Date of Graduation


Document Type


Degree Name

Bachelor of Science in Nursing

Degree Level





Liu, Tingting

Committee Member/Reader

Agana, Carol


Background: Menstruation is an ongoing biological process that affects a large portion of the population and requires consistent health and medical care. However, menstruation does not affect women and girls equally in resource-poor communities and girl-unfriendly schools, particularly in low- and middle-income countries. Without proper menstrual hygiene management (MHM) and menstrual health and hygiene (MHH), girl’s attendance at school is reported to decline or cease altogether. Providing the proper resources to fulfill women’s and girl’s menstrual hygiene needs may impact female’s attendance rates at school, and furthering women’s education is fundamental in advancing female’s equality world-wide.

Purpose: The purpose of this systematic review is to synthesize the literature evaluating the impacts of menstrual hygiene management resource interventions and educational interventions on adolescent female’s school attendance rates in low- and middle-income countries.

Methods: CINAHL, PubMed, and Web of Science, were systematically searched, along with a manual internet search, for journal articles that studied adolescent females in low- and or middle-income countries (P), and interventions of physical menstrual hygiene resources and education (I), with a comparison of study outcomes to control groups or existing groups within the community (C), resulting in reports on post-intervention school attendance rates (O).

Results: 21 peer-reviewed articles were retrieved through a database search of CINAHL, PubMed, and Web of Science, as well as a manual internet search. 19 articles were primary studies evaluating the PICO guidelines, and 2 articles were systematic reviews fitting PICO criteria. The included articles spanned seven countries, primary and secondary or both school types, rural and urban settings, and government and public or non-government and private schools. Attendance rates were more often reported to improve after any MHM intervention type than they were reported to cause no effect or a decline in attendance.

Conclusions: Despite many studies presenting supportive evidence for MHM interventions improving attendance, no concrete conclusions can be made about their effect due to the variations between studies and the non-generalizability of the results. While education interventions alone proved to have the most unanimous results, there is a gap in the literature regarding which type of intervention is the most effective and the overall effect of a menstrual cup intervention. Further research is necessary to inform evidence-based practice and to determine the most successful interventions that should be used to eliminate menstrual disparities world-wide.


menstruation, schoolgirl, low-income, attendance, disparity, education