Relationship between menstrual hygiene practices and school performance among adolescent girls in Karachi, Pakistan

Menstrual hygiene management (MHM) plays an important part in adolescent girls' health and education. Adolescent girls' school attendance and performance could be negatively impacted by poor menstrual hygiene practices, inadequate WASH, and menstrual stigma. The purpose of this study was to understand the association between menstrual hygiene and school performance among adolescent girls in Karachi, Pakistan. Menstrual hygiene management (MHM) plays an important part in adolescent girls. An analytical cross-sectional study was conducted from December 2024 to February 2025 among a total of 451 adolescent girls from two public and two private schools of Karachi. The data were obtained from a structured questionnaire that included details of sociodemographic, menstrual hygiene practices, school attendance, WASH facilities, and academic performance. The factors related to academic performance and school attendance were determined by descriptive statistics and binary logistic regression. Among the participants, 57.6% had prior knowledge about menstruation, whereas 42.4% had inadequate knowledge. Menstrual pain was reported by 29.5% of participants, and 37.5% reported that menstruation affected their academic performance. Sanitary pads were used by 45.5% of participants, while 54.5% used cloth or other absorbent materials. Overall, 76.1% of participants reported participating in extracurricular activities, while 69.2% reported missing such activities due to menstruation. Regular school attendance (AOR=3.31, 95% CI: 1.92–5.72), private school enrollment (AOR=2.26, 95% CI: 1.39–3.68), prior menstrual knowledge (AOR=2.43, 95% CI: 1.50–3.96), absence of menstrual pain or discomfort (AOR=6.67, 95% CI: 2.00–20.00), access to clean water (AOR=2.18, 95% CI: 1.38–3.46), school support (AOR=1.92, 95% CI: 1.06–3.47), and participation in extracurricular activities (AOR=7.21, 95% CI: 4.28–12.15) were significantly associated with good academic performance. Menstrual health and hygiene factors were significantly associated with the academic performance of adolescent girls. Improving WASH facilities in schools, strengthening education on menstruation, and increasing access to menstrual products could positively impact educational outcomes and gender equity.