This thesis investigates the extent to which national menstrual health management (MHM) policies in Kenya and South Africa reduce educational inequality for menstruating pupils. Guided by the Capabilities Approach and Sommer’s Theory of Change, the study evaluates whether policy frameworks enhance girls’ educational opportunities and how implementation quality shapes outcomes. By using a deductive qualitative content analysis of policy documents, academic literature, and Non-Governmental Organisation (NGO) reports, the research compares the foundational elements, implementation activities, as well as outcomes and impacts of MHM policies in both countries. Findings reveal that Kenya and South Africa have made policy advances with several context-specific examples serving as best practices for MHM implementation. Nevertheless, the analysis reveals that persistent challenges remain. These mainly include infrastructural gaps, uneven implementation, and inadequate monitoring. The study concludes that, if comprehensive MHM interventions are effectively implemented, they show positive outcomes. Still, although national policies are necessary for promoting educational equality and menstrual dignity, their effectiveness is constrained by contextual barriers and insufficient data. The research highlights the need for more comprehensive, context-sensitive approaches, improved monitoring, and intersectional analyses. Ultimately, this thesis contributes to the academic and policy discourse by offering a comparative, theory-driven evaluation and by identifying priorities for future research and policy improvement in MHM.
Table of Contents
- 1. Introduction
- 1.1 Background and Context
- 1.2 Research Question and Sub-Questions
- 1.3 Structure of the Thesis and Research Approach
- 2. Theory
- 2.1 Conceptual Clarifications of Menstrual Health and Education
- 2.2 Theories and Hypotheses
- 2.2.1 Capabilities Approach
- 2.2.2 Theory of Change
- 3. Research Design and Methodology
- 3.1 Research Design and Case Studies
- 3.2 Method of Data Collection
- 3.3 Method of Data analysis
- 3.4 Limitations and Ethical Considerations
- 4. Results: Context and Implementation of Menstrual Health Policies
- 4.1 Contextual Factors and Challenges
- 4.1.1 Kenya
- 4.1.2 South Africa
- 4.2 Menstrual Health Policy Frameworks
- 4.2.1 Kenya
- 4.2.2 South Africa
- 4.3 Implementation Frameworks and Scale-Up Activities
- 4.1 Contextual Factors and Challenges
- 5. Results: Educational Outcomes and Impacts
- 5.1 Analysis of Policy Outcomes
- 5.2 Analysis of Policy Impacts
- 6. Interpretation and Hypotheses Discussion
- 6.1 Comparative Evaluation
- 6.2 Evaluating Hypotheses
- 6.3 Recommendations for Policy Improvement and Implementation
- 7. Conclusion
- 7.1 Summary of Findings and Answer to Question
- 7.2 Contributions to Research
- 7.3 Final Remarks and Future Research Directions
- 7.4 Limitations
- 8. Literature List
- 9. Figure List
- 10. Appendix
- 10.1 AI Declaration
- 10.2 Data Collection for Atlas.ti
- 10.3 Original Theory of Change Framework (Sommer 2023)
- 10.4 Definition of all Relevant Criteria
- 10.5 Operationalization of ToC
- 10.6 Coding Results – Findings Table
- 10.7 Comprehensive Comparative Evaluation Table
Objectives & Thematic Focus
This thesis investigates the extent to which national menstrual health management (MHM) policies in Kenya and South Africa reduce educational inequality for menstruating pupils. The primary research question guiding this work is: How do national policies addressing Menstrual Health Management and Period Poverty in Kenya and South Africa reduce educational inequality for menstruating pupils?
- Evaluation of national MHM policies and their effectiveness in Kenya and South Africa.
- Analysis of educational inequality for menstruating students.
- Application of the Capabilities Approach and Sommer's Theory of Change as theoretical frameworks.
- Qualitative content analysis of policy documents, academic literature, and NGO reports.
- Examination of contextual barriers and challenges in policy implementation.
- Recommendations for future research and policy improvement in MHM.
Excerpt from the Book
2.1 Conceptual Clarifications of Menstrual Health and Education
There is a wide range of terms across diverse cultures and languages, many of which are euphemisms, to name the natural biological process experienced by approximately half of the global population at some point in their lives, and central to this work. I refer to it as Menstruation, which is the: "Periodic discharge of blood and mucosal tissue shed from the uterus and expelled through the vagina [which] Occurs approximately monthly (~28 days) from puberty to menopause in nonpregnant menstruating people" (Casola 2023, 67). Menstruating people refers to "[a]ny person who experiences a menstrual cycle. This includes but is not limited to cisgender women and transgender men who retain physiologic ability to menstruate." (Casola 2023, 67). Much of the literature I engage with uses "girls” instead of menstruating people, which is not intended to be restrictive in this work. I will try to adopt a gender-inclusive language approach where possible while acknowledging the predominant framing of MH within the context of girls' education.
But Menstruation goes beyond the biological—it is a gendered social experience, shaped by stigma and cultural beliefs. Moreover, scholars examine it as “an issue of public policy” (Olson 2022, 2) as these social constructions influence how MH is prioritized, funded, and addressed in policy frameworks (Sommer 2021). The concept of Menstrual health and hygiene (MHH) or Menstrual Hygiene Management (MHM) “is used to describe the needs experienced by people who menstruate, including having safe and easy access to the information, supplies, and infrastructure needed to manage their periods with dignity and comfort [...] as well as the systemic factors that link menstruation with health, gender equality, empowerment, and beyond". Thus, a term to describe the ability to manage menstruation safely, hygienically, and with dignity (Sommer 2015), which for instance includes the availability of menstrual products. In this thesis due to its limited reach, references to menstrual products primarily denote disposable sanitary pads, although it is acknowledged that a diverse range of products are available and relevant.
