(
Menstrual Hygiene Management
MHM) and WASH in Schools
Baseline Survey Report
South Sudan - Eastern Eqautoria State (EES)
Girls preparing to go for
Cleaning as School as part of
Hygiene Promotion
An adolescent girl demonstrating
how a hole is used during
menstruation
“… Our problem is
that our Senior
Woman Teacher does
not talk to us about
Menstruation”
0|Page
Adolescent girls sharing with the Researcher the experience of using
a hole during Menstruation
May 2014
Supported by: Netherlands Development Organization
(SNV) – South Sudan
Consulting organization:
Multi Media Skills and Health Consult (MSHC)
Multi - Media Skills & Health Consult (MSHC) provides services in areas of;
Research/surveys, support production and application of BCC/IEC Materials in humanitarian,
development partners and government.
Consulting Team:
Kabuye GERALD:
Principal Investigator (PI), Regional Development communication
specialist in primary health care, Education, Research/surveys and
governance with experience from Uganda, Kenya, South Sudan and
Rwanda.
Gerald also uses arts of different forms to enhance community
development
Moses OKWII:
Principal Investigator (PI)1
He has over 6 years’ experience in social researcher, fundraising, capacity
building and organizational development t from East Africa and south
Sudan. He has done consulting for a series organizations including
NGOs small and large, private companies, academic institutions and
government departments.
Nathan OCHATUM: Principal Investigator (PI) 2
He is a statistician with experience in data management, research, M&E,
impact assessment and baseline surveys. Worked in East Africa and
South Sudan, with projects sponsored by; SNV-South Sudan and
Uganda, CABI, PLAN, NAADS among others
Multi-Media Skills and Health Consult (MSHC) Limited
P.O. Box 122 Juba, Sou8th Sudan
Tel.: +211 929 674 060, +211 977 343 627
E-mail: [email protected]
Website: www.mshc-southsudna.org
1|Page
Acknowledgement:
The team would like to thanks all the stakeholders for the outstanding support during this
exercise. In particular we want to give appreciation to the following:

State Ministry of Physical Infrastructure (MoPI)

State Ministry of Education (MoE)

County Education Directors (CED) from Magwi, Torit, Lopa/Lafon, Ikwotos, Kapoeta
and East, Kapoeta South

Head teachers and Teachers from all the schools visited

Pupils/students (boys and girls) from all the schools (primary/secondary) visited

PTAs/SMCs, Local/opinion leaders and

Whoever contributed to the success of this assignment
In a concerted effort, the team above was able to guide and advise MSHC throughout the work.
Not only did they advise/guide us during the assignment but contributed to the discussion and
generating information that built up this report.
2|Page
Table of Contents:
Consulting organization: ............................................................................................................................1
Summary: ......................................................................................................................................................5
Acronyms: .....................................................................................................................................................7
List of tables: .................................................................................................................................................8
List of figures: ...............................................................................................................................................9
1.0 CHAPTER ONE: INTRODUCTION AND BACKGROUND TO THE STUDY ..........................10
1.1 Overview: ....................................................................................................................... 10
1.2 Objectives of the Assessment: ..................................................................................... 10
1.2 Rationale: ........................................................................................................................ 10
1.3 Organisation of the Report:.......................................................................................... 11
1.4 Education in South Sudan: ........................................................................................... 11
1.6 Status of WASH in South Sudan:..................................................................................... 13
1.7 Water and sanitation in schools: Addressing feminine hygiene: ................................ 14
1.8 Menstrual Hygiene Management: ................................................................................... 15
1.9 MHM and school attendance: .......................................................................................... 16
2.1 Scope and Coverage of the Study: ................................................................................... 19
2.2 Study design: ...................................................................................................................... 19
2.3 Sampling Techniques: ....................................................................................................... 19
2.4 Sample size of respondents: ............................................................................................. 20
2.5 Data collection: ................................................................................................................... 20
2.6 Ethical considerations:....................................................................................................... 20
2.7 Data Analysis: ..................................................................................................................... 20
2.8 Challenges, Limitations to consultations: ....................................................................... 21
3.0 CHAPTER THREE: PRESENTATION OF FINDINGS AND DISCUSSION ...............................22
3.1 Introduction: ....................................................................................................................... 22
3.2 Education: ........................................................................................................................... 22
3.2.1 Average enrolment in primary and secondary schools .......................................................22
3.2.2
Total enrolment of pupils in selected schools per county ........................................23
3.2.3 Enrolment age of girls in primary school ..............................................................................24
3.2.4 Teachers: .....................................................................................................................................25
3.2.5 Reasons for dropping out of school........................................................................................26
3.3 MENSTRUAL HYGIENE MANAGEMENT .................................................................. 28
3.3.1 Knowledge on menstruation: ..................................................................................................28
3.3.2 Information on Menstrual Hygiene Management: ..............................................................29
3.3.3 Source of information on Menstrual Hygiene Management: .............................................30
3.3.4 Materials used during Menstruation:.....................................................................................31
3.3.5 Use of sanitary pads in the last 3 months ..............................................................................32
3.3.6 Reasons for not using sanitary pads:......................................................................................33
3.3.7 Usage of Knickers/underwear: .................................................................................................0
3.3.8 How boys react to girls during menstrual periods ................................................................1
3.3.9 How the community treats girls during menstrual periods .................................................2
3.3.10 Channels of ensuring availability of sanitary materials ......................................................3
3|Page
3.3.11 Menstruation and school attendance: ....................................................................................3
3.3.12 Why menstruation makes girls miss school ..........................................................................4
3.4 WASH: ................................................................................................................................... 5
3.4.1 Presence of changing rooms for girls in school: .....................................................................5
3.4.2 Presence of Latrines: ...................................................................................................................6
3.4.3 Presence of water in schools: .....................................................................................................7
3.5 DISCUSSION OF RESULTS ............................................................................................... 9
3.5.1 EDUCATION: ..............................................................................................................................9
3.5.2 MENSTRUAL HYGIENE MANAGEMENT: ........................................................................10
4.1 RECOMMENDATIONS:................................................................................................... 13
4.1.1 Menstrual Hygiene Management: ..........................................................................................13
4.1.2 EDUCATION: ............................................................................................................................14
4.1.3 WASH: ........................................................................................................................................15
4.2 Conclusion: ......................................................................................................................... 15
Annex One: Sample population ...............................................................................................................16
Annex Two: List of Selected School per County for MHM Baseline Survey Project ......... 17
Annex Three: Questionnaires ...................................................................................................................19
Annex Four: QUESTIONNAIRE FOR GIRLS IN PRIMARY & SECONDARY SCHOOLS .....24
Annex five: OBSERVATION CHECKLIST.............................................................................................28
Annex 6: INTERVIEW SCHEDULE FOR GIRLS AND BOYS (FGD) ............................................30
Annex seven: INTERVIEW SCHEDULE WITH LOCAL LEADER, PTA/SMC AND PARENTS .31
Annex eight: List of Enumerators ...........................................................................................................32
4|Page
Summary:
Policy-makers and other actors have cited knowledge on key menstrual hygiene management
issues, inadequate WASH facilities and lack of sanitary products as barriers to girls' schooling. In
this assessment, we evaluated the status of WASH in schools, examined the knowledge, attitudes
and practices in relation to Menstrual Hygiene Management as well as explored available
opportunities, challenges and recommendations aimed towards improvement of WASH and
menstrual hygiene management in Eastern Equatorial State, South Sudan.
A qualitative and quantitative study design was adopted and questionnaires, FGDs, Observation
checklist and interviews were used in collecting data from various respondents that included
school girls, boys, teachers, parents, PTAs/SCMs, Local leaders and Chiefs. Data was collected
from 1280 respondents with a response rate of 71.1% within 49 primary and secondary schools in
Eastern equatorial State.
The findings of this baseline assessment revealed that in Eastern Equatoria State, enrolment of
both boys and girls is mainly concentrated at lower classes (P.1 – P.4) with upper classes (P.5 –
P.8) having fewer pupils. Detailed analysis of class enrolment by gender revealed that, the
number of girls in per classes (P.5 – P.8) including secondary is relatively very low with most
schools in Kapoeta East, Kapoeta South and Lopa-Lafon having no girls completely in some of
these classes. Findings further exposed that there are only 705 girls enrolled in primary eight
compared to 1,263 boys meaning that there is one girl in every six boys in primary eight. The low
level of enrolment of girls in upper classes of primary including secondary has largely been
attributed to early forced marriages and pregnancies.
Limited availability of trained teachers in schools was also revealed by the assessment as one the
major challenges surrounding education. Male teachers were the majority in all schools with
some schools completely lacking a female teacher.
The assessment established that most girls both in primary and secondary had limited
knowledge on what menstruation is about. With 62.9% of girls in Lopa-Lafon citing
menstruation as a disease and 59.9% of the girls citing that someone is unhealthy during
menstruation periods. Findings further revealed issues of menstruation are generally regarded
as a big secret and taboo and that men are not completely supposed to know.
The materials and approaches used by many girls and women for menstrual hygiene
management in Eastern Equatoria State, South Sudan were found to highly diverse ranging from
modern to traditional materials which could regarded as the worst in the world. The assessment
specifically established that most women and school going girls reported to be using goat’s skin,
bark cloth, soil, rags, pieces of mattress, digging holes on the ground, leaves of trees and
traditional herbs like “bene” popular among the Lotuko tribe used for controlling blood flow.
Findings further revealed that42.7% of girls who responded reported that they do not wear
underwear, and this is greatly attributed to the cultural factors surrounding underwear among
the tribes like the Toposa where it’s traditionally illegal for women to wear underwear’s.
5|Page
Based on the findings of this assessment, the issue of menstrual hygiene management is a serious
challenge amongst the girls and is also attributed to the poor attendance in school. We therefore
recommend that teachers, especially males be capacitated on MHM issues and life skills
education so as to empower them in supporting adolescence pupils. In addition massive
community awareness campaigns need to be undertaken targeting parents on MHM and value
of education. There is lack of supplies on menstrual hygiene kits and hence there is need to
explore cost effective methods of making re-usable sanitary pads to improve access by girls and
women. Advocacy is required in relation to designing appropriate sanitation structures that
cater for menstrual hygiene management in schools.
6|Page
Acronyms:
WASH
PTAs
SMCs
UNICEF
MHM
FDGs
NGOs
SNV
Water Sanitation and Hygiene
Parents Teachers Association
School Management Committees
United Nations Children’s Fund
Menstrual Hygiene Management
Focused Group Discussions
Non-Governmental Organizations
Netherlands Development Organization
MoPI
State Ministry of Physical Infrastructure
MoE
State Ministry of Education
CED
County Education Directors
K.E.C
Kapoeta East County
K.S.C
Kapoeta South County
EMIS
CPA
MWRI
GESS
USAID
SSA
MDGs
HIV
UNHCR
SPSS
CSOs
Education Management Information Systems
Comprehensive Peace Agreement
Ministry of Water Resources and Irrigation
Girls Education South Sudan
United States Agency for International Development
Studies for Sub-Saharan Africa
Millennium Development goals
Human Immunodeficiency Virus
United Nations High Commissioner for Refugees
Statistical Package for Social Sciences
Civil Society Organizations
7|Page
List of tables:
Table 1: Showing total enrolment of pupils in primary schools ....................................................... 23
Table 2; Number of trained and untrained teachers by gender ........................................................ 26
Table 3; Showing reasons why girls drop out of school ..................................................................... 26
Table 4; Showing perception of pupils/students on menstruation .................................................. 29
Table 5; Showing sources of information on MHM ............................................................................ 31
Table 6; Showing materials and approaches used during menstruation ......................................... 32
Table 7; Showing perceptions and beliefs associated with menstruation.......................................... 2
Table 8; Average number of school days missed by girls during menstruation .............................. 4
Table 10; Availability of changing room and materials in schools ..................................................... 5
Table 11; Showing presence and state of latrines .................................................................................. 6
Table 12; Showing presence and condition of water sources .............................................................. 7
8|Page
List of figures:
Figure 1.Cross –sectorial schooling profile based on EMIS, 2009 ..................................................... 11
Figure 2.Average enrolment in primary schools Figure 3. Average enrolment in secondary ... 22
Figure 4; Showing the maximum and minimum age of girls per class ............................................ 24
Figure 5 Primary School girls of Lofus Primary school, Ikwoto County ......................................... 26
Figure 6; Percentage of girls that have ever heard information on menstrual hygiene care ........ 30
Figure 7; showing whether girls had used sanitary pads in the last 3 months ............................... 32
Figure 8; Showing reasons for not using pads in the last 3 months ................................................... 0
Figure 9; Showing percentage of girls who put on knickers................................................................ 1
Figure 10.Showing how girls are treated by boys during menstrual periods ................................... 1
Figure 11; how girls are treated by the community during menstruation ........................................ 2
Figure 12; most accessible channels of ensuring availability of sanitary materials .......................... 3
Figure 13; Showing why menstruation makes girls miss school ........................................................ 4
9|Page
1.0 CHAPTER ONE: INTRODUCTION AND BACKGROUND TO THE STUDY
1.1 Overview:
Menstrual hygiene management in schools is receiving renewed attention as its impacts on girl
education have been noted in terms of having long-lasting and far-reaching social and economic
effects. Through the international day for menstrual hygiene management it has become a
primary focus of development efforts in many developing nations including South Sudan. Over
the years, the issue of school hygiene, sanitation and water has been put high on the agenda of
many, international donors, non-governmental organisations, international agencies including
government as a way of promoting a conducive school environment for many girls.
In line with girl’s school attainment, menstrual hygiene management has on the other hand
attained little or no attention and yet many scholars and actors have attributed it to be having far
much reaching implications on overall children schools attainment.
This assessment focused on the current WASH status in schools and how menstruation hygiene
is being managed in view of collecting information that will form basis for future programming
and current programme implementation.
