Project – Menstrual Health Education and School Attendance among Adolescent Girls: A Study of Selected Public Secondary Schools in Osogbo, Osun State

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Adolescence is a critical stage of human development characterised by rapid physical, emotional, psychological and social changes. One of the most significant biological changes experienced by adolescent girls during this period is menarche, which marks the beginning of menstruation. Although menstruation is a normal physiological process, inadequate preparation and limited access to accurate information can make the experience difficult for girls, particularly within school environments. Menstrual health therefore extends beyond the management of menstrual blood to include access to accurate information, appropriate materials, adequate water, sanitation and hygiene facilities, health services, privacy, dignity and freedom from stigma. The World Health Organization (WHO, 2026) emphasises that girls should receive accurate and age-appropriate menstrual health information before their first menstruation and should be able to participate fully in school and other aspects of life throughout the menstrual cycle.

Menstrual health education is an important component of adolescent health education because it equips girls with knowledge about the menstrual cycle, menstrual hygiene, appropriate sanitary materials, management of menstrual symptoms and when to seek professional health care. Timely information can also reduce fear, misconceptions, embarrassment and inappropriate practices associated with menstruation. In a study of Nigerian school girls, pre-menarcheal training was associated with better menstrual experiences and hygiene practices, while girls who had not received such training were more likely to report adverse effects of menstruation on schooling and social life. The study concluded that lack of timely information could contribute to inappropriate menstrual experiences and poor menstrual hygiene practices, thereby demonstrating the importance of menstrual education before and around the onset of menarche (Oche, Umar, & Gana, 2012).

The relevance of menstrual health education becomes clearer when the school environment is considered. Adolescent girls spend a considerable proportion of their formative years in school, and menstruation occurs regularly throughout the school year. Girls therefore require knowledge and practical skills that enable them to manage menstruation while attending classes. UNICEF Nigeria’s assessment of menstrual hygiene management in secondary schools, which included schools in Osun State, found that the experience of menstruating girls was affected by the availability of information, access to menstrual materials and the adequacy of water, sanitation and hygiene facilities. The assessment also identified cultural beliefs and misconceptions as important issues affecting menstrual hygiene management among Nigerian schoolgirls (UNICEF Nigeria, 2016). This indicates that menstrual health education should not be regarded merely as an individual health issue but as an important component of creating a school environment in which girls can participate in education with dignity and confidence.

School attendance is an important indicator of educational participation because regular attendance gives students opportunities to receive classroom instruction, interact with teachers and peers, complete learning activities and participate in assessments. Menstruation can interfere with school attendance when girls experience pain, fear of staining, embarrassment, inadequate sanitary materials, lack of privacy or insufficient facilities for changing and disposing of menstrual materials. In a nationally representative analysis of PMA2020 data, Miiro et al. (2018) found that 23% of Nigerian girls aged 15–24 who had attended school in the preceding year reported missing school because of menstruation. The same study observed variations in menstrual-related school absenteeism across Nigerian states, demonstrating that menstruation can constitute a significant educational participation issue.

The relationship between menstrual experiences and school attendance is also evident in empirical studies conducted in Nigeria. Edet et al. (2022), in their study of adolescent schoolgirls in Cross River State, found that fear of ridicule and unavailability of sanitary towels were significantly associated with missing school during menstruation. Respondents also identified fear of staining uniforms, lack of places to dispose of sanitary materials, and menstrual pain as reasons for school absence. The researchers concluded that menstruation-related absenteeism could adversely affect academic performance and recommended improved access to sanitary materials and appropriate WASH facilities in schools. These findings demonstrate that school attendance during menstruation is influenced by a combination of knowledge, practical preparedness, social attitudes and environmental conditions.

Educational interventions have also demonstrated that structured menstrual health education can improve girls’ menstrual hygiene knowledge and practices. Agbede et al. (2022) conducted a quasi-experimental study among adolescent girls in secondary schools in Ogun State, Nigeria, involving peer-led, parent-led and combined parent-and-peer-led menstrual hygiene education. The study found statistically significant improvements in menstrual hygiene practices following the interventions, with the peer-led intervention producing the largest observed change among the intervention groups. This evidence is important because it suggests that menstrual education delivered through appropriate school-based approaches can improve the capacity of adolescent girls to manage menstruation. However, improved hygiene knowledge and practices need to be considered alongside educational outcomes such as attendance because the ultimate concern for schools is not only whether girls know how to manage menstruation but whether they can remain engaged in learning during their menstrual periods.

