WASH challenges to girls’ menstrual hygiene management in Metro Manila, Masbate, and South Central Mindanao, Philippines
Anna Ellis | Jacquelyn Haver | Jon Villasenor | Amado Parawan | Mohini Venkatesh | Matthew C. Freeman | Bethany A. Caruso
This paper examines water, sanitation, and hygiene (WASH) conditions that enable and hinder Philippine schoolgirls to hygienically manage their menstruation. We collected qualitative data from 13 schools in three regions of the Philippines. Schools in both urban (Metro Manila) and rural areas (Masbate and South Central Mindanao) were included to allow for comparison across settings. Unreliable access to water, lack of disposal mechanisms for menstrual materials, unclean facilities, and insufficient number of latrines were identified as the key barriers to effective menstrual management in Masbate and Metro Manila. In South Central Mindanao, there was greater oversight of WASH hardware at schools and hardware was in better condition, which created a more enabling environment for girls to manage menstruation. Creating an enabling WASH environment for girls to manage menstruation requires sustained support and system oversight, combined with knowledge and information.Abioye-Kuteyi, E.A. (2000) ‘Menstrual knowledge and practices amongst secondary school girls in Ile Ife, Nigeria’, Journal of the Royal Society for the Promotion of Health 120: 23–6 <http://dx.doi.org/10.1177/146642400012000113>.
Ainsworth, M., Beegle, K. and Nyamete, A. (1996) ‘The impact of women’s schooling on fertility and contraceptive use: a study of fourteen sub-Saharan African countries’, The World Bank Economic Review 10: 85–122.
Alexander, K.T., Oduor, C., Nyothach, E., Laserson, K.F., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C. and Mohammed, A. (2014) ‘Water, sanitation and hygiene conditions in Kenyan rural schools: are schools meeting the needs of menstruating girls?’ Water 6: 1453–66 <http://dx.doi.org/10.3390/w6051453>.
Caruso, B.A. (2014) WASH in Schools Empowers Girls’ Education: Tools for Assessing Menstrual Hygiene Management in Schools, New York: UNICEF.
Caruso, B., Fehr, A., Inden, K., Sahin, M., Ellis, A., Andes, K. and Freeman, M. (2013) WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An Assessment of Menstrual Hygiene Management in Schools, New York: UNICEF.
Caruso, B., Dreibelbis, R., Ogutu, E.A. and Rheingans, R. (2014) ‘If you build it will they come? Factors influencing rural primary pupils’ urination and defecation practices at school in western Kenya’, Journal of Water, Sanitation and Hygiene for Development 4(4): 642–53 <http://dx.doi.org/10.2166/washdev.2014.028>.
Chatterly, C., Javernick-Will, A., Linden, K., Kawser, A., Bottinelli, L. and Venkatesh, M. (2014) ‘A qualitative comparative analysis of well-managed school sanitation in Bangladesh’, BMC Public Health 14: 6 <http://dx.doi.org/10.1186/1471-2458-14-6>.
Crofts, T. and Fisher, J. (2012) ‘Menstrual hygiene in Ugandan schools: an investigation of low-cost sanitary pads’, Journal of Water, Sanitation and Hygiene for Development 2: 50–8 <http://dx.doi.org/10.2166/washdev.2012.067>.
Department of Education (2010) DepEd Education Facilities Manual, Pasig City, Philippines: Physical Facilities and Schools Engineering, Office of Planning Service.
Garn, J., Greene, L., Dreibelbis, R., Saboori, S., Rheingans, R. and Freeman, M. (2013) ‘A cluster-randomized trial assessing the impact of school water, sanitation, and hygiene improvements on pupil enrollment and gender parity in enrollment’, American Journal of Public Health 104(1): e91–7 <http://dx.doi.org/10.2166/washdev.2013.217>.
Garn, J., Caruso, B., Drews-Botsch, C., Kramer, M., Brumback, B., Rheingans, R. and Freeman, M. (2014) ‘Factors associated with pupil toilet use in Kenyan primary schools’, International Journal of Environmental Research and Public Health 11(9): 9694–711 <http://dx.doi.org/10.3390/ijerph110909694>.
