Girls and boys, men and women, need information regarding what menstruation is and how it relates to sexuality and reproduction. When the whole community is included, cultural taboos can be lifted, myths can be broken and the social restrictions that prohibit the full participation of women and girls in society can be removed.
Malawian girls have a lower attendance and many drop out of school due to the lack of sanitary products. Interventions such as access to reusable sanitary products increase the years of schooling which has have important secondary health outcomes, enhances girls’ economic potential over the life course, impacts population health outcomes, and extends to girls’ sexual and reproductive health outcomes, self-esteem, and sense of agency.
Females that stay longer in school are associated with; reduced maternal death, improved population health, increased contraceptive uptake, decreased fertility rate, improved child health, increased vaccination rates and decreased HIV infection rates.
The provision of information and guidance can reduce a girl’s experience of fear, shame, and embarrassment managing menstruation due to; leakage and dropping of sanitary material; smell and staining of clothes; teasing, fears of pregnancy; and experience of harassment by male students and teachers.
The lack of knowledge on how to use sanitary products, such as reusable sanitary pads, might prohibit girls to use them. Many schools lack physical provisions for MHM such as lockable, single-sex, private toilets with water and soap for washing, a private open air space to dry wet cloths and a closed bin or incinerator for used pads.
Many school systems in low and middle income countries (LMIC) have a predominance of male administrators and teachers, who may be unaware of or reluctant to talk about the challenges that schoolgirls and female teachers are facing. Further contributing to unsupportive social environments at school, boy students report having little understanding about menstruation, and some tease and bully girls because they do not understand girls’ behaviors during menstruation.
It has been reported that parents often decide to stop the secondary education of their daughters when they reach menarche since commuting between home and school makes them vulnerable for rape which could lead to pregnancy once menstruation starts.
In the wider field of Health Promotion it is well known that no intervention (such as accessibility of reusable sanitary pads) can stand alone: it needs an additional intervention focused on education to reach its full potential. Recent studies support this, stating that there’s strong evidence that educational interventions can improve MHM practices and reduce social restrictions. Especially pre-menarche training for girls and educational interventions such as sexual and reproductive health classes for boys and girls, training for mothers on how to talk to their daughter's, teacher training and training specifically for boys.
There exists a window of opportunity to reach girls at menarche, as their bodies are biologically changing and they are encountering profound new social dynamics within their families and communities. Many girls in LMIC receive no, or factually incorrect guidance, prior to menarche about the normal physiological process of menstruation or the pragmatics of MHM. This in turn results in numerous misconceptions about their own fertility, creating vulnerability to adolescent pregnancy if girls are sexually active. The adolescent sexual and reproductive health (SRH) sector is called on to expand its focus and intervention timing beyond contraception (i.e., family planning) and disease prevention to include puberty and menstrual care guidance.