Menstrual health management and schooling experience amongst female learners in Gauteng, South Africa: a mixed method study

Abstract

Background: There has been increased attention to the menstrual health management (MHM) needs of girls and young women in Eastern and Southern Africa, relating to dignity, and to the potential link between the lack of access to sanitary products and school absenteeism. In the South Africa, there is inadequate evidence to guide appropriate national responses. This study explored the extent of access to modern sanitary products amongst female high school learners and the range of needs and challenges that they face in managing their menses in school settings in Gauteng, South Africa. Methods:We collected mixed method data from 10 schools in Sedibeng district between June and August 2018. The qualitative component consisted of in-depth interviews with female learners (n = 30), educators (n = 8) and mothers of female learners (n = 9) and focus group discussions (FGDs) with male learners (n = 7) and female learners (n = 10). Five hundred and five female learners were recruited into the quantitative component consisting of a self-administered survey focussing on factors associated with access to sanitary products. Results:The median age of survey participants was 17 years (interquartile range 16-18 years) and average age at menarche was 13.36 years. One in seven female learners reported not having enough sanitary products for every period in the last 3 months and this was reflected across the school quintiles. There was a complex interaction between menstrual-related challenges (physical discomfort, teasing, and feeling distracted in class) experienced by female learners, often amplified or compounded by factors in the school environment (unhygienic sanitation facilities and inadequate rest areas), and schooling participation and attendance. Girls who did not have enough products for every period in the last 3 months more likely reported missing school than those who reported sufficient products (46.27% vs 22.49% respectively, p < 0.001). However, there was no statistically significant difference between the groups in number of days missed.(Continued on next page)

Blood flows: mapping journeys of menstrual waste in Blantyre, Malawi

“…The self-reporting method also may have induced inaccuracies in that many women may be unlikely to accurately remember the exact proportions of different menstrual absorbents used, and the ways in which they were disposed. In particular, the comparison of menstrual absorbents used 10 years ago to those used today must be viewed as indicative, rather than precise, although the trends reported are supported by other independent studies (Crankshaw et al 2020). The challenges of recall bias were mitigated to some extent by the skill of the enumerators, who would carefully discuss the participant's practices with them in order to determine an estimate.…”

“…However, at present tampons and reusable pads make up such a small percentage of the menstrual waste composition (at just 6% of absorbents used by participants) that their slow expansion is unlikely to have a noticeable impact in the near future. Tampons in particular are likely to have socio-cultural constraints on their widespread acceptability, due to their use being believed to compromise virginity (Crankshaw et al 2020).…”

How addressing menstrual health and hygiene may enable progress across the Sustainable Development Goals

“…Further, as a final example, menstruation relates to SDG 4 promoting 'inclusive and equitable quality education.' The lack of adequate, safe, clean toilets in schools may impact a girl or female teacher's abilities to engage effectively in the learning process [22][23][24].…”

“…3 [24] by the Education sector indicators, such that the availability and quality of ggender-sensitiveteacher training has a high perceived impact for education, with easy measurement of training presence or absence, but difficulties and high costs to conducting and assessing training quality. This differs from the outcome measure of transition (grade) rates for education, which serves as an output leading to an outcome and is captured easily, albeit not always rigorously in countries with poor data systems.…”

The Stressor in Adolescence of Menstruation: Coping Strategies, Emotional Stress & Impacts on School Absences among Young Women in Nepal

“…Among the most important socio-behavioral consequence to consider is that of missed opportunities at school, for which the World Health Organization (WHO) emphasizes the need to focus on better school facilities. An accumulation of missed school days may ultimately lead to girls dropping out of school altogether [6,[22][23][24][25]. This trend opens the door for such practices as child brides and female genital mutilation-practices that international initiatives such as the Millennium and Sustainable Development Goals [26,27] seek to eradicate.…”