Evaluation of the impact of the Bwiza initiative on period poverty among high school girls in Burera District, Rwanda
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20262077Keywords:
Rwanda, Period poverty, Menstrual hygiene, Menstrual health knowledge, Adolescent girls, AttitudesAbstract
Background: Period poverty remains a significant public health problem and a barrier for adolescent girls in low-income settings. Bwiza initiative was launched in 2022 to address this issue by providing menstrual health education and reusable menstrual products to high school girls in Burera, Rwanda. This study evaluated its impact on menstrual health knowledge, attitudes, practices, and school absenteeism.
Methods: A quasi-experimental cluster study design was employed, including two interventions and one non-intervention school. The same survey used in baseline assessment was administered, with slight modifications to capture additional variables related to Bwiza participation.
Results: A total of 273 female students aged 12-23 years participated. There was no statistical difference in good menstrual health knowledge between 2022 and 2025 (p=0.204), or between those who received Bwiza training and those who did not (p=0.853). Students in the non-intervention school were more likely to have good knowledge (22.1% versus 12.9%, p=0.048). Attitudes improved, with fewer girls considering themselves “unclean” or avoiding religious spaces during menstruation in 2025 than in 2022. Trained participants were less likely to feel insecure during menstruation (p=0.019). However, emotional discomfort, such as fear of odor (56.4%) remained prevalent. Use of unhygienic materials declined from 19% to 9.7%. Among those who received Bwiza products, over 70% found them comfortable, but only 55.6% reported sufficient supply. Absenteeism increased from 18.3% to 43.2%.
Conclusions: Despite improvements in attitudes and practices, persistent gaps highlight the need for comprehensive education, consistent product access, and strengthened school-based menstrual health support systems.
References
Cleveland clinic. Menstrual Cycle. 2022. Available from: https://my.clevelandclinic.org/health/articles/10132-menstrual-cycle. Accessed on 11 January 2025.
WHO. Menstrual health is a fundamental human right. 2024. Available from: https://www.who.int/europe/news/item/15-08-2024-menstrual-health-is-a-fundamental-human-right. Accessed on 11 January 2025.
Michel J, Mettler A, Schönenberger S, Gunz D. Period poverty: why it should be everybody’s business. J Glob Health Rep. 2022;6.
UNICEF. Guidance on Menstrual Health and Hygiene. 2019. Available from: https://www.unicef.org/documents/guidance-menstrual-health-and-hygiene. Accessed on 11 January 2025.
Rossouw L, Ross H. Understanding period poverty: socio-economic inequalities in menstrual hygiene management in eight low- and middle-income countries. IJERPH. 2021;18(5):2571.
Ishimwe Bazakare ML, Ngabo Rwabufigiri B, Munyanshongore C. Knowledge and practice toward menstrual hygiene management and associated factors among visual impaired adolescent girls: a case of two selected institutions in Rwanda. Clin Med Insights Reprod Health. 2024;18:26334941241303518.
Isano S, Iradukunda IG, Ingabire P, Igiraneza B, Nkurunziza F, Wong R. Assessing the knowledge and attitude of menstrual hygiene among high school students, and menstrual practices among high school girls in rural Rwanda. Int J Reprod Contracept Obstet Gynecol. 2022;11(3):696.
Njee RM, Imeda CP, Ali SM, Mushi AK, Mbata DD, Kapala AW, et al. Menstrual health and hygiene knowledge among post menarche adolescent school girls in urban and rural Tanzania. PloS One. 2024;19(3):e0284072.
Mietafrica. Period Power: Animated Menstrual Health Management (MHM) Clips. MIET AFRICA. 2024. Available from: https://mietafrica.org/period-power-animated-menstrual-health-management-mhm-clips/. Accessed on 10 June 2025.
Harvard TH. Chan School of Public Health. Show and tell: The menstrual cycle, animated. 2022. Available from: https://hsph.harvard.edu/health-communication/news/show-and-tell-the-menstrual-cycle-animated/. Accessed on 10 June 2025.
ZanaAfrica Foundation. About ZanaArica. GuideStar Profile. Available from: https://www.guidestar.org/profile/26-1358805. Accessed on 10 June 2025.
Jarrahi R, Golmakani N, Mazloom SR, Forouzanfar H. The effect of menstrual health education adopting the peer education method with the participation of mothers on adolescents’ menstrual health behaviors: a clinical trial. J Midwife Reprod Health. 2021;9(1):2582-9.
Hennegan J, Shannon AK, Rubli J, Schwab KJ, Melendez-Torres GJ. Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PLoS Med. 2019;16(5):e1002803.
Duby Z, Katz A, Musara P, Nabukeera J, Zimba CC, Woeber K, et al. “The state of mind tells me it’s dirty”: menstrual shame amongst women using a vaginal ring in Sub Saharan Africa. Women Health. 2020;60(1):72-86.
Mason L, Nyothach E, Alexander K, Odhiambo FO, Eleveld A, Vulule J, et al. ’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. 2013;8(11):e79132.
Macours K. Addressing menstrual stigma and hygiene to improve education and psychosocial well-being among adolescent girls in Madagascar. The Abdul Latif Jameel Poverty Action Lab. 2023.
Patel K, Panda N, Sahoo KC, Saxena S, Chouhan NS, Singh P, et al. A systematic review of menstrual hygiene management (MHM) during humanitarian crises and/or emergencies in low- and middle-income countries. Front Public Health. 2022;10:1018092.
Together women rise. Sustainable Health Enterprises (SHE). Available from: https://togetherwomenrise. org/programfactsheets/sustainable-health-enterprises-she/. Accessed on 11 January 2025.
Dodroe KB, Wampande LN, Nishimwe A, Mukinisha M, Schurer JM. “Where does my menstruation come from?” Experiences and costs of menstrual hygiene management among Rwandese school girls. PLOS Glob Public Health. 2025;5(5):e0004152.
Sommer M, Chandraratna S, Cavill S, Mahon T, Phillips-Howard P. Managing menstruation in the workplace: an overlooked issue in low- and middle-income countries. Int J Equity Health. 2016;15(1):86, s12939-016-0379-8.
Das P, Baker KK, Dutta A, Swain T, Sahoo S, Das BS, et al. Menstrual hygiene practices, WASH access and the risk of urogenital infection in women from Odisha, India. Wilson BA, editor. PLoS One. 2015;10(6):e0130777.
Downloads
Published
How to Cite
Issue
Section
