Menstrual hygiene management and school absenteeism among adolescent students in Indonesia: evidence from a cross-sectional school-based survey

Jessica Davis, Alison Macintyre, Mitsunori Odagiri, Wayan Suriastini, Andreina Cordova, Chelsea Huggett, Paul A. Agius, F. Faiqoh, Anissa Elok Budiyani, Claire Quillet, Aidan A. Cronin, Ni Made Diah, Agung Triwahyunto, Stanley Luchters, Elissa Kennedy

Research output: Contribution to journalArticlepeer-review

60 Citations (Scopus)


Objective: To assess the prevalence of menstrual hygiene management (MHM) knowledge and practices among adolescent schoolgirls in Indonesia, and assess factors associated with poor MHM and school absenteeism due to menstruation. Methods: A cross-sectional survey enrolled a representative sample of urban and rural school-going girls aged 12–19 years in four provinces of Indonesia. A semi-structured, self-administered questionnaire obtained socio-demographic characteristics, knowledge, practices and attitudes related to menstruation, MHM and school absenteeism. School water, sanitation and hygiene (WASH) facilities were also assessed. Univariate weighted population prevalence was estimated and multivariable logit regression analyses applied to explore associations. Results: A total of 1159 adolescent girls with a mean age of 15 years (SD = 1.8) participated. Most girls (90.8%, 95% confidence interval (95% CI) = 79.7–96.1) had reached menarche. Over half (64.1%, 95% CI = 49.9–76.2) reported poor MHM practices, and 11.1% (95% CI = 8.1–15.2) had missed one or more days of school during their most recent menstrual period. Poor MHM practices were associated with rural residence (Adjusted odds ratio (AOR) = 1.73, 95% CI = 1.13–2.64), province (various AOR), lower school grade (AOR = 1.69, 95% CI = 1.05–2.74) and low knowledge of menstruation (AOR = 3.49, 95% CI = 1.61–7.58). Absenteeism was associated with living in rural areas (AOR = 3.96, 95% CI = 3.02–5.18), province (various AOR), higher school grade (AOR = 3.02, 95% CI = 2.08–4.38), believing menstruation should be kept secret (AOR = 1.47, 95% CI = 1.03–2.11), experiencing serious menstrual pain (AOR = 1.68, 95% CI = 1.06–2.68) and showed mixed associations with school WASH facilities. Conclusions: High prevalence of poor MHM and considerable school absenteeism due to menstruation among Indonesian girls highlight the need for improved interventions that reach girls at a young age and address knowledge, shame and secrecy, acceptability of WASH infrastructure and menstrual pain management.

Original languageEnglish
Pages (from-to)1350-1363
Number of pages14
JournalTropical Medicine and International Health
Issue number12
Publication statusPublished - Dec 2018
Externally publishedYes


  • Indonesia
  • adolescent health
  • cross-sectional design
  • menstrual health
  • menstrual hygiene
  • school absenteeism
  • school-based survey


Dive into the research topics of 'Menstrual hygiene management and school absenteeism among adolescent students in Indonesia: evidence from a cross-sectional school-based survey'. Together they form a unique fingerprint.

Cite this