1.2 Objectives of the Assessment:
The overall objective of the baseline study was to establish baseline data on WASH in schools so
as to provide benchmark information on indicators of WASH in school, Menstrual Hygiene and
policy interventions in relation to WASH in Eastern Equatorial state. The specific objectives of
the baseline study were;
1. To map out trends in the selected schools with regard to schools WASH services which
include but not limited to status of WASH in schools, enrolment, Menstrual Hygiene
management, key actors, infrastructure availability, management of PTA/SMC, type of
material available, costs acceptability and affordability.
2. Analyse existing menstrual hygiene product supply chain/enterprises, with a view to
identify entry point (s) into sustainable supply chain menstrual hygiene materials with
potential for highest social impact and commercial returns
1.2 Rationale:
The baseline survey was conducted in view of expanding SNVs school WASH programmes
especially in creating child friendly schools with emphasis on menstrual hygiene management.
SNV and its stakeholders particularly the State Ministry of Education, Youth and Sports, would
like to ensure interventions that influenced by evidence from the beneficiary communities in line
with current practices, attitudes, knowledge levels and beliefs. It was therefore on this basis that
the baseline assessment was undertaken so as to inform planning approaches given the diversity
of unmet needs, challenges, including menstrual hygiene in schools and available resources
(technology, institutions and organizations). This diversity necessarily suggests a balance
between standardization allowing evidence-based innovation experimentation.
10 | P a g e
Menstrual hygiene management has emerged as one of the major challenges confronting all
schools in South Sudan and has been attributed to low retention of girls in schools. This baseline
survey which was undertaken in 49 schools in Eastern Equatorial provided the benchmarks
against which the project successes will be measured. In addition it will contribute to the body of
knowledge that will inform roll out of the projects in schools towards addressing the WASH
challenges and hence increasing the number of pupils in schools and in particular the girl child.
1.3 Organisation of the Report:
The report is arranged into four chapters. Chapter one presents background, objectives, rational
and review of related literature. Chapter two provides an insight into the overall survey
methodology that was employed. Chapter three presents assessment findings and discussions.
Finally chapter 4 presents conclusion and recommendations based on the findings from the
assessment and other studies taken earlier.
1.4 Education in South Sudan:
South Sudan has some of the lowest educational indicators in the whole world. The adult literacy
rate stands at only 27 per cent, and 70 per cent of children aged 6–17 years have never set foot in
a classroom1. The completion rate in primary schools is less than 10 per cent, and is one of the
lowest in the world as shown in the figure 1 below. Gender equality is another challenge, with
only 33 per cent of girls in schools.
Figure 1.Cross –sectorial schooling profile based on EMIS, 2009
Source; UNICEF South Sudan
1
Unicef South Sudan, Basic Education and Gender Equality, http://www.unicef.org/southsudan/Education.pdf
11 | P a g e
Despite the fact that demand for education in South Sudan far outstrips supply, few children and
youth are able to complete the full primary cycle – let alone go on to complete secondary and
post-secondary studies2. The failure to complete the full education cycle at all levels has far much
reaching implications and as such it’s important to unpin the underlying factors.
Worse still, women and girls in South Sudan are more likely to die at childbirth than to complete
primary education3. While enrolment in the primary and secondary systems has increased
dramatically in the years since the CPA, over-age children make up 85% of all primary school
enrolees, and 90% of those children enrolled in secondary school and this has a negative effect on
competition rates4. The average recommended age range for completion of primary cycle in
South Sudan is estimated at 14 years and Secondary 18. The Net Enrolment Rate for at-age
children in the primary system is only 42.9%5 implying that 57.1% of children in primary
schooling are over age.
Currently there are 1.4 million children in primary schools, out of 2.4 million children aged
between 5 and 146.
There are only an estimated seven girls for every 10 boys in primary school and five girls for
every 10 boys in secondary.7 In the whole country, only five hundred (500) girls are in the last
grade of secondary school (Senior four). Only one in four girls enrols in primary school and a
mere one in ten completes primary education. Out of 377,085 girls of the secondary level age
group only 2.6% (9,898) are in schools. These numbers are among the lowest in the world8.
There are about 26,000 teachers and 30,000 classrooms meaning on average 118 children will
need to share a classroom and about 88 share 1 teacher.9 There are 3.400 primary schools, and
196 secondary schools.
The unbalance of pupil-classroom and pupil-teacher ratio in the Country has led to a huge
shortage of qualified primary school teachers with government resorting to use volunteer
untrained staff as an option. In addition poor management and supervision of teachers, lack of
physical infrastructure, inadequate teaching and learning materials, and low participation of
PTAs/School Management Committees and communities in school management contribute to
access and quality challenges10
The underlying factors for this trend are enormous from few numbers of secondary schools to
rigid cultures in terms of early forced marriages for girls as low as 9 years, and general
preference by parents to educating boys than girls. Just only 12% of teachers are female. Literacy
rates for girls are 40% compared to 60% for boys.11 Girls’ lack of access to educational
opportunity has been exacerbated by certain cultural practices as well as widespread insecurity
2
DFID, Business Case for the Girls Education South Sudan (GESS) Programme, December 2012
Comparison made using data from South Sudan Statistical Yearbook 2011 and Education National Statistics Booklet 2011
4
EMIS Data 2011
5
EMIS Data 2011
6
EMIS Data 2011
7
World Bank, Education in the Republic of South Sudan – Status and Challenges for a New System , 2012
8
EMIS Data 2011
9
EMIS Data 2011
10
DFID, Business Case for the Girls Education South Sudan (GESS) Programme, December 2012
11
World Bank, Education in the Republic of South Sudan-Status and Challenges for a New System, 2012
3
12 | P a g e
and conflict. Whilst education is voiced by many communities as a priority, opportunity costs in
girls’ education mean that demand is actually low.
A combination of supply and demand side constraints underlies this unusual gender disparity in
education in South Sudan. Lack of schools, especially secondary schools; low numbers of female
teachers; and inadequate water and sanitation facilities in schools are some of the supply side
factors. Poverty, insecurity, early marriage and pregnancy have been identified across the States
as key causes of drop out from schools12. Each percentage point increase in poverty reduces a
girl’s chance of being enrolled at a primary school by 0.3 percentage point13.
A cattle culture and economy is predominant in South Sudan and in many communities women
are viewed as a household resource, commonly valued by the number of cows they would bring
as dowry; and as a tool for domestic chores14. These social views and the economic realities that
underpin them result in further barriers for girls’ education. Communities fear that girls will be
‘spoilt’ by going to school, mixing with boys and men un-chaperoned, and that educated girls’
will not respect their men folk and thus their future husbands and therefore they will be harder
to marry off15.
1.6 Status of WASH in South Sudan:
Recent surveys show that more than 30 per cent of people in South Sudan do not have access to
safe water supplies with only 13 per cent having access to adequate sanitation facilities16. This
makes South Sudan to be one of the lowest service coverage statistics in the world. The lack of
access to clean water has propelled increase in Guinea worm cases making South Sudan a host to
98% of the whole world’s population despite a reduction in caseload from more than 20,500 in
2006 to below 1,000 in 201117
The Ministry of Water Resources and Irrigation (MWRI) states that 30-50 percent of water
facilities are non-functional at any point in time due to the lack of spare part supply chains, weak
maintenance capacity, poor management and/or inappropriate choice of technology18. Thus, the
actual level of access to an improved water source in rural areas is estimated to be only 34
percent – which affects most of the country as over 80 percent live in rural areas, representing 90
percent of those living in poverty19. Furthermore, only 13 percent of the population has access to
adequate sanitation facilities and for those using an improved water source, 34 percent travel
less than 30 minutes20 the recommended minimum average time to access a water point
according to the World Health organization.
Beyond limited access to improved water and sanitation there is low knowledge and practice of
good hygiene behaviours. The lack of access to improved water and sanitation and poor hygiene
behaviours is a principal cause of water-related diseases such as diarrhoea and cholera, infection
12
UNICEF, 2008. A Study on Socio-economic and Cultural Barriers to Schooling in South Sudan
13
Michael Morris, 2010. Analysis of Provincial Education Statistics of South Sudan.Unpublished.DFID Sudan 2010
DFID, Business Case for the Girls Education South Sudan (GESS) Programme, December 2012
15
DFID, Business Case for the Girls Education South Sudan (GESS) Programme, December 2012
16
Unicef, South Sudan “ Water, Sanitation and Hygiene”, http://www.unicef.org/southsudan/WASH.pdf
14
17
Unicef, South Sudan “ Water, Sanitation and Hygiene”, http://www.unicef.org/southsudan/WASH.pdf
USAID, Draft Water Sanitation and Hygiene Programme, 2013
19
USAID, Draft Water Sanitation and Hygiene Programme, 2013
20
USAID, Draft Water Sanitation and Hygiene Programme, 2013
18
13 | P a g e
from guinea worm, and contributes to malnutrition21. Water, sanitation, and hygiene (WASH) is
also associated with educational access and nutritional outcomes. Access to water and sanitation
can be the reason why girls are kept out of school and improved access to water and sanitation at
schools has been shown to increase school attendance among girls22
Access to improved drinking water sources and improved sanitation and hygiene can improve
nutritional outcomes and can prevent intestinal parasitic infections alongside diarrhoea, and
these infections also have synergistic effects with increasing incidences of malnutrition.
Improved access to safe water, sanitation, and adequate hygiene can predict child growth and
malnutrition and is associated with improved child development outcomes. Improving WASH is
necessary to improve health, nutrition, and educational outcomes in South Sudan. Beyond these
burdens related to poor WASH access and behaviours, it is also associated with economic losses,
environmental impacts, gender/social burdens, and potential conflict. Access to and good
management of water resources improves health and education outcomes, brings more certainty
and efficiency in productivity across economic sectors, and contributes to the health of the
ecosystem.
Making improvements in the areas of water and sanitation is vital to transforming people’s lives.
Engaging with communities about choices they wish to make over safe water and sanitation
improvements provides an important entry point for human rights principled dialogue on peace
building and sustainable service delivery. Achieving community stability through timely and
appropriate safe water improvement interventions is a key priority for WASH interventions in
South Sudan23.
However, the negative effect of inadequate sanitary care on female educational achievement is
completely undocumented by research in South Sudan. Thus, despite the problem’s rising
salience, many international aid community members resist the notion that providing care will
improve educational outcomes.
1.7 Water and sanitation in schools: Addressing feminine hygiene:
Studies in Sub-Sahara African (SSA) countries show that the lack of adequate toilet facilities is a
common feature in many schools where the child-toilet ratios is on average 1:10024.
It has been argued that only 45 per cent of South Sudan’s 3,349 basic primary schools have access
to safe water and a mere 17 per cent have adequate sanitary latrines for both girls and boys25.
Even the few 17% that exist in schools have unfriendly environments for girl’s management of
menstrual hygiene. This happens in many schools of South Sudan though it has been stressed
that school toilets, are built to accommodate menstruating girls’ specific needs for privacy,
space, washing facilities and correct disposal or cleaning of menstrual pads26.
Access to improved drinking water sources and improved sanitation and hygiene can improve
nutritional outcomes and can prevent intestinal parasitic infections alongside diarrhoea, and
21
USAID, Draft Water Sanitation and Hygiene Programme, 2013
USAID, Draft Water Sanitation and Hygiene Programme, 2013
23
USAID, Draft Water Sanitation and Hygiene Programme, 2013
24
Unicef ESARO, “Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi”, 2010
25
Unicef, South Sudan “ Water, Sanitation and Hygiene”, 2013
26
UNICEF, Raising clean hands: Advancing learning, health and participation through WASH in schools, UNICEF, New York, 2010
22
14 | P a g e
these infections also have synergistic effects with increasing incidences of malnutrition27.
Improved access to safe water, sanitation, and adequate hygiene can predict child growth and
malnutrition and is associated with improved child development outcomes. Improving WASH is
necessary to improve health, nutrition, and educational outcomes in South Sudan28. Access to
and good management of water resources improves health and education outcomes, brings more
certainty and efficiency in productivity across economic sectors, and contributes to the health of
the ecosystem.
1.8 Menstrual Hygiene Management:
Menstruation is a natural process, which begins to occur for girls between the ages of 9 and 16
years with a mean of 13 years29. The menstruation period usually lasts for an average of five
days, but may vary from three to over seven days30. The duration and heaviness of a period
influences its management, menstrual products used and frequency of change.
In South Sudan, like in many parts of the developing world, menstrual hygiene management is
one of the critical challenges adolescent girls face while they are in school. This is largely due to
lack of facilities as well as poor management of the existing facilities coupled with many cultural
norms and taboos against menstruation.
Young girls in developing countries often receive minimal instruction on menstrual hygiene
management because menstruation is seen as taboo by many communities, which makes it
extremely difficult for adolescent girls to acquire necessary information and support from
parents and school teachers31.There is evidence that boys, male teachers and even male head of
schools are completely ignorant of girls menstruation needs32 and therefore are unable to
provide a supportive environment to girls in school during menstruation periods.
Menstruation has often been dealt with secrecy in many cultures33 and such perceptions coupled
with poor and inadequate sanitary facilities have often kept girls from attending schools
especially during periods of menstruation.
There is gross lack of information on menstrual management among adolescent girls, a situation
made worse by the shyness and embarrassment with which discussions about menstruation is
treated. Most of these girls seek information about menstruation from their peers who do not
know better34.
Adolescence being a time of tremendous opportunity, and at the same time also a time of
heightened vulnerabilities, it is imperative to empower adolescent girls with adequate
information and skills on crucial issues like menstrual hygiene and its management.
27
USAID, Draft Water Sanitation and Hygiene Programme, 2013
USAID, Draft Water Sanitation and Hygiene Programme, 2013
29
Dasgupta A and Sarkar M (2008). Menstrual hygiene: how hygienic is the adolescent girl in India, Journal of Community Medicine, 33(2): 77-80.
