Project – The Effect of Health Education on Menstrual Hygiene Practices Among Adolescent Girls: A Study of Selected Secondary Schools in Ikeja Local Government Area, Lagos State.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Menstrual hygiene is an important component of adolescent health, personal hygiene, reproductive health education, and the overall wellbeing of girls. Menstruation is a natural biological process that occurs as part of the female reproductive cycle, yet many adolescent girls experience uncertainty, embarrassment, misconceptions, and difficulties managing their periods safely and comfortably. Menstrual hygiene practices involve using appropriate menstrual materials, changing them as needed, maintaining personal cleanliness, washing hands, managing used materials safely, and accessing adequate water, sanitation, and privacy. The World Health Organization (WHO, 2025) explains that menstrual health requires access to accurate information, appropriate materials, adequate sanitation facilities, and healthcare when menstrual difficulties arise. Therefore, menstrual hygiene should not be viewed merely as a private matter of personal cleanliness; it is also a public health and educational concern that affects girls’ dignity, confidence, participation in school, and general wellbeing.

Adolescence is a critical stage of human development during which girls undergo physical, emotional, psychological, and social changes associated with puberty. The onset of menstruation, known as menarche, can be confusing when girls have not received adequate information before their first menstrual period. Some girls may not understand why menstruation occurs, how long it normally lasts, which materials are suitable for absorbing menstrual blood, or how to maintain hygiene during their periods. Aniebue, Aniebue, and Nwankwo (2009) found that inadequate preparation before menarche was associated with unfavourable menstrual experiences, including inappropriate menstrual hygiene practices and adverse effects on school and social life. Their findings underscore the importance of providing age-appropriate menstrual health education before and after menstruation begins. When girls receive accurate and timely information from teachers, parents, healthcare workers, and other trusted sources, they are better positioned to understand menstruation as a normal biological process and develop appropriate hygiene habits.

Health education is a planned process of providing information and developing the understanding, attitudes, and practical skills individuals need to make informed decisions about their health. In relation to menstrual hygiene, health education may cover the biology of menstruation, selection and proper use of menstrual materials, frequency of changing absorbents, handwashing, genital hygiene, disposal or washing of used materials, management of menstrual discomfort, and recognition of symptoms that require professional medical attention. The WHO (2025) emphasises that menstrual health education should provide accurate, understandable information and enable individuals to manage menstruation safely and with dignity. In secondary schools, health education can be delivered through classroom lessons, school health programmes, demonstrations, counselling, peer education, health clubs, and discussions facilitated by trained teachers or healthcare professionals. Such approaches may help correct myths, improve confidence, and encourage girls to adopt healthier menstrual hygiene practices. However, the effectiveness of health education depends on whether the information is understood, remembered, accepted, and translated into daily behaviour.

The importance of menstrual hygiene extends beyond the choice of sanitary materials to include the maintenance of personal cleanliness and the availability of suitable school facilities. Girls need access to clean water, soap, private toilets, facilities for changing menstrual materials, and safe arrangements for disposing of used products. UNICEF Nigeria’s assessment of menstrual hygiene management in secondary schools found that girls’ experiences were influenced by the availability and adequacy of water, sanitation and hygiene facilities, the quality of information received, and access to menstrual materials (UNICEF Nigeria, 2016). Where these resources are inadequate, girls may find it difficult to change menstrual materials privately, wash their hands, clean reusable materials appropriately, or dispose of used products safely. This demonstrates that health education and the school environment are complementary: education can improve knowledge and decision-making, but appropriate facilities and resources are also necessary for girls to put that knowledge into practice.

