On the onset of menstruation, girls are often confused about the changes their bodies are going through. Some experience shame and others fear.

These emotions often lead to many behavioural changes such as missing school and limiting their participation in activities such as sports. Advocates for girl education have suggested these issues are a direct result of the lack of proper sanitary towels in developing countries.

Increasing female education is an important policy priority. Presently, girls lag behind boys in terms of school enrollment and completion. Misbah Sheikh, the Chief of Communications at UNICEF- Rwanda Country Office, said that although there are no studies that have been done on the educational impact of separate school sanitation facilities for girls managing their periods, a few studies have investigated the relationship between menstruation and education directly.UNICEF and Emory University, in collaboration with the Ministries of Education and Health, are developing a project on how to safely address menstrual hygiene whilst ensuring the comfort and good health of adolescent girls."This project will fulfill the gap in current knowledge by clearly exploring how menstruation impacts education and health. Intervention strategies need to be tailored to specific cultural and environment contexts like the type of sanitary towels or personal hygiene devices for girls,” Sheikh explained.She adds that this project will take an in-depth look at school-specific challenges and the accompanying girl-centered interventions will include improving school water sanitation and hygiene resources to mention but a few.Gauthami Penakalapati, a researcher from Emory University, says girls modify their behavior during menstruation and depending on the context or setting these changes may have a negative impact. "Adaptation in behavior may also be self- prescribed or means of coping privately,” she explained.She continues to illustrate that in a focus group discussion in a primary school in Kenya, girls who were close to their menstrual cycles reported decreased participation in activities at school and teachers confirmed that the girls would be distracted, sat at the back of classroom and left class last during the days they were menstruating.In 2010 the NGO Sustainable Health Enterprises (SHE), founded by Elizabeth Scharpf, started an initiative to educate and advocate the making of sanitary pads from banana fiber to make it easy for school girls to access to sanitary towels. This was after research indicated that girls in both primary and secondary schools, especially in rural Rwanda, missed school due to the lack of these towels.According to Juliana Kayibanda the Country Coordinator, SHE, much as the initiative makes affordable sanitary pads, there is fear that the end users of their product still need to be educated on how to manage their menstrual cycles."We are tackling this issue in three ways. We are educating the girls and their families, encouraging for both the Ministries of Education and Health to come on board and we are also developing the sanitary towels,” she explained.According to Stephen Rudatemwa, the Deputy Principal of Wellspring Academy, a Kigali school, there have been no reports of girls missing classes or even dropping out of school due to menstruation periods. "We have not received any reports that girls did not attend school because of this issue in either of our primary and secondary school sections,” Rudatemwa explained.SHE is calling on the Rwandan Government to lift the 18 percent sales tax on feminine hygiene products to make them more affordable.Awakened to the issue, Parliament recently appropriated $35,000 to pay for sanitary pads for impoverished girls who otherwise might miss school — a small sum, but an acknowledgment that the problem is important and real.Currently sanitary pads range from Rwf700 to Rwf100 a packet. The use of banana-fiber sanitary pads is seen as a way to not only make pads accessible but more affordable as well.According to research done in Nepal by UNICEF, education experts increasingly believe that a cost-effective way to keep high school girls from dropping out in poor countries is to help provide them with sanitary products. However there are those who say such arguments are based largely on unreliable evidence.In response, a number of NGOs and sanitary product manufacturers have begun campaigns to increase availability of sanitary products, with a stated goal of improving school attendance. The largest of these is a programme by Proctor & Gamble, which has pledged $5 million toward providing puberty education and sanitary products, with the goal of keeping girls in school.The Clinton Global Initiative has pledged $2.8 million to aid businesses which provide inexpensive sanitary pads in Africa. Again, the goal is improvement in school and work attendance.