Schoolgirls’ experiences of changing and disposal of menstrual hygiene items and inferences for WASH in schools

Menstrual hygiene management (MHM) challenges during changing and disposal of menstrual items are important in low-income countries (LICs) where schools lack sufficient water and sanitation. Changing in poorly maintained latrines may expose girls to excrement and infection. We examine the frequency of dropping menstrual items and disposal of waste by schoolgirls in a menstrual solutions feasibility study in western Kenya. Drops when changing were reported in 17 per cent (20 per cent <16 years; 16.5 per cent 16 years plus; p=0.04) of girls’ reports overall. Differences by socio-economic status were not evident. Fifty-four per cent of girls dropped at least once. A quarter of girls using pads and cups reported drops in the first few months, reducing to 10 per cent over time, compared with ~30 per cent among traditional item users. One in four accidental drops occurred at school during the study. When dropped at school, most girls swapped the dropped item for a new one, but 24 per cent brushed/washed the item and reused it. While no clinical events occurred during this study, data suggest dropping within latrines could place girls at potential risk of exposure to infection. Disposal of items, or emptying cups, was mostly into the latrine. We conclude that accidental dropping of menstrual items while changing is common, including at school. Prevention will be helped by improving poorly constructed sanitation facilities, shelving, privacy, and staggering/increasing break time for girls to change. Provision of special garbage bins to prevent clogging and overflow of latrines is recommended.