Guest, G., Macqueen, K. and Namey, E. (2012) Applied Thematic Analysis, 1st edn, Thousand Oaks, CA: SAGE Publications.
Haver, J., Caruso, B.A., Ellis, A., Sahin, M., Villasenor, J.M., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Masbate Province and Metro Manila, Philippines: An Assessment of Menstrual Hygiene Management in Schools, New York: UNICEF.
Hennink, M., Hutter, I. and Bailey, A. (2010) Qualitative Research Methods, London: Sage Publications.
Hunt, F. (2008) ‘Dropping out of schools: a cross country review of literature’, in Consortium for Research on Educational Access, T.A.E.C. (ed.), Create Pathways to Access, Brighton, UK: University of Sussex.
Kjellen, M., Pensulo, C., Nordquist, P. and Fogde, M. (2012) Global Review of Sanitation System Trends and Interactions with Menstrual Management Practices, Stockholm: Stockholm Environment Institute.
Lionde, R. (2004) ‘Scaling up school sanitation and hygiene promotion and gender concerns’, School Sanitation and Hygiene Symposium. The Way Forward: Construction is Not Enough! Delft, The Netherlands, 8–10 June 2004.
Long, J., Caruso, B., Lopez, D., Vancraeynest, K., Sahin, M., Andes, K. and Freeman, M. (2013) WASH in Schools Empowers Girls’ Education in Rural Cochabamba, Bolivia: An Assessment of Menstrual Hygiene Management in Schools, New York: UNICEF.
McAlister, C. and Baskett, T.F. (2006) ‘Female education and maternal mortality: a worldwide survey’, Journal of Obstetrics and Gynaecology Canada: JOGC 28: 983–90.
McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.F., Ogutu, E.A., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head”: reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health and Human Rights 11: 7 <http://dx.doi.org/10.1186/1472-698X-11-7>.
Maimaiti, Y. and Siebert, S. (2009) The Gender Education Gap in China: The Power of Water, Birmingham: University of Birmingham Institute for the Study of Labor.
Mason, L., Nyothach, E., Alexander, K., Odhiambo, F.O., Eleveld, A., Vulule, J., Rheingans, R., Laserson, K.F., Mohammed, A. and Phillips-Howard, P.A. (2013) ‘“We keep it secret so no one should know”: a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya’, PloS one 8: e79132 <http://dx.doi.org/10.1371/journal.pone.0079132>.
National Statistical Coordination Board (2014) ‘Poverty incidence unchanged as of first semester 2012-NSCB’ [online] <www.nscb.gov.ph/poverty/defaultnew.asp> [accessed 30 June 2014].
Republic of the Philippines Commission on Audit (2014) Consolidated Annual Audit on the Department of Education, for the year ended December 31, 2013, Quezon City, Philippines: Republic of the Philippines Commission on Audit.
Rihani, M. (2006) Keeping the Promise: 5 Benefits of Girls’ Secondary Education, Washington, DC: AED Global Learning Group.
Saboori, S., Mwaki, A. and Rheingans, R. (2010) ‘Is soapy water a viable solution for handwashing in schools?’ Waterlines 29(4): 329–36 <http://dx.doi.org/10.3362/1756-3488.2011.040>.
Sommer, M. (2009a) ‘Ideologies of sexuality, menstruation and risk: girls’ experiences of puberty and schooling in northern Tanzania’, Culture, Health and Sexuality 11: 383–98 <http://dx.doi.org/10.1080/13691050902722372>.
Sommer, M. (2009b) ‘Where the education system and women’s bodies collide: the social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence 33: 521–9 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008>.
Sommer, M. (2010) ‘Putting menstrual hygiene management on to the school water and sanitation agenda’, Waterlines 29: 268–77 <http://dx.doi.org/10.3362/1756-3488.2010.030>.
