Improving the Menstrual Health Social Ecosystem in Urban Schools of Addis Ababa, Ethiopia: A Program Evaluation

The complex nature of menstrual health (MH), being partly physical, mental, and social, makes it critical to women’s health but also frequently undervalued, primarily due to societal misconceptions about menstruation that lead to stigma, shame, and inadequate support systems. Poor MH has wide-ranging effects across society, particularly for young menstruators, but can be improved via better education; engaged and aware social support systems; and reduced belief in myths about menstruation among both menstruators and non-menstruators. In Ethiopia, many girls reach menarche without adequate knowledge about menstruation, leading to stigma, shame, school absenteeism, and poor MH. In response, Splash International has implemented holistic MH programs that consider the complete physical, mental, and social well-being of girls regarding menstruation. Including girls, boys, and mothers, Splash’s MH program in Addis Ababa holistically considered and addressed key aspects of MH in many communities. Program indicators show that the Program successfully improved girls’ MH knowledge but was less successful with mothers and had little effect on boys. The Program successfully fostered girls’ self-efficacy in managing MH, increasing the number of girls being able to manage MH at school from 74% to 99%. Despite reports of boys teasing girls about menstruation decreasing only by 5-10%, the Program built empathy and inspired boys to be allies of their menstruating peers, increasing boys’ approachability to talk with girls about menstruation from 34% to 57%. The Program also built mothers’ self-efficacy to discuss puberty and menstruation with their children, giving up to 96% of mothers the confidence to talk with their daughters about menstruation and puberty; however, many mothers remained uncomfortable talking with their sons about these topics (31%). Splash’s sustainable and holistic Menstrual Health Program transformed both physical and social environments to empower girls so that they can manage menstruation with dignity.