By Sarah Jewitt, University of Nottingham
Many girls in the developing world feel they are forced to skip school while they are menstruating. They don't have proper sanitary wear or don't have underwear to hold sanitary pads in place. The bathrooms at their schools are not clean or hygienic. They are also frightened that their school uniforms - which are often light in colour - will be stained.
The United Nations has acknowledged menstrual health requirements as a major issue in its recently ratified Sustainable Development Goals (SDGs). Target 6.2 emphasises "adequate and equitable sanitation and hygiene for all" with "special attention to the needs of women and girls".
As the world marked the UN's International Day of the Girl Child on October 11, it's important to remember that menstruation isn't the only thing keeping girls away from school. Other contributors include generally unsatisfactory school environments; family pressure or a girl's own desire to get married; parents who refuse to pay school fees; pregnancy and HIV.
The inclusion of menstrual hygiene in the SDGs marks an important step forward, but to what extent will it address the issue of schoolgirl absenteeism? To find out, we interviewed girls and teachers from nine schools in Kisumu, which is Kenya's third-largest city and among its poorest.
Shame and a lack of privacy
In the nine Kisumu schools we studied, pupils and teachers alike identified menstruation-related issues as important causes of schoolgirl absenteeism. Many girls admitted that they stayed home or in the school's sick bay when they had menstrual cramps.
One teacher told us that girls who had access to sanitary towels came to school, but those who didn't felt "shy" and stayed away. Poverty underpins many girls' lack of access to disposable sanitary towels. These cost between 65 and 120 Kenyan Shillings (US$0.79-$1.45) and are unaffordable to families earning the average Kenyan daily income of just above US$1 per day.
Many girls rely on rags or tissues instead, so they worry about leaks - especially because they have no underwear to keep their protection in place.
There is nothing to make it stick! At times (the pads or tissues) fall down when you are walking!
Those who attend school while menstruating still miss out, both socially and academically. Several girls said they daren't go out to play during break times during their periods. One told us that she sometimes sat in her classroom all day in case she leaked. Others refused to answer questions when menstruating - they must stand up to do so and were afraid that other pupils might see their stained uniforms.
These uniforms, which were mostly pale in colour, presented a particular difficulty. The slightest stain was clearly visible and many girls talked of feeling "shy", "embarrassed" and afraid of being ridiculed if their sanitary protection leaked.
They also mentioned the difficulties of staying in school if a leak did occur: they had to remove their dresses (most had only one uniform), wash out the stains in the latrines and return to class after their uniforms had dried. In most schools, latrines were very dark and had neither doors nor locks. There was also no soap available and the water supply was far from the latrines.
Risks and abuse
Those girls with access to reliable forms of sanitary protection were more likely to attend school. But in some cases this access came at a high price. Two head teachers revealed that girls sometimes agreed to have sex with older men in exchange for sanitary products so that they could attend school. This happens elsewhere in Kenya, too. Inevitably this sometimes resulted in pregnancy and HIV, which ultimately forced the girls to drop out of school.
Other girls reported increased pressure from their parents, as they visibly matured, to drop out of school so that they could either help out at home or marry. These conversations revealed an underlying acknowledgement of the cultural tolerance of girls' sexual exploitation and a desire by parents to reduce the risk of pregnancy or sexual assault en route to or at school.
Such risks were also acknowledged in girls' conversations about poorly lit school toilets with no locks where boys sometimes hide,sexually harass and threaten to rape them.
There are simple changes that can be made relatively quickly and easily to address the issues in Kisumu.
These include better latrine lighting, drying lines for reusable sanitary products and access to painkillers for menstrual cramps. Within Kenyan classrooms, a shift in etiquette that allows pupils to answer questions while sitting and enables girls to take toilet breaks without punishment would also improve girls' experience of school during menstruation.
Hopefully the SDGs' emphasis on women and girls' sanitation needs will incentivise national governments all over the world to improve privacy, safety, maintenance and menstrual hygiene management provision in schools.
All of this research reflects a need for broader challenges to cultural norms about gender roles within other parts of sub-Saharan Africa. It is also important to overcome the cultural silence surrounding menstruation and puberty in many parts of sub-Saharan Africa and beyond.