Sanitary pad interventions for girls' education in Ghana: a pilot study

PLoS One. 2012;7(10):e48274. doi: 10.1371/journal.pone.0048274. Epub 2012 Oct 31.


Background: Increased education of girls in developing contexts is associated with a number of important positive health, social, and economic outcomes for a community. The event of menarche tends to coincide with girls' transitions from primary to secondary education and may constitute a barrier for continued school attendance and performance. Following the MRC Framework for Complex Interventions, a pilot controlled study was conducted in Ghana to assess the role of sanitary pads in girls' education.

Methods: A sample of 120 schoolgirls between the ages of 12 and 18 from four villages in Ghana participated in a non-randomized trial of sanitary pad provision with education. The trial had three levels of treatment: provision of pads with puberty education; puberty education alone; or control (no pads or education). The primary outcome was school attendance.

Results: After 3 months, providing pads with education significantly improved attendance among participants, (lambda 0.824, F = 3.760, p<.001). After 5 months, puberty education alone improved attendance to a similar level (M = 91.26, SD = 7.82) as sites where pads were provided with puberty education (Rural M = 89.74, SD = 9.34; Periurban M = 90.54, SD = 17.37), all of which were higher than control (M = 84.48, SD = 12.39). The total improvement through pads with education intervention after 5 months was a 9% increase in attendance. After 3 months, providing pads with education significantly improved attendance among participants. The changes in attendance at the end of the trial, after 5 months, were found to be significant by site over time. With puberty education alone resulting in a similar attendance level.

Conclusion: This pilot study demonstrated promising results of a low-cost, rapid-return intervention for girls' education in a developing context. Given the considerable development needs of poorer countries and the potential of young women there, these results suggest that a large-scale cluster randomized trial is warranted.

Trial registration: Pan African Clinical Trials Registry PACTR201202000361337.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Cities / statistics & numerical data
  • Education / statistics & numerical data*
  • Educational Status
  • Female
  • Geography
  • Ghana
  • Health Promotion / economics
  • Health Promotion / methods*
  • Health Promotion / statistics & numerical data
  • Humans
  • Hygiene*
  • Menstruation
  • Pilot Projects
  • Puberty
  • Rural Population / statistics & numerical data
  • Schools / statistics & numerical data
  • Time Factors

Grant support

The study was funded by Templeton College, the John Fell Fund and Green Templeton College - all at Oxford University. Pads were supplied by Proctor and Gamble. No supporter of the study had any influence over the publication of any results. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.