30
Ezra Guya, Aloyce W. Mayo, Richard Kimwaga, Menstrual Hygiene Management in Secondary schools in Tanzania, International Journal of
Science and Technology, January 2014
31
Shannon A, Peter J, Bethany A, Alfredo F, Emily A, Imelda A and Richard D (2011). The girl with her period is the one to hang her head.
Reflections on menstrual management schoolgirls in rural Kenya, BMC International Health and Human Rights Journal, 11(7): 689-698
32
Ezra Guya, Aloyce W. Mayo, Richard Kimwaga, Menstrual Hygiene Management in Secondary schools in Tanzania, International Journal of
Science and Technology, January 2014
33
Unicef India, Sharing simple facts handbook “useful information about menstrual health and hygiene”, 2008
28
34
Same as one above
15 | P a g e
1.9 MHM and school attendance:
Lack of soap, hand wash facilities, emergency pads and privacy which are important
determinant for proper practice of menstrual hygiene and school attendance has been identified
as main problems35in many schools in developing countries.
Various studies have shown that girls who attend schools without appropriate water supply and
sanitation facilities prefer to remain at home during menstruation36. A Menstrual Hygiene
Management (MHM) survey conducted by SNV Uganda in 120 schools across six Districts
revealed that girls are more likely to remain at home from school during their period due to a
lack of facilities for and embarrassment about menstrual hygiene37.
The World Bank has put concrete numbers on the menstruation problem and asserts that; if a girl
misses 4 days of school every 4 weeks due to her period, she will miss 10 to 20% of her school
days38. Tion and Varina, (2007) are also in great agreement with this analysis. 39
UNICEF (2005) estimated that about 10% of school-age African girls do not attend school during
menstruation, or drop out at puberty because of the lack of clean and private sanitation facilities
in schools.
This possible role for menstruation limiting school attendance has received significant attention,
and nearly all arguments indicate that menstruation is likely to be a significant factor in
schooling40, 41.This argument has received mixed reactions among various scholars for example,
Kristof (2009) writes that education experts increasingly believe that a cost effective way to keep
high school girls from dropping out in poor countries is to help provide them with sanitary
products42.
On a practical level many schools lack hygiene facilities such as toilets, water, washrooms,
changing rooms, pads and pain killers. Providing these facilities would make regular school
attendance easier for girls43. In addition to providing benefit to the schoolgirls, opportunities for
the local development of sanitary pads including manufacturing and marketing of innovative
low-cost sanitary towels should be explored.
Emily and Thornton (2010) strongly assert that these arguments are based largely on anecdotal
evidence. In their experimental design on menstruation hygiene management using the
menstrual cup in Nepal, they have argued that, the impact of menstruation on attendance is very
35
Ezra Guya, Aloyce W. Mayo, Richard Kimwaga, Menstrual Hygiene Management in Secondary schools in Tanzania, International Journal of
Science and Technology, January 2014
36
Nahar Q and Ahmed R (2006). Addressing special needs of girl’s challenges in schools, Paper presented at the 2nd South Asian Conference on
Sanitation, Islamabad, Pakistan, 2006.
37
SNV Uganda, Keeping girls in school with improved menstrual hygiene management, June 2013
38
World Bank, “Toolkit on Hygiene Sanitation & Water in Schools: Gender Roles and Impact," 2005
39
Tjon A Ten, Varina, - Menstrual Hygiene: A Neglected Condition for the Achievement of Several Millennium Development Goals," Europe
External Policy Advisors, October 2007
40
Kristof, Nicholas, “A Most Meaningful Gift Idea”, New York Times, December 23 2009.
41
BBC News, Sanitary pads help Ghana girls go to school," 2010.
Kristof, Nicholas, “A Most Meaningful Gift Idea”, New York Times, December 23 2009.
42
43
SNV Uganda, Keeping girls in school with improved menstrual hygiene management, June 2013
16 | P a g e
small. They estimate that girls miss a total of 0.4 days in a 180 day school year due to period44.
Moreover, using a randomized evaluation they argue that providing better sanitary products (in
their case, a menstrual cup) had no impact on closing the small attendance gap.
This critical issue of MHM has been largely overlooked by the Water, Sanitation and Hygiene
(WASH) sector in general 45 in many developing countries including south Sudan. Failure to
provide appropriate menstrual hygiene facilities at home or school could prevent WASH
services being used as intended46. In recent years, some governments, institutions and NGOs
have realized that without addressing the problems associated with menstruation, the
achievement of at least three MDGs (no. 2, 3 and 7) will be hampered47, female school drop-out
rates will remain high and the dignity of schoolgirls will be compromised.
The consequence of this is that many girls grow up with low self-esteem and disempowered
from poor educational attainments. Menstruation has also been identified to cause discomfort
and high incidences of pain for a majority of women. It can also cause shifts in mood,
depression, vomiting, pyrexia, endometriosis, haemorrhage, migraines, anaemia and fibroids48.
Menstruation can potentially cause cancer if cells mistakenly divide uncontrollably49. Poor
management of menstruation can result in health problems such as infections of urinary or
reproductive tracts, although the route of transmission and the strength of the effects have not
been adequately established50. The potential risk of contracting blood-borne diseases such as HIV
or Hepatitis B through unprotected sex is also increased during menstruation because the
highest concentrations of virus are found in blood51. As a result many girls suffer from these
diseases and their complications can even lead on to the infection being transmitted to the
offspring when they conceive52.
In recognition of the impact of menstruation on school attendance, a number of NGOs and
sanitary product manufacturers have launched a series of campaigns to increase availability of
sanitary products, with a stated goal of improving school attendance53
The largest of these is a program by Proctor & Gamble, which pledged $5 million toward
providing puberty education and sanitary products, with the goal of keeping girls in school. The
Clinton Global Initiative has pledged $2.8 million to aid businesses that provide inexpensive
sanitary pads in Africa; again, the stated goal is improvement in school and work attendance.
In South Sudan, little information is available on who is doing what and where in regard to
MHM, however notable among them are, Plan South Sudan54 and United nations High
Emily Oster and Rebecca Thornton, “Menstruation, Sanitary Products and School Attendance: Evidence from a Randomized Evaluation”,
American Economic Journal, April 2010
44
45
Guya E (2013). Menstrual Hygiene Management in Secondary Schools: A case of Kinondoni District in Tanzania, Masters of Integrated Sanitation
Management, Department of Water Resources Engineering, University of Dar es Salaam.
46
Shoemaker D (2008). Proper procedure for sanitary napkin disposal, Cleaning and Maintenance Journal, 45(4): 33-37.
47
Tjon V (2007). Menstrual Hygiene: A neglected condition for the achievement of several millennium development goals, EEPA, Zoetermeer,
Netherlands.
48
Dalton K (1964).The influence of menstruation on health and disease.Proceeings of the Royal Society of Medicine, 57(4): 262-264.
49
Donimirski, M (2013). Health Effects of Menstruation and Birth Control Pills
http://serendip.brynmawr.edu/biology/b103/f00/web2/donimirski2.html.Retrieved on October 23rd 2013.
50
Sumpter C and Torondel B (2013). A systematic review of the health and social effects of menstrual hygiene management, PLOS One, 8(4): 1-15.
51
UNAIDS, UNFPA and UNIFEM (2004).Women and HIV/AIDS: Confronting the Crisis, Joint Report on the Global AIDS Epidemic.
52
Shanbhag D, Shilpa R, D’Souza N, Josephine P, Singh J and Goud R (2012). Perceptions regarding menstruation and Practices during menstrual
cycles among high school going adolescent girls in resource limited settings around Bangalore city, Karnataka, India.
53
Callister, Lynn Clark, \Always Stay in School," Journal of Maternal Child Nursing, May/June 2008.
17 | P a g e
Commissioner for Refugees, UNHCR55 who have recently distributed sanitary pads in the fragile
states of Lake state and Jonglei.
However, some of the critical issues that arise in regard to current interventions are; 1) what is
the actual short and long-term impact of these interventions to girls’ attendance and
performance in school? 2) How sustainable are these interventions? 3) Have the traditional
beliefs and practices that surround MHM been addressed? And 4) have all the relevant
stakeholders been involved in forging a way forward for sustainability and creation of a
conducive learning environment for girls in schools.
54
http://plan-international.org/where-we-work/africa/south-sudan/what-we-do/our-successes/adolescent-girls-benefit-from-menstrualhygiene-tips/
55
http://www.sca.com/en/Media/News-features/2014/SCA-help-refugee-girls-in-South-Sudan-to-stay-in-school/
18 | P a g e
2.0 CHAPTER TWO: METHODOLOGICAL APPROACH
2.1 Scope and Coverage of the Study:
The Menstrual Hygiene Management and WASH Baseline Survey (2014) was carried out in 49
primary and secondary schools in Eastern Equatoria State, South Sudan in the counties of; Torit,
Magwe, Lopa-lafon, Kapoeta East, Kapoeta South and Ikwotos in May 2014.
2.2 Study design:
This was a descriptive cross-sectional study in which quantitative and qualitative methods were
applied. Self-administered structured close-ended questionnaire survey, Observation (inspection
visits), Observation Checklist (quantitative), Focus Group Discussions (FGD) and semistructured in-depth interviews (qualitative) were applied to collect the information. All these
tools were pre-tested at Torit East Primary School and revised accordingly before they were used
for the study population. All the tools were prepared in English however, during FGD and semistructured in-depth interviews they were translated to relevant local languages.
In each of the schools (primary and secondary), two sets of questionnaires were used in the
study. The Head teachers/teacher questionnaire was the main questionnaire and collected
information on availability of a conducive learning environment in schools with focus on girls.
The second set of the questionnaire was administered to only girls and was used to collect
detailed information on Menstrual Hygiene Management in schools, homes and communities.
In addition, 2 focus group meetings, 2 key Informant Interviews and one observation checklist
were used in each school.
The respondents for the Focus Group Discussions included pupil/students both boys and girls
in the respective schools including parents both male and female with whom discussions were
separately held with. The Key Informant Interviews questionnaires were on the other hand
administered to opinion leaders especially chiefs and women leaders from surrounding
communities of the schools
2.3 Sampling Techniques:
The schools were selected by the state Ministry of Education, Youth and Sports officials using
stratified random sampling technique in the six counties of Eastern Equatoria State for this
purpose. The sample population included girls, boys, parents (male and female), local leaders,
head teachers, senior women teachers and other teachers.
Stratified random technique was employed in the selection of girls from the age of 11 and above
studying in all grades at both primary and secondary schools. Only girls who were staying in the
nearby homes surrounding the school and were willing to participate in the study were
included. Convenient sampling technique was used in the selection of boys for the FGD as well
as their willingness to be involved in the study.
Purposive sampling technique was used in the section of head teachers and teachers while
convenience and snow ball sampling methods were employed to select parents (male and
19 | P a g e
female), community/local leaders depending on availability willingness and readiness to
participate in the study.
2.4 Sample size of respondents:
A total of 1,800 respondents were targeted in the baseline assessment. Out of these, 1280
respondents were successfully interviewed, yielding a response rate of 71.1% Percent. Refer to
appendix
2.5 Data collection:
Data collection was carried out at the school site with prior communication (written) and due
verbal consent from respective head of schools. Voluntary willingness from the respondents to
participate in the study was also sought before they were requested to fill the questionnaires and
engage in FGDs and were allowed to enquire any clarifications from the research team.
Different FGD’s were conducted in each of the 49 schools with both parents and pupils/students
who were selected out of the respondents with the help of teachers. The pupils/students and
parents were asked open-ended questions and the moderator included probes and follow-up
questions. To make the respondents feel at ease and express freely, male and female pupils were
separated during FGD. On the other hand, in FGDs with parents, relevant local language was
used in communication. A closed ended questionnaire was administered to both head of school
and senior woman teacher or any other available female teacher at the school at the time of data
collection in each of the 49 schools.
Observation (inspection visits) was done by the research team using pre-designed checklist
guide by visiting into relevant school areas that are related to menstrual hygiene management
and WASH. These areas included latrines, staff latrines, school water source facilities,
dormitories (for boarding), Classrooms, staff room/office and in some school special room used
to attend menstrual emergency need was visited if found available.
2.6 Ethical considerations:
Rights, anonymity and confidentiality of the respondents were respected in all phases of the
study. Informed verbal consent with the respective head of school and the respondents were
taken before data collection. Through verbal consent process, the type and purpose of the
survey, discussion or interview; issues of anonymity and confidentiality; voluntary participation
and freedom to discontinue the interview/discussion at any stage; and absence of any known
risk or benefit for participating in the study was explained beforehand. Photos were made with
due verbal permission from the respondents. To preserve anonymity, all findings are presented
without ascribing names or identifiable personal description.
2.7 Data Analysis:
Quantitative data from the survey was captured analysed using SPSS software. Descriptive
statistics were generated to show the socio-demographic characteristics as well as the
20 | P a g e
distribution of knowledge and practices regarding menstrual hygiene and management using
frequencies, crosstabs, tables and graphs. Cross-tabulation was run to see the association
between some socio-demographic variables with knowledge or practice variables. A Pearson
product moment correlation was run to establish the relationship between menstruation and
missing school
Data from FGDs and in-depth interviews was captured during the discussions and processed
manually based on recurrent themes and patterns.
2.8 Challenges, Limitations to consultations:





Negative perception of respondents about NGOs on the basis that many NGOs go and
collect information about them but they completely never get back
Mobilization of participants was not adequately done by the concerned officials and this
resulted into delays and affecting meeting of some respondents and this affected the
response rate
Accessibility of some schools in the study was challenging due to the bad nature of roads
and rain
Communication in some areas was also a huge challenge and this affected coordination
efforts.
Language was also a challenge as respondents had a series of diverse languages.
