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American Journal of  Physical Education 
and Health Science (AJPEHS)

Role of  Academic Institutions in Promoting Menstrual Hygiene Management among 
School Girls in Lofa County, Liberia. Evidence from a Mixed-method Survey in Senior 

High Schools in Voinjama City
Washington Kezelee1*, James J. N. Morlu1, Mustapha Mohammed Tarwulleh1

Volume 2 Issue 2, Year 2024
ISSN: 2992-9679 (Online) 

DOI: https://doi.org/10.54536/ajpehs.v2i2.3475
https://journals.e-palli.com/home/index.php/ajpehs

Article Information ABSTRACT

Received: July 27, 2024

Accepted: August 25, 2024

Published: August 29, 2024

This study explores the role of  academic institutions in promoting menstrual hygiene 
management (MHM) among school girls in Lofa County, Liberia, focusing on senior high 
schools in Voinjama City. A mixed-method survey was conducted among 308 girls from seven 
high schools to assess their knowledge, access to menstrual products, sanitation facilities, and 
the impact of  menstrual hygiene management (MHM) on school attendence.The findings 
reveal that 66.1% of  respondents were informed about menstruation before their first period, 
with family being the primary source. While 70.4% of  girls received menstrual health education 
in schools, a significant 29.6% did not, indicating the need for more inclusive programs. 
Regarding menstrual products, 71.8% of  girls use disposable sanitary pads, though nearly 
half  (47.7%) consider them unaffordable. The study also highlights deficiencies in school 
sanitation facilities, with only 42.1% of  girls reporting access to clean and private facilities, and 
just 28.3% having proper disposal mechanisms for used products. Nearly half  (47.9%) of  the 
girls miss school due to menstruation, missing an average of  2.5 days per month. Qualitative 
findings emphasize the demand for sanitary pads and improved facilities, as well as the need for 
government intervention. The lack of  formal MHM policies in schools, coupled with limited 
teacher training and resources, further complicates effective MHM. The study concludes that 
while some progress has been made, significant gaps remain, necessitating enhanced efforts 
from schools, government, and communities to ensure comprehensive MHM for all girls, 
ultimately improving their education and well-being.

Keywords
Menstrual Hygiene Management, 
Menstrual Health Education, 
Menstruation and School 
Attendance

INTRODUCTION
The health, dignity, and educational attainment of  
schoolgirls are significantly affected by menstrual hygiene 
management (MHM), especially in low-income regions. 
Schools worldwide are increasingly acknowledging the 
necessity of  addressing MHM to support girls’ academic 
performance and overall well-being. According to the 
United Nations, adequate menstrual hygiene management 
involves the use of  clean menstrual materials, access to 
facilities for changing and disposing of  these materials, 
and maintaining proper hygiene during menstruation 
(Deshpande et al., 2018). Nonetheless, millions of  girls 
and women, particularly in low-income countries, face 
substantial barriers to achieving adequate menstrual 
hygiene. Approximately 800 million women aged 15 to 49 
menstruate each day, and for many, this natural biological 
process presents considerable challenges (UNFPA, 2022). 
Consequently, many girls encounter academic difficulties 
or miss school during their menstrual periods (Boosey, 
Prestwich, & Deave, 2014).
In sub-Saharan Africa, including Liberia, menstrual 
hygiene remains insufficiently addressed, with a lack 
of  regionally representative data on the prevalence of  
effective menstrual hygiene practices among adolescent 
girls (Anbesu & Asgedom, 2023). Research in Ethiopia 
indicates that inadequate menstrual hygiene practices 
among schoolgirls can negatively impact their dignity, 

