Secrecy, Stigma, Period Poverty Keep Girls Out Of School in Ghana: Mubarick Nungbaso is Breaking the Silence

For years, the subject of menstruation in schools sat in the shadows. It was an unspoken challenge, a quiet but powerful force that disrupted education for millions of girls, particularly in low-resource settings in Ghana.

Classrooms lacked privacy, toilets were unhygienic or absent, and cultural stigma made the issue of menstruation forbidden. As a result, young girls are often frail and stay at home during their menstrual periods, losing days of learning each month.

Fortunately, Mr. Mubarick Nungbaso Asumah, a Ghanaian US-based nurse scientist and a current PhD student at the University of Michigan researching maternal health and gender-based violence, investigated the deep, rotten, unspoken stigma into the light. He has transformed how the world responds to it. International observers and health educators increasingly describe him as a pioneer whose research has redefined how menstrual health is framed in both policy and practice.

Using surveys, one of his studies shows the prevalence of menstruation-related school absenteeism. Out of the 338 respondents, the majority (59%) were between the ages of 15 and 19 years. Approximately one-fifth of all respondents reported missing school during their menstrual cycle. Reasons assigned to missing school were menstrual pains (57%), stained clothes (43%), heavy bleeding (40%), and self-stigmatization (2%). The majority (95%) of respondents used some form of material to absorb menstrual blood. About 88% of respondents used sanitary pads, 11% used cloth, and 1% used tissues to absorb their menstrual blood.

“Menstruation-related school absenteeism is considered high and could affect girls’ educational attainment. School absenteeism due to menstruation, particularly in public schools, warrants attention by the Ghana Education Service,” the research reads in part.

According to the UN Educational, Scientific and Cultural Organisation (UNESCO), in Kenya alone, approximately 50 percent of school-age girls do not have access to sanitary pads.

Globally, 52 percent of the female population, or 26 percent of the total population, is of reproductive age for whom menstruation is a monthly reality. However, as the subject continues to be taboo in societies around the world, access to menstrual hygiene management (MHM) materials remains limited.

Breaking the Silence

Mr. Asumah pushed for research that has reshaped policy debates, driven program design, and redefined what effective menstrual hygiene management means in schools. As a researcher and scientist, his landmark study published in BMJ Open set a new global standard for measuring how ready schools are to meet the menstrual health needs of students. He created a readiness index that assessed infrastructure, privacy measures, trained staff, and waste disposal facilities with a level of precision and clarity that had not existed before.

“This index provided, for the first time, a data-driven means to classify schools according to their level of preparedness, enabling education and health authorities to target interventions more effectively. Beyond local relevance, the model introduced a replicable, evidence-based approach that has since guided programmatic strategies and advocacy efforts for menstrual hygiene and WASH (Water, Sanitation, and Hygiene) improvement across Ghana and similar low-resource settings globally,” Mr Asumah told this reporter.

Adding that his motivation to develop the readiness index arose from a critical gap I identified in Ghana, particularly in the underserved Northern Ghana region, where no standardized tool existed to evaluate schools’ preparedness for menstrual hygiene management. “While national discussions often acknowledged inadequate facilities, there was no scientific framework to quantify the combined influence of infrastructure, privacy measures, trained staff, and waste-disposal systems on girls’ educational and health outcomes.

“Working in the newly created Savannah Region of Ghana, I observed that these deficits were especially acute and that policy responses were fragmented due to the absence of measurable indicators. I therefore created the readiness index as a pioneering evaluative framework that brought structure and comparability to an area that had previously relied on anecdotal assessments,” He said.

Global Impact

Mr. Asumah revealed that researchers worldwide have not only cited his work but have also directly adopted the model to assess their own schools. His school readiness index for menstrual management has since been referenced in NGO toolkits supported by UNICEF and incorporated into government strategies in multiple countries, giving his work both academic authority and policy traction. Initially, he said, the creation of the index was for a practical tool, but it is now being used internationally to guide real-world interventions on MHM.

Similarly, his qualitative research in the Pan African Medical Journal broke new ground by revealing the cultural, economic, and social realities that shape menstrual hygiene practices. This work moved beyond numbers to show how secrecy, stigma, and period poverty combined to keep girls out of school. Also, the findings have been woven into studies in Asia, Africa, and Europe, from PLoS ONE research on menstrual secrecy in Laos to Frontiers in Global Women’s Health studies in India and Healthcare (Basel) studies on migrant women in Europe. Rather than merely citing his work, these projects used it as the foundation of their investigative frameworks, underscoring the depth and authority of his scholarship.

