Project – Assessment of Menstrual Hygiene Management Practices and Associated Health Challenges among Adolescent Girls

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Menstruation is a normal biological process that marks an important stage in the reproductive development of girls and is experienced throughout the reproductive years. The onset of menstruation, commonly referred to as menarche, usually occurs during adolescence, a period characterised by substantial physical, psychological, emotional and social development. Although menstruation is a natural physiological process, the ability of adolescent girls to manage it safely and with dignity depends on access to accurate information, appropriate menstrual materials, water, sanitation and hygiene (WASH) facilities, privacy, social support and an enabling social environment. The World Health Organization (WHO) emphasises that menstrual health extends beyond the management of menstrual blood to include access to accurate and age-appropriate information, suitable and affordable menstrual materials, adequate WASH facilities, appropriate healthcare for menstrual difficulties and freedom from stigma and discrimination (World Health Organization [WHO], 2024).

Menstrual hygiene management (MHM) is therefore an important component of adolescent reproductive health and general wellbeing. Effective MHM involves using clean and appropriate absorbent materials, changing them as frequently as necessary, maintaining personal cleanliness, having access to clean water and soap, using private sanitation facilities, and disposing of used menstrual materials safely. However, these practices are not determined by individual behaviour alone. They are influenced by household economic circumstances, parental education, cultural beliefs, availability of sanitary products, school policies and the quality of WASH infrastructure within schools. UNICEF identifies four interconnected areas that are essential to menstrual health and hygiene: social support, knowledge and skills, facilities and services, and access to menstrual materials and other supportive supplies (UNICEF, 2024).

Globally, menstrual health and hygiene remain important public-health and gender-equity concerns. The WHO and UNICEF Joint Monitoring Programme reported that major gaps continue to exist in school-based menstrual health support. In 2023, only about 39% of schools globally provided menstrual health education, while only 31% had bins for menstrual waste in girls’ toilets. The report also highlighted continuing deficiencies in school water, sanitation and hygiene services, with hundreds of millions of children lacking basic water, sanitation or hygiene services at school (WHO & UNICEF, 2024). These shortcomings are particularly significant for adolescent girls because menstruation requires facilities that allow them to change menstrual materials privately, wash themselves and their hands, and dispose of used materials safely.

The problem is more pronounced in many low- and middle-income countries where poverty, inadequate infrastructure and gender-related social norms intersect. Girls may have limited access to commercially produced sanitary pads and may resort to alternative materials when menstrual products are unavailable or unaffordable. In addition, girls may lack private spaces in which to change menstrual materials, particularly during school hours. UNICEF notes that gender inequality, poverty, discriminatory social norms and cultural taboos can prevent girls from meeting their menstrual health needs. Such constraints can affect their mobility, confidence, participation in school and psychosocial wellbeing (UNICEF, 2024).

Knowledge is an important determinant of menstrual hygiene management. Girls who receive accurate information before menarche are more likely to understand menstruation as a normal physiological process and to develop appropriate hygiene practices. Conversely, inadequate information may expose girls to fear, embarrassment, misconceptions and inappropriate practices. A Nigerian study examining the impact of pre-menarcheal training found that girls who had not received appropriate training were more likely to report negative experiences of menarche, adverse effects of menstruation on schooling and social life, and use of unhygienic menstrual absorbents (Akinwole et al., 2010). The finding demonstrates that menstrual education before and around menarche can play an important role in preparing girls to manage menstruation safely.

The school environment is particularly important because adolescent girls spend a substantial proportion of their active day in school. A school without adequate water, toilets, privacy, soap and disposal facilities may make effective menstrual hygiene management difficult even when girls possess adequate knowledge. Girls may be forced to remain in uncomfortable conditions, leave school temporarily, return home to change their menstrual materials or avoid participating in school activities. The WHO and UNICEF therefore recognise menstrual health as an important component of creating safe, inclusive and gender-responsive school environments (WHO & UNICEF, 2024).

