Access to WASH facilities and health implications of period poverty among in-school girls in rural areas of Africa: a scoping review

INTRODUCTION: Menstrual health is essential to adolescent well-being, yet many girls experience period poverty, an inadequate access to sanitary products, water, sanitation facilities, and menstrual education. This scoping review synthesised existing evidence on access to menstrual products, commonly described barriers and reported associations between poor health and period poverty among in-school girls in rural areas of Africa. METHODS: This study was developed in accordance with the Joanna Briggs Institute recommendations and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. PubMed, Web of Science and Google Scholar were searched for literature published in English, between 2015 and 2025. The literature must meet the inclusion criterion of being conducted among in-school girls in rural communities in Africa. Extracted data were summarised in an Excel spreadsheet, and descriptive analyses were conducted. RESULTS: Twenty-one (21) relevant studies were identified, of which 14 were quantitative, four were qualitative, and three were mixed methods studies. The studies were conducted across six countries, with the largest proportion from Kenya (5/21; 23%). Many of the girls were between 10 and 19 years. Period poverty was common among in-school menstruating girls in rural areas of Africa, and it negatively influenced their physical, mental, social and sexual health. Period poverty was linked to body odour, body burns, headaches, fatigue, urogenital symptoms, experience of fear, discomfort, shame, and stress. It can also lead to vulnerability to sexual exploitation, disrupted schooling, poor academic performance and school dropout. CONCLUSIONS: Period poverty was widespread among in-school girls in rural Africa and linked to negative implications on their health. Integrated interventions that reduce girls' vulnerability to stigma and sexual exploitation, such as free or subsidised menstrual products, gender-responsive water, sanitation and hygiene facilities, and menstrual education for boys and girls, are urgently required.