Pads, power, and paradoxes: a study of the psycho-social factors informing girls’ menstrual distress and absenteeism from school

Abstract Background School absenteeism among girls lacking menstrual health management (MHM) products has increasingly attracted attention from researchers and activists. While research highlights the challenges caused by a lack of products, the focus of such work is on the facilities available at schools to ensure MHM. Less attention is paid to the fact that a lack of water, sanitation, and hygiene (WASH) for MHM compounds girls’ distress while managing menstruation at school. Furthermore, while programs focus on access to MHM products and WASH facilities, they often fail to address the stigma and taboos surrounding menstruation that contribute to girls’ distressing experiences of menstruating at school. Accordingly, this study aimed to explore how school-going girls with access to menstrual products and adequate WASH facilities experience and interpret menstruation at school, with particular attention to the psycho-social discourses that shape menstrual distress, participation, and school attendance. It further examined how girls experience, support or resist the discipline and concealment of menstruating bodies within an all-girls’ school environment. Methods This qualitative study considers an all-girls’ school with adequate WASH facilities. Female high school students ( n = 35), aged 15–18, with access to MHM products, participated via self-report surveys. Data were analysed using Foucauldian Discourse Analysis and Feminist Theory. Results Despite recognising menstruation as ‘normal’, girls experience distress around menstruation due to conflicting societal messages. Paradoxical meanings acquired at home and in society inform their experiences at school, reinforcing stigma. Even with access to MHM products and WASH facilities, discomfort associated with managing menstruation at school may contribute to disrupted participation and absence. Conclusion While MHM products and WASH facilities need to be accessible, problematic social messages must also be addressed to emancipate women from the social power that informs their understanding that menstruation is both shameful and life-giving—leading to cognitive dissonance and distress. MHM activism must move beyond access to products and facilities to challenge societal norms that perpetuate menstrual stigma. Addressing psycho-social distress requires broader community engagement, including educational interventions involving people of all genders. By integrating such approaches into MHM strategies, we can work towards a future where menstruation does not hinder girls' education and well-being.