Effects of sanitary pad distribution and reproductive health education on upper primary school attendance and reproductive health knowledge and attitudes in Kenya: a cluster randomized controlled trial

None of the interventions increased participants’ school attendance, but both reproductive health education and combined sanitary pad distribution with reproductive health education were found to positively affect girls’ reproductive health attitudes and knowledge, increased their support of equitable gender norms, and improved their self confidence.

Menstruation Measures  

• Participants who were provided menstrual pads (the pad distribution group) and participants who were provided both menstrual pads and menstrual health education (the combined groups) experienced an increase in reporting having enough period products to manage menstruation.  
• There was no association between having enough pads and school attendance. 
  • 89% of girls were present for the 60 days on which researchers took attendance during the intervention.  
• Participants in the pad distribution only and combined groups reported less leaking during their periods.  
• Participants in the reproductive health education and combined groups experienced positive increases in menstrual attitudes measured on a 0-12 scale. 
  • The average menstrual attitude score for girls in the reproductive health education only group increased from 7.5 at baseline to 8.6 at endline.  
  • The average menstrual attitude score for girls in the combined group increased from 7.6 at baseline to 8.9 at endline.  
• The combined group experienced a larger effect size on attitudes towards menstruation compared to the education only group. 

Reproductive Health Knowledge Measures

• Participants in the combined group experienced an increase in pregnancy knowledge and STI knowledge.  
• Participants in the reproductive health education only group experienced an increase in the percentage of girls who could name a form of contraception. 

Gender Norm Measures

• Participants in the reproductive health education and combined groups experienced a positive increase in equitable adolescent gender norms and gendered sexual norms.
• There was a larger increase in reported self-confidence in the reproductive health education only group compared to the combined group.   

As these interventions did not improve girls school attendance or engagement, the researchers caution against implementing these menstrual health management (MHM) interventions as educational interventions. Instead, the research supports a recent move away from the focus of school attendance as the central outcome of MHM. Furthermore, the researchers argue these programs should be implemented as comprehensive sexual education programs to address the stigma of menstruation, promote menstrual product access, and increase knowledge of reproductive health issues.  

140 schools took part in this experiment, with 35 schools randomly assigned to each of the 4 treatment groups. The four arms of this experiment are as follows: (1) control (2) sanitary pad distribution only (3) reproductive health education only and (4) both sanitary pad distribution and reproductive health education. Sanitary pad distribution included girls being given two pairs of underwear at the start of the intervention, as well as a pack of 10 sanitary pads each month.  Reproductive health education consisted of 25 sessions on topics like puberty, menstrual health, reproductive systems, self-esteem, gender, human rights, teen pregnancy, STIs, and HIV delivered by trained facilitators. The intervention lasted for a full year.

3489 girls in primary grade 7 took part in a face-to-face baseline survey in Swahili prior to the intervention from January to April of 2017. Of the 3489 girls interviewed at baseline, 2725 (79%) had started menstruating. Of these, 2544 (93%) were successfully interviewed at endline in November. The survey included questions asking about school enrollment and engagement, views towards menstruation, reproductive health knowledge, gender norms, and self-confidence. Attitudes towards menstruation were calculated with 12 agree/disagree questions like “I feel ashamed of my body when I have my period,” with the score reflecting how many of these responses indicated a positive view of menstruation. School attendance was measured separately from these surveys.