Pakistan: UNICEF Implementing Partner for Menstrual Hygiene Management (MHM) Research

MHM Research Study in Sindh, Pakistan is Complete: January-April 2017

May 11, 2017

Dr. Rubina Mumtaz

Completion of MHM Research Study in Sindh, Pakistan 

Our Menstrual Hygiene Management (MHM) research study launched in the Province of Sindh in December 2016 came to a successful close by February 2017. This UNICEF-funded study was part of the continuation of nationwide MHM research conducted by RMF in close collaboration with (and based in the methodology of) Professor Marni of Columbia University, New York. The key outcome of the study findings is to develop the Pakistan Girls’ Puberty Book, which is a natural next step to UNICEF’s research and interventions in Menstrual Health Management in Pakistan since 2012. This research also forms part of UNICEF’s global WinS/MHM project that aims to strengthen evidence-based advocacy of MHM in 10 different countries.

Research Methodology

As is the normal procedure, we first had to obtain a no-objection certificate (NOC) from the Sindh Ministry of Education, whose members proved to be very cooperative in issuing the document. They also identified the two districts that were safe for us in terms of the security protocols for our team of researchers. The data collection methodology included three strategic approaches:

  • Ethnographic observations
  • Key informant interviews with adults
  • Participatory group activities with adolescent young women aged 10–19

The next step was identification of one rural and one urban girls’ school. The rural district identified was Khairpur, and a government girls’ high school was randomly selected. After an observation checklist for the school was carried out, four groups of schoolgirls and one group of out-of-school girls were subjects for participatory group activities. Four interviews with key stakeholders of the community were also conducted, bringing the total number of participants to 62.
The urban component was a government girls’ high school in District Hyderabad. The same methodology was applied, and led to 65 participants, including 4 groups of schoolgirls, 1 group of out-of-school girls, and 4 interviews with community leaders and key stakeholders. 

Progress on the Pakistan Girls’ Puberty Book 

The data collected is undergoing transcription and analysis. The Pakistan Girls’ Puberty Book is currently in the illustration phase. It is expected that the study’s final results will be ready to be presented in a knowledge dissemination seminar by the end of May



The intersections between menarche and education in Pakistan are still poorly understood. Nonetheless, existing reports suggest the dominance of male students in middle and high schools, and the absence of other “girl friendly” supports in the schooling environment are causes, e.g. water is rarely available in rural schools in Pakistan, with 75% of hand pumps and 28% of latrines being non-functional. Furthermore, female students lack separate, private latrines, and they often are attacked, sexually harassed, or shamed when waiting to use lavatory services, posing yet another barrier to school attendance. Female students may also have difficulty accessing sanitary materials owing to their high cost, especially if male family members make most major household purchases, as is the case in the majority of households in Pakistan. Given that menarche may be jeopardizing young women’s schooling and health in Pakistan, it is both timely and important to better understand the relationship between menstruation, education, and health for young Pakistani women, and to improve pubertal transitions.


  • To describe local cultural understandings and meanings of menarche in urban and rural Pakistan through the use of ethnographic observations, interviews, and participatory activities with adolescent young women and the adults who play key roles in the lives of school-aged young women.
  • To explore, through comparative case studies of young women’s lives, the ways in which local cultural meanings about menarche and menstruation interact with sanitary technology, school design, and peer group relations, creating intolerable menstrual-related stigma that leads to young women dropping out of school.
  • To utilize adolescent young women’s own recommendations for improving the pubertal and menstrual management-related guidance adolescent girls receive through the development of a girls’ puberty book in Pakistan.