October 2021: New Study Highlights the Impact of ZanaAfrica’s Interventions
October 2021 - Nairobi, Kenya: We are thrilled to announce the results of the Nia Project, a randomised control trial (RCT) which evaluated the impact of ZanaAfrica’s program model of delivering pads + adolescent health and rights education.
Format: Two-year, four-armed cluster-randomized controlled trial (RCT)
Cohort: 3,500 girls across 140 schools
Location: three rural sub-counties of Kilifi, Kenya
Timeline: 2017-2019
Funders: The Bill & Melinda Gates Foundation with support from Open Road Alliance
Research Partner: The Population Council
Implementing Partner: Plan International Kenya
This pioneering study proved that our combined intervention of sanitary pads and health education has significant impacts on girls’ health and wellbeing. This includes statistically significant, positive changes in:
Reproductive health knowledge: knowledge of pregnancy, of sexually transmitted diseases, and of modern contraceptives
Pride and comfort about managing menstruation, including reduced leakage and embarrassment
Self-efficacy, self-confidence, and general resilience to address life’s challenges
Shifts to equitable social and gender norms, including reduced acceptance of spousal violence as a norm
All of which, independently or combined, help girls to have more control over their bodies, their decisions, and their futures.
The Nia Project also examined the assumption that sanitary pads improve girls’ education outcomes, and it found that the distribution of sanitary pads did not impact school attendance, performance, or transition to secondary school, contrary to popular belief. The determinants of these outcomes are largely related to poverty and cannot be addressed through sanitary pads alone.
In Kenya, girls drop out of school at a higher rate than boys beginning at puberty, and many do not have access to reliable reproductive health education as they enter adolescence. Access to menstrual hygiene products and sexual and reproductive health education is thought to help reduce school absence and improve health and social outcomes, however, little rigorous evidence exists to date.
These findings also reaffirm the importance of providing sanitary pads in schools. The study underscores the importance of pad provision as a basic human right and a key driver of broader health and education outcomes. When pads and health education are combined, their impact on negative social and gender norms is amplified. Girls who have a consistent supply of reliable pads are better able to manage their menstruation with confidence, helping to break menstrual stigma and taboos, which serves as a gateway for personal empowerment and broader norms change. On their own, pads and rights-based health education are necessary and impactful, but when paired together, they are transformative. These results echo ZanaAfrica’s longstanding view that there is no silver bullet solution to girls' education, empowerment, or equality, but that pads are a critical tool when combined with broader health education.
ZanaAfrica and others in the menstrual health management and girls’ empowerment space have been leaders in shifting the global narrative away from “pads keep girls in school,” to a more nuanced understanding of the role that pads play as an entry-point in engaging girls, boys, and communities in conversations about adolescent health, rights, and equity.
Megan White Mukuria, ZanaAfrica’s Founder and visionary behind the organization’s interventions, asserts: “The challenges girls face are complex and intersectional, requiring complex solutions. You can’t just give girls sanitary pads and expect that to solve the issue of school attendance or achieving their dreams. Adolescent health programs need to provide accurate and contextualized information regarding reproductive health and rights. As someone who has seen the growth and impact of our community-driven interventions for the past 15 years, it is both thrilling and affirming to know that we now have data to support what we have known to be true. This strong evidence-base is compelling, and our engagement with the Kenyan government has generated momentum for scaling this solution widely through schools and communities.”
The Nia Project was one of the first large-scale RCTs to explore the role of sanitary pad distribution and reproductive health education on girls’ educational and reproductive health outcomes. The findings of this study provide a critical contribution to filling an evidence gap in the field of menstrual health management and girls’ empowerment, and in doing so will guide education and health policy in Kenya and in the region.
The results were published in the academic journal, Reproductive Health, an open access journal available online. This publication marks a pivotal moment for ZanaAfrica: by providing reproductive health and rights education to adolescents through the lens of menstrual health, ZanaAfrica has a proven solution that transforms the lives of girls and creates a more gender equal world.