well-being, academic performance, and school attendance 
(Habtegiorgis et al., 2021). Similarly, studies in Nigeria have 
demonstrated that many girls lack access to clean materials, 
facilities, pain relief, and proper disposal methods for 
menstrual hygiene (Nnennaya et al., 2021). A multi-method 
survey in Ghana revealed the sociocultural restrictions 
and barriers faced by adolescent schoolgirls and boys in 
managing menstruation (Anbesu & Asgedom, 2023).
A UNESCO report indicates that 1 in 10 girls in sub-
Saharan Africa misses school during menstruation due 
to a lack of  menstrual products or adequate sanitation 
(UNESCO, 2011). UNICEF has identified inadequate 
menstrual hygiene as a significant barrier to girls’ education 
in numerous regions, with poor facilities, insufficient 
sanitary products, and cultural taboos contributing to 
absenteeism and school dropouts (UNICEF, 2019). 
Effective menstrual hygiene management is crucial 
for the health and education of  adolescent girls, as 
it significantly influences their school attendance, 
participation, and performance. Good MHM practices 
include using clean menstrual management materials, 
changing these materials in privacy as needed, using soap 
and water for personal hygiene, and having access to safe 
and convenient facilities for disposing of  used materials 
(Sumpter & Torondel, 2013). Poor MHM can adversely 
affect the health and psychosocial well-being of  women 
and girls (Das et al., 2015).

1 Lofa County University, Republic of  Liberia
* Corresponding author’s e-mail: anesthetist15@gmail.com



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Despite these challenges, awareness of  the importance 
of  addressing MHM in schools is growing. Efforts are 
underway to integrate MHM into school curricula and 
provide girls with the necessary knowledge and resources 
to manage their menstruation effectively. For instance, 
UNICEF has recommended including menstrual hygiene 
management in the curricula of  primary schools in Asia 
and Africa (Shah et al., 2023). Academic institutions play a 
pivotal role in tackling these challenges. Schools serve not 
only as centers of  learning but also as critical environments 
for shaping attitudes and behaviors toward menstruation. 
They can furnish the necessary infrastructure, education, 
and support systems to help girls manage menstruation 
with dignity and comfort. Research has demonstrated 
that when schools actively promote MHM, significant 
improvements in girls’ attendance and academic 
performance ensue (Sommer et al., 2015). Studies 
conducted in India indicate that structured menstrual 
education programs in schools significantly enhance girls’ 
awareness of  menstrual hygiene and help reframe their 
understanding of  menstruation as a normal physiological 
process (Sivakami et al., 2019).
This study aims to investigate the role of  academic 
institutions in promoting effective menstrual hygiene 
management among senior high school girls in Voinjama 
City, Lofa County, Liberia. It seeks to understand existing 
practices, challenges, and the impact of  menstrual 
hygiene on girls’ education and develop actionable 
recommendations to enhance menstrual hygiene 
management within the school environment.

Menstrual Hygiene Situation in Liberia
Menstrual hygiene management (MHM) remains a critical 
issue in Liberia among women and girls. The availability 
of  affordable menstrual hygiene products is limited, and 
inadequate sanitation facilities further exacerbate the 
challenge, leaving many without the necessary means 
to manage their menstruation hygienically. According 
to a study by WaterAid Liberia, approximately 30% of  
Liberian women and girls are unable to consistently afford 
menstrual pads or tampons, highlighting the pervasive issue 
of  period poverty in the country (Borgen Project, 2024). 
The United Nations has underscored the importance 
of  addressing menstrual hygiene as a fundamental right, 
recognizing that access to water, sanitation, and hygiene 
(WASH) facilities, affordable menstrual hygiene materials, 
and a supportive environment are essential for effective 
MHM (Boisen et al., 2016).

Impact of  Inadequate Menstrual Hygiene 
Management on Girls Education
Menstrual hygiene management is pivotal to the 
educational success of  girls. Inadequate MHM can have 
a profound negative impact on girls’ school attendance, 
participation, and overall education experience. Cultural 
taboos and restrictions related to menstruation often limit 
girls’ activities during their menstrual cycles, including, 
restrictions on religious practices and leaving the house. 