Evidence from Nigeria demonstrates that these challenges are not merely theoretical. UNICEF Nigeria’s assessment of menstrual hygiene management in secondary schools examined girls’ knowledge, attitudes and practices as well as the school environmental conditions affecting menstrual hygiene. The assessment, which covered schools in Anambra, Katsina and Osun States, found that menstruating schoolgirls faced multiple challenges related to cultural beliefs, availability and adequacy of WASH facilities, the flow of information on menstrual hygiene and access to appropriate menstrual materials. The report concluded that these factors affected girls’ ability to manage menstruation in a hygienic and dignified manner (UNICEF Nigeria, 2016).

The Nigerian situation is further illustrated by empirical studies among secondary school girls. Nwimo et al. (2022), in a study involving 600 adolescent secondary school girls in Nigeria, reported poor menstrual hygiene management practices and high levels of menstrual distress. The study also found statistically significant differences in menstrual hygiene practices according to factors such as age, residential location and mother’s occupation, while menstrual distress was associated with father’s occupation. Importantly, the researchers reported a significant relationship between menstrual hygiene management practices and menstrual distress, reinforcing the connection between menstrual practices and adolescent wellbeing.

The relationship between menstrual hygiene and health is multidimensional. Poor menstrual hygiene may increase discomfort and may contribute to health problems where girls have inadequate access to clean water, soap, appropriate absorbents and suitable changing facilities. However, it is important not to assume that every menstrual symptom is caused by poor hygiene. Some challenges, such as abdominal cramps, headaches, fatigue and emotional discomfort, may arise from normal menstrual physiology or underlying menstrual disorders. Consequently, research on MHM should distinguish between challenges associated with menstrual physiology and those associated with inadequate hygiene management, poor facilities, stigma and restricted access to care. This broader perspective is consistent with the WHO’s understanding of menstrual health, which includes access to appropriate care and treatment for menstrual difficulties (WHO, 2024).

Menstrual pain is one of the common challenges experienced by adolescent girls. Severe menstrual pain can interfere with concentration, physical activity, school attendance and participation in social activities. Nwimo et al. (2022) specifically identified menstrual distress among Nigerian secondary school girls and reported high levels of distress among the study participants. Their findings suggest that menstrual health interventions should not focus exclusively on hygiene materials but should also provide appropriate information about menstrual symptoms, coping strategies and when to seek healthcare.

Menstruation can also affect educational participation. When girls fear staining their uniforms, lack access to sanitary materials or cannot find a private place to change, they may avoid school or participate less actively in classroom and extracurricular activities. UNICEF Nigeria has documented how inadequate school WASH facilities, lack of disposal mechanisms and menstrual stigma can contribute to school absenteeism and undermine girls’ ability to participate fully in education (UNICEF Nigeria, 2022). The organisation has consequently emphasised that menstruation should not constitute a barrier to girls’ education.

The Nigerian context also demonstrates significant socioeconomic inequalities in menstrual hygiene management. Uwadia et al. (2022) conducted a cross-sectional study among 420 schoolgirls in Badagry Local Government Area of Lagos State and found substantial differences between public and private schools. While 67.1% of the respondents reported using sanitary napkins, others reported using tissue paper and clothes. The researchers found that all private schools studied had functioning WASH facilities, whereas only half of the public schools had functioning water and toilet facilities. Public-school students were also more likely to use alternative menstrual materials, experience inadequate privacy and take used menstrual materials home because of limited access to sanitary bins.

The findings from Badagry are particularly relevant to the present study because Badagry and Ikorodu are both Local Government Areas in Lagos State. The Badagry study demonstrates that menstrual hygiene challenges exist within the Lagos State school environment and that school type, WASH infrastructure, socioeconomic circumstances and access to menstrual materials can influence MHM practices. However, findings from Badagry cannot automatically be generalised to adolescent girls in Ikorodu because the two LGAs differ in demographic characteristics, settlement patterns, school environments and socioeconomic conditions. This creates a justification for generating location-specific evidence from secondary schools in Ikorodu Local Government Area.

Period poverty is another factor that may influence menstrual hygiene management. Period poverty refers broadly to inadequate access to affordable menstrual products, appropriate information and facilities required for managing menstruation safely and with dignity. Uwadia et al. (2022) found that cost was an important reason why some girls used alternatives to conventional sanitary pads in Badagry. Their findings further showed that public-school students were more likely to use non-sanitary materials and had poorer access to water, toilets and privacy than their private-school counterparts. Such findings suggest that menstrual hygiene cannot be addressed through health education alone; economic and infrastructural conditions must also be considered.