However, translators had to be involved at certain points of the study
21 | P a g e
3.0 CHAPTER THREE: PRESENTATION OF FINDINGS AND DISCUSSION
3.1 Introduction:
The findings obtained through different methods and tools used in the study have been
organized and presented in this section under three main themes arising from the quantitative
and qualitative data. The main themes are: Enrolment, Menstrual Hygiene Management and
WASH.
3.2 Education:
3.2.1 Average enrolment in primary and secondary schools
Figure 2.Average enrolment in primary schools
Figure 3. Average enrolment in secondary
Figure.2 and 3 above show the average enrolment figures per class in primary and secondary
schools and the following are explanations.
1. Enrolment for boys is greater than that of girls in all classes and at all levels of education.
2. The average enrolment for boys in primary one is 58 in primary two, and 46 in primary
three while that of girls is 48 in primary one, 42 in primary two, and 43 in primary three.
This therefore means that the enrolment of both boys and girls in lower classes is
relatively the same.
3. The average enrolment for boys in primary eight is 30 in primary seven, and 36 in
primary six while that of girls at primary eight is 19, 25 in primary seven, and 26 in
primary six. There is therefore a large discrepancy between girls and boys enrolment at
upper classes of primary with some schools completely lacking girls in class eight, seven
and six. This same trend is being observed in secondary schools with most schools
22 | P a g e
having one or no girls at all in some classes or
having a total enrolment of at most 10 girls in
school.
“---Some parents come here to
school forcefully with guns and
pick their daughters for marriage
---”. Head Teacher, Primary
School, Kapoeta East County
The underlying reasons for this low figure on girls
enrolment in upper classes and secondary schools is that
in the cultures of the communities girls are generally
viewed at a major source of wealth and as such immediately the girl grows up to the age of 9 -12
years, she is picked out of school for marriage.
“Some parents bring their daughters to school only when they are still young because they want them
to feed well and grow up very fast. Immediately she grows up and fattens, they come and pick them
for marriage. That’s why the WFP in schools has been very successful in attracting Toposagirls to
school”. Head Teacher, Primary School, Kapoeta East County
Discussions with parents revealed that
“Some teachers get into relationships with girls and
early pregnancies among girls in upper
end up impregnating them and that will prevent
classes of primary affect their
them from going to secondary if she gets pregnant at
transitioning in secondary schools.
primary”. ----Female parent, Magwi Central P/s
Parents in Magwi County where
Magwi County
particularly concerned withthe rate at
which girls were being impregnated at school especially by teachers thus limiting their chances
of joining secondary school
3.2.2
Total enrolment of pupils in selected schools per county
Table 1: Showing total enrolment of pupils in primary schools
COUNT
Y
CLASS
P.1
Girl
s
348
Boy
s
366
KAPOETA
EAST
Girl Boys
s
212
176
P.2
240
299
214
179
573
633
350
454
361
357
437
473
P.3
206
256
180
164
569
630
255
327
407
394
522
541
P.4
220
287
148
152
721
893
176
221
565
604
484
531
P.5
192
219
72
142
604
822
111
176
527
496
407
440
P.6
153
235
56
125
435
577
101
161
358
389
327
662
P.7
110
214
20
48
308
403
75
137
265
340
286
375
P.8
90
174
12
54
200
309
46
110
145
287
212
329
23 | P a g e
IKWOTOS
KAPOETA
SOUTH
Girl Boy
s
s
489
707
LOPALAFON
Girl Boy
s
s
616
677
MAGWI
TORIT
Girl
s
332
Boy
s
419
Girls
Boys
526
499
From table 1 above, it can be deduced that Kapoeta East County and Lopa-lafon have the lowest
number of girls in primary eight at only 12 and 46 respectively. Magwi and Torit Counties on the
other hand had the highest enrolment rates of both boys and girls totalling to 145 and 212 for
girls respectively. This could be due to the fact that in Kapoeta East, Lopa-lafon most schools are
in rural areas where issues of early forced marriages are reported to be rampant. On the other
hand, Magwi, Torit and Kapoeta South had most of the schools visited within town areas where
parents value education of girls as a result of being exposed to other countries like Uganda and
Kenya.
Findings further exposed that there are only 705 girls enrolled in primary eight compared to
1,263 boys meaning that there is one girl in every six boys in primary eight.
3.2.3 Enrolment age of girls in primary school
Figure 4; Showing the maximum and minimum age of girls per class
The figure 4above presents that the minimum age at which girls enrol for primary One is 11
years and the maximum age being 14 years, while the minimum age of children in class eight is
14 years with a maximum age of 24 years. This finding therefore reveals that the age at which
girls are in primary level is over and above the required age of being in primary of between 13
and 14 years. It’s therefore worth noting that children across all schools in Eastern Equatorial
State girls generally delay to enrol in primary school and this affects their ability to complete a
primary schooling level. This analysis was further reaffirmed during FGDs where a male parent
from Pageri in Magwi County was quoted saying, “most of our girls are old to be in primary,
and most of them even know it --- some of their parents will definitely marry them off”
This Finding is in agreement with EMIS data (2011) revealing that over-age children make up
85% of all primary school enrolees, and 90% in secondary school and this has a negative effect on
24 | P a g e
completion rates56. The average recommended age range for completion of primary cycle in
South Sudan is estimated at 14 years and Secondary 18. The Net Enrolment Rate for at-age
children (below 14 years) in the primary system is only 42.9%57 implying that 57.1% of children
in primary schooling are over age.
The enrolment age of the children in this assessment shows that more than half of the children
are over aged (over 14 years, the recommended age of being in primary with the context of South
Sudan)
3.2.4 Teachers:
Across all the schools visited, the number of male teachers compared to female teachers was
observed and reported to be higher. Some schools did not even have a female teacher and this
was noted to greatly affect management of menstrual hygiene in those schools. Though some
schools had female teachers, the majority were untrained and also very few numbering about
two per school. The assessment noted that the male teachers either trained or untrained were
completely ignorant on menstrual hygiene management issues and had no clue on how it affects
girls and learning. This observation calls for concerted efforts to capacitate teachers on issues
WASH and menstrual hygiene.
56
EMIS Data 2011
EMIS Data 2011
57
25 | P a g e
Figure 5: Primary School girls of Lofus Primary school, Ikwoto County during focus group
discussions
Table 2; Number of trained and untrained teachers by gender
Male trained staff
Female trained staff
Male untrained staff
Female untrained staff
Primary
Minimum
Maximum
0
13
0
2
1
9
0
6
3.2.5 Reasons for dropping out of school
Fifty two percent ( 52.9%) of head teachers
and teachers cited early and forced
marriages as a major contributing factor to
girls dropping out of school. Twenty two
(22.4%)
identified
early
unwanted
pregnancies while 16.5% cited lack of
parental care as other major factors
contributing to school dropout.
Average
5
2
8
2
Minimum
0
0
0
0
Secondary
Maximum
22
5
10
2
Average
8
2
6
1
“One of the parents impregnated some girl in the
village…; he forced his 17 year old Primary Six
daughter studying in this school to get married so
that he pays off the cows his in laws wanted”.
Head Teacher, Primary School, Kapoeta South
The reason for early forced marriages by parents was cited in FGDs and it came out very clearly
that girls are generally viewed as a source of wealth and as such all measures should be done to
protect her.
Only 3.5% teachers identified menstruation as one the contributing factors to girls dropping out
of school while poor performance in school and poverty was cited by 3.5% and 2.4% of the
teachers respectively.
Table 3; Showing reasons why girls drop out of school
Reasons for dropping out
Early and forced marriage
Pregnancy
Lack of parental care
Lack of school fees
Cultural belief of girls not going to school
Menstruation periods
Poor performance
Poverty
Too much domestic work
26 | P a g e
Frequency
45
19
14
11
7
3
3
2
1
Percentage
52.9
22.4
16.5
12.9
8.2
3.5
3.5
2.4
1.2
Other factors identified during the FGDs for girls dropping out of school included; lack of
awareness among parents on the value education and therefore the do not adequately provide
for girls in school, lack of appropriate guidance and counselling about education from both
teachers and parents, teachers using in appropriate child friendly teaching techniques like
abusive language, and a heavy reliance on parents on girls on domestic issues.
The findings of this assessment relate with the findings of UNICEF (2008) which cited that girls’
lack of access to educational opportunity has been exacerbated by certain cultural practices as
well as widespread insecurity and conflict. The report shows that poverty, insecurity, early
marriage and pregnancy have been identified across the States as key causes of drop out from
schools58. Morrison (2010) further builds on this argument by stating that ‘each percentage point
increase in poverty reduces a
girl’s chance of being enrolled at
“… if I have four girls, I send one to school and keep three at
home so that I may also get something” (something meaning
a primary school by 0.3
cows). Local Chief, Kapoeta South County
percentage point’59.
The cultural norms that give girls not a chance of going to school is common in many
communities. This assessment supports similar findings by DIFD (2012) who showed that a
cattle culture and economy is predominant in South Sudan and in many communities women
are viewed as a household resource, commonly valued by the number of cows they would bring
as dowry; and as a tool for domestic chores60. These social views and the economic realities that
underpin them result in further barriers for girls’ education. Communities fear that girls will be
‘spoilt’ by going to school, mixing with boys and men un-chaperoned, and that educated girls’
will not respect their men folk and thus their future husbands and therefore they will be harder
to marry off61. In relation to this view, the PTA chairperson at one of the primary schools in Torit
County is quoted saying “People here value cattle so much that they can give away their daughter even
at a young age just to get cows. So they will
not take the girl to school but instead marry her off”.
“In our culture, if a girl gets married, someone can pay something like 70 cows, the brothers, uncles
and unties are also given a share. So if your daughter is still in school, they tell you “you prefer
sending your girls to school and yet you enjoy receiving the cows of our daughters, so when shall we
enjoy yours also?” Female Parent, Kapoeta South County
Another parent is quoted saying “when
you take a girl to school, she will end up
learning a bad culture and forget about our
culture, this girls become prostitutes, and
they lose respect for others. We do not
58
“Parents do not budget for their girls. The girls are
neglected and in the end they just drop out of school”
---PTA Chairperson, Primary School, Torit County
Unicef, 2008. A Study on Socio-economic and Cultural Barriers to Schooling in South Sudan
59
Michael Morris, 2010. Analysis of Provincial Education Statistics of South Sudan. Un published. DFID Sudan 2010
DFID, Business Case for the Girls Education South Sudan (GESS) Programme, December 2012
61
DFID, Business Case for the Girls Education South Sudan (GESS) Programme, December 2012
60
27 | P a g e
want our culture to be distorted by this girls moving away from the community in the name of
education”…..male parent, Hiyala, Torit county
“… Our problem is that our
Senior Woman Teacher does
not talk to us, we need her to
talk to us on this issues of
MHM” ---Female Pupil,
AIC Primary School, Ikwoto
County
3.3 MENSTRUAL HYGIENE MANAGEMENT
3.3.1 Knowledge on menstruation:
The assessment revealed that on average 69.9% of the respondents felt that old women do not
menstruate, 28.4% claimed that menstruation is a disease with Lopa-Lafon having 62.9% of its
respondents asserting this claim. 19.2% of respondents said that pregnant women menstruate,
while 63.7% agreed that menstrual blood comes from the uterus/womb. 48.7% of the
respondents claimed that menstrual blood is harmful to the body with Lopa-Lafon having the
highest claims at 82.3% followed by Kapoeta South at 62.7%. On the other hand, 59.9% of the
respondents argued that
“But where did this painful thing called menstruation come from
pain during menstruation
and for what reason? Female pupil, Primary School, Kapoeta East
means that someone is
County
unhealthy with Lopa-Lafon
having the highest claims at 80.6% followed by Kapoeta South at 70.6% and Torit at 64.4%. When
asked on whether women are dirty during menstruation periods, 74.2% of the respondents from
Lopa-Lafon agreed with this assertion followed by 65.8% from Torit and 62.7% from Kapoeta
South.
Overall, 86.1% of the respondents agreed that menstruation is something that is normal and
natural as indicated in the table 4 below.
The underlying reason for lack of knowledge is that pupils/students are not adequately
provided with information if any when growing up. Information is either got from peers and by
first time experience without an preparation and hence it creates a sudden shock.
28 | P a g e
Table 4; Showing perception of pupils/students on menstruation
P Perception on Menstruation
Old women do not menstruate
Menstruation is a disease
Pregnant women menstruate
Menstrual blood comes from the
uterus/womb
Menstrual blood is harmful to the body
Pain during menstruation means that
someone is unhealthy
Women are dirty during menstruation
Menstruation is normal and natural
COUNTY
Ikwoto Kapoeta Kapoeta Lopa- Magwi Torit Average
%
East % South % Lafon
%
%
%
%
64.6
62.1
92.2
56.5
69.9 70.1
69.9
17.2
18.2
21.6
62.9
20.7 32.9
28.4
28.1
20.0
13.7
11.3
16.3 24.7
19.2
66.2
61.5
70.6
74.2
46.7 71.2
63.7
43.1
49.2
37.9
47
62.7
70.6
82.3
80.6
40.2
53.3
35.6
64.4
48.7
59.9
50.8
66.2
50
84.8
62.7
88.2
74.2
96.8
50
89.1
65.8
90.4
58.2
86.1
It is evident from the results of this assessment that girls are less informed about menstruation
and this is in line with Shannon et al (2011) argument that young girls in developing countries
often receive minimal instruction on menstrual hygiene management62.There is therefore an
urgent need to provide girls before and during adolescence with adequate information on
puberty and practical ways of managing menstruation in a hygienic and discrete way.
“The issue of menstruation is not meant for men, women
are the one who face it and therefore they are the best
people who can deal with it and even help girls” -- Male
Parent, Kerepi, Magwi County
” ---Female Pupil, AIC Primary School, Ikwoto County
3.3.2 Information on Menstrual Hygiene Management:
62
Shannon A, Peter J, Bethany A, Alfredo F, Emily A, Imelda A and Richard D (2011). The girl with her period is the one to hang her head.
