Menstrual Health Matters: What We’ve Learned from Our School-Based MHM Programme in Cameroon 

Menstruation should never be a reason for a girl to miss school. Yet, for many adolescent girls in Cameroon and across sub–Saharan Africa, managing their monthly cycle remains a daily challenge, shaped by inadequate sanitation facilities, limited access to menstrual products, low levels of information, and persistent social taboos.

At eBASE, we set out to understand whether a more comprehensive, school-based approach to menstrual hygiene management (MHM) could help address this challenge. While global evidence suggests that poor MHM contributes to school absenteeism among girls, existing studies have produced mixed results. Many have focused on single solutions, such as providing sanitary pads, without addressing the wider systems that shape girls’ experiences at school. Others have been small scale or context specific, making it difficult to draw clear conclusions for policy and practice in Cameroon. 

Why this work matters in Cameroon 

In Cameroon, barriers to effective menstrual hygiene management in schools are well documented. Studies have highlighted gaps in girls’ knowledge of menstrual health, poorly maintained sanitation facilities, and the absence of safe and private spaces for managing menstruation. National efforts, including the Ministry of Secondary Education’s Clean School Concept, have helped to improve school hygiene in some settings. However, these initiatives have not always addressed menstrual health in a holistic way, leaving many girls without the support they need to attend school regularly and with confidence. 

Recognising this gap, we designed and implemented a multi component MHM intervention that went beyond products or infrastructure alone. Our approach combined improved sanitation facilities, the provision of dignity kits, teacher training, student led MHM clubs, and engagement with parents and community leaders. The aim was simple, to create school environments where girls can manage menstruation safely, confidently, and without shame. 

Testing what works at scale

Building on lessons from an earlier pilot carried out in 15 schools between 2021 and 2022, we rolled out the intervention across 40 secondary schools in four regions of Cameroon, alongside 40 comparison schools. To generate reliable evidence, we commissioned a cluster randomised control trial to assess whether this holistic approach could improve girls’ school attendance, educational outcomes, and experiences related to menstruation. 

The evaluation, conducted between January and June 2024, provides some of the most robust evidence to date on school based MHM interventions in Cameroon. The findings offer important insights, not only into what worked, but also into what takes time, what remains challenging, and what it means to support girls effectively during a critical stage of their education. 

What we found: Improved attendance for adolescent girls

 
The evaluation shows that the MHM intervention had a positive and meaningful effect on girls’ school attendance. Girls in intervention schools attended school more regularly than their peers in comparison schools, with an average increase in attendance of 1.57 percentage points between January and May 2024. This translates into a reduction in absenteeism of around 21%, a result that is consistent with findings from similar MHM interventions in other contexts. 

Importantly, the attendance gains were not uniform across all groups. The effects were strongest among girls in Forms 4 and 5, approximately ages 14 to 16, a period closely aligned with the onset and early years of menstruation. This suggests that MHM support may be particularly impactful when girls are first learning to manage their periods. We also found that the intervention worked best in schools that fully implemented all components and in urban settings, underlining the importance of programme fidelity and adequate implementation capacity.

 
What we didn’t see yet: Learning outcomes and attitude change 

While attendance improved, the evaluation did not find evidence of short-term impacts on academic performance in mathematics, French, or English. Similarly, no statistically significant changes were detected in students’ knowledge of menstruation, attitudes towards menstruation, or perceived levels of support.

These findings are important and should be interpreted carefully. Improvements in learning outcomes are often long-term effects, reliant on sustained attendance and classroom engagement over time. Given the relatively short evaluation period, it is plausible that the assessment took place too early for such changes to be observed.

Likewise, shifts in knowledge, attitudes, and social norms, particularly around a topic as sensitive as menstruation, often require sustained exposure and reinforcement. The evaluation sample size for pupil surveys was also relatively small, meaning that more subtle changes may not have been captured. 
Rather than indicating failure, these results highlight the complexity of translating improved attendance into broader educational and social outcomes. 

What this means for future programming and policy 

The findings from this evaluation offer several important lessons:

First, they provide robust evidence that well designed, school-based MHM interventions can reduce girls’ absenteeism, particularly at a critical stage in adolescence. Ensuring that girls can attend school consistently is a foundational step toward improving educational equity.

Second, the results reinforce the value of holistic intervention designs. Improvements in sanitation facilities alone are unlikely to be sufficient. The combination of infrastructure, menstrual products, teacher engagement, student leadership, and community involvement appears to be key, especially when all components are delivered as intended. 

Third, the absence of short-term effects on learning outcomes and attitudes underscores the need for longer term investment and evaluation. Policymakers and practitioners should be cautious about expecting immediate gains beyond attendance and should consider sustained support if broader educational and social benefits are the goal. 

Finally, the evaluation highlights the importance of high-quality evidence in informing education and gender programming. By using a randomised control trial design at scale, this study contributes credible, context specific insights that can support decision making in Cameroon and beyond. 

Looking ahead 

For eBASE Africa, this work confirms the importance of integrating menstrual health into education policy and programming, not as a peripheral issue, but as a practical determinant of whether girls can attend school. While attendance gains are only one piece of the puzzle, they represent an essential starting point. 
As conversations around girls’ education continue, we hope these findings encourage sustained, evidence informed investment in menstrual health interventions that are comprehensive, context appropriate, and designed with long term outcomes in mind. 

References

1. eBASE Africa. (n.d.). Menstrual hygiene management – pilot. eBASE Learning. https://ebaselearning.org/projects/menstrual-hygiene-management-project
 2. eBASE Africa. (n.d.). Menstrual Hygiene Management (MHM) in Schools. eBASE Learning. https://ebaselearning.org/projects/menstrual-hygiene-management-mhm-in-schools