The plight of menstruating secondary school-girls: a wake-up call for parents and the school system

Emmy Metta, Hellen Mwita, Melkizedeck Leshabari


Background: This study assessed secondary schoolgirls’ menstruation experiences and the appropriateness of the school environment in fostering menstrual hygiene management in Tanzania’s rural settings.

Methods: A cross-sectional study was conducted among 506 secondary schools girls from Mara Region, Tarime district in Northern Tanzania. Self-administered questionnaire were used for generating data which was analysed using SPSS version 20.

Results: The age at menarche for the 506 secondary schoolgirls in the study ranged from 9-17 with a median age of 14 years. Less than a third (31.6%) were informed about menstruation and how to manage it before the first experience. Mothers were the first source of information to 50.2%of the girls. Slightly more than a half (51.4%) were scared and 43.3% were uncomfortable about the experience when it first occurred. More than half (54.8%) missed school for two days and 18% could not go to school for four or more days during menstruation. Almost three-quarters (73.5%) did not have access to sanitary pads. None of the schools had suitable and appropriate WASH facilities to support girls during menstruation.

Conclusions: Secondary school girls in Tarime district experience various challenges during their menstruation. Improved awareness and knowledge on menstruation, enhanced access to sanitary and WASH facilities at the school environment would improve menstrual hygiene management among secondary schoolgirls and boost their school attendance and participation in education generally.



Menstruation, Menstrual hygiene management, Rural Tanzania secondary school girls

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Budhathoki, Bhattachan M, Castro-Sánchez E, Sagtani RA, Rayamajhi RB, Rai P, et al. Menstrual hygiene management among women and adolescent girls in the aftermath of the earthquake in Nepal. BMC Women's Health. 2018;18(1):1-8.

Ayele E, Berhan Y. Age at menarche among in-school adolescents in Sawla Town, South Ethiopia. Ethiopian J. Health Sciences. 2013;23(3):189-200.

Michael J, Iqbal Q, Haider S, Khalid A, Haque N, Ishaq R, et al. Knowledge and practice of adolescent females about menstruation and menstruation hygiene visiting a public healthcare institute of Quetta, Pakistan. BMC Women's Health. 2020;20(1):1-8.

Johnson J. Feminine futures: female initiation and aspiration in matrilineal Malawi. J Royal Anthropological Institute. 2018;24(4):786-803.

Sahin M, Guest editorial: tackling the stigma and gender marginalization related to menstruation via WASH in schools programmes. Waterlines. 2015;34(1):3-6.

Dasgupta A, Sarkar M. Menstrual hygiene: how hygienic is the adolescent girl? Indian J Community Medicine: official publication of Indian Association of Preventive & Social Medicine. 2008;33(2):77

Sommer M, Chandraratna S, Cavill S, Mahon T, Phillips-Howard P. Managing menstruation in the workplace: an overlooked issue in low-and middle-income countries. Int J Equity in Health. 2016;15(1):1-5.

Sumpter C, Torondel B. A systematic review of the health and social effects of menstrual hygiene management. PloS one. 2013;8(4):e62004.

McMahon SA, Winch PJ, Caruso BA, Obure AF, Ogutu EA, Ochari IA, et al. 'The girl with her period is the one to hang her head' Reflections on menstrual management among schoolgirls in rural Kenya. BMC Int Health and Human Rights. 2011;11(1):7

Coast E, Lattof SR, Strong J. Puberty and menstruation knowledge among young adolescents in low-and middle-income countries: a scoping review. Int J Public Health. 2019;64(2):293-304.

Thakur H, Aronsson A, Bansode S, Stalsby Lundborg C, Dalvie S, et al. Knowledge, practices, and restrictions related to menstruation among young women from low socioeconomic community in Mumbai, India. Frontiers in Public Health. 2014;2:72.

Choudhary N, Gupta MK. A comparative study of perception and practices regarding menstrual hygiene among adolescent girls in urban and rural areas of Jodhpur district, Rajasthan. J Family Medicine and Primary Care. 2019;8(3):875.

Chandra-Mouli V, Patel SV. Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in low-and middle-income countries. Reproductive Health. 2017;14(1):30.

Elledge Elledge MF, Muralidharan A, Parker A, Ravndal KT, Siddiqui M, Toolaram AP, et al., Menstrual hygiene management and waste disposal in low and middle income Countries—A review of the literature. Int J Environmental Research and Public Health. 2018;15(11):2562.