Reflections on menstrual management schoolgirls in rural Kenya, BMC International Health and Human Rights Journal, 11(7): 689-698
29 | P a g e
Assessment findings revealed that 22% of the girls from Lopa-Lafon County had never heard
information on how to care for themselves during menstrual periods followed by Ikwoto County
at 20% and Kapoeta South at 19%. Torit County had the highest number of girls (98%) who have
ever heard information on how to care for themselves during menstrual periods and this could
have been influenced by the fact that being a relatively urban town, parents are generally literate
and as such are able to offer advice on MHM in addition to availability of various media
platforms including radios, TVs, and newspapers.
Figure 6; Percentage of girls that have ever heard information on menstrual hygiene care
3.3.3 Source of information on Menstrual Hygiene Management:
The results showed that mothers were the major source of information on Menstrual Hygiene
Management at 83.4%, followed by sisters at 82.3% and friends at 71.8%. Fathers on the other
hand were the least identified as source of information used by girls on issues of MHM. It was
established that issues of menstruation are
generally a big secret and that men are not
“What assistance do you need from your
supposed to know it and it’s the sole
father or mother for you to defecate? --responsibility of women to provide such
that’s how menstruation is --- it’s something
information to girls at all circumstances.
normal” Local Chief, Kapoeta South County
In fact other parents both men and women in the communities of Kapoeta South and Kapoeta
East asserted in the FGDs that there was completely no need of providing MHM information to
30 | P a g e
girls as they compared it to defecating as something that is normal and natural. It was noted that
64.6% of the girls had ever heard information on how to care for themselves during menstrual
periods from School Health Clubs as shown in table 5 below though some schools did not have
School Health Clubs.
Girls only feel free to discuss with the mothers and the elder sisters. The men do not even get to know
sometimes if his daughter or wife is menstruating. In our culture, we men are not even supposed to
talk about menstruation---Male Parent, Pageri p/s, Magwi County
Table 5; Showing sources of information on MHM:
Source of information
Mother
Father
Sister
Relative
Teacher
Friend
Books/newspaper
Radio
Community leader
NGO representative
School health club
Frequency
322
62
318
202
216
278
167
141
116
195
250
Percentage
83.4
16
82.2
52.3
56
71.8
43.2
36.4
30
50.4
64.6
3.3.4 Materials used during Menstruation:
The materials used by many girls’ during menstruation were found to be highly diverse and
varied from county to county. 23.3% of girls from Ikwoto County use pieces of mattress, 21.6%
and 24.3% of girls from Kapoeta East and South dig holes on the ground respectively, while
20.8% of girls from Lopa-Lafon use natural materials like leaves and skins of animals especially
goats. In Torit and Magwi Counties, 21.6% and 21.9% of the girls respectively use purchased
sanitary pads like Always with 26.2% and 12.9% relying on pieces of cloth especially rags.
Unbelievably, 42.9% of the girls from Ikwoto County and 22.2% from Kapoeta East completely
use nothing and this view was shared by some
“For us here we don’t care… we don’t use anything,
parents during FGDs.
even if it comes (periods) when you are walking, you
just continue, for there is no problem”. FGD female
parents, Kapoeta South County
31 | P a g e
Table 6; Showing materials and approaches used during menstruation:
Material used
COUNTY
Ikwoto
%
Cloth
Purchased sanitary pads
Toilet paper
Cotton
Pieces of mattress
Natural materials
(leaves,tree back)
Digging a hole
Ash or sand
I use nothing
Kapoeta
South %
Lopa-Lafon
%
Magwi
%
Torit
%
15.2
9.2
20
17
23.3
20.8
Kapoeta
East
%
12.5
17
8.2
12.5
7.8
25
15.2
11.4
12.9
11.5
9.7
12.5
17.9
19
30.6
21
26.2
20.8
26.2
21.9
18.8
24
23.3
4.2
12.9
21.6
9.4
14
9.7
16.7
18.9
16.7
42.9
21.6
16.7
22.2
24.3
10.4
11.1
8.1
29.2
11.1
24.3
18.8
7.9
2.7
8.3
4.8
Focus group Discussions with girls and parents revealed a number of approaches and methods
used by girls and women during menstruation periods including among others; 1) Making
sanitary pads using goats skin and oil, 2) Doubling underwear’s or skirts, 3) use of backcloth, 4)
Traditional herbs like “bene” which is popular among the Lotuko tribe and is used for
controlling blood flow.
3.3.5 Use of sanitary pads in the last 3 months
When asked on whether they had used sanitary pads like always in the last 3 months, 71% of
girls from Lopa-lafon acknowledged not to have used them completely, with Kapoeta South at
70.6%, Ikwoto at 67.7%, 65.2% from Magwi, 54.5% from Kapoeta East and only 43.8% of girls
from Torit had not used a sanitary pad.
Figure 7; showing whether girls had used sanitary pads in the last 3 months:
32 | P a g e
3.3.6 Reasons for not using sanitary pads:
Seventy two (72%) of respondents in secondary schools and 68% from primary schools said they
did not have money for buying sanitary pads, 27% from primary acknowledged that sanitary
pads were generally not available in their areas, 12% was comfortable with local materials while
10% were not comfortable with use of sanitary pads. The study further revealed that 9.8% of
respondents in primary schools do not completely what know what sanitary pads are and have
never seen or touched them.
33 | P a g e
Figure 8; Showing reasons for not using pads in the last 3 months:
3.3.7 Usage of Knickers/underwear:
Being a crucial factor in management of menstrual hygiene, surprising
“Women here are not
42.7% of all respondent do not put on underwear. Overall, Lopa-lafon
allowed to put on
had the highest rates of girls not wearing underwear estimated at 90%.
knickers…..”
This was closely followed by Magwi at 64% while 59%, 57% and 51%
of girls from Kapoeta East, Ikwoto and Kapeta South never put on
Local Chief, Kopeata
underwear. The underlying reasons for this trend included; cultural
East County
beliefs against wearing knickers, un
“A woman can only be
affordability, and some girls are generally comfortable moving
allowed to put on
freely without underwear.
knickers when her
husband has died”.
However, in Torit County 72% of girls were found to be wearing
Local Chief, Kopeata
underwear and this could have been influenced by the fact that it’s
East County
an urban town.
The assessment further revealed that even at secondary school level, 53.5% of female students do
not
put Chief,
on knickers
despite their advancement in education level attainment.
Local
Kopeata
East County
0|Page
Figure 9; Showing percentage of girls who put on knickers
3.3.8 How boys react to girls during menstrual periods
The assessment revealed that, 52.6% of boys laugh at girls during their menstrual periods and
35.2% abuse them. 26.4% of the girls however reported being approached for love and sex since
they have a high attraction to the opposite sex during that time. Boys however refuted the
assertion of laughing at girls during FGDs on grounds they even do not when girls experience
their periods since they secretly protect themselves.
Figure 10: Showing how girls are treated by boys during menstrual periods:
1|Page
3.3.9 How the community treats girls during menstrual periods
In the assessment, 52% of the girls cited being restricted from movement by the community
during their menstrual periods, 25% on the other cited said that cleansing and rituals are usually
performed while 23% identified being seen as unclean by the community.
Figure 11; how girls are treated by the community during menstruation
The head teachers and senior women teachers and teachers in schools however identified the
following beliefs and perceptions surrounding menstruation in their communities.
Table 7; Showing perceptions and beliefs associated with menstruation
Perceptions and beliefs associated with menstruation
If a witch comes across your sanitary materials, she will make you barren
Isolation of menstruating girls from peer groups
Ladies are not supposed to use the latrine during their menstrual periods
Menstruation should be kept a secret
Menstruation shows maturity and therefore ready for marriage
No bathing in the river during menstruation because they will lose their womb
No bathing till the flow is over
Performing rituals if the girl is experiencing her first periods by grand mothers
Women are not allowed to sit amongst men during menstruation
Women are not supposed to visit a certain big tree
2|Page
3.3.10 Channels of ensuring availability of sanitary materials
The assessment established, School
Health Clubs and Senior Women
Teachers were identified as the main
channels through which girls can receive
sanitary pads and appropriate education
on MHM in all Counties as shown in the
figure below.
“… the best way of ensuring that all women and
girls get sanitary pads is by using women groups
and senior women teachers in schools and
allowing girls collect pads for free on certain
particulars days of the month and we women
paying at least 3 pounds for each in order to
ensure sustainability”. FGD parents, St. Mathew
P/s, Ikwoto County
However, during focus group discussions
with parents, women groups were also identified as channels through which both girls in school
and women can access sanitary pads local type. They argued that if only school girls and
Local Chief, Kopeata East County
teachers are trained on making pads, they women will not be able to access pads. They therefore
proposed all the stakeholders i.e. women, girls and female teachers to be involved in this
process.
Figure 12; most accessible channels of ensuring availability of sanitary materials
3.3.11 Menstruation and school attendance:
Findings of the assessment revealed that on average girls miss an average of four (4) days during
menstruation periods as shown in the table 8 below. Shocking, some girls reported staying home
for up to 8 days and this was attributed to a number of factors like heavy bleeding and parents
advising them to completely stay home during periods.
3|Page
Table 8; Average number of school days missed by girls during menstruation
Descriptive Statistics
Minimu
Maximu
m
m
277
1
8
N
Number of school days
missed in a month
during menstruation
Valid N (list wise)
Mean
3.69
Std.
Deviation
1.401
277
3.3.12 Why menstruation makes girls miss school
The opinion of girls on why menstruation makes girls’ miss school was sought and 73.7% of the
girls cited lack of sanitary pads as the major hindrance to school attendance. Other issues cited
included feeling severe pain at 72.5%, lack of a private changing room in school 56.6%, afraid of
being made fun of 43.8%, feeling dirty 43.6%, discomfort due to tiredness 43.6% and not allowed
by parents at 21.1% as shown the figure 12 below.
Figure 13; Showing why menstruation makes girls miss school
4|Page
Focus group discussions with girls also reaffirmed that lack of sanitary pads; severe pain
and lack of private places in schools were
contributing factors to school attendance.
“When these periods come, I feel like dying
because it pains a lot”. Female pupil,
Primary School, Kapoeta East County
3.4 WASH:
3.4.1 Presence of changing rooms for girls in school:
Of all schools visited in the study, changing rooms were only observed in Kapoeta East and
Kapoeta South and these were mainly girls’ dormitories that were available as changing rooms.
In regard to availability of sanitary materials,
only 6 schools in the selected 49 were at least
“When am in school and periods come, I just
providing sanitary kits with only two schools
go back home and bathe because I can’t bathe
in Torit and Magwi respectively and one
from school”. Female Pupil, Primary School,
Kapoeta South County
school in Ikwoto and Kapoeta East as shown in
the table 10 below.
Table 9; Availability of changing room and materials in schools:
Ikwotos
Kapoeta East
Kapoeta
South
Lopa-Lafon
Magwi
Torit
Changing room
for girls
available
0
1
1
0
0
0
Sanitary
materials
available
1
1
0
0
2
2
Basins/buckets Washrooms next to
available
girls changing room
available
0
0
1
1
1
1
0
2
2
0
0
0
The findings in this assessment relate well to the findings of Ezra et al (2014) who show that a
Lack of soap, hand wash facilities, emergency pads and privacy are important determinant for
proper practice of menstrual hygiene and school attendance and have been identified as main
problems63in many schools in developing countries. Mahon and Fernandes (2010) show, that,
MHM is neglected but there is an awareness that the problem exists but few have attempted to
address it64 while Devrain and Mathias (2011) state that Inadequate access to WASH impacts
significantly on girls’ learning opportunities65
63
Ezra Guya, Aloyce W. Mayo, Richard Kimwaga, Menstrual Hygiene Management in Secondary schools in Tanzania, International Journal of
Science and Technology, January 2014
64
Mahon T, &Fernandes M (2010); Menstrual hygiene in south Asia, a neglected issue for WASH programs, gender &development 18 (1) 99-113
65
DevnarainA&Sarkar M (2008); How hygienic is the adolescent girl? Indian Journal of community medicine, 33 (2), 77-80
5|Page
3.4.2 Presence of Latrines:
Observation was made on the availability of latrines in schools visited during the assessment
and the findings revealed that, 1 school in Ikwoto County, 2 in Kapoeta East, 1 in Kapoeta South,
3 in Lopa-Lafon and 1 in Torit completely lacked school latrines. A cross examination of the
whether there were separate latrines maintained for girls, boys and teachers also revealed that 2
schools in Ikwoto, 3 in Kapoeta East, Kapoeta South, Lopa-Lafon and 1 in Torit lacked separate
latrines for girls, boys and teachers.
On whether the Latrines were in good condition and functional, only 4 in Ikwoto, 3 in kapoeta
East, 4 in Kapoeta South, 3 in Lopa-Lafon, 6 in Magwi and 3 in Torit were effectively functioning.
In respect to whether the available Latrines are in regular use, only 3 in Ikwoto, 4 in Kapoeta
East, 6 in Kapoeta South, 5 in Lopa-Lafon, 9 in Magwi and all the 10 in Torit were regularly used.
Table 10; Showing presence and state of latrines
County
Ikwotos
Kapoeta East
Kapoeta
South
Lopa-Lafon
Magwi
Torit
School
latrines not
available
Latrines in good
condition and
functioning
Latrines in
regular use
Faeces on
the floor of
the latrine
1
2
1
Separate latrines
for girls, boys and
teachers
unavailable
2
3
3
4
3
4
3
4
6
2
2
3
3
0
1
3
0
1
3
6
3
5
9
10
0
4
5
The findings of UNICEF Esaro(2010) are not different from the findings of this assessment.
