Reducing School Absenteeism through Menstrual Hygiene Interventions: A Scoping Review of Evidence from African Countries

Abstract

Background: Deficiencies in menstrual hygiene management (MHM) remain a pervasive but insufficiently addressed constraint on girls’ educational participation in low- and middle-income countries (LMICs). Entrenched sociocultural taboos surrounding menstruation, inadequately equipped school environments, and constrained access to appropriate menstrual materials, particularly disposable or reusable sanitary pads, collectively contribute to recurrent school absence among adolescent girls.  Objective: This scoping review sought to systematically map school-based MHM interventions implemented in LMICs, with particular emphasis on sub-Saharan Africa, and to synthesise available evidence on their influence on school attendance, menstrual hygiene behaviours, psychosocial outcomes, and academic performance.  Methods: Guided by the PRISMA-ScR reporting guidelines and the Population–Concept–Context framework, a comprehensive search of peer-reviewed and grey literature published between 2015 and 2025 was undertaken using PubMed, Google Scholar, Scopus, and Web of Science. Eligible studies focused on schoolgirls aged 10–19 years in LMIC settings and evaluated interventions explicitly addressing MHM. Twenty-five studies met the inclusion criteria and were examined using narrative synthesis, with results organised thematically and documented through summary charts and a PRISMA flow diagram.  Results: The identified interventions clustered into four broad categories: menstrual health education, provision of menstrual products, improvements to water, sanitation, and hygiene (WASH) facilities, and integrated interventions combining multiple components. Multi-component programmes demonstrated the most consistent and substantial effects, with several studies reporting reductions in menstruation-related school absenteeism of up to 70%. Positive changes in hygiene practices and psychosocial well-being were also frequently reported. Nonetheless, important evidence gaps persist, notably the scarcity of long-term evaluations, limited contextual and cultural tailoring of interventions, and inadequate representation of marginalised populations, including girls with disabilities and those residing in rural or conflict-affected settings.  Conclusions: The available evidence indicates that integrated MHM interventions hold considerable promise for enhancing girls’ school attendance and overall well-being in LMIC contexts. To sustain and scale these gains, policymakers should advance comprehensive national MHM policies, invest in resilient and gender-responsive WASH infrastructure, and adopt inclusive approaches that explicitly address equity and vulnerability. Menstrual health should be recognised as a fundamental component of the right to education rather than an obstacle to it.