Sommer, M. and Sahin, M. (2013) ‘Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls’, American Journal of Public Health 103: 1556–9 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Trinies, V., Caruso, B., Sorgore, A., Toubkiss, J. and Freeman, M. (2015) ‘Uncovering the challenges to menstrual hygiene management in schools in Mali’, Waterlines 31(1): 31–40 <http://dx.doi.org/10.3362/1756-3488.2015.004>.
UNESCO (2015) Empowering Adolescent Girls and Women through Education [pdf] <http://unesdoc.unesco.org/images/0023/002319/231944e.pdf> [accessed 2 February 2016].
UNICEF (2012) Equity of Access to WASH in Schools: A Comparative Study of Policy and Service Delivery in Kyrgyzstan, Malawi, the Philippines, Timor-Leste, Uganda and Uzbekistan, New York: UNICEF.
Abioye-Kuteyi, E.A. (2000) ‘Menstrual knowledge and practices amongst secondary school girls in Ile Ife, Nigeria’, Journal of the Royal Society for the Promotion of Health 120: 23–6 <http://dx.doi.org/10.1177/146642400012000113>.
Ainsworth, M., Beegle, K. and Nyamete, A. (1996) ‘The impact of women’s schooling on fertility and contraceptive use: a study of fourteen sub-Saharan African countries’, The World Bank Economic Review 10: 85–122.
Alexander, K.T., Oduor, C., Nyothach, E., Laserson, K.F., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C. and Mohammed, A. (2014) ‘Water, sanitation and hygiene conditions in Kenyan rural schools: are schools meeting the needs of menstruating girls?’ Water 6: 1453–66 <http://dx.doi.org/10.3390/w6051453>.
Caruso, B.A. (2014) WASH in Schools Empowers Girls’ Education: Tools for Assessing Menstrual Hygiene Management in Schools, New York: UNICEF.
Caruso, B., Fehr, A., Inden, K., Sahin, M., Ellis, A., Andes, K. and Freeman, M. (2013) WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An Assessment of Menstrual Hygiene Management in Schools, New York: UNICEF.
Caruso, B., Dreibelbis, R., Ogutu, E.A. and Rheingans, R. (2014) ‘If you build it will they come? Factors influencing rural primary pupils’ urination and defecation practices at school in western Kenya’, Journal of Water, Sanitation and Hygiene for Development 4(4): 642–53 <http://dx.doi.org/10.2166/washdev.2014.028>.
Chatterly, C., Javernick-Will, A., Linden, K., Kawser, A., Bottinelli, L. and Venkatesh, M. (2014) ‘A qualitative comparative analysis of well-managed school sanitation in Bangladesh’, BMC Public Health 14: 6 <http://dx.doi.org/10.1186/1471-2458-14-6>.
Crofts, T. and Fisher, J. (2012) ‘Menstrual hygiene in Ugandan schools: an investigation of low-cost sanitary pads’, Journal of Water, Sanitation and Hygiene for Development 2: 50–8 <http://dx.doi.org/10.2166/washdev.2012.067>.
Department of Education (2010) DepEd Education Facilities Manual, Pasig City, Philippines: Physical Facilities and Schools Engineering, Office of Planning Service.
Garn, J., Greene, L., Dreibelbis, R., Saboori, S., Rheingans, R. and Freeman, M. (2013) ‘A cluster-randomized trial assessing the impact of school water, sanitation, and hygiene improvements on pupil enrollment and gender parity in enrollment’, American Journal of Public Health 104(1): e91–7 <http://dx.doi.org/10.2166/washdev.2013.217>.
Garn, J., Caruso, B., Drews-Botsch, C., Kramer, M., Brumback, B., Rheingans, R. and Freeman, M. (2014) ‘Factors associated with pupil toilet use in Kenyan primary schools’, International Journal of Environmental Research and Public Health 11(9): 9694–711 <http://dx.doi.org/10.3390/ijerph110909694>.
Guest, G., Macqueen, K. and Namey, E. (2012) Applied Thematic Analysis, 1st edn, Thousand Oaks, CA: SAGE Publications.