The issue is particularly relevant to Osogbo, Osun State, because evidence already exists showing that menstrual health management challenges occur within schools in Osun State. UNICEF Nigeria’s assessment specifically included Osun State and documented challenges involving menstrual-health information, sanitary materials and school WASH conditions. UNICEF has subsequently emphasised that menstrual health interventions require a combination of information, access to menstrual products, adequate WASH facilities and efforts to reduce stigma and harmful social norms. More recent WHO and UNICEF evidence similarly identifies menstrual health education as an important school intervention for health, dignity and equal learning opportunities, while noting continuing global gaps in menstrual-health education and menstrual facilities in schools. Despite the availability of evidence on menstrual hygiene management in Nigeria, there remains a need for location-specific research examining the relationship between menstrual health education and school attendance among adolescent girls in public secondary schools in Osogbo. This study therefore seeks to examine whether menstrual health education is associated with regular school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State.

1.2 Statement of the Problem

Menstruation is a normal biological process, yet it can become a barrier to educational participation when adolescent girls lack adequate knowledge, sanitary materials, privacy and supportive school environments. Girls may experience uncertainty about menstrual management, fear of staining their uniforms, embarrassment and anxiety about being teased by classmates. UNICEF Nigeria has documented that Nigerian schoolgirls experience challenges related to inadequate information, poor WASH facilities and limited access to menstrual materials, while social and cultural beliefs can further affect their ability to manage menstruation with dignity. These challenges raise concern because repeated absence from school can result in missed lessons and reduced educational participation.

A second problem concerns the persistence of menstrual-related school absenteeism among adolescent girls despite increasing recognition of menstrual health as an educational and public-health issue. Evidence from Nigeria indicates that a substantial proportion of school-going girls have reported missing school because of menstruation. Miiro et al. (2018), using PMA2020 data, reported that 23% of Nigerian girls aged 15–24 who had attended school in the previous year reported menstruation-related school absence. Similarly, Edet et al. (2022) found that fear of ridicule and lack of sanitary towels were significantly associated with school absenteeism among adolescent girls in Cross River State. The persistence of these challenges suggests that menstrual health education and related school support require further attention.

A third problem is that menstrual health education may not always adequately address the practical and social difficulties adolescent girls face during menstruation. Knowledge about the menstrual cycle alone may be insufficient when girls lack practical information on sanitary-material use, changing procedures, disposal, pain management, personal hygiene and available sources of assistance. The Nigerian study by Oche et al. (2012) showed that girls without pre-menarcheal training were more likely to experience adverse effects of menstruation on schooling and social life, while Agbede et al. (2022) demonstrated that structured educational interventions could significantly improve menstrual hygiene practices among Nigerian schoolgirls. This creates a need to investigate whether the level and nature of menstrual health education received by adolescent girls are related to their ability to attend school consistently during menstruation.

Finally, there is a specific contextual research gap concerning public secondary schools in Osogbo, Osun State. Although the UNICEF assessment of menstrual hygiene management included Osun State and established that information, sanitary materials and school WASH conditions influence girls’ menstrual experiences, there is limited recent location-specific evidence focusing specifically on the relationship between menstrual health education and school attendance among adolescent girls in public secondary schools in Osogbo. Furthermore, studies from other Nigerian states, including Ogun and Cross River States, demonstrate the importance of menstrual education, sanitary access and supportive environments but cannot automatically be generalised to Osogbo because school conditions, community norms, socioeconomic circumstances and educational practices may differ. The study therefore seeks to examine the relationship between menstrual health education and school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State.

1.3 Purpose of the Study

The main purpose of this study is to examine the relationship between menstrual health education and school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State.

Specifically, the study seeks to:

1. examine the relationship between menstrual health knowledge and school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State;
2. determine the relationship between menstrual hygiene education and school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State;
3. assess the relationship between menstrual health communication and school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State; and
4. examine the relationship between access to menstrual-health information and support services and school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State.

1.4 Research Questions

The following research questions will guide the study:

1. What is the relationship between menstrual health knowledge and school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State?
2. What is the relationship between menstrual hygiene education and school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State?
3. What is the relationship between menstrual health communication and school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State?
4. What is the relationship between access to menstrual-health information and support services and school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State?

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 health education and school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State.