Cultural beliefs and menstrual stigma can further affect MHM. In some communities, menstruation is treated as a private or shameful subject, making girls reluctant to discuss menstrual problems with parents, teachers or health workers. UNICEF Nigeria has identified poor knowledge, misconceptions and menstrual taboos as important challenges confronting schoolgirls. The resulting culture of silence may prevent girls from asking questions, obtaining accurate information or seeking help when they experience unusual menstrual symptoms (UNICEF Nigeria, 2015).

The social environment within schools also influences how girls experience menstruation. Teasing, embarrassment and fear of menstrual stains may reduce girls’ confidence and make them uncomfortable while participating in school activities. UNICEF Nigeria’s recent work with Nigerian schoolgirls illustrates how access to accurate information, improved hygiene practices and supportive school environments can increase confidence and enable girls to remain engaged in school during menstruation (UNICEF Nigeria, 2026). This demonstrates that menstrual hygiene management has an important psychosocial dimension in addition to its physical-health dimension.

Menstrual waste management is another essential component of MHM. Girls require appropriate and convenient systems for disposing of used menstrual materials. Where sanitary bins are unavailable, girls may hide used materials, take them home or dispose of them through inappropriate methods. The 2024 WHO/UNICEF report indicates that fewer than one-third of schools globally have bins for menstrual waste in girls’ toilets, demonstrating that waste disposal remains a significant international challenge (WHO & UNICEF, 2024). In the Badagry study, lack of sanitary bins contributed to girls taking used menstrual materials home, particularly among public-school students (Uwadia et al., 2022).

Menstrual hygiene management is therefore a public-health issue, an educational issue and a gender-equity issue. Appropriate MHM enables girls to maintain personal hygiene, protect their dignity, participate in school activities and continue their education without unnecessary interruption. Inadequate MHM, on the other hand, can expose girls to discomfort, menstrual distress, embarrassment, restricted participation and potentially unsafe hygiene practices. Effective interventions must therefore combine menstrual health education with access to affordable materials, water, sanitation, privacy, waste-disposal facilities, supportive teachers and an environment free from stigma (UNICEF, 2024; WHO & UNICEF, 2024).

Despite growing attention to menstrual health in Nigeria, important gaps remain in local evidence. Existing studies have provided evidence from different parts of Nigeria, including Ebonyi State, Owerri and Badagry in Lagos State. Nevertheless, menstrual hygiene practices and associated health challenges may vary between communities and school environments. In particular, there is limited location-specific evidence focusing on adolescent girls in selected secondary schools in Ikorodu Local Government Area. Therefore, assessing MHM practices and associated health challenges among adolescent girls in selected secondary schools in Ikorodu is necessary to establish the extent to which girls are able to manage menstruation safely and identify the health, environmental, socioeconomic and educational factors that may influence their experiences.

The present study is consequently designed to assess menstrual hygiene management practices and associated health challenges among adolescent girls in selected secondary schools in Ikorodu Local Government Area, Lagos State. The study will examine the girls’ knowledge of menstruation and menstrual hygiene, the menstrual materials they use, personal hygiene practices, access to water and sanitation facilities, methods of menstrual waste disposal, menstrual-related health challenges and the effects of menstruation on school attendance and participation. Findings from the study are expected to provide evidence that can assist schools, parents, health educators, policymakers and other stakeholders in developing practical interventions for improving menstrual health and hygiene among adolescent girls in Ikorodu.

1.2 Statement of the Problem

Menstruation is a normal biological process, yet for many adolescent girls it remains associated with inadequate information, limited access to menstrual materials, poor WASH facilities, cultural restrictions, stigma and various physical and psychosocial challenges. Ideally, every girl should enter menarche with accurate knowledge about menstruation and have access to affordable menstrual materials, clean water, soap, private toilets and safe disposal facilities. The WHO considers these elements essential components of menstrual health. However, evidence from Nigeria and other low- and middle-income settings suggests that many girls continue to experience substantial barriers to achieving safe and dignified menstrual hygiene management (WHO, 2024; UNICEF, 2024).

