Menstrual blood and ritual beliefs: a qualitative study on menstrual health and hygiene practices among senior high school girls in Volta Region, Ghana

Abstract

Background: Menstrual health and hygiene (MHH) are a global public health priority, particularly for adolescent girls. Improper menstrual hygiene practices are linked to negative health outcomes. This study explored menstrual hygiene practices among adolescent girls in senior high schools in the Volta Region of Ghana, focusing on practices and beliefs surrounding menstrual blood disposal. Aim: To investigate menstrual hygiene practices, including disposal methods and the influence of ritualistic beliefs on adolescent girls in selected high schools. Methods: This qualitative study employed an exploratory design, using purposive and convenience sampling to select participants from five senior high schools in the Volta Region. Data were collected from 60 adolescent girls through focus group discussions. MAXQDA 2022 software was used for thematic analysis. Results: Participants reported varied menstrual product disposal practices shaped by safety concerns and cultural beliefs. Common methods included burning, burying, or discarding in latrines. Fear of ritual use of menstrual blood led many to avoid public disposal, with parental advice reinforcing these fears. Observations, however, revealed inconsistent practices, including disposal in open pits and washroom floors. Additionally, water and hygiene facilities were mostly inadequate, with many girls relying on poorly maintained pit latrines and non-functional flushing toilets. Conclusion: The study found a mismatch between what girls say they do with menstrual waste and what actually happens in schools. While they report discreet methods like burning or burying due to fear of ritual misuse, observations showed that waste were often left in open or unsanitary areas. This gap points to poor school sanitation and deep-rooted cultural beliefs. Improving menstrual hygiene in schools requires more than infrastructure – secure, private disposal options and culturally sensitive education are essential.