These constraints foster negative attitudes toward 
menstruation and impose both physical and psychological 
burdens on girls. The lack of  proper menstrual hygiene 
facilities, such as access to clean and effective absorbents, 
appropriate places to change and dispose of  them, 
and access to soap and water, contributes to increased 
absenteeism among girls during menstruation (Sivakami 
et al., 2019). The challenges faced by adolescent girls in 
low- and middle-income countries regarding effective 
MHM can lead to school dropout. Without access to 
clean absorbents, adequate facilities, and sufficient 
privacy, managing periods at school becomes challenging, 
resulting in disengagement from education and, ultimately, 
dropping out (Nnennaya et al., 2021).

Roles of  Schools in Menstrual Hygiene Management
The role of  schools in menstrual hygiene management 
(MHM) is critical in ensuring that girls have equitable access 
to education. Inadequate MHM facilities and education 
in schools have been linked to increased absenteeism, 
lower academic performance, and higher dropout rates 
among girls. In many low- and middle-income countries, 
the stigma and taboos surrounding menstruation are 
compounded by a lack of  appropriate infrastructure 
and education, leaving girls to manage menstruation in 
isolation and often with a sense of  shame (Sommer et 
al., 2016). Studies have shown that when schools provide 
adequate MHM resources—such as access to sanitary 
products, private and hygienic latrines, and comprehensive 
menstrual health education—girls are more likely to 
attend school consistently during their menstrual periods 
(Mahon & Fernandes, 2010). Furthermore, engaging boys 
and men in MHM education has been found to reduce 
stigma and foster a more supportive school environment 
(Hennegan & Montgomery, 2016).

MATERIALS AND METHODS
This study used a mixed methods approach, incorporating 
quantitative, and qualitative interviews, to investigate 
menstrual hygiene management practices among senior 
high school girls across seven high schools in Voinjama 
City, Lofa County, Republic of  Liberia. The selected 
schools included Voinjama Multilateral High School, 
Voinjama Free Pentecostal Mission High School, Korma 
Shepherd Mission High School, Voinjama Public High 
School, St. Joseph Catholic Mission School, Japan 
Elementary Junior and Senior High School, and Lutheran 
Mission High School. Excluding 12th graders engaged in 
the West Africa Examination for senior high students, the 
quantitative phase employed structured questionnaires 
to gather statistical insights into menstrual hygiene 
practices, facility availability, and their impact on school 
attendance and academic performance. Concurrently, 
qualitative interviews with one school administrator and 
two teachers from each selected high school delved into 
their perspectives on existing policies, implementation 
challenges, and attitudes toward menstrual hygiene 
education within their respective institutions. This mixed 



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method approach aimed to provide a comprehensive 
understanding of  the factors influencing menstrual 
hygiene management in these educational settings.

Sample Size and Sampling Method
The researchers recruited a sample from all high schools 
in Voinjama City, Lofa County, encompassing seven 
institutions including two public and five private high 
schools. Convenience sampling was employed to select 
all available 10th and 11th graders present on their school 
campus on the survey day. The survey was strategically 
scheduled on a regular school day to maximize the students 
participation. A total of  308 students participated this 
study. Additionally, within each school, one administrator 
and two classroom teachers were selected to participate in 
the interviews, providing further insights into institutional 
perspectives on menstrual hygiene management.

Data Collection
Data were collected using structured questionnaires 
administered to 308 female students in the 10th and 11th 
grades. The questionnaires were pretested among six female 
students to detect and correct any issues with question 
wording, structure, or format that could lead to biased 
or inaccurate responses. The questionnaire comprised 
eight sections: Section one covered demographic profiles, 
Section Two assessed the participants’ knowledge and 
awareness of  menstrual hygiene management, Section 
Three examined participants’ access to menstrual 
products, Section Four focused on sanitation facilities, 
Section five explored the impact of  menstrual hygiene 
management on participants’ learning, and Section 
six solicited suggestions for improving menstrual 
hygiene management. Qualitative data were gathered 
through in-depth interviews with school administrators 
and teachers. These interviews concentrated on the 
availability of  written school policies on menstrual 
hygiene management, and how school administrators 
and teachers support girls during menstruation. The 
interviews aimed to collect insights into their knowledge, 
attitudes, and practices regarding menstrual hygiene. Data 
collection was conducted by female nursing students who 
received training on survey data collection techniques to 

ensure accuracy and consistency.