One major problem is inadequate knowledge and preparation for menstruation. Adolescence is a period when girls require reliable information concerning menstrual physiology, personal hygiene, menstrual materials, menstrual pain and appropriate healthcare-seeking. However, menstruation may remain a difficult topic to discuss openly because of cultural beliefs, embarrassment and social taboos. When girls do not receive accurate information before menarche, they may experience fear and confusion and may adopt practices based on misinformation from peers or other informal sources. Nigerian evidence has shown that inadequate pre-menarcheal training is associated with inappropriate menstrual experiences and poorer menstrual hygiene practices (Akinwole et al., 2010).

A second problem concerns access to appropriate menstrual materials. Sanitary pads and other menstrual products are essential for effective MHM, yet their cost can constitute a significant barrier for girls from economically disadvantaged households. Where girls cannot consistently obtain appropriate products, they may resort to tissue paper, pieces of cloth or other alternative materials. Such practices may be uncomfortable and may make girls more vulnerable to leakage, embarrassment and other hygiene-related difficulties. In Badagry, Lagos State, Uwadia et al. (2022) found that although sanitary napkins were the most commonly used menstrual material, a considerable proportion of girls used tissue paper and clothes, with cost identified as an important reason for using alternatives.

A third problem relates to inadequate WASH facilities in schools. Menstruating girls require access to clean and functional toilets, water, soap, privacy and appropriate waste-disposal facilities. Where these are absent or inadequate, girls may be unable to change their menstrual materials as frequently as necessary or maintain personal cleanliness during school hours. The 2024 WHO/UNICEF report demonstrated that substantial numbers of schools globally continue to lack basic water, sanitation and hygiene services, while menstrual-specific facilities such as sanitary waste bins remain particularly inadequate (WHO & UNICEF, 2024).

Evidence from Lagos State reinforces this concern. Uwadia et al. (2022), in their study of secondary schoolgirls in Badagry LGA, found that only half of the public schools assessed had functioning water and toilet facilities. The researchers also identified problems of privacy and access to sanitary disposal facilities. Some public-school girls reported changing sanitary materials in the bush, while others took used menstrual materials home because of inadequate sanitary bins. These findings demonstrate that even within Lagos State, the school environment can substantially constrain girls’ ability to practise safe MHM.

A fourth problem is the potential health burden associated with poor menstrual hygiene and menstrual difficulties. Although not every menstrual symptom results from poor hygiene, adolescent girls may experience menstrual cramps, discomfort, fatigue, emotional distress and difficulties with concentration during their periods. Girls who lack appropriate information may also fail to recognise symptoms that require medical attention. Nwimo et al. (2022) found poor MHM practices alongside very high menstrual distress among Nigerian secondary school girls and identified a significant relationship between MHM practices and menstrual distress. This suggests the need to examine menstrual hygiene practices together with the health challenges experienced by adolescent girls.

A fifth problem is the effect of menstruation on school attendance and academic participation. A girl who fears staining her uniform, lacks access to sanitary products or cannot find a private place to change may avoid school or withdraw from activities. UNICEF Nigeria has reported that inadequate school WASH facilities and menstrual stigma can contribute to school absenteeism and reduce girls’ ability to participate fully in education (UNICEF Nigeria, 2022). In the Badagry study, 30.7% of respondents reported missing school at times because of the lack of an enabling environment for healthy MHM, while more than half reported discomfort with menstruating at school (Uwadia et al., 2022).

A sixth problem is the persistence of stigma, shame and cultural silence surrounding menstruation. When menstruation is viewed as something embarrassing or something that should not be discussed openly, adolescent girls may hesitate to seek information or report menstrual difficulties. Such silence may also make it difficult for teachers and school authorities to understand the specific needs of menstruating students. UNICEF Nigeria has identified stigma, misconceptions and cultural taboos as important barriers to effective menstrual hygiene management among Nigerian girls (UNICEF Nigeria, 2015).

