Improving Menstrual Health Literacy Through Life-Skills Programming in Rural Ethiopia

Abstract

Despite its cultural and biological importance, limited knowledge about menstruation and cultural taboos in many contexts mean that menarche often brings fear and stigma. In Ethiopia, the context of this paper, lack of knowledge and the stigma around menstruation create challenges for adolescent girls related to menstrual hygiene management and their reproductive health more broadly. This paper uses a cluster-randomized controlled trial (cRCT), with 97 communities (kebeles) randomly assigned to treatment or control, to assess the impact of a gender-transformative life-skills intervention [Act With Her-Ethiopia (AWH-E)] on the menstrual health literacy of very young adolescent girls and boys (10–14) in two diverse regions of Ethiopia (South Gondar, Amhara and East Hararghe, Oromia). The evaluation employs a longitudinal mixed-methods design, with baseline data collected in late 2017/early 2018 and follow-up data collected in late 2019/early 2020. Quantitative surveys were undertaken with 2,492 very young adolescents and their primary caregivers, and complemented by qualitative interviews with 291 adolescents and their caregivers, as well as 96 key informants at community and district levels. Our quantitative findings highlight large and statistically significant improvements on norms around menstruation, knowledge about menstruation and biological function, and knowledge and behavior related to menstrual hygiene management, but with important differences by location and gender. Qualitative findings further unpack these gender and regional differences, highlighting the importance of adapting programming to the local context and, where possible, connecting to other health and gender initiatives. This analysis helps fill the evidence gap on “what works” to improve menstrual health literacy in rural low- and middle-income contexts.

Effect of a school-linked life skills intervention on adolescents' sexual and reproductive health skills in Guji zone, Ethiopia (CRT)—A generalized linear model

“…These results are in line with school-based study programs in Thailand ( 24 ), India ( 6 ), and the Netherlands ( 25 ). In Ethiopia, these findings are also similar to Baird et al ( 14 ) which showed significant progress in the knowledge of menstrual hygiene skills and reproductive health issues ( 16 ). Moreover, in India, the outcome also aligns with the findings of Sukumar et al ( 39 ), which showed significantly improved life skill scores ( 39 ).…”

“…Similarly, Pradeep et al ( 1 ) found that 91.6% of students in India reported improved awareness of life skills after participating in life skills training. Furthermore, studies conducted in Ethiopia by Malango and Hegena ( 11 ), Tesema et al ( 12 ), and Baird et al ( 13 ) showed that open parent discussions to develop SRH life skills had established positive longer-term impacts and increased student participation by 25.7, 24.5, and 8.2%, respectively ( 11 – 13 ). In North and East Ethiopia, a gender transformative life skills intervention program was conducted, demonstrating a significant improvement in knowledge of menstruation and its hygiene ( 14 ).…”

“…Hence, it is crucial to examine the gap in life skills training to address the practical needs of adolescents and understand the different co-existing factors in modern African societies ( 15 ). One possible reason for poor sexual and reproductive health outcomes among Ethiopian adolescents is the absence of life skills training ( 14 ). UN Care Ethiopia conducted life skills training for adolescents of UN staff in Ethiopia ( 16 , 17 ); however, this training has yet to consider adolescents with visibly deficient gaps in life skills.…”

Spanish menstrual literacy and experiences of menstruation

“…School-based education is suggested by several researchers as a tool to address low menstrual literacy [ 9 , 31 ]. Schools are useful sites for the dissemination of knowledge about menstrual health as they are considered a trusted source of information [ 9 ].…”

“…Menstrual education before menarche might contribute to girls feeling more prepared and reducing negative emotions during menarche. However, this alone does not make shame or fear disappear, nor eliminate the taboo or social restrictions as menstrual experiences are shaped by sociocultural context [ 31 ] and the immediate environment of young people has a strong influence [ 33 ].…”