Evidence from Nigeria indicates that inadequate menstrual health information and unfavourable social attitudes can affect girls’ experiences of menstruation. Menstruation may be treated as a subject that should not be discussed openly, while myths and cultural beliefs can create embarrassment or discourage girls from asking questions. In a study of Nigerian schoolgirls, Aniebue et al. (2009) identified the importance of timely preparation for menstruation, while other research on Nigerian secondary schoolgirls has documented concerns about menstrual perceptions and hygiene practices. UNICEF Nigeria (2022) has also highlighted how stigma, inadequate school sanitation facilities, and limited access to menstrual information and products can contribute to difficulties managing menstruation and may affect school attendance. Such challenges suggest that girls may need more than occasional information: they may benefit from repeated, practical, and culturally sensitive health education that involves teachers, parents, school administrators, and health professionals. An enabling environment can help girls ask questions without shame, understand their bodies, and practise menstrual hygiene with confidence.

The potential educational consequences of poor menstrual hygiene management make this issue particularly important in secondary schools. Girls who lack suitable menstrual materials, accurate information, privacy, or supportive school facilities may experience anxiety about staining their uniforms, fear teasing from classmates, or feel uncomfortable participating in lessons and school activities. In some circumstances, these concerns may contribute to absence from school or reduced classroom participation. The joint WHO and UNICEF report on drinking water, sanitation, and hygiene in schools identified continuing gaps in menstrual health education and the facilities needed to support menstruating learners (WHO & UNICEF, 2024). These findings reinforce the need for schools to provide both health information and a supportive physical environment. Effective menstrual health education may improve girls’ confidence and preparedness, but its influence should be examined rather than assumed. It is therefore necessary to assess whether girls who receive health education demonstrate better menstrual hygiene practices and whether educational activities address their actual information and practical needs.

In Ikeja Local Government Area of Lagos State, secondary schools provide an important setting for investigating how health education may influence menstrual hygiene practices among adolescent girls. Although existing Nigerian research and international guidance establish the importance of menstrual health education, adequate facilities, and access to appropriate menstrual materials, they do not automatically establish the level of knowledge or the effect of health education among girls in the particular schools selected for this study. Differences in the content and frequency of school health lessons, teacher preparedness, parental communication, access to menstrual products, and the adequacy of water and sanitation facilities may shape girls’ experiences. A focused investigation is therefore needed to assess the menstrual hygiene practices of adolescent girls, examine their exposure to health education, and determine whether health education is associated with better practices in the selected secondary schools. This study consequently examines the effect of health education on menstrual hygiene practices among adolescent girls in selected secondary schools in Ikeja Local Government Area, Lagos State, with a view to providing evidence that may support improved school health education and menstrual health promotion.

1.2 Statement of the Problem

Menstrual hygiene is essential to the health, dignity, comfort, and educational participation of adolescent girls. However, some girls enter adolescence without adequate information about menstruation and the appropriate ways to manage their menstrual periods. Inadequate preparation may result in fear, embarrassment, misconceptions, and inappropriate hygiene practices, particularly among girls experiencing menstruation for the first time. Aniebue et al. (2009) reported that girls who had not received preparation before menarche experienced less favourable menstrual experiences and were more likely to engage in inappropriate menstrual practices. Although menstruation is a normal biological process, insufficient health education may prevent girls from understanding it correctly and managing it confidently. This raises concern about whether adolescent girls in selected secondary schools in Ikeja Local Government Area receive adequate health education to support safe and appropriate menstrual hygiene practices.

Another problem concerns the possibility that adolescent girls may have incomplete knowledge of the practical measures required for menstrual hygiene. Such measures include selecting suitable menstrual materials, changing them regularly, maintaining hand and body cleanliness, managing reusable materials appropriately, and disposing of used products safely. The WHO (2025) identifies accurate menstrual health information, access to appropriate materials, and adequate sanitation facilities as important elements of menstrual health. Nevertheless, girls may rely on information from friends, social media, or informal sources that do not always provide accurate or complete guidance. Cultural taboos and embarrassment may also discourage them from discussing menstruation with parents, teachers, or healthcare workers. These circumstances create a need to examine whether health education in the selected schools provides sufficient practical information to help adolescent girls make informed decisions and develop appropriate menstrual hygiene habits.

