Menstrual hygiene management practices and associated factors among in-school adolescent girls in Uganda: Secondary analysis of the 2023 AGYW survey data

For millions of girls around the world, the arrival of menstruation is a biological milestone that should mark a step toward adulthood. Yet, for many, it becomes a barrier to education. When a girl lacks access to clean materials to manage her flow, or when her school lacks private toilets and running water, the result is often shame, discomfort, and missed classes. This is not merely a matter of personal hygiene; it is a public health issue that keeps young women out of the classroom. Researchers have long known that providing sanitary products and education can help, but the specific habits of younger girls—those just beginning their cycles—remain less understood. To design interventions that truly work, we need to know exactly what these girls are doing, what they are using, and what factors in their lives help or hinder them.

A team of researchers at Makerere University School of Public Health in Uganda set out to fill this gap. They turned their attention to in-school girls between the ages of ten and seventeen, a group that includes many who are experiencing menstruation for the first time. The team did not conduct a new survey from scratch; instead, they performed a careful secondary analysis of data collected in July 2023 from a large study involving over 5,000 adolescent girls and young women across fourteen districts in Uganda. This original survey gathered detailed information on the girls' lives, their households, and their health. The researchers focused specifically on the 1,097 girls in that group who were currently attending school. They asked these girls about their most recent menstrual period: what materials they used to manage the flow, how often they washed their genitals, and what they used to clean themselves. They also looked at the girls' ages, their level of education, their religion, who they lived with, and the possessions their families owned to determine their economic standing.

The results paint a clear picture of the current reality for these students. The vast majority of the girls who had started their periods reported using disposable pads during their most recent cycle. Nearly 89 percent of them relied on these single-use products, while only about 11 percent used reusable materials like cloth or washable pads. This preference for disposable items was not random; it was strongly linked to the wealth of the girl's household. Girls from the wealthiest families were significantly more likely to use disposable pads than those from poorer households. The data suggests that money is a primary gatekeeper for this specific choice, as the most affordable option for many remains the reusable alternative, despite the convenience of disposables.

When it came to cleanliness, the girls showed a strong commitment to hygiene. Almost all of them, roughly 98 percent, reported washing their genitals at least twice a day during their period. However, the method they used to clean themselves told a more complex story. Slightly more than half of the girls said they used both soap and water to wash, while the rest used water alone. The researchers found that the decision to use soap was influenced by several factors. Girls who used reusable pads were more likely to use soap and water, perhaps to manage odors or ensure the cloth was clean. Similarly, girls who started their periods at an older age, between fifteen and seventeen, were more likely to use soap. Interestingly, the frequency of bathing also played a role; girls who bathed only once a day were more likely to use soap and water for cleaning their genitals compared to those who bathed more often. This finding was unexpected, as one might assume that more frequent bathing would correlate with more frequent use of soap, but the data pointed in the opposite direction.

The study also highlighted that wealth influences more than just the choice of pad. Girls from the poorest households were actually more likely to use soap and water to wash their genitals than their wealthier peers. The researchers noted that this might seem counterintuitive, as poorer households often have less access to soap. They suggested that girls in these households might lack specific health information regarding the potential risks of using soap on sensitive areas, leading them to use it more frequently. Conversely, wealthier girls might have better access to health education that advises against it, or they might simply have more options for cleaning. The study did not prove this explanation, but it offered it as a plausible reason for the pattern they observed.

Ultimately, the research confirms that while most in-school adolescent girls in Uganda are managing their periods with disposable pads and washing frequently, their practices are deeply shaped by their economic circumstances and their age. The use of disposable pads is a privilege tied to household wealth, and the choice to use soap for cleaning is linked to the type of material used and the girl's age. The authors conclude that to help these girls stay in school, interventions cannot be one-size-fits-all. Programs need to be tailored to the specific needs of different groups, ensuring that girls from poorer backgrounds have access to affordable menstrual materials and that all girls receive clear, safe education on how to maintain their hygiene without risking their health. The path forward requires understanding these nuances to turn the biological reality of menstruation from a barrier into a manageable part of daily life.