Menstruation and Menstrual Hygiene Experiences of In-School Adolescents in Urban and Rural Secondary Schools in Cross River State, Nigeria: A Qualitative Study

Background: Menstruation, a normal physiological occurrence in females from puberty to menopause is yet to become a regular subject of discussion between parents/caregivers and their children/wards leading to misinformation and poor hygiene practices among adolescent girls.

Objective: This study aimed at exploring in-school adolescent girls’ experiences at menarche and current menstrual hygiene practices.

Methods: Adolescent female students from junior secondary-two to senior secondary-two in eight schools participated in audiotaped focus group discussions. There were two groups per school; one from junior and one from senior students. Thematic and content analysis of the transcripts were conducted manually. Ethical approval was obtained and all ethical principles were observed.

Results:  Majority of the adolescents had no prior knowledge of menstruation before menarche. After a menstrual accident, leading to stained underwear, whomever they confided in, provided the emergency education on sanitary materials. Materials used included, sanitary pads, tissue paper and rags. Men’s involvement in emergency education was minimal including referrals with or without education. Participating schools lacked gender sensitive toilets and sanitary pads leading to students missing classes because they had to go home to clean up.  Culturally, there is fear of harm from evil people through soiled sanitary materials so, disposal was done in secret. Some religious organizations placed restrictions on girls/women, such as getting on the worship altar during menstruation. On relationship with boys after menarche, the teenagers heard the warnings; “avoid touching”, respect yourself around boys, or “do not play” with boys.

Conclusions:  It is recommended that schools should organize annual menstrual hygiene education sessions for parents, students and teachers.