The school environment may further complicate the practice of menstrual hygiene, even when girls possess adequate knowledge. A student may understand the importance of changing menstrual materials and washing her hands but may be unable to do so conveniently if the school lacks clean water, soap, private toilets, suitable changing spaces, or safe disposal facilities. UNICEF Nigeria (2016) found that the menstrual hygiene experiences of girls in Nigerian secondary schools were influenced by the adequacy of school water, sanitation and hygiene facilities, access to menstrual materials, and the availability of information. Similarly, WHO and UNICEF (2024) documented continuing gaps in menstrual health education and school facilities internationally. These findings demonstrate that health education should be considered alongside the practical conditions that enable girls to follow the information they receive. However, the extent to which these issues affect girls in the selected secondary schools in Ikeja requires local investigation.

Furthermore, although health education is widely recognised as a useful approach to improving health knowledge and behaviour, its actual influence on menstrual hygiene practices among adolescent girls in the selected schools has not been established by the general evidence cited above. It remains necessary to determine whether girls who have received menstrual health education demonstrate better practices than those with limited or no exposure, and to identify the aspects of menstrual hygiene that require further instruction. Without such evidence, school administrators, teachers, parents, and health educators may find it difficult to determine which educational activities should be strengthened and what practical barriers need attention. The WHO (2025) emphasises the need for accurate information, suitable materials, supportive services, and freedom from menstrual stigma. Consequently, this study seeks to investigate the effect of health education on menstrual hygiene practices among adolescent girls in selected secondary schools in Ikeja Local Government Area, Lagos State.

1.3 Objectives of the Study

The main objective of this study is to examine the effect of health education on menstrual hygiene practices among adolescent girls in selected secondary schools in Ikeja Local Government Area, Lagos State.

The specific objectives are to:

1. Assess the level of knowledge of menstrual hygiene among adolescent girls in selected secondary schools in Ikeja Local Government Area.

2. Identify the sources and forms of health education on menstrual hygiene received by adolescent girls in the selected secondary schools.

3. Examine the menstrual hygiene practices adopted by adolescent girls in the selected secondary schools.

4. Determine the relationship between exposure to health education and menstrual hygiene practices among adolescent girls in the selected secondary schools.

1.4 Research Questions

The following research questions will guide the study:

1. What is the level of knowledge of menstrual hygiene among adolescent girls in selected secondary schools in Ikeja Local Government Area?

2. What sources and forms of health education on menstrual hygiene are available to adolescent girls in the selected secondary schools?

3. What menstrual hygiene practices are adopted by adolescent girls in the selected secondary schools?

4. Is there a significant relationship between exposure to health education and menstrual hygiene practices among adolescent girls in the selected secondary schools?

1.5 Research Hypothesis

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

H₀: There is no statistically significant relationship between exposure to health education and menstrual hygiene practices among adolescent girls in selected secondary schools in Ikeja Local Government Area, Lagos State.

1.6 Significance of the Study

The findings of this study may be beneficial to adolescent girls, teachers, school administrators, parents and guardians, healthcare professionals, government agencies, researchers, and future students.

Adolescent girls: The study may help identify gaps in menstrual hygiene knowledge and practices. Its findings may support the development of age-appropriate educational activities that help girls understand menstruation, select and use suitable menstrual materials, maintain personal hygiene, and manage their periods with confidence and dignity.

Teachers and health educators: The findings may help teachers identify areas where students need further instruction. They may also provide a basis for improving the delivery of menstrual health education through classroom lessons, demonstrations, discussions, counselling, and school health programmes.

School administrators: The study may provide useful information for planning school-based health education and improving the conditions that support menstrual hygiene. The findings may draw attention to the importance of clean water, soap, private toilets, suitable waste-disposal arrangements, and access to menstrual hygiene information and materials.

