WASH in Schools fosters social inclusion and individual self-respect. By offering an alternative to the stigma and marginalization associated with hygiene issues, it empowers all students – and especially encourages girls and female teachers. In recognition of the positive impact on girls’ school attendance and achievement, initiatives around the world are addressing adolescent girls’ menstrual hygiene management (MHM) needs through WASH in Schools programming. Such interventions are increasingly implemented in both development and humanitarian emergency contexts.

In 2012, UNICEF and the Center for Global Safe Water at Emory University initiated a programme to support collaborative research focused specifically on exploring the MHM challenges faced by female students in Bolivia, the Philippines, Rwanda and Sierra Leone. The project includes developing or strengthening MHM-related programming in schools in those countries.

The onset of menstruation presents multiple challenges for schoolgirls. Many girls lack the knowledge, support and resources to manage menstruation in school. This project aims to understand the scope of education and health challenges faced by girls in Cochabamba, Bolivia. Findings will inform strategies that mitigate challenges and appropriately support adolescent girls at school during menstruation. Data were collected in rural communities in the municipalities of Tacopaya and Independencia of Cochabamba, Bolivia.

Findings focus on the challenges surrounding menstrual hygiene practices from the perspectives of schoolgirls, teachers, male classmates and mothers. Major challenges discussed by schoolgirls focused on feelings of fear and shame during their menstrual cycle, associated with their inability to maintain privacy while managing menses in school. Girls were worried that peers and teachers would know they were menstruating. They especially feared exposing themselves through bloodstains and odor because this led to teasing from classmates. The challenges girls faced had health and education impacts, including girls’ self-exclusion, reduced school participation, distraction, missed class time, absenteeism and fear of pregnancy. Participants also suggested detrimental long-term education and health risks due to the inability to properly manage and understand menstruation, including school dropout, infections, long-term mental health consequences and unplanned pregnancy.

Determinants of challenges included sociocultural factors associated with rural Bolivian communities and schools, lack of practical guidance on MHM and a biological understanding of menstruation, inadequate school facilities and limited access to absorbent materials. Participants provided recommendations to expand education, provide workshops, programmes and training about menstruation, and improve WASH facilities in schools and girls’ access to absorbent materials for managing menstruation.


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