Menstruation Accounts for Only a Small Proportion of Girls’ Absenteeism in Malawi, Study Suggests

In many countries of the developing world, and especially in rural areas, girls who attend school do so for only a few years, often dropping out when they are in their early teenage years.

The reasons for school dropout vary. Education for girls is not considered important or is actively opposed in some societies. Often girls are expected to marry at an early age; few stay in school afterward, especially if they have children. Economic factors can be just as important because families sometimes cannot afford school fees for any or all of their children. When decisions must be made among siblings in regards to education, boys nearly always are given priority.

The slow but steady change in traditions and school access in parts of the developing world has provided more and more girls with opportunities to attend school regularly and remain enrolled longer. Yet as such barriers fall, it is important to consider other reasons why girls are absent from school or withdraw.

One potential factor often discussed in relation to adolescent girls is menstruation. There is no doubt that menstruation is associated with numerous physical, socio-cultural, and economic challenges for female students in the developing world. Among them are the physical discomforts and inconveniences of menstruation, ranging from cramps to headaches; lack of access to adequate sanitary materials and toilets on school grounds; and insufficient understanding of menstruation, which can lead to shame and poor preparation for dealing with the physical issues. Poverty plays an important role as well: even if sanitary napkins are available to purchase in a community, many girls and their families cannot afford them.

All of these problems may interfere with a student’s ability to participate in classroom activities. In some cases, they may limit her inclination or ability to attend school altogether.

However, despite the intuitively clear links between menstruation-related challenges and the quality and length of girls’ schooling (including absenteeism), little evidence exists as to whether there is a direct relationship. A recent Population Council study, “Menstruation and school absenteeism: Evidence from rural Malawi,” highlighted research aimed at better understanding such links and identifying potential entry points to overcome the main barriers.

The Malawi Schooling and Adolescent Survey

The authors—Monica Grant of the University of Wisconsin, Population Council senior consultant Cynthia B. Lloyd, and Council researcher Barbara Mensch—focused on Malawi for several reasons. The country has one of the highest recorded rates of school absenteeism among adolescents in sub-Saharan Africa. Also, data were available from the Population Council’s Malawi Schooling and Adolescent Survey (MSAS), a school-based survey undertaken from 2007–2013 in two rural districts in the southern part of the country. More than 1,600 students from 59 primary schools participated in the survey. All were aged 14–17 when they first participated in 2007; most were re-interviewed each year through the end of the survey.

The researchers used MSAS findings to create statistical models to explore potential factors affecting variations in menstruation-related absenteeism. The models contained school- and individual-level variables including type of toilets available and their cleanliness; privacy of school toilets; travel time to and from school; the presence of older female relatives at home; and parental encouragement for studying and school attendance.

What Were the Main Findings?

Findings show that nearly one-third of female students reported missing at least one day of school during their previous menstrual period. However, the data indicate that menstruation accounts for only a small proportion of all female absenteeism. The lack of a gender gap in overall absenteeism underscores this finding.

The study’s authors interpret the results of their research as suggesting that absenteeism due to menstruation does not stem primarily from school environment (e.g., cleanliness and privacy of toilets).

“Menstruation accounts for only a small proportion of female absenteeism among school-going adolescents in Malawi,” said Lloyd. “Absenteeism is not affected by features of the school environment such as the type, cleanliness, and privacy of toilet facilities.”

Findings clearly show, however, that factors associated with girls’ home environments can be significantly associated with lower likelihood of absence during the last menstrual period. These include co-residence with older women (especially a grandmother) and the amount of time girls are able to study at home, which is partly related to parental support and encouragement.

What Are the Lessons for the Future?

Based on these observations, the authors conclude that adolescent girls’ school attendance is unlikely to increase substantially through the improvement of toilet facilities or provision of sanitary supplies—interventions in support of girls’ education that have been proposed by many in the policy and NGO communities. Nevertheless, such interventions are likely to improve the quality of girls’ lives.

In addition, the authors note the potential value of increasing the availability of analgesics that lessen pain during menstruation. That recommendation is based on the finding that school absence at such times is closely related to the severity of physical symptoms. Almost 85 percent of girls who reported missing school during their last menstrual period said the primary reason was one or more of the following: heavy bleeding, cramps, or diarrhea.

The findings also reflect the critical importance of support at home. Female students with parents and other relatives who are invested in their education appear to be more motivated to avoid missing school for any reason, including menstruation. Efforts to increase support for girls’ schooling, such as policies that reduce domestic drudgery or provide after-school programs for girls that protect time for their studies, might be more successful than the provision of menstrual supplies in reducing absenteeism.


Grant, Monica, Cynthia B. Lloyd, and Barbara Mensch. 2013. “Menstruation and school absenteeism: Evidence from rural Malawi,” Comparative Education Review 57(2): 260–284.

Outside Funding

Eunice Kennedy Shriver National Institute of Child Health and Human Development, The John D. and Catherine T. MacArthur Foundation, The Spencer Foundation, and The William and Flora Hewlett Foundation