Sociodemographic characteristics of participants

The table (Table 1) below presents the sociodemographic data of the participants. The study involved 60 adolescent girls, with majority aged 17 (40%). Participants were distributed across Form 1 (33.3%), Form 2 (40%), and Form 3 (26.7%). Most girls were of Ewe ethnicity (53.3%), with others being Akan (23.3%), Ga/Dangbe (16.7%), and Guan (10%).

Table 1 Sociodemographic information of participantsThematic results

The table (Table 2) below summarizes the topical issues identified in the data. Detailed narratives are provided below for better understanding of the data.

Disposal practices

The disposal of menstrual products as reported by participants in this study reveals a range of practices shaped by both practical concerns and sociocultural beliefs. Participants consistently demonstrated caution in their disposal methods, with many opting for practices they deemed safest, such as burning or burying the used menstrual materials. Generally, participants would dump used materials in pits or toilets, burn or bury them. For those who dump them, some said these;

“When I am home after I remove it, I dump it in the dustbin to be disposed of later but when I am in school, I will wrap it and put it in the toilet” (ALPG, 17 years old).

“Okay in the school I remove my pad, wrap it and dump it in the toilet” (ALPG, 16 years old)

“I dump my used sanitary pad in the old KG pit but in the house, I burn it or put it in the dustbin” (KPAPJ, 16 years old).

Nevertheless, some of the adolescents explained that for fear of their used menstrual material being accessed by other people or animals, they prefer digging a hole to bury the used materials while others indicated they prefer burning their used materials. The following quotes summarized their responses:

“Whenever I change my pad, the one I used, I burn it because I don’t want to dispose it and then because I don’t know where the refuse will be dumped so I always burn my pad (ALPE, 17 years old).

“In disposing of my sanitary pad in the house, I burn it but in school, because of how we dispose of the used pads that’s why I decided to use tampons because they are a bit smaller and disposing it is quite easy when you drop it in the ‘KG’ [a local term for improved pit] it as well…” (KPAPH, 18 years old).

“I dispose my used sanitary pad in the house by burning it with petrol but in school, I dump it in the old ‘KG’ pit” (KPAPF, 16 years old).

“In school if I want to change the pad, I put it in a polythene and dig a hole and bury it” (ALPS, 18 years old).

“In the house I burn it but, in school I dig a whole and burry it” (ALPA, 17 years old).

Meanwhile, a few participants expressed concerns about the disposal of menstrual products at school, opting to take the used materials home due to uncertainty about how the school manages waste.

“Okay when am in school and then if I want to change my pad, I will go to the washroom then I will just remove the pad from my pant and the then I will wrap the pad and put it in a black polythene bag, then I will fold it, I can decide to put it on the rubbish. But I put it in my bag and send it home because I don’t know how they will dispose the rubbish” (ALPJ, 19 years old).

The findings from the observations present a slightly different picture from what participants reported. Unlike the reports of discreet disposal practices influenced by ritual beliefs, the observations revealed that used materials were often deposited at waste dumping sites, in open pits, shallow latrines, on the floors in washrooms, and in one incident, an abandoned sink. The attached photos provide evidence of these observed waste disposal practices, which diverge from the participant reports of more discrete and ritually-influenced methods (Figs. 1, 2, 3, 4).

Fig. 1

Used materials in an open pit in one of the sites

Fig. 2

An incident of a used pad in an abandoned sink

Fig. 3

Used materials deposited in the washroom

Fig. 4

Used materials in a shallow pit latrine

Menstrual blood and ritual perception

Participants expressed strong concerns about the potential use of menstrual blood in rituals. Several participants were uncomfortable with disposing of used menstrual products in public or communal areas, fearing that others might collect them for harmful purposes.

One participant described not feeling safe even when disposing of products in designated pits at school, worrying that strangers might pick them up and use them without their knowledge.

“Ok for me, in the house, I keep it till when my period is over, I burn it and also in the school, they have a pit for us so we tie it and dump it there but to me, it’s not safe because if you’re in class and someone comes to campus and goes to the girl’s dormitory and pick it and use it for something, we’ll not know…I’m not ok with that one” (KPEPA, 18 years old).

Others emphasized the importance of securely disposing of their menstrual products to prevent them from being used for rituals. For instance, one participant explained they felt more secure burying their used pads because “no one will find it”.

I feel comfortable with that one because that one, no one is going there to pick it. If I dig a hole and cover it up. No one will find it (KPEPK, 18 years old).

Some participants directly expressed fears of ritual use, while others mentioned the fear that someone might “use it for something like ritual that can affect me”.

“Haha because I am afraid that someone can take it and use it for rituals” (ALPS, 18 years old).

“We are in school, so you don’t know ‘who is who, anyone can use your materials to do anything at all against you” (ALPB, 16 years old).

“Because I am scared someone will use it for something like ritual that can affect me” (ALPG, 17 years old).

“Okay in the school I remove my pad wrap and dump it in the toilet. Because my mom told me that when its somewhere else, some people use the menstruation for money rituals, so I am afraid about it” (ALPH, 17 years old).

“Nowadays, they have been using people’s pads for sakawa [a form of ritualistic fraud involving blood]” (KPEPH, 16 years old).

“Because some people are using blood to do ritual so I’m not safe” (SHIPH, 17 years old).

Parental advice also influenced their concerns, as some participants were warned that menstrual blood could be used in money rituals, with some recalling their mother’s instruction to burn or securely bury the products to avoid them being stolen for rituals.

“Nowadays, they are using our blood so my mum advised me that if someone should steal your blood [they will use it for rituals], you have to tie it in a rubber, dig a hole [and burry it] … if I can’t dig a hole, then I’ll burn it” (KPEPG, 19 years old).

Participants were worried not only about ritual use but also about the possibility of dogs or other animals scattering the used pads, further contributing to their sense of insecurity.

[I keep it] eh, a month sometimes, even more... to me because I think some dogs will go there and go and pick them and be disposing it around or someone will take it and go and do something about it so I’ve not been feeling safe at all. Yes, that’s me” (KPEPC, 19 years old).

These perceptions were reinforced by cultural and familial teachings, with one participant noting,

“My mother told me that it’s not everyone that sees people’s blood so I should not be putting it down anyhow” (SHIPA, 17 years old).

Sanitation and Hygiene Infrastructure

The observation was also carried out on water, sanitation and hygiene (WASH) facilities in the study locations to assess their availability and state. Based on the evidence gathered, three key findings emerged.

First, it was observed that there were some WASH facilities available in the study locations, although they were inadequate to properly serve the population. Second, the predominant types of WASH facilities were cemented or wooden pit latrines, with only a few flushing toilet facilities present. Third, the limited flushing toilet facilities that were available lacked flow of water and were not in a good state. The photos below document these observation points and the overall state of WASH infrastructure in the study locations (Figs. 5, 6, 7, 8).

Fig. 5

Inside view of cemented pit latrine

Fig. 6

Inside view of wooden pit latrine

Fig. 7

Full view of wooden pit latrine

Fig. 8

Non-functional WC facility due to lack of flow of water and poor infrastructure