Studies on MHM and schoolgirls' health and schooling - and possible impact or otherwise on absenteeism


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  • JenniferRubli
  • Research Coordinator for Femme internaional
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Re: studies on MHM and schoolgirls' health and schooling

Hello Penny and others,

This is such a great discussion happening here!

The issue of deliberate absenteeism is interesting and very important, especially as, as has been mentioned in this thread, in the virtual MHM conference, and in several recent studies, absenteeism does not seem to be a valid indicator; an RCT in Nepal (Oster & Thornton, 2010) showed that providing girls with pads had no significant effect on absenteeism. And as Penny mentioned, we have also seen girls unwilling to disclose menstruation as the reason they are absent, if school records are being used.

Femme has found that there are larger issues beyond supplying a method of menstrual management that need to be addressed, one reason we ask students WHY they were absent (it includes things like pain, fear of leaking, embarrassment, etc). Schoolgirls report pain and/or discomfort in prevalences up to 100%. All schoolgirls mention boys' teasing and unfriendly school atmosphere. We came across an headmaster who did not allow menstruating girls to attend, because there was no disposal system, and disposable pads were filling up and blocking the latrines. Poor WASH facilities inhibit girls' ability to change pads, and they will go home early so as still be be marked 'present.' They might be at school, but not concentrating, not raising their hand, not willing to sit down or go up to the blackboard, and so developing indicators that are a more valid, reliable measure of their situation in school is something we're working on.

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  • PennyPH
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Re: studies on MHM and schoolgirls' health and schooling

Thanks Elizabeth, for following up.

Marni's response eloquently summarizes the knowledge-base to date. The building of a robust evidence base will likely take many years, recognizing there will be geographical and cultural differences.

We used attrition to cover absence and dropout, ultimately attrition means 'loss' - but evidence is needed to demonstrate [or not] that repeated absence (i.e. from inadequate menstrual care each month) leads to dropout, which also has multiple causes.

A group of us have recently published a MHM research priorities paper, based on discussions at the MHM in 10 meeting group, which we hope will be taken up by researchers, programmers, funders, and policy-makers, to move the research agenda forward.

(if people are unable to access, let us know).

best wishes all.

Liverpool School of Tropical Medicine
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  • PennyPH
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Re: studies on MHM and schoolgirls' health and schooling

Thanks Camilla
What country would this be in, and what would the dates be?
best, Penny
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  • PennyPH
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Re: studies on MHM and schoolgirls' health and schooling

Dear Jen and colleagues

Well done for summarizing so nicely the multi-disciplinary issues around potential school absence relating to MHM which, when added to 'other' reasons for school absence, exemplifies the difficulties in quantifying the contribution of MHM to school absence. Have you published your research, it would be well worth it, as it would add to the limited data currently available.

As noted in a prior message to Elizabeth, a group of us have recently published an article, which you can also find on researchgate, summarising some of the gaps in the evidence-base for MHM to enable programmes, policy makers, and funders to better support MHM globally. This highlights that absence, while important, is one among numerous outcomes that require confirmation (or refutation) and may differ in relative contribution by location and culture.

You can download from the researchgate website which also lists other publications and 'new projects' under development:

Wishing all readers the very best for 2017, and well done to Elizabeth for keeping these discussions updated, relevant, and on point!

Liverpool School of Tropical Medicine
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  • Camilla
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  • Co-founder of Peepoople and recently launched new MHM project and campaign called The Cup
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Re: studies on MHM and schoolgirls' health and schooling

Dear Penny,

Sorry for late reply.

We are working in Kenya and would like to start as soon as possible.

Happy New Year

Camilla Wirseen
The Cup
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  • Elisabeth
  • Elisabeth's Avatar
  • I'm passionate about SuSanA's role in the WASH sector since about 2005. I'm a freelance consultant since 2012 (former roles: program manager, lecturer, process engineer for wastewater treatment plants)
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Re: studies on MHM and schoolgirls' health and schooling

Here is a very interesting article that touches on all the things that we have discussed in this thread and which conclusively answers the question with which I had started this thread. I started the thread which questioning this statement:

many of them have dropped out of school due to menstrual hygiene related cases.

If only the solution was this simple!

Here is the article:

The title is: Does Handing Out Sanitary Pads Really Get Girls To Stay In School?

And the answer is: probably no, at least not on its own but it should be important and worthwhile nevertheless.

December 28, 2016
Where: Website of NPR which is a mission-driven, multimedia news organization and radio program producer.

Paragraphs that I found particularly important:

"It's like the straw that breaks the camel's back," says Sommer. "There are many things that make going to school difficult, and it's one more thing."

That's a major concern, because compared with boys, a much larger share of girls in poor countries drop out of high school.


For instance, maybe the most serious impact on girls who are menstruating is not that they don't show up to school, but that their concern about leakages makes it harder for them to concentrate or dissuades them from participating in class.

The researchers also question the very idea that there has to be some educational or health justification for spending aid dollars to help girls manage their period. It suggests this isn't worth doing for its own sake.

"I wonder if boys had a similar biological experience," muses Caruso. "If we would be going through so much effort trying to justify whether or not we were investing in giving them what they need."

Really an excellent article explaining the complexities in all this. The answer is never that simple...


P.S. In my role as moderator, I have split off 7 posts from this thread into a spin-off thread dealing specifically with taboos around menstruation in Nepal, see here:
Make sure you subscribe to that thread (or to the whole sub-category) if you have an interest in that topic!
Dr. Elisabeth von Muench
Independent consultant located in Ulm, Germany
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Twitter: @EvMuench
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  • mshoaib
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Re: studies on MHM and schoolgirls' health and schooling

Dear Elisabeth

Thanks for initiating the discussion and keeping it on track.
While answering the link of MHM and sanitation facilities in schools, we need to move step wise. It can be correlated to some kind of service ladder which girls in schools have to move on. It also matters what would be more important and when?
For example, if a girl has to attend examination, she is more likely to attend school if there are appropriate facilities around and less likely if no facilities. Similarly, in normal days, if the facilities are around more likely to attend and if no facilities then less likely and so on. Thus, my take is that, it is good to compare with developing countries and argument above that it absenteeism should be none in countries with all the facilities is argued that it is above level of service one is expecting and used to. For example, many girls in developing countries would be attending the school in spite of no facilities while girls of developed countries would not attend if the facilities are not available on the day of menstruation, so my suggestion is that we should be careful and realistic with due considerations of the situation.
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