Haver, J., Caruso, B.A., Ellis, A., Sahin, M., Villasenor, J.M., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Masbate Province and Metro Manila, Philippines: An Assessment of Menstrual Hygiene Management in Schools, New York: UNICEF.
Hennink, M., Hutter, I. and Bailey, A. (2010) Qualitative Research Methods, London: Sage Publications.
Hunt, F. (2008) ‘Dropping out of schools: a cross country review of literature’, in Consortium for Research on Educational Access, T.A.E.C. (ed.), Create Pathways to Access, Brighton, UK: University of Sussex.
Kjellen, M., Pensulo, C., Nordquist, P. and Fogde, M. (2012) Global Review of Sanitation System Trends and Interactions with Menstrual Management Practices, Stockholm: Stockholm Environment Institute.
Lionde, R. (2004) ‘Scaling up school sanitation and hygiene promotion and gender concerns’, School Sanitation and Hygiene Symposium. The Way Forward: Construction is Not Enough! Delft, The Netherlands, 8–10 June 2004.
Long, J., Caruso, B., Lopez, D., Vancraeynest, K., Sahin, M., Andes, K. and Freeman, M. (2013) WASH in Schools Empowers Girls’ Education in Rural Cochabamba, Bolivia: An Assessment of Menstrual Hygiene Management in Schools, New York: UNICEF.
McAlister, C. and Baskett, T.F. (2006) ‘Female education and maternal mortality: a worldwide survey’, Journal of Obstetrics and Gynaecology Canada: JOGC 28: 983–90.
McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.F., Ogutu, E.A., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head”: reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health and Human Rights 11: 7 <http://dx.doi.org/10.1186/1472-698X-11-7>.
Maimaiti, Y. and Siebert, S. (2009) The Gender Education Gap in China: The Power of Water, Birmingham: University of Birmingham Institute for the Study of Labor.
Mason, L., Nyothach, E., Alexander, K., Odhiambo, F.O., Eleveld, A., Vulule, J., Rheingans, R., Laserson, K.F., Mohammed, A. and Phillips-Howard, P.A. (2013) ‘“We keep it secret so no one should know”: a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya’, PloS one 8: e79132 <http://dx.doi.org/10.1371/journal.pone.0079132>.
National Statistical Coordination Board (2014) ‘Poverty incidence unchanged as of first semester 2012-NSCB’ [online] <www.nscb.gov.ph/poverty/defaultnew.asp> [accessed 30 June 2014].
Republic of the Philippines Commission on Audit (2014) Consolidated Annual Audit on the Department of Education, for the year ended December 31, 2013, Quezon City, Philippines: Republic of the Philippines Commission on Audit.
Rihani, M. (2006) Keeping the Promise: 5 Benefits of Girls’ Secondary Education, Washington, DC: AED Global Learning Group.
Saboori, S., Mwaki, A. and Rheingans, R. (2010) ‘Is soapy water a viable solution for handwashing in schools?’ Waterlines 29(4): 329–36 <http://dx.doi.org/10.3362/1756-3488.2011.040>.
Sommer, M. (2009a) ‘Ideologies of sexuality, menstruation and risk: girls’ experiences of puberty and schooling in northern Tanzania’, Culture, Health and Sexuality 11: 383–98 <http://dx.doi.org/10.1080/13691050902722372>.
Sommer, M. (2009b) ‘Where the education system and women’s bodies collide: the social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence 33: 521–9 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008>.
Sommer, M. (2010) ‘Putting menstrual hygiene management on to the school water and sanitation agenda’, Waterlines 29: 268–77 <http://dx.doi.org/10.3362/1756-3488.2010.030>.
Sommer, M. and Sahin, M. (2013) ‘Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls’, American Journal of Public Health 103: 1556–9 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Trinies, V., Caruso, B., Sorgore, A., Toubkiss, J. and Freeman, M. (2015) ‘Uncovering the challenges to menstrual hygiene management in schools in Mali’, Waterlines 31(1): 31–40 <http://dx.doi.org/10.3362/1756-3488.2015.004>.
