Article Text

Download PDFPDF

Measuring the prevalence and impact of poor menstrual hygiene management: a quantitative survey of schoolgirls in rural Uganda
  1. Julie Hennegan1,
  2. Catherine Dolan2,
  3. Maryalice Wu3,
  4. Linda Scott4,
  5. Paul Montgomery1
  1. 1Centre for Evidence-Based Intervention, University of Oxford, Oxford, UK
  2. 2SOAS, University of London, London, UK
  3. 3Applied Technologies for Learning in the Arts and Sciences, University of Illinois, Urbana-Champaign, Urbana, Illinois, USA
  4. 4Said Business School, University of Oxford, Oxford UK
  1. Correspondence to Julie Hennegan; julie.hennegan{at}


Objectives The primary objective was to describe Ugandan schoolgirls’ menstrual hygiene management (MHM) practices and estimate the prevalence of inadequate MHM. Second, to assess the relative contribution of aspects of MHM to health, education and psychosocial outcomes.

Design Secondary analysis of survey data collected as part of the final follow-up from a controlled trial of reusable sanitary pad and puberty education provision was used to provide a cross-sectional description of girls’ MHM practices and assess relationships with outcomes.

Setting Rural primary schools in the Kamuli district, Uganda.

Participants Participants were 205 menstruating schoolgirls (10–19 years) from the eight study sites.

Primary and secondary outcome measures The prevalence of adequate MHM, consistent with the concept definition, was estimated using dimensions of absorbent used, frequency of absorbent change, washing and drying procedures and privacy. Self-reported health, education (school attendance and engagement) and psychosocial (shame, insecurity, embarrassment) outcomes hypothesised to result from poor MHM were assessed as primary outcomes. Outcomes were measured through English surveys loaded on iPads and administered verbally in the local language.

Results 90.5% (95% CI 85.6% to 93.9%) of girls failed to meet available criteria for adequate MHM, with no significant difference between those using reusable sanitary pads (88.9%, 95% CI 79.0% to 94.4%) and those using existing methods, predominantly cloth (91.5%, 95% CI 85.1% to 95.3%; χ2 (1)=0.12, p=0.729). Aspects of MHM predicted some consequences including shame, not standing in class to answer questions and concerns about odour.

Conclusions This study was the first to assess the prevalence of MHM consistent with the concept definition. Results suggest that when all aspects of menstrual hygiene are considered together, the prevalence is much higher than has previously been reported based on absorbents alone. The work demonstrates an urgent need for improved assessment and reporting of MHM, and for primary research testing the links between menstrual management and health, education and psychosocial consequences.

  • menstrual hygiene management
  • adolescent girls
  • education
  • reproductive heatlh
  • risk factors

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

Statistics from


  • Twitter Follow Julie Hennegan @julie_hennegan

  • Contributors JH, PM, CD and LS conceived and designed the experiments. PM, CD, MW and LS performed the experiments. JH analysed the data. JH and PM wrote the paper. CD, MW and LS commented on the paper. All authors have read and approved the final manuscript.

  • Funding The study was funded by a DFID-ESRC (Economic and Social Research Council) grant (ref: ES/I034145/1).

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Ethics approval Social Science and Humanities Interdivisional Research Ethics Committee at the University of Oxford (Ref: SSD/CUREC1/11-056), the AIDS Support Organisation (TASO) Institutional Review Committee Uganda (TASOIRC/022/14-UG-IRC-009), and the University of Illinois (#12236).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.