Throughout history, Menstruation has always been a taboo in many cultures and a topic that is rarely discussed. There are many cultural and religious beliefs, social norms, unwritten rules and practices about managing menstruations and interaction with menstruating women. Although Menstruation is a universal experience through-out the world, girls in Sub-Saharan Africa experience challenges during Menstruation, especially in rural and resource-poor areas. In developing countries, Menstruation affects the daily lives of girls, especially in school attendance and academic performance. (Chege & Arnot, 2012; Jewitt &Ryley, 2014; McMahon et al., 2011). In Kenya, it is estimated that female students miss nearly 3.5 million days per month because of limited access to reliable, hygienic sanitation and sanitary products (Jewitt & Ryley,2014).

Social attitudes and Power dynamics that contribute to the cause of this problem

Most schools in Kenya schools in Kenya lack access to private toilets, running water, funding for sanitary products and extra classing and this causes school attendance to be limited. Many girls stay at school during Menstruation due to fear or shame. Statistics show that Ten percent of girls in Kenya, miss school when menstruating. The reason is none other than the culture of shame surrounding the topic. Girls often miss school when menstruating because they do not have the proper sanitary products to deal with their period. Besides, the stigma around the topic is mainly caused by the lack of knowledge about the topic. Most girls are misinformed when it comes to the menstruation topic. Very few girls receive education about Menstruation. One example that can be given is a belief among these young girls that they can only get pregnant during their Menstruation. Only 50 percent of girls say that they can openly discuss the topic of Menstruation at home. Another reason for girls absenteeism at school is because only 32 percent of rural schools have actual facilities where girls can change the products for the period during the day. (Girod et al., 2017)

Additionally, the momentum at the national level, girls and boys still have limited access to high-quality and comprehensive puberty education. According to the study by population Council 1 in 5 girls in Nairobi, informal settlements can accurately pinpoint the time of the month that they are most likely to get pregnant. In more impoverished and more rural areas including the North Eastern and Rift valley provinces, the need for puberty and menstruation education is dire. Sixty-four percent of girls self- reported their knowledge of puberty as fair or poor states. A UNICEF study in Garissa. The Kenyan Government mandates puberty education in schools. However, the curriculum focuses on the biological rather than psycho-social changes, including the hygienic use and disposal of sanitary pad. The curriculum broadly used in public school do not address these issues. However, there exist curricula like “It is All One” which do take a gender equity lens and discuss power dynamics in intimate relationships hence providing the necessary information in regards to Menstruation.


The quality of instruction by teachers varies significantly across the country. Teachers are meant to receive training on how to provide puberty education. Nevertheless, studies reveal that many teachers find the topic embarrassing to discuss in a classroom setting, which they end up their specific point of view rather than the official curriculum. Experts suggest that teachers prefer to skip puberty education because it is not a graded course and decide to teach and train students on a variety of different topics.

Perceived Norms

In contrast, schools that provide puberty and Menstruation education, access to water, s (WASH)facilities, hygiene and sanitation contribute to an enabling environment that supports girls to attend and participate. In low-income settings, these conditions are nonexistent. Girls fear and get confused when they start experiencing changes. They lack safe private and clean toilets, water for personal hygiene or disposal facilities due to inadequate facilities at school.

Evidence suggests that for women’s education to be associated with improvements in economic productivity and decision-making ability, contraception use and age at first birth, family size and maternal mortality, morbidity, and educational attainment among their children. The girl’s ability to stay in school may be jeopardized by inadequate menstrual hygiene management which would prevent her from achieving better life outcomes for themselves and their future families.

Despite improved education opportunities, school systems still have not achieved gender parity, and girls remain at an elevated risk of not getting unenrolled. In an attempt to carter to their need, The Kenyan government intervened by initiating a school health strategy which includes distributing sanitary pads for girls to administrators in public school. It increased the pupil to toilet ration and designed a disposal mechanism for pads at public and secondary public schools. Nevertheless, little is known whether or not these policies contribute to inequitable experiences among girls in public school and the specific impact the policies have on girls ability to manage Menstruation in school.

Who is affected and How?

Some causes have proved to benefit others, whereas others are suffering from it. The stigma around the topic has painted women who menstruate as unclean or impure. In some phenomenon that dates back for centuries and is still prevalent among numerous different cultures, religions and backgrounds. In extreme cases, girls are forced to remain in menstrual huts and are removed from their community and sometimes can be deadly. Most girls experience discomfort, embarrassment, shame and insecurity because they are tested or they have had their periods. In some cases, girls exchange sex for money to buy sanitary materials, and some in Tanzania relying on’safe days as a method of contraception, raises concern for STI and HIV risk exposure. 

Menstruation remains the leading cause of many girls absenteeism since they are no facilities, therefore, they are forced to stay away from school because they are not facilitated to manage their period. Due to lack of sanitary girl from poor families miss 20% of school days which affect their school performance.

It is with no doubt that most of the interventions from studies address the issue of Menstruation from a management angle. Menstrual health supplies provided do not necessarily address the cultural beliefs of communities. These interventions provide superficial support because most of these interventions do not adequately take into account factors, such as limited financial resources to buy sanitary napkins and cultural beliefs.

One way interventions can address social attitudes would be in having a holistic approach that goes beyond the sanitary pad. The narrative always revolves around menstrual hygiene. It needs to change. The narrative should detract from menstrual hygiene to menstrual health. Where Menstruation is not just regarded as a sanitation issue or only a biological event but a natural process.

Bobel (2018) proposition state that interventions must be culturally and gender-relevant, must include educative programs about menstruation sensitive provision of sanitary materials and improvement of gender-sensitive school hygiene facilities. Agreeing with her proposition, the leading cause around menstruation hygiene management is not just about affordable sanitary pads, but the stigma around the subject remains high. Myths, cultural beliefs, religious beliefs, taboos all this still affect young girls, especially girls, who resided in such communities. To counter the harmful myths that exist around the topic of comprehensive sexuality education and life skills training must make explicit the link between sexuality and Menstruation. (Genoud& Kakal (2019))

Furthermore, men and boys should be engaged in discussion, panels and intervention regarding Menstruation. Menstruation should not be a taboo but instead should be a topic for all. Many men lack knowledge, and most men do not express any concern about the issue. Findings show that to be teased by boys is a fear for many girls. Some men in households fail to allocate money to buy sanitary pads to both their wives and daughter and some households lack latrines. Involving and engaging young boys, fathers and male teachers can help mitigate this and arrest the stigma around the topic. 

More in-depth research should be conducted in the to use the finding to advance the development of problem theory in menstrual health so frameworks can be used in developing interventions and evaluations.

The menstrual health interventions that mainly target schools should also expand to reach out to those that are out of school. It is well known that girls are less likely to graduate from secondary school than boys. According to UNESCO worldwide, 131 million girls are out of school, and 100 million of those girls are of high school age. Phineas Rueckert(2019). Among the reasons for their drop out, Menstruation plays a role. The expansion of menstrual health intervention should consider them since the majority work in formal and informal jobs where they face different challenges with insensitive employers and lack of toilet facilities. (Genoud& Kakal (2019))
Finally, future interventions should aim to address identified antecedents of menstrual experience, including knowledge social support, restrictive behavioural expectations and economic environment. (Hennegan et al., 2019)