Data Analysis
The quantitative data collected from the structured 
questionnaires administered to the 10th and 11th-grade 
female students were analyzed using descriptive statistics. 
This included calculating the frequency, percentage, mean, 
and standard deviation. The qualitative data collected 
through in-depth interviews with school administrators 
and teachers were analyzed using thematic analysis. This 
process involved, identifying and labeling key pieces 
of  data that relate to specific themes or categories. For 
example, codes included “lack of  MHM policy,” “need 
for sanitary pads,” and “improving sanitation facilities. 
“Similar codes were grouped to identify common themes 
and patterns. This helped in understanding the broader 
issues and perspectives related to school menstrual 
hygiene management.

Ethical Issues
Before data collection commenced, formal letters were 
submitted to the principals of  the seven selected high 
schools, requesting permission to conduct the study. 
All principals granted their approval for the study to 
proceed. Ethical considerations were meticulously 
addressed, including obtaining informed consent from all 
participants. Confidentiality was rigorously maintained, 
and participation in the study was entirely voluntary. 
The data collected were handled and analyzed with the 
highest level of  care to ensure the privacy and rights of  
the respondents were fully protected.

RESULTS AND DISCUSSION
Table 1, reveals key demographic insights. The average 
age of  the 308 respondents is 19.9 years, indicating a 
group of  late adolescents. Grade distribution is almost 
even, with 45.9% in the 10th grade and 54.1% in the 11th 
grade, providing a balanced perspective across different 
levels of  secondary education. Additionally, the sample 
comprises 53.4% of  students from private schools and 
46.6% from public schools, suggesting a slight majority 
from private institutions. 
The data from Table 2 on knowledge and awareness 

Table 1: Biography Profile
Respond Category Frequency (n) Percentage (%) Mean ±SD
Age (n = 308) 19.9 ± 2.4
Grade (n = 307)
10th Grade 166 45.9
11th Grade 141 54.1
School type (n = 305)
Private 163 53.4
Public 142 46.6

about menstruation among school girls, shows that 66.1% 
of  the respondents were informed about menstruation 
before their first period, primarily through family (37.1%), 

followed by schools (32.9%) and friends (30%). This 
highlights the significant role families play in menstrual 
education. Furthermore, 70.4% of  the respondents 



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received menstrual health education in school, indicating 
a substantial effort by educational institutions to provide 
this vital information. However, 29.6% did not receive 

such education, pointing to a need for more inclusive and 
comprehensive menstrual health programs in schools.
Table 3 presents valuable findings on the access to 

Table 2: Knowledge And Awareness About Menstruation
Respond Category Frequency (n) Percentage (%)
Knowledge about menstruation before first period (n = 307)
Yes 203 66.1
No 104 33.9
Area information was obtained (n = 210)
School 69 32.9
Family 78 37.1
Friend 63 30
Media / /
Receive menstrual health education in School (n = 307)
Yes 216 70.4
No 91 29.6

Table 3: Access To Menstrual Products
Respond Category Frequency (n) Percentage (%)
Type of  menstrual product primarily use (n = 308)
Disposable sanitary Pads 221 71.8
 Menstrual cloth 75 24.4
Reusable Pads 6 1.9
Other (tissue paper, etc.) 6 1.9
Easy Access to these Products (n = 304)
Yes 185 60.9
No 119 39.1
Menstrual Products Affordable (n = 298) 
Yes 156 52.3
No 142 47.7

menstrual products among school girls in Lofa County, 
Liberia. The results indicate that 71.8% of  the girls 
primarily use disposable sanitary pads, 24.4% use 
menstrual cloth, 1.9% use reusable pads, and another 
1.9% use other materials such as tissue paper. In terms 
of  access to these products, 60.9% of  the girls reported 
easy access, while 39.1% stated that access was not easy. 

