Menstrual hygiene management (MHM) is a problem for adolescent girls in low- and middle-income countries (LMICs), particularly when attending school. Poor water, sanitation, and hygiene (WASH) facilities in schools, inadequate puberty education, and lack of hygienic MHM items (absorbents) cause girls to experience menstruation as shameful and uncomfortable. Qualitative studies report girls’ fear and humiliation from leaking blood and body odor, which leads menstruating girls to absent themselves from school, with little quantitative data confirming this. Cultural taboos add to girls’ difficulties, preventing them from seeking help and imposing restrictions on their diet and activities when menstruating. Insufficient MHM may result in health symptoms involving the urinary and genital tracts. Recent international concern for MHM, spearheaded through work to improve WASH in schools, has focused on the need for dignity and privacy, raising awareness to break the silence and stigma, making safe and effective MHM absorbents accessible, and improving the school WASH environment. The latter includes separate toilets for girls, water and cleansing materials, and safe disposal of soiled materials.

Most participants bathed daily during menstruation, with no difference between urban and rural settings; bathing was significantly less in one study in a slum. A subgroup of rural studies found that daily baths were less common during menstruation compared to before or after menstruation. Other studies also noted bathing restrictions for girls during menstruation, due to fear that bathing might cause problems in future pregnancies, a scarcity of water, non-availability of bathing space, physical discomfort, and lack of privacy.