Another concern is that the existing Nigerian evidence does not adequately capture the experiences of adolescent girls in every locality. Studies such as Nwimo et al. (2022) have documented MHM and menstrual distress in Ebonyi State, while Uwadia et al. (2022) examined inequalities in Badagry Local Government Area of Lagos State. Although the Badagry findings are highly relevant to Lagos, they cannot be assumed to represent the situation in Ikorodu. Differences in school infrastructure, household socioeconomic conditions, access to menstrual products, cultural practices and health-service availability may produce different outcomes. Consequently, there is a need for empirical evidence specifically from Ikorodu Local Government Area.

The problem is therefore not simply whether adolescent girls menstruate or whether they possess some knowledge about menstruation. The critical issue is whether they can translate their knowledge into safe, consistent and dignified menstrual hygiene practices within the realities of their homes and schools. It is equally important to determine the health challenges they experience and whether those challenges are associated with the way they manage menstruation. Without such information, interventions may focus narrowly on distributing sanitary products while overlooking knowledge gaps, WASH deficiencies, stigma, menstrual distress and school-related barriers.

Furthermore, although menstrual health has increasingly been recognised as an important component of adolescent health, there remains a need for school-specific evidence that can guide interventions at the local level. Understanding the practices and challenges of girls in selected secondary schools in Ikorodu can help determine whether existing school environments adequately support menstrual health and where improvements are required. Such evidence is particularly important because interventions designed without local assessment may fail to address the actual barriers experienced by girls.

It is against this background that this study seeks to assess menstrual hygiene management practices and associated health challenges among adolescent girls in selected secondary schools in Ikorodu Local Government Area, Lagos State. The study will generate evidence on the girls’ menstrual hygiene practices, access to menstrual materials and WASH facilities, menstrual-related health challenges and the relationship between MHM practices and reported health challenges.

1.3 Purpose of the Study

The main purpose of this study is to assess menstrual hygiene management practices and associated health challenges among adolescent girls in selected secondary schools in Ikorodu Local Government Area, Lagos State.

Specifically, the study seeks to:

1. assess the level of knowledge of menstruation and menstrual hygiene management among adolescent girls in selected secondary schools in Ikorodu Local Government Area;
2. determine the menstrual hygiene management practices adopted by adolescent girls in the selected secondary schools;
3. assess the availability and accessibility of menstrual materials and WASH facilities among the adolescent girls;
4. identify the common health challenges associated with menstruation among the adolescent girls

1.4 Research Questions

The following research questions will guide the study:

1. What is the level of knowledge of menstruation and menstrual hygiene management among adolescent girls in selected secondary schools in Ikorodu Local Government Area?
2. What menstrual hygiene management practices are adopted by adolescent girls in the selected secondary schools?
3. What menstrual materials and WASH facilities are available and accessible to the adolescent girls?
4. What are the common health challenges experienced by adolescent girls during menstruation?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no significant relationship between menstrual hygiene management practices and associated health challenges among adolescent girls in selected secondary schools in Ikorodu Local Government Area, Lagos State.

1.6 Significance of the Study

The study will be beneficial to adolescent girls, parents, schools, teachers, healthcare providers, government agencies, public-health practitioners, researchers and other stakeholders concerned with adolescent health and education.

Adolescent girls: The study will contribute to a better understanding of the importance of appropriate menstrual hygiene practices and the health challenges that may accompany menstruation. The findings may help identify areas where girls require additional information, menstrual materials, supportive services and appropriate health education.

Parents and caregivers: The findings will help parents and caregivers understand the importance of preparing girls adequately for menarche and providing appropriate menstrual materials. The study may also encourage parents to create an environment in which girls can discuss menstrual concerns without fear, shame or embarrassment.

Secondary schools and teachers: The findings will provide evidence on the extent to which school environments support menstrual hygiene management. School administrators may use the findings to improve access to water, functional toilets, privacy, soap, sanitary disposal facilities and menstrual health education. Teachers may also become better positioned to support girls experiencing menstrual difficulties.

Healthcare providers: The study will provide useful information concerning common menstrual-related health challenges experienced by adolescent girls. Healthcare professionals, particularly nurses, community health practitioners and school health personnel, may use the findings to strengthen adolescent-friendly menstrual health education, counselling, early identification and referral services.

Government and policymakers: The findings may assist relevant government ministries and agencies in designing or strengthening adolescent reproductive health and school WASH programmes. Evidence concerning access to menstrual materials, sanitation, hygiene and menstrual education can contribute to more gender-responsive school-health policies.

