Characterizing the experiences and financial burden of menstrual hygiene management among Rwandan Lower Secondary School girls

Background:
Menstrual hygiene management (MHM) is integral to a woman’s health and
requires access to clean sanitary products, resources to wash her body, and safe places to dispose
of used menstrual products.
Objective:
Describe the perceptions, practices, financial burden, and environmental factors that
influence the experiences of menstruation for public, government aided, and private lower
secondary school girls in Rwanda in 2022.
Methods:
In this cross-sectional study, a quantitative survey was conducted at one randomly
selected public, government aided, and private school in each of Rwanda’s five provinces. The
survey was administered in-person to menstruating girls in lower secondary school years 2 and 3
from March to June in 2022. The research team conducted a checklist surveying the water,
sanitation, and hygiene (WASH) facilities and resources at each school. The quantitative survey
described the participants' practices and preferences surrounding menstrual hygiene management
and assessed the financial burden of menstruation. Students reported most frequently used MHM
products during menstruation, source of information about MHM, and access to MHM WASH
facilities and products. The annual cost of menstruation was calculated as a composite of the cost
of MHM products and transportation required to access products. Quantitative measures were
disaggregated by school type and reported descriptively with frequencies and counts.
Quantitative analysis to test for the association between variables was conducted. WASH
checklist data was reported with frequencies and counts.
Results:
A total of 1,117 menstruating girls were surveyed at fifteen schools in Rwanda. Most
girls used disposable sanitary pads while menstruating (89.3%). Lack of money was the primary
barrier for not accessing the MHM supplies they needed (61.3%). Out of 645 respondents, 81.7%
of girls missed four or fewer days of school per year due to menstruation. Girls also missed
spiritual activities (43.2%), sporting activities (36.3%), and social activities (20.3%) due to
menstruation. MHM cost girls a median of 4,000 RWF per menstrual cycle. There was a
statistically significant difference in cost among school types, with girls from private schools
spending the least on MHM. During site visits, researchers found that almost half of schools
(n=7) had no water source on campus and most schools had pit latrines (n=13). Girls primarily
disposed of used sanitary products in pit latrines at home and school (>78%). Ten schools had
menstrual hygiene rooms on site.
Conclusion:
Most surveyed girls who are enrolled in lower secondary school years 2 and 3 in
Rwanda menstruate, though they do not always have sufficient resources to manage their
menstruation safely and privately. MHM education, access to sanitary products, and WASH
facilities is integral to a girls’ engagement in school and social activities.