Furthermore, 52.3% of  the girls found menstrual products 
affordable, while 47.7% considered them unaffordable. 
These findings highlight the dominance of  disposable 
sanitary pads and the need for academic institutions to 
address the challenges of  access and affordability faced 
by school girls in Lofa County, Liberia.
The findings from Table 4 highlight significant 

deficiencies in sanitation facilities on school campuses for 
supporting menstrual hygiene management. Less than 
half  of  the schools (42.1%) provide clean and private 
sanitation facilities for girls, while a majority (57.9%) do 
not. Similarly, only 42.1% of  the schools have adequate 
facilities for washing hands and menstrual products, 

leaving 57.9% of  the schools without these necessary 
resources. Moreover, a critical gap is observed in the 
proper disposal mechanisms for used menstrual products, 
with only 28.3% of  schools having adequate systems in 
place, and a striking 71.7% lacking such mechanisms.
The findings from Table 5 highlight the substantial impact 

Table 4: Sanitation Facilities
Respond Category Frequency (n) Percentage (%)
The school provides clean and private sanitation facilities for girls ( n = 304)
Yes 128 42.1
No 176 57.9



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of  menstrual hygiene management on school attendance 
and student comfort. Almost half  of  the students miss 
school due to menstruation, with an average of  2.5 days 
missed per month. While a majority of  students feel 

comfortable managing their menstruation at school, a 
significant portion (32.6%) do not, indicating a need for 
improved menstrual hygiene facilities and support systems.
The responses from the school girls highlight critical 

Adequate facilities for washing hands and menstrual products    (n = 297)
Yes 125 42.1
No 172 57.9
A proper mechanism for disposing of  used menstrual products  (n = 304)
Yes 86 28.3
No 218 71.7

Table 5: Impact on Education
Respond Category Frequency (n) Percentage (%) Mean±SD
Students miss school due to menstruation (n = 305)
Yes 146 47.9
No 159 52.1
Number of  days missed per month due to menstruation (n = 146) 2.5 ±1.2
Feel comfortable managing your menstruation at school (n = 282)
Yes 190 67.4
No 92 32.6

areas for improving menstrual hygiene management 
on campus (Table 6). A significant majority (243 out 
of  261) suggested that schools should provide sanitary 
pads, indicating a substantial demand and potential lack 
of  access to these essential items. Additionally, some 
respondents (18 out of  261) called for government 
support to supply sanitary pads, underscoring the 
need for broader policy intervention. Concerns about 
sanitary facilities were also prominent, with 38 out of  

43 respondents emphasizing the necessity for clean 
and private sanitation facilities, suggesting current 
inadequacies. Furthermore, a smaller group (5 out of  43) 
stressed the need for basic hygiene supplies like water 
and soap, highlighting gaps in essential resources. These 
insights underscore the urgent need for both material 
support and infrastructure improvements to enhance 
menstrual hygiene management for school girls.
The interviews with seven school principals revealed a 

Table 6: Suggestions For Improvement (n = 304)
Themes Quote Number of  

Interviewees
Interpretation

Sanitary Pads 
(N = 261

“I suggest that the school 
provide sanitary pads”

243 Most respondents (243 out of  261) believe that 
providing sanitary pads at school is crucial. This 
indicates a high demand and potential lack of  
access to these essential items

“Government should help 
to supply sanitary pads to 
all girls”

18 Some respondents (18 out of  261) extend the 
responsibility to the government, highlighting 
a need for broader policy support and resource 
allocation for menstrual hygiene products.

Sanitary Facilities 
(N = 43

“To provide clean and 
private sanitation facilities 
for girls”

38 Most of  these themes (38 out of  43) emphasize 
the importance of  clean and private sanitation 
facilities. This suggests that current facilities may 
be inadequate, impacting girls’ comfort and privacy 
during menstruation.

“provide water and 
soap on campus for 
hand washing during 
menstruation”

5 A smaller number of  respondents (5 out of  43) 
focus on the need for basic hygiene supplies like 
water and soap, indicating that these essentials are 
either insufficient or not readily available.



