Menstrual Hygiene Management and School Absenteeism Among Schoolgirls Attending an Ethnic Minority High School in Vietnam: A Mixed-Methods Study

Background Menstrual hygiene management (MHM) is important for adolescent girls’ health, well-being, and school participation, yet evidence from rural and mountainous Vietnam remains limited. This study examined MHM practices at home and school, compared practices between Kinh and ethnic minority students, and identified factors associated with menstruation-related school absenteeism among upper secondary schoolgirls attending a high school serving predominantly ethnic minority students in northern Vietnam. Methods A mixed-methods study included a cross-sectional survey of 423 post-menarche schoolgirls and 20 in-depth interviews. The survey assessed MHM practices and menstruation-related school absenteeism. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression, while qualitative data were analyzed using thematic analysis. Ethnic differences in MHM practices were also examined. Results Almost all participants (98.1%) used disposable sanitary pads. At home, 80.1% reported washing with water and feminine hygiene solutions during menstruation. School-based practices were more limited: 48.7% washed with water at school, and 9.0% did not change pads at school. No significant differences in MHM practices or school absenteeism were observed between Kinh and ethnic minority students. Overall, 29.3% reported missing school during menstruation. Menstruation-related teasing was the only measured factor independently associated with absenteeism (adjusted OR=2.92, 95% CI: 1.63-5.24); other measured sociodemographic and school-related factors were not significant. Qualitative findings highlighted inconsistent access to clean, private toilets, water, sanitary products, and supportive school practices as barriers to effective MHM. Conclusions Although home-based MHM practices were generally adequate, students reported greater challenges managing menstruation at school. Menstruation-related teasing was associated with school absenteeism, highlighting the importance of the psychosocial school environment. Improving school facilities, access to sanitary products, supportive practices, and the social environment may help reduce menstruation-related absenteeism. These findings support interventions that address both physical resources and social barriers to improve menstrual management and sustained school participation among girls.