The study explored menstrual hygiene management (MHM) knowledge and practices among adolescent girls and women in six districts in Ghana using qualitative methods. Participants demonstrated basic awareness of hygiene needs but faced persistent barriers such as myths, high product costs, and inadequate WASH facilities. Preferences centered on affordable, comfortable sanitary pads, while media, health workers, and community influencers emerged as key information channels. The findings highlight the need for expanded MHM education, more affordable menstrual products, and targeted strategies to improve access and promote healthier menstrual practices.
Executive Summary
Background
Menstrual Hygiene Management (MHM) is an essential yet frequently overlooked component of public health, especially within the Water, Sanitation, and Hygiene (WASH) sector. Globally, approximately 900 million menstruating women encounter difficulties in accessing clean and safe menstrual products, adequate water, and private facilities for changing and washing. These issues are particularly severe in sub-Saharan Africa, where adolescent girls particularly those in rural settings face significant struggles in managing menstrual hygiene. In Ghana, nearly 39% of adolescents and young people engage in poor menstrual hygiene practices, often driven by financial constraints and the limited availability of menstrual products. Additionally, social and cultural norms often hinder open discussions about MHM, as some cultures consider it a taboo (Agyekum, 2002). However, there is limited empirical evidence on knowledge and practices related MHM. Hence, this study assessed MHM knowledge and practices among adolescent girls and women in Ghana.
Methods
This study utilized a qualitative research design, employing in-depth interviews and focus group discussions to collect data. These methods were selected to capture detailed insights into the menstrual hygiene knowledge, practices and experiences of adolescent girls and women across six districts in Ghana: Kumasi Metro, Ejura Sekyeredumase, North East Gonja, West Gonja, Bodi, and Sefwi Wiawso. Participants were recruited from educational institutions (Junior and Senior High Schools, and Tertiary institutions), markets and the household level using purposive sampling. The sampling frame comprised in-school and out-of-school adolescent girls, teachers, parents, female community/opinion leaders, key stakeholders such as Community Health Nurses (CHN) and young women. Groups of between 6 – 8 were constituted for the focus group discussion based on the age of participants. A total of 60 IDIs and 18 FGDs were conducted, strictly adhering to the Ethical Principles and Guidelines for the Protection of Human Subjects outlined in the Belmont Report (The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978). The data obtained were transcribed verbatim, reviewed, and imported into the NVivo software application for coding and analysis, using the thematic analytical approach.
Key Findings
Knowledge and Practices Related to Menstrual Hygiene Management
The level of knowledge about menstrual hygiene management (MHM) varied among participants. Most adolescent girls and women understood the importance of maintaining personal hygiene during menstruation, such as bathing regularly and using proper menstrual hygiene materials. However, some misconceptions and gaps in knowledge were also noted.
“It is the way a female in her menstrual cycle keeps herself clean”
– [16 yr old adolescent in school]
“Menstrual Hygiene is the way we clean our body during menstruation”
– [14yr old adolescent in school]
Barriers and Motivators to the Use of Disposable Sanitary Pads
The study identified several barriers to the use of disposable sanitary pads, including misconceptions that they cause infertility, economic constraints, and limited access to appropriate WASH facilities. Conversely, motivators for using disposable pads included ease of use, comfort, and hygiene benefits.
“Some of them feel that it is not advisable for you to use pad because it comes with infertility problems.”
– [37yr adult woman]
“What will motivate us to use it is the fact that you can use and dispose of it at any time without thinking of washing or drying it.”
– [39yr old adult woman
Preferred Product Features and Package Sizes
The study participants preferred sanitary pads that were highly absorbent, comfortable, and had features like wings for better protection. The size and quantity of pads in a package also influenced their choice.
“I prefer the one that has 15 pieces because I could use that for 3 months.”
– [32yr old adult woman]
“My ideal sanitary pad should be able to soak the blood well, so you don’t stain yourself.”
– [19yr old adolescent out-of-school]
Prices Clients are Willing to Pay
Most participants suggested that a price range of 5 to 10 Ghana Cedis would be ideal for a pack of sanitary pads. Some indicated that they prioritize quality over price, while others were constrained by financial limitations.
“Not any pad because at the moment, Yazz is very expensive, they should consider bringing the price down to GHS 6”
– [34yr old adult woman]
“I think GHS 5 because with GHS 5 even if you do not have it someone can support me with it.”
– [17yr old adolescent in school]
Communication Channels for Menstrual Hygiene and Product Information
The study found that women of reproductive age access menstrual hygiene and product information primarily through radio, television, the internet, and social media. Health workers also play a crucial role in educating women and girls on menstrual hygiene.
“I get it from the radio and the TV, the internet too.”
– [19yr old adolescent out of school]
“Yes, I get information on social media when I see some information, I read it.”
– [19yr old adolescent out of school]
Strategies to Promote and Market New Brand of Sanitary Pads
The study revealed three key strategies to effectively promote and market a new brand of sanitary pads in Ghana: using media personalities, engaging community leaders, and leveraging mass communication. These strategies are grounded in the influence these figures and channels have on consumers, particularly adolescent girls and women. For instance, media personalities like Giovani of TV3, Nana Ama McBrown, and others were mentioned as influential figures whose endorsements could drive product adoption.
“I think Giovani of TV3 can influence a lot of girls.”
– [19yr old adolescent out of school]
“Anyone that is from this community will not come and sell something bad to us because we are here with the person, and we will go back to ask him or her why he/she sold a bad item to us if we buy it, and it is not good”.
– [33yr old adult woman]
Recommendations
Expand/increase outreach and education initiatives by implementing targeted outreach programs to educate adolescent girls and women on MHM and dispel myths about the use of disposable sanitary pads.
- Partner with schools, community centres, and health clinics to conduct periodic workshops on menstrual hygiene management.
- Develop and distribute easy-to-understand educational materials, such as flyers, posters, notepads and books with MHM information as cover, as well as, to ensure widespread understanding.
Consider and implement strategies to make sanitary pads more affordable, such as providing subsidies or discounts for bulk purchasing.
- Collaborate with other non-governmental organizations (NGOs) and civil society organizations (CSOs) to amplify advocacy efforts aimed at urging the government to continue to implement policies that reduce the cost of menstrual products. This includes supporting subsidies for low-income communities and encouraging the inclusion of menstrual health supplies in public health initiatives.
- Introduce bulk purchase discounts through partnerships with local retailers and distributors, allowing consumers to buy sanitary pads at reduced prices when purchased in larger quantities.
- Launch a pilot program that provides sanitary pads to schools (i.e., schools and poor and rural communities, as well special schools) for free distribution to students, with plans to expand based on success.
Develop sanitary pads that address the diverse needs of users, such as varying absorbency levels, sizes, and packaging options.
- Develop a product line that includes various absorbency levels, sizes, and packaging options, including eco-friendly and reusable options.
Conclusion
The study provides valuable insights into the menstrual hygiene practices and preferences of adolescent girls and women in Ghana. The findings highlight the need for increased education, affordable menstrual products, and improved WASH facilities. Addressing these issues will enhance the overall well-being and dignity of adolescent girls and women in the country.