Studies in Sub-Sahara African (SSA) countries show that the lack of adequate toilet facilities is a
common feature in many schools where the child-toilet ratios is on average 1:10066. In this study,
more than a quarter of the schools visited in this study do not have separate latrines for girls and
boys. This is in agreement with the findings of UNICEF south Sudan (2013) who stated that 17 of
percent of schools have adequate sanitary latrines for both girls and boys67 meaning that a
greater percentage (83 percent) do not have separate latrines for girls and boys. They further
show that even the few 17% that exist in schools have unfriendly environments for girl’s
management of menstrual hygiene. This happens in many schools of South Sudan though it has
been stressed that school toilets, are built to accommodate menstruating girls’ specific needs for
privacy, space, washing facilities and correct disposal or cleaning of menstrual pads68.
66
Unicef ESARO, “Impact of puberty and feminine hygiene on girls’ participation in education –Kenya and Malawi”, 2010
Unicef, South Sudan “ Water, Sanitation and Hygiene”, 2013
68
UNICEF, Raising clean hands: Advancing learning, health and participation through WASH in schools, UNICEF, New York, 2010
67
6|Page
3.4.3 Presence of water in schools:
The assessment of the 49 schools revealed that generally, most schools had a water source
available and functioning with the exception of 1 school in Kapoeta East, 1 in Kapoeta South, 3 in
Lopa-Lafon, 1 in Magwi and 1 in Torit. The majority of schools had the water source within the
school compound or within 1 km as shown in the table 12 below with the exception of 1 school
in Ikwotos, 2 in Kapoeta East, 1 in Kapoeta South, 2 in Lopa-Lafon and 3 in Magwi which had
the water source more than 1km from the school.
Table 11; Showing presence and condition of water sources
County
Ikwotos
Kapoeta
East
Kapoeta
South
Lopa-Lafon
Magwi
Torit
Water source
available and
not
functioning
0
1
Water source
available and
functioning
6
6
Water source
within the
school
compound
2
4
Water source
within 1km
Water source
more than
1km
1
1
1
2
1
6
6
0
1
3
1
1
5
5
10
4
4
9
2
5
1
2
3
0
The findings of this assessment in regard to water accessibility are not different from the findings
of recent surveys cited by UNICEF South Sudan which show that more than 30 per cent of
people in South Sudan do not have access to safe water supplies with only 13 per cent having
access to adequate sanitation facilities69
It is further argued that only 45 per cent of South Sudan’s 3,349 basic primary schools have
access to safe water70. In this assessment only half of the schools visited have access to water
either, being from its own water source or a community water source. The safety of this water
varies since different schools and communities have different water sources. The most common
water sources available in school are boreholes and water tanks while the communities access
water from the boreholes, rivers and unprotected shallow wells. However the environment
around most of these water sources was observed to be dirty and some are non-functional. 2 in 8
schools in each county have a non-functional water source. This finding is not far different from
the findings of the Ministry of Water Resources and Irrigation (MWRI), UNICEF 2013 showing
that 30-50 percent of water facilities are non-functional at any point in time due to the lack of
spare part supply chains, weak maintenance capacity, poor management and/or inappropriate
choice of technology71. Thus, the actual level of access to an improved water source in rural areas
69
Unicef, South Sudan “ Water, Sanitation and Hygiene”, http://www.unicef.org/southsudan/WASH.pdf
70
Unicef, South Sudan “ Water, Sanitation and Hygiene”, 2013
USAID, Draft Water Sanitation and Hygiene Programme, 2013
71
7|Page
is estimated to be only 34 percent – which affects most of the country as over 80 percent live in
rural areas, representing 90 percent of those living in poverty72.
The findings in the focus group discussion further build on these findings. One of the girls is
quoted saying; “I cannot come to school during my menstrual periods because we do not have water at
school that I can use to wash my body”….Primary six girl, St.Marys P/S Eboni. While a teacher
stated that “sometimes also finds problems when I also experience my periods because there is no water at
school. I prefer to remain at home. I cannot help myself at school”….Senior woman teacher, Lohutok
girls P/S, Lopa-Lafon county
This is further supportedby findings of this assessment that established that access to water and
sanitation is one major reason why girls are kept out of school and improved access to water and
sanitation at schools has been shown to increase school attendance among girls73
72
73
USAID, Draft Water Sanitation and Hygiene Programme, 2013
USAID, Draft Water Sanitation and Hygiene Programme, 2013
8|Page
3.5 DISCUSSION OF RESULTS
3.5.1 EDUCATION:
Education in South Sudan has been recited as being in the catch-up phase by many scholars and
organizations including the World Bank (2012) citing massive enrolments in schools with key
challenges being overcrowding and lack of qualified teachers. However adult literacy rates are
still low at only 27 per cent with 70% of children aged 6–17 years never setting foot in a
classroom and with only 33 per cent of girls in schools74.
The findings of this study however revealed that in Eastern Equatoria state, enrolment of both
boys and girls is mainly concentrated at lower classes (P.1 – P.4) with upper classes (P.5 – P.8)
having fewer pupils. Detailed analysis of class enrolment by gender revealed that, the number of
girls in per classes (P.5 – P.8) including secondary is unbelievably very low with most schools in
Kapoeta East, Kapoeta South and Lopa-Lafon having no girls completely in some for these
classes. Findings further exposed that there are only 705 girls enrolled in primary eight
compared to 1,263 boys meaning that there is one girl in every six boys in primary eight. This
results are closely related to the findings of World Bank (2012) that there is one girl in every
seven boys and in South Sudan there are , only five hundred (500) girls in the last grade of
secondary school (Senior four) and only one in four girls enrols in primary school and a mere
one in ten completes primary education.75
The low level of enrolment of girls in upper classes of primary including secondary has largely
been attributed to early forced marriages and pregnancies. It’s dreadful to note that in South
Sudan, girls are regarded as a major source of wealth in many tribes who can raise as many as 50
– 200 cows upon marriage equivalent to approximately $ 23,584 – $94,200 perhaps one the
highest dowry rates in the whole world in the 21st century.
Despite some communities slowly becoming aware of the benefits of education both girls and
boys to school completion, a lot of community awareness campaigns on value of education still
need to reemphasized coupled with appropriate policing on issues of child early marriage.
Availability of trained teachers in schools was also revealed by the study as some the major
challenges surrounding education. All most all schools visited had at least 1 untrained teacher
with the number of untrained teachers surpassing the trained once with the exception of
secondary schools. Male teachers in all schools were the majority in both primary and secondary
with some schools completely lacking a female teacher. The level of knowledge on MHM among
teachers and support extended to girls during menstrual periods was found to be very low and
non-existing in some case. It’s therefore not surprising that, 62.9% of girls in one Lopa-Lafon
cited menstruation as being a disease and 59.9% citing pain during menstrual periods meaning
that someone is unhealthy.
Measures should
74
Unicef South Sudan, Basic Education and Gender Equality, http://www.unicef.org/southsudan/Education.pdf
75
World Bank, Education in the Republic of South Sudan – Status and Challenges for a New System , 2012
9|Page
The low level of enrolment of girls in the upper classes that was revealed in the study is in
agreement with DFID, GESS programme (2012) that shows demand for education in South
Sudan far outstrips supply with few children and youth able to complete the full primary cycle –
let alone go on to complete secondary and post-secondary studies76.
The drop out of girls could also be attributed to the age at which they enrol for primary.
Findings in the study reveal that the average age of girls in primary stands at 16 years with most
of the girls of this age being in primary five. Figure 3.xx below shows the minimum and
maximum age of pupils per class in the schools reached in this study
3.5.2 MENSTRUAL HYGIENE MANAGEMENT:
Despite the fact that many developing countries have a number of challenges in management of
menstrual hygiene in schools as identified by many scholars, according to the findings of this
study, South Sudan has one of the worst menstrual hygiene management approaches in the
whole world. The study findings reveal that girls in school, both primary and secondary level
are ill informed on what menstruation is about. 62.9% of girls in one of the Counties (LopaLafon) cited menstruation as being a disease an assertion that is completely very wrong. 59.9% of
the 842 girls involved in the study also claimed that pain during menstrual periods means that
someone is unhealthy.
In one of the focus group discussions, a Primary eight girl was quoted asking, “… but where this
painful thing did called menstruation come from and for what reason?” This therefore implies that girls
in general receive minimum or no instruction in school or at homes on issues of puberty and
menstrual hygiene management.
These study findings are in agreement with Shannon el at (2012) argument that girls in many
developing countries often receive minimal instruction on menstrual hygiene management
because menstruation is seen as taboo by many communities, which makes it extremely difficult
for adolescent girls to acquire necessary information and support from parents and school
teachers77.
Study findings revealed that Fathers were the most unsought source of information on
menstrual hygiene and issues of menstruation are generally regarded as a big secret in their
culture and men are not completely supposed to know anything about it and it’s the sole
responsibility of women to provide such information to girls since men do not menstruate.
There is therefore an urgent need of ensuring that girls in school receive relevant and adequate
knowledge on puberty as well menstrual hygiene management from all existing possible
channels including teachers (both male and female), school health clubs as well as parents.
76
DFID, Business Case for the Girls Education South Sudan (GESS) Programme, December 2012
77
Shannon A, Peter J, Bethany A, Alfredo F, Emily A, Imelda A and Richard D (2011). The girl with her period is the one to hang her head.
Reflections on menstrual management schoolgirls in rural Kenya, BMC International Health and Human Rights Journal, 11(7): 689-698
10 | P a g e
Based on these findings, it’s therefore not surprising that 20% of girls had never heard any
information on how to care for themselves during menstrual periods. 80% of those who had
hoverer heard also relied heavily on friends, sisters and mothers who are also inadequately
informed about puberty and menstrual hygiene management. It was shocking to hear during
focus group discussions with the parents that some women do not completely use anything, for
they just let the menstrual blood flow and they continue with their work as it will eventually
dry. This kind of act exists in the community because menstruation is regarded as something
normal and compared it to defecating as thus girls in school do not need any support or
guidance on menstruation. This claim was further reaffirmed by 42.9% of the girls from Ikwoto
County and 22.2% from Kapoeta East who asserted that during their menstruation periods, they
completely use nothing.
The materials and approaches used by many girls and women for menstrual hygiene
management in Eastern Equatoria state, South Sudan were found to highly diverse, traditional,
unhealthy and perhaps the worst in the whole world.
In the 21st century, some women and school going girls in South Sudan still use goat’s skin, bark
cloth, soil, digging holes on the ground, leaves of trees and traditional herbs like “bene” popular
among the Lotuko tribe used for controlling blood flow because even a mere piece of cloth or rag
can be extremely very difficult to find in some villages. Despite scholars like Doinimirski
(2013)78 and Sumpter&Torondel (2013)79 citing use of materials like pieces of cloth/rags as being
unhealthy and can result into serious health complications, little is yet known on the level of
health complications that women and girls in South Sudan are exposed as a result of using such
traditional menstrual hygiene methods.
However, taking on averages, findings revealed that 12.9% of respondents use cloths/rags, only
21.6% use sanitary pads influenced by the over 15 schools visited in the study were urban, 16.7%
use natural materials like leaves, 9.7% use pieces of mattress and 4.8% completely use nothing.
Accessibility and affordability of modern sanitary pads like Always is a huge challenge to many
to many girls in school. When asked on whether they had used sanitary pads like always in the
last 3 months, 71% of girls from Lopa-lafon asserted having not used them completely, closely
followed by from Kapoeta South at 70.6%, Ikwoto at 67.7%, 65.2% from Magwi, 54.5% from
Kapoeta East and only 43.8% of girls from Torit had not used a sanitary pad. The reasons for this
trend was that pads are generally expensive and unavailable with some girls reporting to be
comfortable with current materials like cloth and skin while 9.8% of the girls had completely
never heard or seen a sanitary pad.
Use of knickers/underwear among school going girls in both primary and secondary schools in
Eastern Equatoria state, South Sudan is generally very low and probably the worst in Africa.
42.7% of the 410 of 842 girls involved in the study do not wear underwear, and this is greatly
78
Donimirski, M (2013). Health Effects of Menstruation and Birth Control Pills
http://serendip.brynmawr.edu/biology/b103/f00/web2/donimirski2.html.Retrieved on October 23rd 2013.
7979
Sumpter C and Torondel B (2013). A systematic review of the health and social effects of menstrual hygiene management, PLOS One
11 | P a g e
attributed to the cultural factors surrounding underwear among the tribes like the Toposa.
Women are by culture not allowed to wear underwear whether educated or not and it’s believed
that if a woman wore underwear, her husband would die. She is therefore only allowed to put
on underwear when her husband has died. This cultural factor surrounding wearing underwear
needs to be strongly addressed by any actor intending to implement MHM project in Toposa and
Lotoku tribe.
52.6% of Girls in the study complained being laughed at and 35.2% reported being abused by
boys in school during their menstrual periods. This happens in addition to a number of beliefs
and perceptions surrounding women and girls in menstruation including; girls and women are
unclean during menstruation, if a witch comes across your sanitary materials, she will make you
barren, performance of rituals to a menstruating woman or girl, and Women are not allowed to
sit amongst men during menstruation among others.
This has therefore contributed to low school attendance during menstrual periods with girls
missing up to four days in a month. This findings are in agreement with World Bank (2005)
argument that girls miss up to 4 days80 and SNV Uganda Menstrual Hygiene Management
(MHM) survey conducted in 120 schools across six Districts that indicated that girls are more
likely to remain at home from school during their period due to a lack of facilities for and
embarrassment about menstrual hygiene81.
However, we tested relationship between menstruation and missing school, in order to
establish if a statistically significant relationship existed between girls’ menstruation and missing
school during their menstruation. The hypothesis was; “There is no significant relationship between
girls’ menstruation and their missing school at 0.05 level of significance”
The results revealed that a correlation coefficient of r = 0.092 and p = 0.063 using Pearson
Product Moment Correlation Coefficient. This correlation shows a positive weak and statistically
non-significant relationship between menstruation and missing school due to menstruations
meaning that the relationship between the two variables was not by chance, however not
entirely conclusive on menstruation.
