Effects of Sanitary Pad Distribution and Reproductive Health Education on Primary School Attendance and Reproductive Health Knowledge and Attitudes in Kenya: A Cluster Randomized Controlled Trial
Abstract Background: Adolescent girls’ risk of school dropout and reproductive health (RH) challenges may be exacerbated by girls’ attitudes toward their bodies and inability to manage their menstruation. We assessed effects of sanitary pad distribution and RH education on girls in primary grade 7 in Kilifi, Kenya.Methods: 140 primary schools were randomly assigned to one of four study arms: 1) control; 2) sanitary pad distribution; 3) RH education; or 4) both sanitary pad distribution and RH education. Outcomes were school attendance, school engagement, RH knowledge and attitudes, gender norms, and self-efficacy. For outcomes measured both at baseline and endline, difference-in-differences (DID) models were estimated and for outcomes without baseline data available, analysis of covariance models were used. Results: There was no evidence of an effect on primary school attendance on arm 2 (coefficient [coef] 0.37, 95% CI -0.73, 1.46), arm 3 (coef 0.14, 95% CI -0.99, 1.26) or arm 4 (coef 0.58, 95% CI -.37, 1.52). There was increased positive RH attitudes for girls in arm 3 (DID coef. 0.63, 95% CI 0.40-0.86) and arm 4 (DID coef. 0.85, 95% CI 0.64, -1.07). There was also an increase in RH knowledge, gender norms and self-efficacy in arms 3 and 4.Conclusions: The findings suggest that neither sanitary pad distribution nor RH education, on their own or together, were sufficient to improve primary school attendance. However, as the RH education intervention improved RH outcomes, the evidence suggests that sanitary pad distribution and RH education can be positioned in broader RH programming for girls. Trial Registration: ISRCTN, ISRCTN10894523. Registered 22 August 2017 - Retrospectively registered, http://www.isrctn.com/ISRCTN10894523