Unmet Menstrual Needs and Psychosocial Well-being among Schoolgirls in Northern Tanzania: Baseline Results from the PASS MHW Study

Abstract Introduction: Improving menstrual health among schoolgirls is essential to meeting the Sustainable Development Goals for gender equality, good health and wellbeing, and quality education. School participation and wellbeing among girls in low and middle-income countries are impacted by a lack of access to quality menstrual materials, taboos around menstruation, inadequate knowledge, and poor WASH facilities. Comprehensive evidence is needed to address these challenges and guide policy and practice. Methods A self-administered questionnaire was used to collect socio-demographic information, menstrual-related data, and school environment data from girls in four mixed-gender government schools in Mwanza. Mean (SD) scores for three Menstrual Practices and Needs Scale (MPNS-36) sub-scores focusing on the extent to which girls perceived needs for carrying menstrual material to school and changing (transport and school environment); washing and drying menstrual material (reuse needs); and privacy and drying menstrual material in school (reuse insecurity) were calculated. An ANOVA test was used to compare MPNS scores for groups, and logistic regression was used to examine the association between menstrual health and wellbeing outcomes (self-efficacy, menstrual anxiety, school attendance, and participation) and MPNS subscale scores. Results The mean age of the 486 participants was 15.6 years (SD 1.3); 87% had started menstruating; and the mean age at menarche was 14.2 years (SD 1.15). Of all participants who had reached menarche, 310 (75%) experienced pain during the last menstrual period, 165 (39%) had menstrual-related anxiety, and 63 (16%) missed at least one day of school due to menstruation. Participants reported using reusable menstrual material (72%), and/or disposable pads (62%), during the last period. Between 36% and 94% of girls in participating schools reported that water was available in school at least half of the time. The mean school climate score ranged from 5.6 to 7.1 out of 8. The mean score for the MPNS subscales ranged from 1.0 to 2.1 out of a maximum score of 3, across schools for the reuse needs subscale; 1.6 to 2.1 for reuse insecurity; and 0.9 to 1.8 for transport and school environment needs. A lower reuse insecurity score was associated with lower odds of menstrual anxiety (OR 0.58; 95% CI 0.45–0.76) and non-participation in school activities (OR 0.72; 0.53–0.97). Higher scores for transport and school environment were associated with confidence to ask a female friend and teacher for menstrual support (OR 1.54; 1.24–1.89), stand up and answer questions in class (OR 1.59; 1.29–1.95), and predict when periods are about to start (OR 1.40; 1.13–1.72). Conclusions Schoolgirls have unmet menstrual practice needs related to transporting and using menstrual material in school and these needs differ across schools in northern Tanzania. Interventions that can address menstrual practice needs in schools in this setting are required.