Public-health practitioners: The study will provide local evidence that can guide health-promotion interventions aimed at improving menstrual hygiene management. Such interventions may combine health education, WASH improvements, affordable menstrual materials and strategies for reducing stigma.

Parents-Teachers Associations and community stakeholders: The findings may encourage greater community participation in addressing menstrual hygiene challenges. Community stakeholders can contribute to improving school facilities and supporting girls who experience financial barriers to obtaining menstrual materials.

Researchers and students: The study will add to the existing literature on menstrual hygiene management among adolescent girls in Nigeria. It will also provide a reference point for future studies on menstrual health, adolescent reproductive health, school WASH and gender-related health inequalities, particularly in Lagos State.

1.7 Scope of the Study

The study focuses on the assessment of menstrual hygiene management practices and associated health challenges among adolescent girls in selected secondary schools in Ikorodu Local Government Area, Lagos State.

The content scope covers adolescent girls’ knowledge of menstruation, sources of menstrual information, menstrual materials used, frequency of changing menstrual materials, personal hygiene practices, washing practices, access to water and soap, availability of private toilets, menstrual waste disposal practices, affordability and accessibility of menstrual materials, menstrual pain and other menstrual-related challenges, as well as the effects of menstruation on school attendance, concentration and participation.

The study will focus on adolescent girls who are menstruating and are enrolled in the selected secondary schools. It will not primarily examine menstrual health among adult women, out-of-school girls or girls outside the selected schools.

Geographically, the study is limited to selected secondary schools within Ikorodu Local Government Area of Lagos State. The findings will therefore be interpreted within the context of the selected schools and should not automatically be generalised to all secondary schools in Lagos State or Nigeria.

1.8 Operational Definition of Terms

Adolescent Girls: Female students within the adolescent age range who are enrolled in the selected secondary schools and have experienced menstruation.

Menstruation: The periodic shedding of blood and tissue from the uterine lining as part of the normal reproductive cycle.

Menstrual Health: A state in which an individual has the information, materials, facilities, social support and healthcare needed to manage menstruation safely, comfortably, confidently and with dignity.

Menstrual Hygiene Management (MHM): The practices adopted by girls to manage menstrual bleeding safely and hygienically, including the use and changing of appropriate absorbent materials, personal cleanliness, access to water and soap, private changing facilities and safe disposal of used menstrual materials.

Menstrual Hygiene Management Practices: The specific behaviours and procedures used by adolescent girls during menstruation, including choice of absorbent, frequency of changing materials, washing practices, hand hygiene, disposal practices and use of sanitation facilities.

Menstrual Materials: Products or materials used to absorb or collect menstrual blood, including disposable sanitary pads, reusable menstrual pads, menstrual cups, tampons and other locally used absorbent materials.

WASH Facilities: Water, sanitation and hygiene facilities available to support safe menstrual hygiene, including water sources, toilets, handwashing facilities, soap, privacy and menstrual waste-disposal facilities.

Menstrual Health Challenges: Physical, psychological, social or educational difficulties experienced in relation to menstruation, including menstrual pain, discomfort, distress, fear of leakage, embarrassment, difficulty concentrating, restricted participation and school absenteeism.

Menstrual Distress: Physical and emotional discomfort associated with menstruation, which may include abdominal cramps, headache, fatigue, mood changes, difficulty concentrating and other symptoms that interfere with daily activities.

Period Poverty: A condition in which a girl or woman lacks adequate access to affordable menstrual materials, appropriate information, suitable WASH facilities or other resources required to manage menstruation safely and with dignity.

Menstrual Stigma: Negative attitudes, embarrassment, shame, discrimination or social restrictions associated with menstruation that may discourage girls from openly discussing or managing their menstrual needs.

Secondary School: An educational institution providing post-primary education to students, including the junior and/or senior secondary school levels.

School Attendance: The regular presence of an adolescent girl in school during the academic period, including attendance during her menstrual period.

Health Challenges: Physical, psychological or social difficulties reported by the respondents in connection with menstruation or the management of menstruation.

Project – Assessment of Menstrual Hygiene Management Practices and Associated Health Challenges among Adolescent Girls