1.6 Significance of the Study

The study will be significant to adolescent girls because it will provide information on the importance of menstrual health education in helping them understand and manage menstruation appropriately. Improved knowledge may help girls feel more prepared for menstruation and reduce some of the uncertainty, embarrassment and misconceptions associated with the menstrual cycle.

The study will be useful to teachers and school administrators because it may provide evidence concerning the relationship between menstrual-health education and school attendance. The findings may assist schools in strengthening health education programmes, providing appropriate information and creating supportive environments in which girls can manage menstruation without unnecessary disruption to their education.

The study will also benefit parents and guardians. Evidence from Nigerian research shows that parents, particularly mothers, are important sources of menstrual information, while timely education before menarche can influence girls’ menstrual experiences and hygiene practices. The findings may therefore encourage parents and guardians to provide accurate and timely menstrual information and to communicate openly with adolescent girls about menstrual health.

The study will be relevant to government agencies and health-education policymakers, particularly those responsible for adolescent health, school health, girls’ education, WASH and reproductive health. WHO and UNICEF have identified menstrual health education, appropriate facilities and access to menstrual materials as important elements of creating supportive school environments and promoting equal learning opportunities. Evidence from Osogbo may assist policymakers in designing interventions that respond to the circumstances of girls in public secondary schools.

The study will also be valuable to health professionals and non-governmental organisations working in adolescent and reproductive health. Findings may help such organisations identify areas where girls require additional education, counselling, menstrual-health information and referral support.

Finally, the study will contribute to academic knowledge by providing empirical evidence on menstrual health education and school attendance within the specific context of selected public secondary schools in Osogbo, Osun State. It may provide a basis for further studies on menstrual health, adolescent education, school attendance, WASH and reproductive-health education in other parts of Nigeria.

1.7 Scope of the Study

The study focuses on menstrual health education and school attendance among adolescent girls in selected public secondary schools in Osogbo, Osun State.

The geographical scope of the study is limited to selected public secondary schools within Osogbo. The population of the study will comprise adolescent girls who are enrolled in the selected public secondary schools and who have experienced menarche.

The independent variable is menstrual health education, measured through four dimensions: menstrual health knowledge, menstrual hygiene education, menstrual health communication, and access to menstrual-health information and support services.

The dependent variable is school attendance, which refers to the regularity with which adolescent girls attend school, including attendance during and around their menstrual periods.

The study does not attempt to examine every factor that may affect school attendance. Factors such as household income, distance to school, transportation, general illness, family responsibilities and academic motivation may influence attendance but are outside the principal variables of this study unless they emerge as relevant background characteristics.

1.8 Operational Definition of Terms

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

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

Menstrual Health: A state in which girls have accurate information, appropriate materials, adequate WASH facilities, health services, privacy, dignity and freedom from stigma to manage menstruation safely and participate fully in everyday life.

Menstrual Health Education: The organised provision of accurate, age-appropriate information and practical guidance concerning menstruation, menstrual hygiene, menstrual symptoms, use of sanitary materials, disposal practices, menstrual disorders and sources of health support.

Menstrual Health Knowledge: The level of understanding an adolescent girl possesses concerning the menstrual cycle, menarche, menstrual hygiene, symptoms, sanitary materials and appropriate health practices.

Menstrual Hygiene Education: Instruction concerning the practical management of menstruation, including personal hygiene, changing sanitary materials, safe disposal, hand hygiene and maintenance of cleanliness during menstruation.

Menstrual Health Communication: The process through which adolescent girls receive, discuss and exchange information about menstruation with parents, teachers, health workers, peers and other trusted persons.

Menstrual-Health Information and Support Services: The information, counselling, guidance, materials, facilities and referral assistance available to adolescent girls to help them manage menstruation safely and confidently.

School Attendance: The regular presence of an adolescent girl at school and participation in scheduled school activities, including attendance during her menstrual period.

School Absenteeism: Failure of an adolescent girl to attend school for a scheduled school day, including absence associated with menstruation or menstrual-related difficulties.

Public Secondary School: A secondary school established, funded or administered by a government authority and serving students within the public education system.

Osogbo: The capital city of Osun State, Nigeria, and the geographical setting within which the selected public secondary schools for this study are located.

Project – Menstrual Health Education and School Attendance among Adolescent Girls: A Study of Selected Public Secondary Schools in Osogbo, Osun State