UNESCO (2015) Empowering Adolescent Girls and Women through Education [pdf] <http://unesdoc.unesco.org/images/0023/002319/231944e.pdf> [accessed 2 February 2016].
UNICEF (2012) Equity of Access to WASH in Schools: A Comparative Study of Policy and Service Delivery in Kyrgyzstan, Malawi, the Philippines, Timor-Leste, Uganda and Uzbekistan, New York: UNICEF.
Abioye-Kuteyi, E.A. (2000) ‘Menstrual knowledge and practices amongst secondary school girls in Ile Ife, Nigeria’, Journal of the Royal Society for the Promotion of Health 120: 23–6 <http://dx.doi.org/10.1177/146642400012000113>.
Ainsworth, M., Beegle, K. and Nyamete, A. (1996) ‘The impact of women’s schooling on fertility and contraceptive use: a study of fourteen sub-Saharan African countries’, The World Bank Economic Review 10: 85–122.
Alexander, K.T., Oduor, C., Nyothach, E., Laserson, K.F., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C. and Mohammed, A. (2014) ‘Water, sanitation and hygiene conditions in Kenyan rural schools: are schools meeting the needs of menstruating girls?’ Water 6: 1453–66 <http://dx.doi.org/10.3390/w6051453>.
Caruso, B.A. (2014) WASH in Schools Empowers Girls’ Education: Tools for Assessing Menstrual Hygiene Management in Schools, New York: UNICEF.
Caruso, B., Fehr, A., Inden, K., Sahin, M., Ellis, A., Andes, K. and Freeman, M. (2013) WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An Assessment of Menstrual Hygiene Management in Schools, New York: UNICEF.
Caruso, B., Dreibelbis, R., Ogutu, E.A. and Rheingans, R. (2014) ‘If you build it will they come? Factors influencing rural primary pupils’ urination and defecation practices at school in western Kenya’, Journal of Water, Sanitation and Hygiene for Development 4(4): 642–53 <http://dx.doi.org/10.2166/washdev.2014.028>.
Chatterly, C., Javernick-Will, A., Linden, K., Kawser, A., Bottinelli, L. and Venkatesh, M. (2014) ‘A qualitative comparative analysis of well-managed school sanitation in Bangladesh’, BMC Public Health 14: 6 <http://dx.doi.org/10.1186/1471-2458-14-6>.
Crofts, T. and Fisher, J. (2012) ‘Menstrual hygiene in Ugandan schools: an investigation of low-cost sanitary pads’, Journal of Water, Sanitation and Hygiene for Development 2: 50–8 <http://dx.doi.org/10.2166/washdev.2012.067>.
Department of Education (2010) DepEd Education Facilities Manual, Pasig City, Philippines: Physical Facilities and Schools Engineering, Office of Planning Service.
Garn, J., Greene, L., Dreibelbis, R., Saboori, S., Rheingans, R. and Freeman, M. (2013) ‘A cluster-randomized trial assessing the impact of school water, sanitation, and hygiene improvements on pupil enrollment and gender parity in enrollment’, American Journal of Public Health 104(1): e91–7 <http://dx.doi.org/10.2166/washdev.2013.217>.
Garn, J., Caruso, B., Drews-Botsch, C., Kramer, M., Brumback, B., Rheingans, R. and Freeman, M. (2014) ‘Factors associated with pupil toilet use in Kenyan primary schools’, International Journal of Environmental Research and Public Health 11(9): 9694–711 <http://dx.doi.org/10.3390/ijerph110909694>.
Guest, G., Macqueen, K. and Namey, E. (2012) Applied Thematic Analysis, 1st edn, Thousand Oaks, CA: SAGE Publications.
Haver, J., Caruso, B.A., Ellis, A., Sahin, M., Villasenor, J.M., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Masbate Province and Metro Manila, Philippines: An Assessment of Menstrual Hygiene Management in Schools, New York: UNICEF.
Hennink, M., Hutter, I. and Bailey, A. (2010) Qualitative Research Methods, London: Sage Publications.
