Improving Adolescent Girls' Menstrual Health and School Attendance Through Community-Based Health Education and Peer Support in Pakistan

Background: Girls in government schools in Peshawar often start menstruation with little accurate information, limited privacy at school, and strong pressure to stay at home on heavy or painful days. Broken locks, water shortages, and the absence of disposal bins make school toilets hard to use, so absence becomes a routine response rather than an exception. Objective: This programme aimed to improve menstrual health knowledge, hygiene practice, and school attendance among adolescent girls through community-based health education and peer support. Methods: A community-based participatory research programme ran from October 2025 to March 2026 in six government girls schools in Peshawar district, Khyber Pakhtunkhwa, with 240 girls aged 11 to 16 years, 84 mothers, and 30 female teachers as partners. Girls, mothers, and teachers acted as co-researchers, led six education sessions and peer support circles, and pressed for facility repairs. Data came from pre-programme and post-programme questionnaires, school registers on menstruation days, facility audits, and focus group discussions. Results: The mean knowledge score rose from 38.4 to 74.9. Girls absent for at least one day in their last cycle fell from 148 (61.7 percent) to 57 (23.8 percent), and attendance on menstruation days rose from 71.3 percent to 88.6 percent. Conclusion and Implications: Education worked best when peer support and usable toilets arrived together. Schools should protect both elements, not treat lessons alone as sufficient.