His 2023 study, published in Women, expanded evidence to urban areas, completing a rare and comprehensive picture of menstrual health challenges across rural, peri-urban, and city environments.

But Mr. Asumah’s impact is not confined to the printed page.

Today, his works are widely cited and embedded in NGO toolkits, government policy documents, and training manuals across multiple continents. His findings are used to plan infrastructure, inform teacher training, guide budget allocation, and design school health programs. And he has been described as combining the precision of a scientist with the empathy of a community advocate, and his frameworks have become the international benchmark for menstrual hygiene readiness.

In the Savannah Region of Ghana, his recommendations for private, hygienic spaces in schools where girls can change sanitary pads have been adopted by some institutions.

Reshaping Policies, Ghana’s Government Intervention

In 2023, his research gave weight to his voice in national policy debates. When Ghana’s President Nana Addo Dankwa Akufo-Addo launched the One District, One Factory (1D1F) initiative, Mr. Asumah and his colleagues wrote a widely read editorial, “The Increasing Cost of Sanitary Products and the Potential Impact on Menstrual Hygiene Management Practices in Ghana,” arguing that sanitary pads should be classified as essential goods and that the 20 percent import tariff and 12.5 percent value-added tax should be abolished.

“We called for government subsidies to make pads affordable through local production under the 1D1F program, and for the installation of adequate Water, Sanitation, and Hygiene (WASH) facilities in all schools and workplaces,” Mr. Asumah recalled.

While their proposals have not yet been fully enacted, their recommendations continue to shape government policies, public discussions, and advocacy campaigns.

In a report published by Modern Ghana in March (2025), the Ghanaian government allocated GH¢292.4 million to begin the distribution of free sanitary pads to female students in primary and secondary schools, stating that for many girls in Ghana, access to sanitary products is a luxury they simply cannot afford, especially those from low-income families.

In parts, the report furthered that, “cost of sanitary pads can be a significant financial burden, forcing them to choose between essential needs like food and education, or hygienic menstrual management. This often leads to the use of unhygienic alternatives such as rags, old cloths, paper, and even leaves, posing serious health risks and increasing the likelihood of infections.

“The consequences of period poverty extend far beyond physical health. Studies have shown a direct correlation between lack of access to sanitary products and school absenteeism. Girls frequently miss school during their periods due to embarrassment, fear of leakage, and lack of adequate sanitation facilities.”

Mr. Mubarick Asumah’s work moves from research journals into the real world, changing how menstrual hygiene is addressed in classrooms and communities. In the Savannah Region of Ghana, his studies have inspired School Health Education Programme (SHEP) coordinators to take proactive measures: setting up private, hygienic spaces where girls can manage their periods with dignity, and fostering open and respectful conversations about menstrual health in schools that once avoided the subject entirely.

“I have been in those classrooms, training male teachers and SHEP coordinators to support menstruating students with empathy and confidence. The impact has been visible, with fewer girls missing school because of their periods, and the long-standing silence around menstruation steadily giving way to dialogue and understanding,” he said. Adding that students themselves have testified that these changes restored their dignity, allowed them to remain in school without fear of ridicule, and gave them confidence to pursue their education without interruption.

The Hurdles

Mr. Asumah’s efforts to improve menstrual hygiene have not been seamless; he stressed that one of his major challenges in assessing the school preparedness was the lack of baseline data and standardized tools to evaluate menstrual hygiene management, particularly in Northern Ghana. “Many schools had no reliable records or infrastructure, requiring me to design a new readiness index and train data collectors to ensure accuracy. Cultural sensitivity around menstruation also limited open discussion, which I addressed by engaging female facilitators and community leaders,” the abroad-based scientist expressed.

Adding that for the SHEP coordinators, there was a lack of structured guidance on supporting girls during menstruation. “To address this, I co-developed a practical guide that helped them understand the needs of the girl child and provide supportive measures to help girls remain in school. Limited resources and competing priorities affected implementation, but the initiative strengthened local capacity and informed broader education and sanitation strategies in Ghana.”

Despite the challenges, his works influenced the globe: from the villages in Ghana to ministries of education abroad, continuing to ensure that menstruation is no longer a barrier to learning, dignity, or equality, or a silencing, so he has become one of the world’s leading voices for menstrual equity.

About the author:
Ismaila Biliaminu Manne is a Nigerian-based Freelance Journalist and Creative Writer, whose works have been featured in national and international media outlets. He is an alumnus of the African Liberty Writing Fellowship and Journalism for Liberty Fellowship.

By Ismaila Biliaminu Manne