Givology Staff's Blog

Sanitary Pad Distribution in sub-Saharan Africa: An Effective Way to Increase School Participation Amongst Girls?

By Brent Harlow
Two weeks ago, Kenyan president Uhuru Kenyatta signed into law the Basic Education Amendment Act, which requires state-run schools to provide all girls who need them with free sanitary pads and appropriate on-site facilities for changing and disposing of them.
This represents an important victory for advocacy groups, NGOs, and policy makers who have long argued that menstrual hygiene management (MHM) is needed in order for women in sub-Saharan Africa to experience significant quality of life improvements over a number of areas, including education. They contend that menstruation—or more accurately, the built environments and social attitudes that tend to discriminate and exclude menstruating women from public spaces such as schools—is a major factor contributing to girls’ lower school attendance rates, higher drop-out rates, and lower literacy rates compared to their male peers. Indeed, these disparities in school participation and educational attainment are frequently mentioned by those seeking to generate support for MHM programs.
But is there evidence that MHM programs can increase school participation and educational attainment for girls, as many have suggested?
[b]UNESCO’s call for improved MHM in schools in sub-Saharan Africa[/b]
According to a 2014 UNESCO report entitled [i][url=http://unesdoc.unesco.org/images/0022/002267/226792e.pdf]Puberty Education and Menstrual Hygiene Management [/url][/i] the onset of puberty, and specifically the beginning of menstruation, brings with it an entire set of new challenges that can negatively impact girls’ participation in school. The authors of the report cite statistics from UNICEF and the World Bank estimating that one out of ten school-aged African girls does not attend school during menstruation, adding up to an average of four school days every four weeks, and much lower attendance and school completion rates overall, compared to boys.
The report relies on a review of qualitative research involving girls’ own reports on how menstruation has affected their school participation and attitudes about school. In various studies, girls have reported that menstrual cramping, inadequate menstrual hygiene materials, insufficient water or sanitation facilities at school, unsupportive environments, and fear of menstrual accident are all factors that have caused them to either miss school or reduce their willingness to fully participate in class. Running through all of these factors is the taboo and shame attached to menstruation, making it so that—especially in school environments that do not allow for it to be managed discretely and with dignity—girls find themselves at increased risk of being teased, ridiculed, and bullied.
On the basis of these reports, the authors recommend that girls be provided with separate toileting and changing facilities; access to clean water and soap; safe and sanitary menstrual hygiene products; and a more supportive school environment where education and understanding prevail over ill-informed beliefs and harmful attitudes about menstruation and female sexuality. They suggest that reducing these sources of gender-based discrimination in the school will lead to increases in school participation and educational attainment for girls.
However, there is little evidence at present to suggest that MHM programs have a direct impact on school participation. Specifically with regard to policies designed to increase girl students’ access to menstrual hygiene products, the little research that does exist suggests that these policies may not be as effective as one might expect.
[b]Quantitative research on the impact of programs designed to increase access to menstrual hygiene products [/b]
The authors of the UNESCO report acknowledge that in the one study in which this intervention was evaluated in isolation, the results showed no significant impact on school participation. They cite the [url=https://www.povertyactionlab.org/node/966]Poverty Action Lab’s randomized evaluation[/url] of a program in Nepal in which the treatment group, comprised of seventh and eighth grade students (and their female guardians), was provided with re-usable menstrual cups and was instructed in their proper use. The researchers found that while women both liked and used the product, this accounted for no significant increase in school attendance over the control group.
The authors of the UNESCO report cite a second study, carried out in Ghana, in which researchers tried to identify the impact that providing adolescent girls with sanitary pads plus education would make on school attendance. The author of the study concluded that providing pads with education did significantly improve attendance within three months, but he also found that providing puberty education alone—after just two more months—had a similar positive impact on school attendance, making it unclear what role pads played in improving school participation. For this reason, together with the fact that this was a non-randomized, smaller-scale study with some data-collection difficulties, the trial in Ghana ought to be treated as an opening onto an important new area of research, rather than as evidence that providing sanitary pads to girls in sub-Saharan Africa will necessarily have a positive impact on school attendance. This at least seems to be the opinion of many researchers in the field, who both acknowledge the importance of this work, and caution policy makers about some of its limitations (to link to an NPR article with statements from experts in the field, [url=http://www.npr.org/sections/goatsandsoda/2016/12/28/506472549/does-handing-out-sanitary-pads-really-get-girls-to-stay-in-school]click here[/url]).
Rigorous impact evaluation studies can help us understand how particular interventions relate to specific policy objectives. In this case, in a country such as Kenya—where UNESCO estimates that over two million women need support in order to access sanitary pads—there may be very good reasons to give one’s support to groups like Freedom4girls, ZanaAfrica, and others that provide pads and health education to girls. And there may be cause to celebrate, together with Kenyan activists and politicians who have fought hard for progressive policies in this area, the new law mandating that sanitary pads be distributed to girls who need them in all state-run schools. However, no data yet exists to suggest that distributing free pads will result in significant increases in school attendance.
[b]Proven interventions for increasing school participation among girls in the developing world[/b]
If increasing school participation for girls in the developing world is the goal, there are interventions that have been proven to make a positive impact. There is evidence that providing information to parents about how more education will positively impact their daughters’ future earnings, and providing girls with scholarships and free uniforms to offset the cost of schooling both have a significant impact on school participation. And there are many organizations currently dedicated to doing work in these areas, including Givology partners such as [url=https://www.givology.org/~fkites/]Flying Kites [/url](in Kenya) and [url=https://www.givology.org/~sobone/]Starfish [/url](in Guatemala).

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