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significant gap in the availability of  formal menstrual 
hygiene management (MHM) policies, with five out of  
seven principals indicating the absence of  any policy 
and two noting that policies are not written (Table 7). 
The lack of  formal policies was attributed to several 
factors: three principals mentioned that the Ministry 
of  Education (MOE) has not provided the necessary 

directives, one cited the absence of the 
appropriate personnel to develop such policies, and 
two indicated that MHM is addressed orally rather 
than through written guidelines. Additionally, one 
principal  pointed out that his school administrations 
have not prioritized the development of an MHM 
policy.
Table 8, highlights the role and knowledge of classroom 

Table 7: School Policies on Menstrual Hygiene Management (n = 7 Administrators)
Themes Quote Number of  

Interviewees
Interpretation

Menstrual 
Hygiene 
Management 
Policies 
Availability

“No policy” 5 The majority of  principals (5 out of  7) indicated that their 
schools do not have a written MHM policy. This suggests 
a widespread absence of  formal guidelines to support 
menstrual hygiene, which could lead to inconsistent practices 
and a lack of  resources for managing menstruation effectively.

“Policy not written” 2 Two principals mentioned that although there might be 
some understanding or informal practices, there is no 
formally documented policy. This points to a need for 
formalization and documentation to ensure clarity and 
consistency in MHM practices.

Justification 
For Not 
Having A 
Menstrual 
Hygiene 
Management 
Policy

“Not provided by 
MOE”

3 Three principals attributed the lack of  MHM policies to 
the absence of  directives or frameworks from the Ministry 
of  Education (MOE). This indicates a reliance on higher 
authorities for policy development and implementation, 
highlighting a top-down approach in policy initiation.

“Because the school 
has not met the 
appropriate person 
to do so”

1 One principal mentioned the lack of  expertise or the right 
personnel as a reason for not having an MHM policy. 
This reflects challenges in accessing the necessary human 
resources or expertise required to develop such policies at 
the school level.

“It is orally thought” 2 Two principals mentioned that MHM is addressed orally 
rather than through written policies. This suggests that 
while menstrual hygiene may be discussed, the lack of  
formal documentation could lead to inconsistencies and 
gaps in implementation.

“Not available 
by school 
Administration”

1 One principal noted that his school administrations have 
not developed an MHM policy. This highlights the absence 
of  initiative or priority given to MHM by school leadership, 
potentially due to competing priorities or lack of  awareness.

teachers in high schools regarding menstrual hygiene 
management. Among the 14 teachers surveyed, only 36% 
had received training on menstrual hygiene management, 
while 64% had not. Despite this lack of  training, 77% 
of  teachers included information on menstrual hygiene 
management in their classrooms, indicating a willingness 

to address the topic even without formal training. 
However, only 15% of  teachers provided menstrual 
hygiene products to students, with 85% not offering such 
support.
Table 9, illustrates how classroom teachers support students 

Table 8: Classroom Teacher’s role and Knowledge Regarding menstrual hygiene Management
Respond Category Frequency Percentage (%)
Teacher receives training on menstrual hygiene management (n = 14)
Yes 5 36
No 9 64
The teacher includes information on menstrual hygiene management in classroom (n = 14)
Yes 11 77



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experiencing menstrual issues and their efforts to reduce 
menstrual stigma. A majority of  teachers (10 out of  14) 
allow students to visit a female counselor, and 4 provide 
sanitary pads and access to a special bathroom, indicating 
a focus on both emotional support and practical needs. 

To reduce stigma, 6 teachers conduct private discussions 
with female students, 4 educate the broader student body, 
3 refer students to counselors for specialized advice, and 1 
emphasizes the importance of  peer respect and support.

No 3 23
Teacher provides menstrual Hygiene products for students in Classroom (n = 14)
Yes 2 15
No 12 85

Table 9: Teachers support students who experience menstrual issues during class (n = 14)
Themes Quote Number of  

Interviewees
Interpretation

Support 
Students Who 
Experience 
Menstrual 
Issues During 
Class

“Allow them to 
visit the female 
counselor”

10 The majority of  teachers (10 out of  14) support students by 
allowing them to visit a female counselor, indicating reliance on 
specialized support services for addressing menstrual issues.

