Impact of Poor MHM on Girls Education and Health in Rural Areas of Ethiopia

Impact of Poor MHM on Girls Education and Health in Rural Areas of Ethiopia

June 5, 2022

Menstrual Hygiene Management (MHM) is an issue that is insufficiently acknowledged and has not received adequate attention in the Reproductive Health and Water, Sanitation and Hygiene (WASH) sectors particularly in the Baseline Survey areas of Oromia Region generally in Ethiopia and its relationship with and impact on achieving national and Sustainable  Development Goals (SDGs) is rarely acknowledged. This baseline survey on MHM will make the issue visible to the concerned policymakers and inform practical actions are very much warranted. This small scale survey will be undertaken with the objective of determining the prevailing knowledge and experiences of Menstrual Hygiene Management (MHM), and their implications, among school girls in rural and urban settings of the baseline survey areas.

Sanitation and hygiene is vitally important issues in the study area, with clear links to sexual reproductive health and WASH programs. Educating girls and incorporating practical aspects; such as personal hygiene and sanitation in the school curriculum has not yet addressed in the school communities. School girls have been made more vulnerable by a lack of sanitation infrastructure at school. In the study area, it can be said that among the adolescent school girls both in urban and rural setting, menstrual knowledge and perceptions are poor and practices often not optimal for proper hygiene. Often ignored issues of privacy have been affecting the hygienic practices and daily lives, particularly school attendance of school girls.

The know-how, availability and affordability of sanitary products to manage menstruation are far from satisfactory. Schools, home, society and organizations of reproductive health as well as water, sanitation and hygiene sectors need to make an effort towards making menstrual hygiene and management better for adolescent girls’ population. This baseline survey rapid need assessment study reveals that MHM is not adequately addressed among a large proportion of the school girls while ignorance, misperceptions, unsafe practices and unaware of teachers and parents/mothers to educate their school girls are also quite common among them.

The education of girls is a primary focus of development efforts, particularly in the study areas and generally in Ethiopia because school girls’ achievement, especially at the secondary level, is believed to have long-lasting and far-reaching economic effects. Complex multiple factors work against girls’ education in Ethiopia, including entrenched beliefs and practices that devalue girls’ education. However, one simple contributing factor that has been supposed of having an impact on girls’ remaining in school:  poor girls often have no access to disposable sanitary products and, as a result of feared embarrassment, attend irregularly, perform poorly, and then drop out.

This study points to a number of important issues for policy makers and NGOs/CSOs in Ethiopia, how to integrate MHM with the ongoing related programs. Yet the benefits appear such that further research is warranted. It also observed that the onset of menstruation itself puts the girls at educational risk, bringing an array of negative practices, including sexual harassment (especially from boys, who, in such areas, are mostly young males), withdrawal of economic support from home, sudden pressure to marry or to leave the community to find work.

Noting that the respondents themselves consistently express a strong desire to finish their education, the study observed that, to overcome community beliefs about the unimportance of educating girls will take at least a generation of intense effort on the part of NGOs/CSOs and governments, but the simple intervention of educating the girl about her period and providing her with a reliable, clean, and privacy to manage it, could have a dramatic impact on female educational achievement within only a few years. The study indicated further to the accumulating evidence showing that higher female education levels have a rapid impact on a number of key, measurable indicators that positively affect the society, the economy, the health, and the environment in poor nations, like Ethiopia.  If we can keep even a percentage of these girls in school only another year or two, it could pay off enormously, in terms of the effect on fertility rates, child mortality, disease transmission, and other matters of urgent concern for gender equality.

It is clear that the reproductive health implications of menstruation and its management, and its effect on quality of life permeating school and other social activities are many for the school girls. These invariably call for all stakeholders to urgently address the deep-rooted and incorrect menstrual perceptions, and enable proper hygiene practices amongst this segment of the population. There is no yet considered as significant issues by parents and school communities as well as Reproductive Health and Water, Sanitation and Hygiene (WASH) sectors on working concertedly towards developing appropriate policy and adequate actions on the hitherto neglected issue of MHM.

In the study areas the means of coping for school girls during their menstruation is the use of old cloth, dirty rags and other unhygienic materials. Very few schools have arranged separate classes/rooms for menstrual girls and provided sanitary pads and other protecting materials. However, most of the separated classes for menstrual girls have been founded non-functional due to lack of privacy, water and fear of isolation.  The results of the study reflect that one key means of keeping girls in schools is the provision of better awareness, menstrual management materials and facilities. This study has revealed that a lack of sustainable menstrual hygiene management support for school girls, including suitable sanitary facilities, sanitary materials and psychological support for girls dealing with menstruation.

Many of the girls who took part in the survey preferred to stay at home during their period. If not addressed properly menstrual hygiene management will not only lead to more girls missing schools; but can potentially cause health complications and an increase in the number of girls dropping out of school altogether. This baseline survey on MHM has also revealed that the needs of school girls to have accurate and adequate information about menstruation and its appropriate management. Formal as well as informal channels of communication, such as mothers, female teachers, and peers, need to be emphasized for the delivery of such information – particularly linking instructions on menstrual hygiene to an expanded program of health education in schools and in tandem with more informal means of dissemination channels. In view of the vital role of the mothers, it is utmost important that the mothers and female teachers to be armed with the correct and appropriate information on reproductive health, to give to their growing girl child on a ‘dose-related’ continuous basis.

To recapture, within the context of this study, the following facts were obtained:

  • Missing school: About 327(50.3%) of the school girls in the study report missing 2-5 days of school per month. This translates into a loss of 16 to 32 school days per year. This means per term a school girl may miss up to 16 days of study. On average, there are 220 learning days in a year and missing 32 days a year translates into 14.4% of the time a girl student have been missed learning due to menstrual periods;
  • Effects of Menstruation on Girls Education: Over 67.5% of the respondents (school girls) were confirmed that they have been absent themselves from school during their menstruation while other school girls noted that around 19.2% absent themselves from teaching during menstruation;
  • Inadequate Toilet Facilities in Schools: Majority of the respondents (school girls) and most of boy students and teachers stated that they were highly unsatisfied with existing toilet/sanitation facilities at their schools;
  • Using of Menstrual Sanitary Pads during Menstruation: Over 76.1% of the school girls confirmed that they have been used unhygienic reusable sanitary pads and rags during menstruation; and
  • Keeping Girls in School during Menstruation: Majority of the school girls stated that they need better toilet facilities (hardware aspects). In addition, issues around sensitization of boy students and parents, and the role of the female teacher were also cited.

MHM in school is vitally important issues for school girls; with clear links to health, infant mortality and education. Educating girls and incorporating practical aspects such as personal hygiene and sanitation in the school curriculum can have massive impacts on keeping girls in school. School girls are made more vulnerable by a lack of sanitation infrastructure and must be included in decision-making to ensure that new sanitation initiatives including MHM are appropriate for all. There is a need for greater awareness of the different community groups of women and men, and cultural stigmas and taboos around MHM issues must be broken.