Parents and guardians: The study may encourage parents and guardians to communicate more openly with adolescent girls about menstruation. It may also highlight the importance of preparing girls before menarche and providing appropriate guidance and support throughout adolescence.

Healthcare professionals: Nurses, community health workers, and other health educators may use the findings to develop or improve school outreach programmes and adolescent health education activities. The findings may also help them identify common misconceptions that require correction.

Government and education policymakers: The study may provide local evidence to inform school health policies and menstrual health promotion programmes in Ikeja Local Government Area and Lagos State. The findings may support efforts to integrate menstrual health education into broader school health and water, sanitation and hygiene initiatives.

Researchers and students: The study may contribute to the literature on adolescent health education and menstrual hygiene practices. It may also serve as a reference for further studies examining menstrual health knowledge, educational interventions, and school environmental conditions in other locations.

1.7 Scope of the Study

The study focuses on the effect of health education on menstrual hygiene practices among adolescent girls in selected secondary schools in Ikeja Local Government Area, Lagos State. Its content scope includes girls’ knowledge of menstruation, sources and forms of menstrual health education, menstrual hygiene practices, and the relationship between exposure to health education and reported practices. The practices considered may include the use and changing of menstrual materials, handwashing, personal cleanliness, appropriate management of reusable materials, disposal of used products, and seeking assistance when menstrual difficulties arise.

The geographical scope is limited to the selected secondary schools in Ikeja Local Government Area, Lagos State. The population of the study comprises adolescent girls enrolled in the selected schools, subject to the study’s inclusion criteria and the approved data-collection arrangements. The study does not automatically represent all adolescent girls in Ikeja or Lagos State.

1.8 Limitations of the Study

The study may encounter certain limitations. First, participants may provide socially desirable responses about their menstrual hygiene practices because the subject is personal and sometimes sensitive. Second, girls may have difficulty recalling the specific health education they have received or how often they practise particular hygiene behaviours. Third, differences in school resources, menstrual material availability, and home support may influence practices independently of health education. These factors may complicate the interpretation of the relationship between education and hygiene behaviour.

In addition, if the study uses a cross-sectional questionnaire, it may identify an association between health education exposure and menstrual hygiene practices but may not establish a causal effect conclusively. To reduce these limitations, the researcher will use clear, age-appropriate questions, protect participants’ privacy, explain that participation is voluntary, and obtain the necessary ethical approvals and consent or assent in accordance with institutional requirements. The findings will be interpreted within the limits of the study design and the selected schools.

1.9 Operational Definition of Terms

Health education: The planned provision of information and practical guidance intended to improve adolescent girls’ understanding, attitudes, and behaviours relating to menstruation and menstrual hygiene.

Menstruation: The natural process in which blood and tissue from the lining of the uterus are discharged through the vagina as part of the menstrual cycle.

Menstrual hygiene: The personal hygiene behaviours and practices adopted to manage menstrual bleeding safely, comfortably, and with dignity.

Menstrual hygiene practices: The reported actions of adolescent girls during menstruation, including the use and changing of menstrual materials, handwashing, personal cleanliness, and appropriate management or disposal of used materials.

Adolescent girls: Female students within the adolescent age range who meet the inclusion criteria and attend the selected secondary schools in Ikeja Local Government Area.

Menarche: The first menstrual period experienced by a girl, marking the onset of menstruation.

Menstrual materials: Products or absorbent materials used to collect or absorb menstrual blood, including disposable sanitary pads and suitable reusable menstrual materials.

Selected secondary schools: The secondary schools chosen for participation in the study within Ikeja Local Government Area, Lagos State.

Effect of health education: For this study, the extent to which exposure to menstrual health education is associated with differences in girls’ menstrual hygiene knowledge and reported practices. Where a non-experimental design is used, the findings will be interpreted as associations rather than definitive proof of causation.

Project – The Effect of Health Education on Menstrual Hygiene Practices Among Adolescent Girls: A Study of Selected Secondary Schools in Ikeja Local Government Area, Lagos State.