“Provide sanitary 
pads and a special 
bathroom for 
them”

4 A significant number of teachers (4 out of 14) provide 
practical support by supplying sanitary pads and ensuring 
access to a special bathroom, highlighting efforts to address 
immediate needs.

Reducing 
Menstrual 
Stigma In The 
Classroom

“Provide private 
discussions with 
female students”

6 Many teachers (6 out of  14) engage in private 
discussions with female students, suggesting personalized 
approaches to reduce stigma and provide support.

“To educate 
students on how 
to address the 
problem”

4 Some teachers (6 out of  14) focus on educating the 
entire class on menstrual hygiene, aiming to foster a more 
informed and supportive classroom environment.

“Refer them to a 
female counselor 
for counseling 
about their 
menstrual hygiene 
management”

3 A few teachers (3 out of  14) refer students to female 
counselors for specialized advice on menstrual hygiene 
management, indicating reliance on professional guidance.

“By advising 
students to respect 
their mates and 
provide support”

1 One teacher emphasizes the importance of  peer respect 
and support, highlighting the role of  fostering a respectful 
and supportive classroom culture.

Discussion
The findings of  this study highlight the crucial role that 
academic institutions can play in promoting menstrual 
hygiene management (MHM) among senior high school 
girls in Voinjama City, Lofa County, Liberia. Despite 
some progress, significant challenges remain, particularly 
in the areas of  menstrual education, access to menstrual 
products, sanitation facilities, policy development, and 
teacher training.
A substantial portion of  the girls surveyed (29.6%) 
did not receive menstrual health education in school, 
despite the efforts of  some institutions to provide this 
information. Families were identified as the primary 
source of  menstrual education for many girls, which 
points to a gap in the school-based provision of  this 
vital information. This finding aligns with studies from 

Ethiopia and India, where similar deficiencies in school-
based menstrual education have been reported. These 
gaps underscore the need for more comprehensive and 
consistent educational programs within schools to ensure 
that all girls are adequately informed about menstrual 
hygiene (Habtegiorgis et al., 2021; Sivakami et al., 2019).
Access to menstrual products was another significant 
issue identified in this study. While the majority of  girls 
used disposable sanitary pads, nearly 40% reported 
difficulties in accessing these products, and almost half  
found them unaffordable. This situation reflects the 
broader economic barriers faced by girls in low-income 
settings, similar to findings from Nigeria and other parts 
of  sub-Saharan Africa. These economic challenges 
highlight the need for schools and academic institutions 
to take a more proactive role in ensuring that girls have 



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access to affordable menstrual products, possibly through 
partnerships with governmental and non-governmental 
organizations (Nnennaya et al., 2021).
The study also revealed significant shortcomings in the 
availability of  adequate sanitation facilities in schools, 
with less than half  of  the schools providing clean and 
private facilities for girls to manage their menstruation. 
The majority of  schools lacked proper handwashing and 
disposal facilities, which are essential for maintaining 
good menstrual hygiene. These deficiencies are consistent 
with reports from UNESCO and UNICEF, which have 
identified inadequate school sanitation as a major barrier 
to effective MHM in sub-Saharan Africa. The lack of  
proper facilities not only affects girls’ ability to manage 
their menstruation but also contributes to absenteeism, 
with nearly half  of  the respondents missing an average of  
2.5 days of  school per month due to menstruation. This 
absenteeism directly impacts girls’ educational outcomes 
and underscores the need for significant improvements 
in school sanitation infrastructure (UNESCO, 2011; 
UNICEF, 2019).
Furthermore, the study found a notable absence of  
formal MHM policies within schools. Interviews with 
school principals revealed that most schools either did 
not have formal MHM policies or relied on informal, 
oral communication to address the issue. This lack of  
formal guidelines can be attributed to several factors, 
including the absence of  directives from the Ministry 
of  Education and a lack of  trained personnel to develop 
such policies. Similar challenges have been observed in 
other low-income settings, where the absence of  formal 
MHM policies has been linked to poor menstrual health 
outcomes among students. This finding highlights the 
need for a coordinated effort at both the school and 
national levels to develop and implement comprehensive 
MHM policies (Sivakami et al., 2019).
Lastly, the role of  teachers in supporting MHM was 
examined, revealing that while many teachers included 
MHM in their classroom discussions, only a small 
percentage had received formal training on the topic. 
Despite this, many teachers were willing to support 
their students by providing information and, in some 
cases, menstrual hygiene products. However, the limited 
provision of  products and the lack of  formal training 
highlight a significant area for improvement. Providing 
teacher training on MHM, as recommended by scholars, 
could empower educators to better support their students 
and reduce the stigma associated with menstruation, 
thereby creating a more supportive school environment 
(Shah et al., 2023).