It was therefore found that menstruation contributes only contributed only 1% to their missing school.
This implies that the other 99% is being contributed by other factors that need to be established
School Health Clubs and Senior Women Teachers were identified as channels through which
girls can receive sanitary pads and appropriate education on MHM in all Counties of the study.
However, parents especially women proposed inclusion of women groups or mothers in the
supply chain since they are in close contact with the girls and as means of forging sustainability
strategies.
80
World Bank, “Toolkit on Hygiene Sanitation & Water in Schools: Gender Roles and Impact," 2005
81
SNV Uganda, Keeping girls in school with improved menstrual hygiene management, June 2013
12 | P a g e
4.0 CHAPTER FOUR RECOMMENDATIONS AND CONCLUSIONS
4.1 RECOMMENDATIONS:
4.1.1 Menstrual Hygiene Management:
1. Teachers, especially male, should be capacitated on MHM issues and adolescence
education so as to empower them in supporting pupils when needed.
2. Massive community awareness campaigns need to be undertaken on;
 Role of parents both male and female in MHM issues
 Breaking barriers, practices and taboos surrounding MHM like no wearing
underwear’s for women and performance of rituals
3. Efficient and cost effective methods of making re-usable sanitary pads need to be
explored with due consideration on design, availability of materials, cultural diversity
and acceptability of each state. Pre-testing of sample sanitary materials in each state need
to be undertaken in order to further assess absorptive ability, comfort, cost and
sustainability.
4. Support for the availability of sanitary pads should be done with consideration that girls
would inevitably need proper underwear to secure the pad in place and that for some
families may not afford to buy girls any/adequate underwear as 42.7% do not put on
underwear. Sanitary Pads that double as underwear should therefore be explored if
success is to be realised.
5. Training of girls on puberty, menstrual hygiene management, personal hygiene in all
schools needs to under-taken with due consideration on girls who have not yet started
menstruating and are about to begin. Some of the possible approaches that can be used
include; menstrual hygiene manuals, use of drama and use posters among others.
6. Overall, there is need to have MHM integrated into existing health and WASH
surveillance systems in the community and schools like the PTA’s and SMCs
7. MHM needs to be implemented with due consideration that there is inadequate supply
of detergents like soap. Training of women and girls in school in making of sanitary pads
and soap should be explored so that there is a sustainable supply of pads and soap in
schools and communities.
8. Sharing, lobbying and advocacy with relevant stakeholders including, Government and
CSOs needs to be undertaken for inclusion of MHM in school curricular and
development of MHM and child friendly school aspects.
9. Need to mainstream MHM issues into the normal school teaching programmes that
should be untaken by both male and female including school health clubs
10. MHM interventions in schools should integrate senior women teachers, school health
clubs and women groups/ mothers in promotion of MHM, puberty education towards
realisation of sustainability.
11. In areas where there is ample supply of rain, MHM interventions should be linked to
agricultural production in order to address issues of raw materials like cotton.
13 | P a g e
4.1.2 EDUCATION:
1. Facilitate formulation of bylaws:
Communities through the PTA’s, Chief’s and other existing local government structures
at Counties should be trained and facilitated on development of appropriate bylaws that
will put parents into task on education of children. The bylaws will also have to tackle
issues concerning forced marriages and early pregnancies among girls contributing to
school dropout.
2. Community awareness campaigns on the value of education should be conducted with focus
on both parents and children. This can be made more effective through involvement of
PTAs, teachers, children in school and women role models in respective areas.
Approaches like use of drama, theatre for development, IEC/BCC materials, video
documentary and poems need to be explored.
3. Training, couching and mentoring: Schools should be encouraged, trained, coached and
mentored on how to organize school festivals (such as parents day) where all
stakeholders are invited, entertained while learning through children’s folk songs,
poems, skits. This will enable other stake holders learn from the children.
4. Introduction and establishment of a Promotion, advocacy and Girl’s Education (PAGE)
clubs. This group of women is elected form the community such that they advocate for
girl’s rights among the community members. This will campaign for girls among
community members and support girls to acquire special needs
5. Introduction and re-establishment of the Girl’s Education movement (GEM) clubs in
schools. These clubs will handle the needs of the girls by availing them a platform to
present their issues/challenges to the teachers and other stakeholders.
14 | P a g e
4.1.3 WASH:
1. Review of existing schools latrine designs to incorporate wash rooms
It’s important to have designs of school latrines especially girls reviewed to accommodate
a changing/wash room. The changing/wash room should at least have a regular supply
of water, soap and a basin/bucket which can be used for bathing. There should as well be
ample washing space with enough water and privacy to wash and dry cloths and rags
used during menstruation.
All relevant stakeholders including, Ministry of Education at all levels, Development
partners in WASH and Education, Health Departments at state and county level,
Chairpersons PTA, Chiefs and Head teachers need to therefore be aware of the need for
this component as they are the direct recipients and implementers.
2. Hygiene and sanitation campaigns involving teachers, pupils and parents need to be
conducted in view of increasing the level of knowledge and improving their practices.
3. There is need to facilitate schools to establish and strengthen hygiene and sanitation clubs
such that they are used as channels of communication to; pupils teachers, parents and
community on Menstrual hygiene management and good hygiene and sanitation
practices.
4.2 Conclusion:
In conclusion, it can be said that girls in Eastern Equatoria State, South Sudan are greatly
challenged in education attainment. The number of girls in school especially upper levels is very
low compared to boys in both primary and secondary schools with some schools having a total
enrolment of only 9 girls in the whole school. The underlying factors for these include the high
cultural orientation that girls are a source of wealth and as such should be jealously protected.
Adolescent school girls both in urban and rural areas have limited menstrual knowledge in
addition to negative perceptions, poor practices which are not often optimal for proper hygiene
in addition to un conducive school environments. Often ignored issues of privacy affect the
hygienic practices and daily lives, particularly school attendance, of the adolescent girls. The
know-how, availability and affordability of sanitary products to manage menstruation are far
from satisfactory. Schools, home, government, society and organizations of reproductive health
as well as water, sanitation and hygiene sectors need to be able to break cultural barriers
surround girls education and MHM in an effort towards making menstrual hygiene and
management better for adolescent population.
15 | P a g e
ANNEXES
Annex One: Sample population
Sample population
Planned
Actual Response
Actual
Total
Total
Ikwoto
KEC
KSC
Lopa
Torit
Magwi
Head teachers primary school
44
6
5
6
7
9
7
40
Head teachers secondary
schools
Senior woman teacher/other
teacher primary school
Senior woman teacher/other
teacher secondary
Girls for primary
6
0
2
1
0
2
1
6
44
4
6
5
6
5
8
34
6
0
2
1
0
1
2
6
440
57
54
48
67
47
96
369
Female Students for secondary
school
PTA/SMC
60
0
14
5
0
16
6
41
50
5
6
4
17
6
6
44
Local/opinion Leaders
50
5
5
1
3
1
2
17
Parents
500
73
40
36
60
64
33
302
Pupils Primary
528
71
51
68
88
79
50
407
Students secondary
72
0
5
5
0
0
0
10
Total
1800
230
211
1280
Focus Group Discussions
16 | P a g e
221
190
180 248
Annex Two: List of Selected School per County for MHM Baseline Survey Project
S/N
1.
2.
3.
4.
5.
6.
County
Name
Magwi
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
17 | P a g e
Lopa
/Lafon
Greater
Torit
School Name
Days
Date
Magwi Central Primary school
Magwi Primary school
Obbo Primary school
Pamakong Primary school
Kerepi Primary school
Panyikwara Model Primary
school
Pageri Primary school
Loa Senior Secondary school
OwinykibulCentral Primary
School
Day 1
Day 1
Day 2
Day 2
Day 3
Day 3
5th – 9th
May
Lokutok Girls Primary school
Lokutok AIC P/S
Ibahore Primary school
St. Mary’s Eboni Primary school
Imehejek Primary school
Mura Lopit Primary School
Lafon Central Primary school
Lofiriang Primary school
Day 1
Day 1
Day 2
Day 2
Day 3
Day 3
Day 4
Day 4
Torit E. Primary school
Torit Day SS
Ileu Primary school
Hilaya P/s
Dr.Garang Memorial SS
Porit Model Primary school
Dumak Primary school.
AIC (Africa Inland Curch)
Primary school
Torit West Primary school
Torit one Primary school
Haramorok Primary school
Kudo Central P/s
Day 4
Day 4
Day 5
Day 1
Day 1
Day 1
Day 2
Day 2
Day 2
Day 3
Day 3
Day 3
Day 4
Day 4
17th - 21st
12th –15th
May
30.
Ikwoto
31.
32.
33.
34.
35.
36.
37.
KapoetaEa
st
38.
39.
40.
41.
42.
43.
44.
Kapoeta
South
45.
46.
47.
48.
49.
50.
18 | P a g e
St. Mathew Primary
School
AIC Primary school
Momoria Primary school
Ikwoto Primary school
Lofus Primary school
Katire Primary school
Day 1
Bakhita Senior Secondary
school
Bakhita Girls’ Primary
school
Lopoa SS
Narus Mixed Primary
school
Nakwartuum Primary
school
ISTL/Brainstorm Primary
school
Nathapal Primary school
St. Thomas Primary
schools
Day 1
Kapoeta Day Secondary
school
Kapoeta Mixed Primary
School
Kotome Primary school
Singaita Primary school
Longeleya Primary school
Hope for South Sudan
Primary school
Kuleo Light Primary
school.
Day 1
15th – 19th
Day 1
Day 2
Day 2
Day 3
Day 4
5th – 8th
Day 1
Day 1
Day 2
Day 2
Day 3
Day 3
Day 4
Day 1
Day 2
Day 2
Day 3
Day 3
Day 4
9th – 13th
Annex Three: Questionnaires
TOOL3: SEMI STRUCTURETED INTERVIEW WITH THE SCHOOL TEACHERS
I wish to appreciate your participation in this very important area of study. This questionnaire is
designed to solicit for your responses on the status of WASH and MHM in your school. The
output of this study will not only be used to design programs for MHM in schools but the
information obtained will be used to facilitate formulation of better policies/recommendations
that will enhance WASH and MHM in the school, county, state and the country. The findings will
also be distributed and can be used as a stepping stone for further research.
Please feel free to express your opinions as all responses will be treated with confidentiality.
Instructions
 This tool is to be used by enumerators to gather data.
 Enumerators are to interview school head.
1.
1
Date of information
1collection
2. Title of Respondent
School Information
3. 2
Name of school
4. Level of School
5. 4
County
6. 5
Payam
7. 6
Boma
8.
9.
19 | P a g e
Year
Head
Teacher
Senior Woman
Teacher
Other Teacher
Secondary
1 = Public
2 = Private
3 = Church
4 = Community
1 = Urban
2 = Semi-Urban
3 = Rural
1
Location
.
8
Nursery
1
2
3
4
5
6
7
Month
Primary
7
Type of school
10. Enrolment Grade/Form Girls
Date
Boys
Total
Dropped out
Boys
Girls
8
Total
11. Why did the girls drop out of school?
……………………………………………………………………………………………………………….
.………………………………………………………………………………………………………………
12. Staff
Staff
Male
Teaching
Trained
Untrained
Non-Teaching
Grand Total
Female
Total
13. What type of toilets/latrines do you have in the school?
VIP
Pit
Other
14. Number of stances for students and staff?
Category
No. stances
Girls
Boys
Teachers
Non-Teaching
Ratio
15. Latrine usage
Are the pupils given lessons on how to use latrine facilities?
Are the pupils monitored/supervised on the use of latrines?
Does the school health teacher/school authority conduct periodic
inspection of latrines
Do pupils practise open defecation
Do pupils practise open urination
1= YES
2 = No
1= YES
2 = No
1= YES
2 = No
1= YES
2 = No
1= YES
2 = No
16. Has the school had any contact and interaction with any NGO staff, school
inspector, in the last 6 month on WASH issues? A. Yes
B. No
C. Do not
remember
17. If yes, what did the staff talk about (remember not to prompt so that we see if they
can mention WASH or MHM)
Issue talked about
Yes
No
Water sources
20 | P a g e
Hand washing
Latrine use and maintenance
Personal hygiene
Menstrual hygiene management
Others (specify)
18. On average, how often does this staff visit the school in a year?...............
19. Have these visits increased the school commitment towards WASH and MHM?
a. Yes
b. No
c. not sure
20. a) Does the school have access to a community water system or its own water system
a. Yes
b. No
b) If yes, has it experienced breakdowns? A. Yes B. No C. Not sure
c)
If yes, is it immediately repaired?
A. Yes B. No C. Not sure
21. What is the primary drinking water source for the school?
Water Source
Borehole
Protected Well
Unprotected Well
Treated Truck Water
Untreated Truck Water
River/Swamp Water
Rain harvesting tanks
Pumped water
Other (Specify) ……………….
YES
NO
22. How far is the water source?
Location
Within school boundaries
Less than 1 km
More than 1km
23. Does the school have adequate drinking water storage facilities?
A. Yes B. No C. Not sure
24. If yes, what type of drinking water storage facilities are used in school?
a. Bucket with a tap
b. Water pot
c. Jerri cans
d. School tank
e. Large containers with tap
others (specify).......................................................
25. What types of materials are used to clean the water storage facilities?
a. Detergent
b. Soap
c. Chlorine
d. Grass
f. Others specify………………………………………………………………
e. Ash
26. Does the school have access to funds to facilitate purchase of improved water
containers? A. Yes B. No C. Not sure
21 | P a g e
27. What mechanisms have been put in place to ensure that the water is safe and clean?
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
28. Do you treat the drinking water?
A. Yes
B. No
C. Sometimes
D. Not sure
29. If yes what do you use to treat the drinking water?
a. Chlorine
b. Boiling
c. Water guard
d. Othersspecify...................................................
