The main objective of the study was to generate data that will provide an understanding of the MHM challenges of in-school deaf adolescent females in Ghana. Menstruation is a natural occurrence, which every female of reproductive age goes through. Maintaining menstrual hygiene during menstruation is fundamental to the dignity and well-being of women and girls. The importance of menstrual hygiene for girls can therefore not be overemphasised.
Good MHM involves having access to clean water, detergents, and clean absorbents that can be changed frequently (29). Likewise, girls and women must have access to WASH facilities that offer privacy, safety, comfort, and are physically accessible for use during menstruation. Access to spaces for drying and disposing of used menstrual materials and hygienically are equally relevant (14). The availability of the required menstrual materials and facilities provide an environment that supports girls to manage their menstruation with dignity and safety without discomfort or fear.
However, the findings from the study revealed that some of the girls in our study did not have access to adequate menstrual materials and suitable facilities to ensure that they are able to manage their menstruation. The limited access to appropriate facilities in the schools means that some of the girls may have to travel far from school discretely at odd times to privately change their menstrual materials, which may cause them to miss classes. The lack of good WASH facilities would also make it difficult for the girls to change their pads regularly. These findings are consistent with the existing literature on MHM among in-school girls in developing countries. It has been observed that although many schoolgirls in low and middle-income countries have their menstruation in school, the school environment does not often have facilities, such as, toilets, regular water supply, privacy, and/or supportive teachers to assist them during menstruation.
Without suitable WASH facilities, schoolgirls are often compelled to poorly manage their menstruations, compelling some to stay away from school (5, 30, 6). For example, a study in Ethiopia revealed that more than 80% of students did not change their menstrual materials in school and they preferred to do so at home, because of lack of water and suitable WASH facilities in the schools (31).
Similarly, girls may be absent from school or less attentive in class during menstruation if there are no WASH facilities or support from the school. In the western province in Zambia, (10) quoted a report by Maboshe Memorial Centre, which indicated that schoolgirls stayed at home during their periods. Similar findings have been reported in Ghana by Blessing (13). In a study to ascertain the menstrual hygiene practices among adolescents and the impact of menstruation on school attendance among adolescent schoolgirls in some rural areas in Ghana, Blessings discovered that the absence of private space for changing sanitary kits has forced some girls to be absent from school during menstruation. Asimah, Diabene and Wellington (12) also revealed that girls in schools had more limitations in managing their menstrual periods than those at home, although the authors acknowledged the impact of social barriers on menstrual hygiene practices at home.
The situation could be very frustrating for the deaf girls in our study because of communication barriers and the fact that they were in the boarding house and may have to use whatever facilities available to them. This observation corroborates that of (11, 17) who observed that stigma, communication issues, and lack of disability inclusive services make menstrual management challenges worse for schoolgirls with disabilities than those girls without disabilities.
The lack of access to sanitary pads among the girls in the study could compel some of the girls to resort to unsuitable alternatives, or unhygienic practices, which is probably the reason for the reported infections and other health-related problems among them. Unhygienic practices, including use of inappropriate menstrual materials during menstruation have been reported among girls in Africa and other low- and middle-income countries (2, 6). In a systematic review of the health and social effects of MHM conducted by Sumpter and Torondel (32), the authors identified an association between poor MHM and increased risk of reproductive tract infections in half of the papers that were reviewed. Poureslami and Osati-Ashtiani (33) also observed that poor menstrual hygiene can lead to menstrual-related stigma, ill-health whiles (6, 5) reported that lack of menstrual materials compelled some girls to engage in poor MHM practices, exposing them to many health problems.
Contrary to our findings, some studies in Ghana discovered that, menstrual hygiene practices among girls in basic schools in urban settings were good. This has been attributed to the socio-economic status of urban dwellers, who used good disposable menstrual products (13). It is, however, worthy to note that although almost all the schools in our study are in the urban setting, the girls were in the boarding schools and they spend more time in school than at home. Their experiences in terms of menstrual hygiene practices are, therefore, likely to be different from those who managed their menses at home.
The major limitation of the study is the use of purposive sampling technique. Although the study covered about three-quarters of the special deaf schools in Ghana, because respondents were not randomly sampled, there is a possibility of selection bias. As a result, generalization of the findings of the study should be done with caution. The applicability of recommendations may also be limited. However, the use of mixed methods, minimized this shortcoming.
IMPLICATIONS OF THE STUDY
Findings of the study provided insights that could be used to improve menstrual hygiene practices among the target population. The findings reinforced the call to implement interventions in schools to ensure good menstrual hygiene practices among schoolgirls to enhance their psychological and educational outcomes (34).
Provision of free menstrual hygiene materials, such as sanitary pads and antiseptics to needy girls could be made a priority issue by the Ghana Health Service School Health Programme.
Although this will require a huge financial outlay, it is worthy course to undertake because it will contribute positively towards the well-being of the girls. Besides, the schools could solicit support from philanthropists, such as Non-Governmental Organizations, to provide free sanitary materials to the girls from poor homes. The special schools often receive donations from philanthropists, but these donations do not include menstrual materials because it is not often seen as a priority.
Also, since the girls spend most of their time in the residential schools, it will be apt for the “housemothers”, to be properly trained in MHM so that they can adequately support them to handle their menstruation effectively. The training could include awareness on deafness and deaf people’s sexual and reproductive health needs to improve their understanding about deaf people. This will enable the “housemother” to establish good relationship with the girls and be more responsive to their needs. This will also reduce the practice of the girls relying on their friends for information and support, which is often incorrect or inadequate.
It is equally important to emphasize that, there are a lot of misconceptions and misinformation about menstruation, which is rooted in the Ghanaian tradition. For instance, menstruation is considered unclean and not discussed openly in public (35, 19). This calls for intensive awareness creation on menstruation and MHM, especially among boys. Currently, men and boys are often excluded in programmes on menstruation and MHM. Hence, many of them have poor knowledge on menstrual issues.
As a result, even male teachers may find it difficult to talk about menstrual issues in class. Any programme on MHM in the schools should, therefore, include male students and teachers in order to nurture a change in their attitude towards menstruation. Indeed, males can be important agents of change and a source of support for girls, if included in MHM sensitization programs.