Co-creation with pupils and educators to overcome menstrual stigma in secondary schools
This project was funded by the Manchester Academic Health Science Centre (MAHSC) Applied Health and Care Research Group, a joint initiative between MAHSC and NIHR ARC-GM.
What were we trying to do?
We wanted to improve communication, reduce embarrassment, and fill gaps in knowledge about menstruation in secondary schools.
Our research challenged norms that make menstruation a taboo topic and created positive change in how periods are perceived and talked about in secondary schools.
Why was it important?
Menstruation (also called a period) and people’s preconceived ideas about it (for example, period blood being dirty or seeing a tampon as disgusting) could make it difficult for menstruating pupils to deal with their symptoms. This could have a negative impact on their school attendance.
How did we do it?
We held co-creation focus groups in 8 secondary schools in Greater Manchester. Pupils and secondary school staff attended separately (8 focus groups with pupils and 8 focus groups with staff) and explored their thoughts about menstrual health, needs, and communication in school.
We used the information to co-create knowledge with pupils and educators (including teachers, Personal Social Health and Economics (PSHE) teams and school nurses) to improve menstrual health communication, education, and support within secondary schools.
Findings
The key findings from this study were:
Rules and restrictions: toilet access in schools
- Restricted access to toilets in school makes it difficult and, at times impossible, to visit the toilet and change menstrual products when needed (i.e., every 2-3 hours on days of heavier flow) during the school day. This negatively impacts menstrual hygiene and menstrual health, especially among menstruating pupils.
- Restrictions and rules around toilet access point towards systematic issues with rules in secondary schools with a focus on managing disruptive behaviour as opposed to supporting and rewarding “good” behaviour.
Menstrual health education
- Some school staff make false assumptions about the knowledge, education and communication that occur regarding menstrual health outside the school environment, assuming that more is done at home than there truly is.
- Menstrual health education is limited and what is offered, for example, one or two science lessons, focuses on the role of the menstrual cycle and menstruation in the context of reproductive health.
- Menstrual health education is limited. School staff and pupils recognise that the current delivery is not enough. They agree that periods need to be taught and discussed more in school and all staff and pupils, including all sexes and genders, should be involved.
- There is significant variability in the extent to which menstrual health, as an experience, as a societal matter, is covered, for example in subjects that focus on personal and social education (often known as PSHE). How much or little menstrual health is covered in these subjects, depends heavily on the effort, investment, and initiative of individual school staff. There is no clarity on whose responsibility it is (or would be) to teach menstrual health in lessons or engage students in menstrual health discussions via other means (e.g., workshops, lecture days).
- Many pupils rely on TikTok to learn about their bodies, which can lead to misinformation.
- School staff discussed that the main barrier to implementing menstrual health education, support, and communication more consistently throughout the secondary education curriculum has to do with the question of whose responsibility it would be to produce and deliver this content.
Enactment of menstrual stigma in school
- Pupils and teachers are keen to learn more and talk more openly about periods, however, they currently do not feel they can do that because of the embarrassment and awkwardness associated with menstruation.
- Pupils worry about going to school and being in school on their period.
- Pupils and school staff agree that it is awkward to have a period, manage it and talk about it.
- Menstrual stigma comes into play between male and female pupils with male pupils using the period as a tool to bully female pupils in the school environment.
- All-girls schools do not have issues with bullying, however, also report issues with misuse of free period products and menstruation is not necessarily discussed more openly in these schools.
- Periods do not have a place in the school environment. While there are free menstrual products, their appropriate use and their need are not discussed in school. This perpetuates the stigma and shame associated with periods and is unhelpful for girls (and boys) in becoming knowledgeable about periods and learning how to approach, manage and talk about matters of menstrual and sexual health more broadly.
Exceptions to the rule: tensions of conformity and care
- Some school staff are supportive of pupils and facilitate toilet visits as and when these are needed mid-lesson. However, these staff find it difficult to make the “right” call as to who is and is not allowed to visit the toilet during lesson times.
The research team
- Principal Investigator (PI): Dr Petra Kolić (Manchester Metropolitan University)
- Dr Christopher Morse (Manchester Metropolitan University)
- Prof Paul Holmes (Manchester Metropolitan University)
- Dr Ben Ives (Manchester Metropolitan University)
- Dr Lamiece Hassan (University of Manchester)
- Dr Joy Probyn (University of Salford)
- Rebecca Murphy (Manchester Metropolitan University)
Who we worked with
Funding
This research project received an award of £35,246 from the 2024-2025 MAHSC Applied Health and Research Group.
Useful information
Contact information
Dr Petra Kolić
Senior Lecturer (Sociology and Sports Coaching), Manchester Metropolitan University
p.kolic@mmu.ac.uk