30. What key areas do you teach about sanitation?
Knowledge and skill
Personal Hygiene
Proper Latrine Use and maintenance
Disposal of rubbish
Hand washing
Sanitation
Others
Yes
No
31. What materials do girls use during menstruation periods?
Yes
No
Cloth
Purchased sanitary pad
Toilet paper
Cotton
Pieces of Mattress
Natural materials (mud, cow dung or leaves)
Ash or sand
They use nothing
I don’t know
32. Which of the above materials would you prefer to be explored further to ensure girls
have constant supply of sanitary pads? .................................................................
33. What actions has the school put in place to help girls deal with their menstrual periods?
a. Training girls on MHM
b. Providing sanitary materials
c. Providing changing room
d. Appointing and training a senior woman teacher
e. Having separate latrines
f. Forming (Girls Education Movement GEM/ Promotion of Advocacy and Girls
Education PAGE
g. Others (specify).....................................................
34. Does menstruation make girls miss school? A. Yes
B. No
35. If yes, how many days of school do they miss in a month?...............................
22 | P a g e
36. Do you know of any girls who have dropped out of school as a result of menstruation?
A. Yes
B. No
37. If yes, how many?....................
38. Are there social cultural beliefs surrounding menstruation? A. Yes
B. No
If Yes List them.
...................................................................................................................................................
...................................................................................................................................................
39. What do you think is the most accessible channels of ensuring availability of sanitary
materials to girls?
a. School health club
b. Senior woman teacher
c. Local clinics
d. Parents
e. Women groups
f. Girls themselves
g. Boys
Others (specify)…………………………………………………………………..
40. Do girls feel free to interact about their periods to the teachers? A. Yes
B. No
41. What key areas do you teach about menstruation?
Menstruation practice
Proper use of sanitary materials
Personal hygiene during menstrual periods
Making of local sanitary materials
General menstrual periods care
Others specify
42.
Health Clubs Activities in schools
Health Clubs
Yes
Yes
No
No
Is there a school health club
Is there a School Health Teacher (Master)
Are there regular hygiene educations sessions conducted
for all classes by School Health Teacher
Are there scheduled hygiene education sessions for the
school by Ministry of Health officials? E.g. nurses, Public
health inspectors
Are there scheduled hygiene education sessions for the
school by Ministry of Education e.g. Education Directors
and Inspectors
43.
In an effort to promote hygiene, sanitation and menstrual hygiene care, what are
the gaps that need to be addressed in your school and what are your
recommendations?
Gaps
.................................................................................................................................................
.................................................................................................................................................
Recommendations
.................................................................................................................................................
.................................................................................................................................................
THANK YOU FOR YOUR TIME
23 | P a g e
Annex Four: QUESTIONNAIRE FOR GIRLS IN PRIMARY & SECONDARY SCHOOLS
I wish to appreciate your participation in this very important area of study. This questionnaire is designed
to solicit for your responses on the status of WASH and MHM in your school. The output of this study will
not only be used to design programs for MHM in schools but the information obtained will be used to
facilitate formulation of better policies/recommendations that will enhance WASH and MHM in the school,
county, state and the country. The findings will also be distributed and can be used as a stepping stone
for further research.
Please feel free to express your opinions as all responses will be treated with confidentiality.
Number:
Age:…………………… School:
Class:……………………….
1. Do you understand what menstruation periods are?
2. Have you started your menstrual periods? A. Yes
A. Yes
B. No
B. No
3. Please indicate whether you think the statements below are true or false.
(Please tick to indicate answer)
a)
b)
c)
d)
e)
f)
g)
h)
True
False
Yes
No
Old women do not menstruate (45 years and above)
Menstruation is a disease
Pregnant women menstruate
Menstrual blood comes from the uterus/womb
Menstrual blood is harmful to the body
Pain during menstruation means that someone is unhealthy
Women are dirty during menstrual periods
Menstruation is normal and natural
4. Please tick what you normally use during menstruation.
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
Cloth
Purchased sanitary pads
Toilet paper
Cotton
Pieces of Mattress
Natural materials (mud, cow dung or leaves)
Digging a hole
Ash or sand
I use nothing
Others (specify)
5. Which locally available materials do you think we can use for making sanitary?
.....................................................................................................................................................
24 | P a g e
6. Who provides you with sanitary materials? (Tick all that apply)
Yes
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
No
My self
Mother
Father
Sister
Friend
Senior woman teacher
Village women leader
NGO (specify)
Relative
Others (specify)
7. Where do you commonly get sanitary materials from? (only one option)
a. Market
b. Shop
c. Clinic
d. Home
e. School
f. others………………….
8. Where can you get sanitary pads (e.gAlways) from?
a. Market
b. Shop
c. Clinic
d. Home
e. School
f. others………………….
9. What feelings do you develop during menstrual periods?
a. Having sex
b. Getting married
c. Living school
d. Having sanitary material
e. Others (specify)………………………………………………………………………….
10. How do boys treat girls during their menstrual periods?
a. Abuse
b. Humiliated
c. Nicknamed
d. Laugh at girls
e. Provide supportive environment
f. Isolate girls
g. Approached for love/sex offers
h. Others (specify)…………………………………………………….
11. How does the community treat you during menstrual periods?
a. Restrict movement
b. Seen as unclean
c. Cleansing/perform rituals
12. Have you used sanitary pads (e.g. always) in the last three months? A. Yes
b. No
13. If no, why?
a. Lack of money
b. Pads not available
c. Comfortable with the local materials (specify)
d. Not comfortable with sanitary
e. Do not know about it
f. Others (specify)
14. Do you put on nickers?
A. Yes
B. No
15. If no, Why?
a. Do not have
b. They are expensive
c. Culture does not allow
d. Not comfortable
e. Others (Specify) ………………………………………………………………………
25 | P a g e
16. Does menstruation make you miss school? A. Yes
B. No
17. If yes, how many days of school in a month do you miss?...............................
18. Why does menstruation make you miss school?
True
a)
b)
c)
d)
e)
f)
g)
h)
False
I feel severe pain
Lack of sanitary materials
Not allowed by parents
Feel dirty
Afraid of being made fun of
Discomfort due to tiredness
Lack of private changing room at school
Others (specify)
19. Other than menstruation, what other reasons make you miss school? (Please list them
here)
………………………………………………………………………………………………..
………………………………………………………………………………………………..
………………………………………………………………………………………………..
………………………………………………………………………………………………..
20. Does menstruation make girls drop out of school? A. Yes
B. No
21. Please mark whether these statements are true for you during your menstrual periods:
(tick all that apply)
True
False
a) Not ashamed of myself
b) Proud and mature
c) Feel less confident than when I am not in my periods
d) Feel dirty
e) Feel uncomfortable
f) Others (specify)
22. Have you ever heard of information on how to care for yourself during menstrual periods?
A. Yes B. No
23. If yes, from where? (tick all that apply)
Yes
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
Mother
Father
Sister
Relative
Teacher
Friends
Books/newspapers
Radio
Community leader
NGO representative
School health club
Others (specify)
24. Do girls have a separate changing room at school during menstrual periods?
A. Yes B. No
26 | P a g e
No
25. Does anyone at school support you during your menstrual periods?
A. Yes B. No
26. If yes, who supports you
a)
b)
c)
d)
e)
f)
g)
h)
i)
Yes
No
Yes
No
Senior woman teacher
Friends
Any other teacher
Health prefect
Senior man teacher
Matron
Head boy
Head girl
Others (specify)
27. If yes, how does this person support you?
a)
b)
c)
d)
Provide materials
Counselling/advise
Protection from humiliation
Others (specify)
28. Are you comfortable with the person who supports you?
A.Yes
B. No
29. If no, why……………………………………………………………………………………………………
30.
a. Do you have a reliable source of water at school? A. Yes
B. No
b. If yes, how has it helped you to improve on menstrual hygiene?
………………………………………………………………………………………………………….
………………………………………………………………………………………………………….
c. If no, how do you deal with menstrual periods without water in school?
………………………………………………………………………………………………………….
………………………………………………………………………………………………………….
31. How best do you feel the issue of menstruation should be addressed to you as a girl in school?
Thank you for your time
27 | P a g e
Annex five: OBSERVATION CHECKLIST
NAME OF SCHOOL:…………………………………………………………………………
COUNTY:……………………………………………………………………………………..
1. Presence of basic School Structures and facilities;
Category
YES
Classrooms available from (P.1-P.8 )/(S.1-S.4)
Classrooms in good state and conducive for
learning
Adequate desks for all pupils/students
Office/ staff room available
Adequate office furniture
Teachers Houses available
School Kitchen available with drying rack
2. Menstrual Hygiene Management facilities/materials
Category
YES
Changing room for girls available
Sanitary Materials available
Basins/buckets available
Sickbay available
Wash rooms next to girls changing room/latrines
Water available
Soap available in washrooms
3. a. Latrines
Category
School latrines available
Latrines in good condition and functionality
NO
NO
YES
NO
YES
NO
Separate latrines for boys, girls and teachers
Latrines in regular use
Latrines swept clean
Faeces on the floor of the latrine
Latrines with cover
No Flies and Bad smell
Open defecation not practiced
b. type of latrine
Type of latrine
Permanent structure with bricks and sand
Grass thatched/mud walls
Hole no superstructure
Latrines made of grass
Latrine with wall but no roof
b. Number of latrine stances
28 | P a g e
Category
Boys
Girls
Teachers/support staff
Number
4. Water source
Category
Available but not functioning
Available and functioning
Water source within school compound
Water source within 1KM
Water source more than 1KM
Water source environment clean
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
5. Senior man and Senior woman Teachers
Category
Appointed by the school
Available in school
Presence of records in the office
6. Hand washing
Category
Hand washing facility available
Facility functioning and not damaged
Soap/Detergent/ash used
7. Conducive school environment
Category
Pupils/students have at least a meal in a school
Play materials available
Clean environment
8. Record
Category
PTA/SMC Files available
Visitors Book
Duty rosters
Enrolment
Thank you
29 | P a g e
Annex 6: INTERVIEW SCHEDULE FOR GIRLS AND BOYS (FGD)
1. What do you understand by menstrual periods?
2. What do you feel when we talk about menstrual periods in public?
3. Have you ever been taught anything regarding menstrual hygiene? If yes, what did you discuss?
And with who?
4. How do girls feel when they are nearing their menstruation periods? What do they always do in
preparation?
5. How do boys treat girls who are in menstruation periods?
6. How does the community treat girls during menstruation periods?
7. What do girls always do when they experience their periods abruptly?
8. Who always helps girls and how, when they are in their periods?
9. What materials do girls always use?
10. Which of the above materials would you prefer to be explored further to ensure girls have
constant supply of sanitary pads?
11. Do periods stop girls from coming to school? If yes, why?
12. Do you know of girls who have dropped out of school due to menstruation? If yes, why?
13. If no what other reasons made the girls drop out of school?
14. How best do you think girls can be supported during menstrual periods?
15. What do you think about your school latrines? What do you feel is lacking? How can they be
improved?
16. Do you have a school health club? What have you gained out of the school health club?
17. Do you have reliable supply of clean water in your school? If yes, how has it helped you to
manage hygiene in the school?
18. What don’t you about menstrual?
30 | P a g e
Annex seven: INTERVIEW SCHEDULE WITH LOCAL LEADER, PTA/SMC AND PARENTS
1.
What are the reasons for the following;
a. Low attendance of girls
b. Drop out
c. Lack of transition of girls from basic level to other levels of education?
2. Why do you prefer educating boys to girls?
3. What difficulties do children especially girls face at home and school that lead to dropping out of
school?
4. What policies or programs are in place to support and promote education, WASH and menstrual
hygiene care in communities and schools?
5. How do parents, PTA, Local leaders support girls during menstrual periods?
6. What should be put in place to support and promote education, WASH and MHM in schools?
7. What appropriate channels would you suggest to improve access and availability of menstrual
hygiene management facilities in schools?
8. What materials do girls use during menstruation periods?
9. Are menstrual hygiene materials easily available and accessible by the girls at school, home and in
the community?
10. Which of the stated materials should be explored further to ensure that girls have constant supply of
sanitary materials?
11. How does the community deal with girls/women during menstrual periods?
12. How do girls behave in your community during their menstrual periods?
13. Do girls openly discuss their menstruation problems with you as parents/PTA/Local leaders? If yes,
how? If no, why?
14. Do you as parents; discuss issues of menstrual periods with your daughters? If no, why?
15. As a community leader, do you discuss information regarding menstrual hygiene? If no, how do you
think you can help your community understand menstrual hygiene?
16. Do you have a reliable source of water in the community and how satisfied are you with its current
state?
17. How far from the community is the water point? Time? Distance?
18. In your view, how is your water managed in your community? How can it be improved?
What mechanisms have been put in place to ensure that the water is safe and clean?
31 | P a g e
Annex eight: List of Enumerators
S/No. Name
1. Justo Thomas
County
2.
Loumo Lawrence
3.
Vitale OyyahaOdemi
4.
5.
Kaya Alfred Taban
KornelioAdafaBulang
State (EES)
Torit
6.
ChristinoGumaSikia
Kapoeta East
7.
Lam Leone Ferem
Kapoeta South
8.
Chandi Pascal S
State (EES)
32 | P a g e
Magwi
Position
County Inspector of
schools
Deputy County
Education Director
County Education
director
SMoE
Deputy County
Director Torit
County Education
Director
County Education
Director
Directorate of GESD
(MoE)
Baseline survey Photographs:
Representative from the State Ministry of Education
doing FGDwith children in Torit East P/S
Communally made latrine in St. Mathew
Primary School Ikwotos County
Girls demonstrating on how they use a
hole during their menstrual periods in
Kapoeta East
33 | P a g e
Broken down borehole in Kapoeta East School
County
Communally made latrine in Ikwotos County
An example of a locally made “san. Kit”
used for keeping pads, knickers for girls
in Kapoeta East