Hennegan J, Shannon AK, Rubli J, Schwab KJ, Melendez-Torres GJ. Women’s and girls’ experiences of menstruation in low-and middle-income countries: A systematic review and qualitative metasynthesis. PLoS Medicine. 2019;16(5):e1002803.

Laborde ND, Leslie J, Krogstad E, Morar N, Mutero P, Etima J, et al., Perceptions of the “Fabric”–An exploratory study of a novel multi-purpose technology among women in Sub Saharan Africa. PLoS One. 2018;13(10):e0204821.

Garg S, and Anand T. Menstruation related myths in India: strategies for combating it. J Family Medicine and Primary Care. 2015;4(2):184.

Mason L, Nyothach E, Alexander K, Odhiambo FO, Eleveld A, Vulule J, et al., ‘We keep it secret so no one should know’–A qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural Western Kenya. PloS one. 2013;8(11):e79132.

Morgan C, Bowling M, Bartram J, Kayser GL. Water, sanitation, and hygiene in schools: Status and implications of low coverage in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. Int J Hygiene and Environmental Health. 2017;220(6):950-9.

Masanyiwa ZS, Kilobe BM, Mbasa BN. Household Access and Affordability to Pay for Domestic Water Supply Services in Small Towns in Tanzania: A Case of Selected Towns along the Shores of Lake Victoria. Int J Applied and Pure Science and Agriculture, 2017;3:45-58.

Adams J, Bartram J, Chartier Y, Sims J, editors. Water, sanitation and hygiene standards for schools in low-cost settings. World Health Organization; 2009.

Chinyama J, Chipungu J, Rudd C, Mwale M, Verstraete L, Sikamo C, et al. Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls. BMC Public Health. 2019;19(1):16.

Sommer M, Caruso BA, Sahin M, Calderon T, Cavill S, Mahon T, et al. A time for global action: addressing girls’ menstrual hygiene management needs in schools. PLoS medicine. 2016;13(2):e1001962.

Miiro G, Rutakumwa R, Nakiyingi-Miiro J, Nakuya K, Musoke S, Namakula J, et al., Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study. BMC Women's Health. 2018;18(1):4.

National Guidelines for Water, S., and Hygiene for Tanzania Schools. The School Water, Sanitation, and Hygiene (SWASH) guideline and its toolkits were developed to contribute significantly to improving water, sanitation and hygiene conditions in Primary and Secondary Schools. Available at: Accessed on 12th November, 2020.

Sommer M. Menarche: a missing indicator in population health from low-income countries. Public Health Reports, 2013;128(5):399-401.

Padmanabhanunni A, Jaffer L, Steenkamp J. Menstruation experiences of South African women belonging to the ama-Xhosa ethnic group. Culture, Health & Sexuality. 2018;20(6):704-14.

Stubbs M. Cultural perceptions and practices around menarche and adolescent menstruation in the United States. Annals of the New York Academy of Sciences. 2008;1135(1):58.

Marvan ML, Trujillo P. Menstrual socialization, beliefs, and attitudes concerning menstruation in rural and urban Mexican women. Health Care for Women Int. 2009;31(1):53-67.

Perianes MB, Ndaferankhande D. Becoming Female: The Role of Menarche Rituals in “Making Women” in Malawi. The Palgrave Handbook of Critical Menstruation Studies. 2020:423-40.

Sommer M. Ideologies of sexuality, menstruation and risk: girls' experiences of puberty and schooling in northern Tanzania. Culture, Health & Sexuality. 2009;11(4):383-98.

Shah V, Nabwera HM, Sosseh F, Jallow Y, Comma E, Keita O et al. A rite of passage: a mixed methodology study about knowledge, perceptions and practices of menstrual hygiene management in rural Gambia. BMC Public Health. 2019;19(1):277.

Costos D, Ackerman R, Paradis L. Recollections of menarche: Communication between mothers and daughters regarding menstruation. Sex Roles. 2002;46(1-2):49-59.

Perianes MB, Ndaferankhande D. Becoming Female: The Role of Menarche Rituals in “Making Women” in Malawi. The Palgrave Handbook of Critical Menstruation Studies. 2020:423-40.

Trinies V, Caruso BA, Sogore’ A, Toubkiss J, Freeman MC. Uncovering the challenges to menstrual hygiene management in schools in Mali. Waterlines. 2015:31-40.

Sivakami M, Van Eijk AM, Thakur H, Kakade N, Patil C, Shinde S, et al., Effect of menstruation on girls and their schooling, and facilitators of menstrual hygiene management in schools: surveys in government schools in three states in India, 2015. J Global Health 2019;9(1).