However, when individuals are unable to access menstrual needs, they experience what is termed period poverty – the “inability to obtain the quality or quantity of resources needed to manage a healthy, safe, and dignified menstrual cycle” (Casola 2023, 67). The term emerged in the early 2010s as scholars and activists began to highlight the significant barriers that individuals face in accessing menstrual products and services. “Period poverty" was used to describe the intersection of gender, health, and economic disparities that prevent individuals from managing their menstrual needs with dignity (Hennegan & Montgomery, 2016) and has become a central concept to discussions on gender equality and public health. Therefore, it goes beyond the individual scope and is recognized as “one of the global challenges of our time" (Campbell 2020, 3).
Summary of Chapters
Chapter 1: Introduction: This chapter provides the background and context of period poverty and its impact on girls' education, outlines the main research question and sub-questions, and describes the thesis structure and research approach.
Chapter 2: Theory: This section delves into the theoretical foundations of the study, clarifying concepts of menstrual health and education, and presenting the Capabilities Approach and Sommer's Theory of Change as guiding frameworks.
Chapter 3: Research Design and Methodology: This chapter details the qualitative comparative case study design, focusing on Kenya and South Africa, and explains the methods for data collection (policy documents, secondary data) and deductive content analysis using the Theory of Change framework.
Chapter 4: Results: Context and Implementation of Menstrual Health Policies: This part presents the findings regarding contextual factors and challenges related to menstrual health in Kenya and South Africa, and compares their national policy frameworks and implementation strategies.
Chapter 5: Results: Educational Outcomes and Impacts: This chapter analyzes how menstrual health policies in Kenya and South Africa have influenced access to products and education, as well as broader impacts on school participation, engagement, and dignity.
Chapter 6: Interpretation and Hypotheses Discussion: This section offers a comparative evaluation of the findings for both countries, discusses the evidence in relation to the two main hypotheses, and provides recommendations for policy improvement.
Chapter 7: Conclusion: This final chapter summarizes the research findings, provides an answer to the main research question, outlines the contributions of the thesis to academic research, and suggests directions for future research.
Keywords
Menstrual Health Management (MHM), Period Poverty, Girls' Education, Educational Inequality, Capabilities Approach, Theory of Change, Kenya, South Africa, Policy Evaluation, Gender Equality, WASH facilities, Social Norms, Stigma, School Attendance, Policy Implementation.
Frequently Asked Questions
What is this work fundamentally about?
This work fundamentally investigates how national policies addressing Menstrual Health Management (MHM) and Period Poverty in Kenya and South Africa influence the reduction of educational inequality for menstruating pupils.
What are the central thematic fields?
The central thematic fields include menstrual health management policies, period poverty, educational inequality, girls' education, gender equality, and policy implementation in the context of Kenya and South Africa.
What is the primary objective or research question?
The primary objective is to evaluate the extent to which national MHM policies in Kenya and South Africa reduce educational inequality for menstruating pupils. The research question is: "How do national policies addressing Menstrual Health Management and Period Poverty in Kenya and South Africa reduce educational inequality for menstruating pupils?"
Which scientific method is used?
The study employs a deductive qualitative content analysis approach, systematically coding and analyzing policy documents, academic literature, and NGO reports, guided by Sommer's Theory of Change framework.
What is covered in the main part?
The main part of the thesis covers the theoretical framework, research methodology, a comparative analysis of policy content and implementation in Kenya and South Africa, and a discussion of findings, including policy outcomes and impacts on educational equality.
Which keywords characterize the work?
Key terms include Menstrual Health Management, Period Poverty, Girls' Education, Educational Inequality, Capabilities Approach, Theory of Change, Kenya, South Africa, Policy Evaluation, and Gender Equality.
How do cultural beliefs and stigma influence MHM policy implementation in Kenya and South Africa?
Cultural beliefs and stigma are identified as pervasive barriers, contributing to the "culture of silence" around menstruation, limiting access to information, and hindering girls' participation, despite policy efforts to address these issues. Inadequate strategies for engaging gatekeepers further exacerbate these challenges.
What are the main limitations identified in the study's methodology?
Methodological limitations include the inability to collect primary data (e.g., interviews with schoolgirls), inconsistent and incomparable data across case studies, a qualitative design that limits systematic quantification of attendance rates, and the narrowed scope of the ToC framework, which meant not all sub-indicators could be fully explored.
How does the Capabilities Approach inform the evaluation of MHM policies in this thesis?
The Capabilities Approach serves as a valuable framework to understand how period poverty restricts fundamental human freedoms, emphasizing the importance of MHM as a capability that must be supported by public policy to enable girls' bodily health, integrity, intellectual growth, affiliation, and control over their environment.
What specific recommendations are made for improving MHM policies and implementation?
Recommendations include building a strong cross-sectoral evidence base, developing global guidelines with minimum standards, advancing MHM activities through evidence-based advocacy, allocating clear governmental responsibility, and integrating MHM into the education system with adequate resources and capacity.
- Citation du texte
- Janna Hettlich (Auteur), 2025, Breaking the Cycle. Evaluating Period Poverty Policies and Their Impact on Girls’ Education, Munich, GRIN Verlag, https://www.grin.com/document/1705463
