Pakistan: Menstrual Hygiene Management (MHM) Research Project

Punjab MHM October 2015 Update

October 16, 2015

Dr. Rubina Mumtaz

Real Medicine Foundation, in collaboration with Columbia University, New York, and with funding from Grow N Know Inc (G&K), launched a Menstrual Health Management research study to explore how the onset of menstruation and puberty influences the Pakistani girls’ school-going experiences and school retention.  An adaption to similar studies conducted in Africa and Cambodia, findings from this research will lead to the development of a culturally sensitive Pakistan Girls’ Puberty Book by Columbia University.

With a qualitative research methodology based on comparative case studies in rural and urban Punjab, the data collection took place in District Chakwal and District Rawalpindi in the Province of Punjab, Pakistan. The urban field setting was in the neighborhood of ‘Dhoke Sayedan” ‘in Rawalpindi and the rural field site was Village Nara Mughla in Chakwal. For each setting, data was collected from both school going girls and young women in vocational training centers as well as from the community.

Project Progress Update:
Data collection has reached completion and took place in two phases. In the first phase, data from a rural girls’ school, “Government Girls’ High School”, Mulahal Mughla, District Chakwal included participation observations with 60 girls, aged 15-18 years, and informal interviews with their teachers. In-depth interviews were conducted with 4 key stakeholders in the community. The Vocational Training Institute in Mulahal Mugla was the site of data collection from a total of 10 older girls in ‘Tailoring’ classes and ‘Religious Education’ classes.  Two girls who had dropped out of school were indentified within the community by snowballing technique and interviewed. The urban school selected is the ‘Government Girls’ Higher Secondary School’ in Morgah, Dhoke Saydan, Rawalpindi and data collection included participation observation with 100 girls. Eight girls dropped out of school were indentified with the same technique and interviewed.

In total 12 key informant and 14 in-depth interviews were conducted, respectively, and 75 hours participation observation notes made. Audio data has been transcribed and shared with Columbia University for analysis and report writing.  Once this stage of the study is complete, we will have a consultative knowledge dissemination session with key stakeholders in Pakistan.


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.


1. 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.
2. 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, to create intolerable menstrual-related stigma that leads to young women dropping out of school.
3. 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.