Hunt, F. (2008) ‘Dropping out of schools: a cross country review of literature’, in Consortium for Research on Educational Access, T.A.E.C. (ed.), Create Pathways to Access, Brighton, UK: University of Sussex.
Kjellen, M., Pensulo, C., Nordquist, P. and Fogde, M. (2012) Global Review of Sanitation System Trends and Interactions with Menstrual Management Practices, Stockholm: Stockholm Environment Institute.
Lionde, R. (2004) ‘Scaling up school sanitation and hygiene promotion and gender concerns’, School Sanitation and Hygiene Symposium. The Way Forward: Construction is Not Enough! Delft, The Netherlands, 8–10 June 2004.
Long, J., Caruso, B., Lopez, D., Vancraeynest, K., Sahin, M., Andes, K. and Freeman, M. (2013) WASH in Schools Empowers Girls’ Education in Rural Cochabamba, Bolivia: An Assessment of Menstrual Hygiene Management in Schools, New York: UNICEF.
McAlister, C. and Baskett, T.F. (2006) ‘Female education and maternal mortality: a worldwide survey’, Journal of Obstetrics and Gynaecology Canada: JOGC 28: 983–90.
McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.F., Ogutu, E.A., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head”: reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health and Human Rights 11: 7 <http://dx.doi.org/10.1186/1472-698X-11-7>.
Maimaiti, Y. and Siebert, S. (2009) The Gender Education Gap in China: The Power of Water, Birmingham: University of Birmingham Institute for the Study of Labor.
Mason, L., Nyothach, E., Alexander, K., Odhiambo, F.O., Eleveld, A., Vulule, J., Rheingans, R., Laserson, K.F., Mohammed, A. and Phillips-Howard, P.A. (2013) ‘“We keep it secret so no one should know”: a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya’, PloS one 8: e79132 <http://dx.doi.org/10.1371/journal.pone.0079132>.
National Statistical Coordination Board (2014) ‘Poverty incidence unchanged as of first semester 2012-NSCB’ [online] <www.nscb.gov.ph/poverty/defaultnew.asp> [accessed 30 June 2014].
Republic of the Philippines Commission on Audit (2014) Consolidated Annual Audit on the Department of Education, for the year ended December 31, 2013, Quezon City, Philippines: Republic of the Philippines Commission on Audit.
Rihani, M. (2006) Keeping the Promise: 5 Benefits of Girls’ Secondary Education, Washington, DC: AED Global Learning Group.
Saboori, S., Mwaki, A. and Rheingans, R. (2010) ‘Is soapy water a viable solution for handwashing in schools?’ Waterlines 29(4): 329–36 <http://dx.doi.org/10.3362/1756-3488.2011.040>.
Sommer, M. (2009a) ‘Ideologies of sexuality, menstruation and risk: girls’ experiences of puberty and schooling in northern Tanzania’, Culture, Health and Sexuality 11: 383–98 <http://dx.doi.org/10.1080/13691050902722372>.
Sommer, M. (2009b) ‘Where the education system and women’s bodies collide: the social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence 33: 521–9 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008>.
Sommer, M. (2010) ‘Putting menstrual hygiene management on to the school water and sanitation agenda’, Waterlines 29: 268–77 <http://dx.doi.org/10.3362/1756-3488.2010.030>.
Sommer, M. and Sahin, M. (2013) ‘Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls’, American Journal of Public Health 103: 1556–9 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Trinies, V., Caruso, B., Sorgore, A., Toubkiss, J. and Freeman, M. (2015) ‘Uncovering the challenges to menstrual hygiene management in schools in Mali’, Waterlines 31(1): 31–40 <http://dx.doi.org/10.3362/1756-3488.2015.004>.
UNESCO (2015) Empowering Adolescent Girls and Women through Education [pdf] <http://unesdoc.unesco.org/images/0023/002319/231944e.pdf> [accessed 2 February 2016].
UNICEF (2012) Equity of Access to WASH in Schools: A Comparative Study of Policy and Service Delivery in Kyrgyzstan, Malawi, the Philippines, Timor-Leste, Uganda and Uzbekistan, New York: UNICEF.
