facilities that are both clean and functional [ 3 ]. Poor menstrual hygiene habits are frequently caused by inadequate water, sanitation, and hygiene (WASH) facilities, a lack of privacy, and a lack of gender-specific wash facilities at schools [ 3 , 8 , 10 ].…”

“…Since they spend six hours in school, it’s critical that they have access to gender-specific sanitation facilities that are both clean and functional [ 3 ]. Poor menstrual hygiene habits are frequently caused by inadequate water, sanitation, and hygiene (WASH) facilities, a lack of privacy, and a lack of gender-specific wash facilities at schools [ 3 , 8 , 10 ]. According to two studies conducted in Bangladesh, only 9% of schools have access to soap, water, and disposal bins in the toilets, and 82% of enrolled adolescents find their schools’ facilities inappropriate for managing their periods [ 8 , 13 , 14 ].…”

A Qualitative Content Analysis of Rural and Urban School Students’ Menstruation-Related Questions in Bangladesh

“…The intervention was piloted and evaluated from August 2017 to April 2018 in four urban and rural schools in Bangladesh. The effects of the intervention on primary outcomes are presented separately [ 27 ]. This paper is a sub-study that aimed to explore the breadth of information regarding menstruation that Bangladeshi adolescents sought from their schoolteachers during the intervention pilot, demonstrating the types of knowledge they desired yet had been unable to reliably access.…”