Adolescent girls’ menstrual hygiene management: evidence from rural northern Ghana

Background: Menstrual Hygiene Management (MHM) among adolescents has emerged as global public health concern in low and middle-income countries. Although research on MHM among adolescents is vast, the peculiar cultural and economic barriers faced by Junior high schoolgirls in menstrual hygiene management in the deprived settings of northern Ghana are seldom explored, even though sanitation coverage in this part of the country does not exceed 20 percent.  We thus explored menstrual hygiene management barriers among adolescent schoolgirls in Junior High Schools in the Upper West region. Methods: A case study of adolescent girls’ menstrual practices and management in selected schools in the Jirapa Municipality was conducted. We employed a qualitative approach in the collection and analysis of the data. A mix of purposive and convenience sampling procedures was used to select 44 diverse participants, comprising: basic schoolgirls (n=32), and mothers (n=12), who participated in semi-structured interviews. The data collected were analysed using the thematic analytical framework. Results: Underpinned by Gusfield’s cultural and structural analysis of public problems as well as Bronfenbrenner’s socioecological theory, we found that limited knowledge of menstruation and its management, cultural beliefs, and high costs of menstrual care products to be main barriers to effective MHM among adolescent girls in basic schools in Ghana. This has often resulted in school absenteeism and dropout, girls engaging in commercial sex to raise funds to buy menstrual hygiene products, menstruation-related stigma and seclusion and exclusion during menstruation. Conclusion: Our findings have implications for MHM policy planning and implementation.  The Ministries of Education, Health and Water Resources need to collaborate and develop an MHM Policy as part of the National Sanitation and Hygiene Strategy, and a strategy to provide direction on how to implement MHM activities in basic schools in the country.