Menstrual Hygiene Management Practices, Knowledge Gaps, and the Imperative for Male Engagement in Coeducational High Schools in Dhaka, Bangladesh

Introduction: Menstrual hygiene management (MHM) is critical for adolescent girls' health and well-being, yet it remains a sensitive topic in many cultures, including Bangladesh, where cultural norms and lack of resources hinder optimal practices. The role of male engagement in MHM is increasingly recognized but insufficiently explored in this context. Objective: This study aimed to explore MHM practices among female students and assess the knowledge and attitudes of both male and female students regarding menstruation, and to understand the role of male engagement in coeducational high schools in Dhaka, Bangladesh. Methods: A cross-sectional study was conducted in three coeducational high schools in Dhaka. Data were collected through quantitative surveys with 300 students (150 girls, 150 boys; grades 9-12, selected randomly via lottery) and qualitative in-depth interviews with 20 participants (10 students, 8 teachers, randomly selected). Descriptive statistics were used for quantitative data, and thematic analysis was applied to qualitative data. Results: The average age of female respondents was 17 years (range 15-19), with menarche occurring at an average age of 11.8 years. Most (73%) students were from medium socioeconomic status families. Among female students, 82% used sanitary pads, but 42% changed them less frequently than recommended, and 87% did not change products at school. While 62% of girls knew about menstruation before menarche, significant prohibitions were reported (e.g., 100% not allowed to perform religious activities). Male students demonstrated limited knowledge (e.g., 62% had 'no idea' about the current perception of menstruation) and discomfort discussing menstruation. Qualitative findings highlighted that male involvement (students and teachers) is crucial for creating a supportive environment, providing education, supporting access to resources, and challenging harmful cultural norms. Conclusion: Suboptimal MHM practices and knowledge gaps, particularly among male students, underscore the need for comprehensive MHM education and proactive male engagement in Bangladeshi schools. A coordinated effort among students, teachers, parents, and policymakers is essential to dismantle silence and promote menstrual health.