CONCLUSION
The findings of  this study underscore the critical 
importance of  academic institutions in Voinjama City, 
Lofa County, Liberia, in promoting effective menstrual 
hygiene management (MHM) among senior high school 
girls. While some progress has been made in providing 
menstrual education and support, significant gaps remain 

in key areas such as access to menstrual products, sanitation 
facilities, and the formalization of  MHM policies. The 
lack of  comprehensive and inclusive menstrual health 
education within schools, coupled with economic barriers 
that limit access to affordable menstrual products, poses 
ongoing challenges for adolescent girls in this region. 
Additionally, the inadequacy of  sanitation infrastructure 
in schools, including the absence of  clean and private 
facilities for managing menstruation, further exacerbates 
the difficulties faced by schoolgirls, leading to absenteeism 
and negative impacts on their educational outcomes.

RECOMMENDATIONS
The study identified several recommendations for 
enhancing menstrual hygiene management (MHM) 
among senior high school girls in Voinjama City, Lofa 
County, Liberia.
First, it is essential to strengthen menstrual health education 
within schools. To ensure that students gain accurate 
information about menstruation, a comprehensive 
menstrual hygiene management curriculum, should be 
integrated into school programs. This curriculum should 
cover menstrual hygiene practices, the use of  menstrual 
products, and the importance of  maintaining proper 
hygiene. Additionally, teachers should receive specialized 
training on menstrual health education to equip them with 
the knowledge and skills necessary to address menstrual 
health issues effectively and to help reduce the stigma 
associated with menstruation.
Improving access to menstrual products is another 
critical area for intervention. Schools should establish 
programs to provide menstrual products directly to 
students, particularly for those facing financial barriers. 
Collaborations with government agencies, NGOs, and 
private sector partners can help ensure a steady supply of  
sanitary pads and other menstrual products. Moreover, 
exploring cost-effective solutions such as reusable 
menstrual pads or menstrual cups can provide more 
affordable options for students in need.
Enhancing sanitation facilities within schools is also 
crucial. Investment in upgrading school facilities to 
ensure they are clean, private, and well-maintained 
will significantly impact students’ ability to manage 
menstruation effectively. This includes providing 
adequate handwashing facilities and proper disposal 
systems for menstrual products. Regular maintenance 
of  these facilities should be implemented to ensure their 
continued functionality and hygiene.
Developing and implementing formal MHM policies 
is necessary to provide structured support for 
menstrual health in schools. Schools should formulate 
comprehensive MHM policies that address menstrual 
health education, access to menstrual products, and the 
availability of  sanitation facilities. These policies should 
be supported by clear guidelines and directives from 
the Ministry of  Education. Additionally, mechanisms 
for monitoring and enforcing these policies should be 
established to ensure compliance and effectiveness.



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Finally, supporting ongoing research and data collection 
on MHM practices and challenges is crucial. Further 
research can provide a deeper understanding of  the needs 
and experiences of  schoolgirls and help evaluate the 
effectiveness of  interventions. Implementing systems for 
regular data collection and analysis will inform policy and 
program development, ensuring that MHM initiatives are 
responsive to the needs of  the community.

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