Will Free Sanitary Pads Address The Identified Factors That Make School Attendance During Menstruation More Difficult?

Parliament has approved a 156 MILLION DOLLAR World Bank facility to support the construction of Senior High Schools in Ghana and out of the money an amount of 15 million dollars will go into scholarship for over ten thousand students to pursue senior high education. Government has indicated that part of that amount would be USED TO BUY AND DISTRIBUTE SANITARY PADS FREE OF CHARGE TO SCHOOL GIRLS.

The Education Minister, Prof. Naana Jane OpokuAgyemang has argued that the decision is warranted given that research has shown that in Ghana, school girls "consistently miss 4 to 5 days every month of the term". However, some media commentators, policy analystshave objected to the decision with some arguing that it is not only misplaced but also shameful and morally corrupt to borrow money for such a project.

In this piece, I do not necessarily saunter into the merits or otherwise of the decision. Rather, I do a close analysis of the factors identified through research as contributing to the skipping of classes by girls during menstruation and examine the probative potential of government's decision to provide free sanitary pads to address those factors. The study 'Sanitary Pad Interventions for Girls' Education in Ghana: A Pilot Study' concluded in 2012 was led by Oxford University Professor, Paul Montgomery and involved 120 schooling teenage girls in Ghana.

Three hypotheses were tested:
1. The provision of Pads-with-EDUCATION will improve attendance among menstruating schoolgirls.

2. The impact of the intervention will vary according to geographical location and associated levels of poverty. Rural areas will have better attendance rates than periurban areas upon provision of Pads-with-education.

3. Education about puberty and menstruation alone will not be sufficient to improve attendance at schools

Discussing their findings, the researchers noted that 'factors such as a longer distance from home to school, greater levels of poverty, and lack of water and toilets typical of rural areas are likely to make school attendance during menstruation more difficult.' The study also pointed out that it may also be the case 'that the degree to which menstruation acts as a barrier to education [in Ghana] is more closely related to cultural dynamics'.

Crucially, Montgomery et al (2012) found that girls who received ONLY Puberty and Menstrual Management Education 'produced similar results to that of Pads-with-Education [those who received Sanitary Pads and Education]'.

The researchers accordingly argued that 'at a proximal level, it may be that the education component is the active ingredient across both interventions. Providing the girls with information and allowing discussion of this taboo subject may address factors at the interpersonal level of the ecological model such as management of cloth materials that enabled girls to better manage their periods, which perhaps resulted in increased school attendance.' Again Montgomery et al argued that 'educating the girls in groups on this topic [puberty and menstruation management] fostered improved peer and other relations making the school environment more supportive and in turn delivering the results presented here.'

Analysis
At this point I look at the problems identified by the study and examine whether they can be addressed by free provision of sanitary pads. As observed earlier, the study noted that 'factors such as a longer distance from home to school, greater levels of poverty, and lack of water and toilets typical of rural areas are likely to make school attendance during menstruation more difficult'. The threshold questions that flow from this can include the ff:

1. Are the identified 'poverty and cultural' issues addressable by providing sanitary pads free of charge?

2. Are the 'lack of water and toilets problems typical of rural areas [which] make school attendance during menstruation more difficult' addressable by the provision of sanitary pads free of charge?

In fact,in the study, where the provision of sanitary pads appeared to come with increased school attendance, the researchers themselves were agnostic about causality: 'At a proximal level' Montgomery et al (2012) noted, 'the [Puberty and Menstruation Management] education component is the active ingredient' NOT the freely provided sanitary pads.

Indeed, in the course of the study, free underwear and sanitary pads were distributed, however, the study found that 'the girls [rather] found the education component of the intervention enjoyable and helpful' which means that the idea to freely distribute sanitary pads is likely NOT to resonate well with girls. Clearly there is no well-established correlation between free sanitary pad provision and school attendance given especially that girls who received ONLY Puberty and Menstrual Management Education 'produced similar results to that of Pads-with-Education [those who received Sanitary Pads and Education]'. This should caution government about the decision to borrow dollars, buy sanitary pads and distribute them to school girls free of charge.

Am inclined to believe that the above observations informed the researchers' decision NOT to urge governments to procure and distribute sanitary pads to girls free of charge. The researchers in fact underscored the cost implications and long term sustainability problems associated with such an idea. Can we sustainably provide say 12 sanitary pads to school girls every month free of charge for say 5 to 10 years?

Conclusion
The decision of government to implement policies rooted in research findings is a welcome idea. However, in the instant case, the decision to provide sanitary pads on gratis to address the problem of girls skipping classes during menstruation has been clearly proven as incapable of addressing the real impediments that 'make school attendance during menstruation more difficult'.

The government's own pointed research findings do not support it. Resources must therefore go into areas such as Puberty and Menstrual Management Education, provision of toilets and water facilities in (rural) schools and general poverty alleviation which are the root issues. Indeed the cost implications and long term sustainability problems viewed against the unestablished causal link between sanitary pad usage and school attendance actually reinforce government's need to abandon the decision to buy and distribute sanitary pads free of charge.

Festival Godwin Boateng
An ordinary Ghanaian

Reference
Montgomery P, Ryus CR, Dolan CS, Dopson S, Scott LM (2012) Sanitary Pad Interventions for Girls' Education in Ghana: A Pilot Study. PLoS ONE 7(10): e48274. doi:10.1371/journal.pone.0048274