Abioye-Kuteyi, E.A. (2000) ‘Menstrual knowledge and practices amongst secondary school girls in Ile Ife, Nigeria’, Journal of the Royal Society for the Promotion of Health 120: 23–6 <http://dx.doi.org/10.1177/146642400012000113>.
Ainsworth, M., Beegle, K. and Nyamete, A. (1996) ‘The impact of women’s schooling on fertility and contraceptive use: a study of fourteen sub-Saharan African countries’, The World Bank Economic Review 10: 85–122.
Alexander, K.T., Oduor, C., Nyothach, E., Laserson, K.F., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C. and Mohammed, A. (2014) ‘Water, sanitation and hygiene conditions in Kenyan rural schools: are schools meeting the needs of menstruating girls?’ Water 6: 1453–66 <http://dx.doi.org/10.3390/w6051453>.
Caruso, B.A. (2014) WASH in Schools Empowers Girls’ Education: Tools for Assessing Menstrual Hygiene Management in Schools, New York: UNICEF.
Caruso, B., Fehr, A., Inden, K., Sahin, M., Ellis, A., Andes, K. and Freeman, M. (2013) WASH in Schools Empowers Girls’ Education in Freetown, Sierra Leone: An Assessment of Menstrual Hygiene Management in Schools, New York: UNICEF.
Caruso, B., Dreibelbis, R., Ogutu, E.A. and Rheingans, R. (2014) ‘If you build it will they come? Factors influencing rural primary pupils’ urination and defecation practices at school in western Kenya’, Journal of Water, Sanitation and Hygiene for Development 4(4): 642–53 <http://dx.doi.org/10.2166/washdev.2014.028>.
Chatterly, C., Javernick-Will, A., Linden, K., Kawser, A., Bottinelli, L. and Venkatesh, M. (2014) ‘A qualitative comparative analysis of well-managed school sanitation in Bangladesh’, BMC Public Health 14: 6 <http://dx.doi.org/10.1186/1471-2458-14-6>.
Crofts, T. and Fisher, J. (2012) ‘Menstrual hygiene in Ugandan schools: an investigation of low-cost sanitary pads’, Journal of Water, Sanitation and Hygiene for Development 2: 50–8 <http://dx.doi.org/10.2166/washdev.2012.067>.
Department of Education (2010) DepEd Education Facilities Manual, Pasig City, Philippines: Physical Facilities and Schools Engineering, Office of Planning Service.
Garn, J., Greene, L., Dreibelbis, R., Saboori, S., Rheingans, R. and Freeman, M. (2013) ‘A cluster-randomized trial assessing the impact of school water, sanitation, and hygiene improvements on pupil enrollment and gender parity in enrollment’, American Journal of Public Health 104(1): e91–7 <http://dx.doi.org/10.2166/washdev.2013.217>.
Garn, J., Caruso, B., Drews-Botsch, C., Kramer, M., Brumback, B., Rheingans, R. and Freeman, M. (2014) ‘Factors associated with pupil toilet use in Kenyan primary schools’, International Journal of Environmental Research and Public Health 11(9): 9694–711 <http://dx.doi.org/10.3390/ijerph110909694>.
Guest, G., Macqueen, K. and Namey, E. (2012) Applied Thematic Analysis, 1st edn, Thousand Oaks, CA: SAGE Publications.
Haver, J., Caruso, B.A., Ellis, A., Sahin, M., Villasenor, J.M., Andes, K.L. and Freeman, M.C. (2013) WASH in Schools Empowers Girls’ Education in Masbate Province and Metro Manila, Philippines: An Assessment of Menstrual Hygiene Management in Schools, New York: UNICEF.
Hennink, M., Hutter, I. and Bailey, A. (2010) Qualitative Research Methods, London: Sage Publications.
Hunt, F. (2008) ‘Dropping out of schools: a cross country review of literature’, in Consortium for Research on Educational Access, T.A.E.C. (ed.), Create Pathways to Access, Brighton, UK: University of Sussex.
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