FINAL REPORT

FINAL REPORT 

1

A study on Menstrual Hygiene Management in Mongolia: 

Understanding practices and impacts on adolescent schoolgirls’ education and health 

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A STUDY ON MENSTRUAL HYGIENE 

MANAGEMENT IN MONGOLIA: 

Understanding practices and impacts on 

adolescent schoolgirls’ education and health 


Ulaanbaatar 2016



Supported by Global Affairs Canada 

Programme Division/WASH 

3 United Nations Plaza 

New York, NY 10017 USA 

www.unicef.org/wash/schools 

Commentaries represent the personal views of the authors and do not necessarily reflect the positions 

of the United Nations Children’s Fund (UNICEF). The designations employed in this publication and 

the presentation of the material do not imply on the part of UNICEF the expression of any opinion 

whatsoever concerning the legal status of any country or territory, or of its authorities or the 

delimitations of its frontiers.


TABLE OF CONTENTS 

ACRONYMS 

ACKNOWLEDGEMENTS 1 

EXECUTIVE SUMMARY 2 

INTRODUCTION 3 

METHODOLOGY 9 

Preparatory work 9 

Study design/scope 9 

Research process 10 

FINDINGS 14 

Social and environmental context 15 

Contextual factor 1. Poor community-level access to water and shower facilities in 

rural and suburban areas 15 

Contextual factor 2. Poor WASH facilities in urban, provincial and rural schools 16 

Contextual factor 3. Parental support 16 

Contextual factor 4. Age of girls at menarche 17 

Contextual factor 5. Rapidly increasing access to information and the media 17 

Challenges girls face 18 

Being unprepared 18 

Hiding menstruation from boys 18 

Fear of leaks, stains and odour 19 

Difficulty in asking for help 19 

Biological challenges 19 

Determinants and Contributing Factors 20 

Determinant 1. Inadequate WASH facilities in schools and dormitories 20 

Determinant 2. Knowledge, information and education 27 

Determinant 3. Access to emergency materials to manage menstruation 32 

Determinant 4. Supportive psychosocial environment 34 

Determinant 5. Biological factors 36 

Impacts on and risks to education and health 37 

Voiced impacts 37 

Potential risks/potential health impacts 39 

RECOMMENDATIONS 42 

1. Recommendations from participants 42 

2. Recommendations from researchers 43 

REFERENCES 45 

ANNEXES 46 

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ACRONYMS 

CSWE 

FGD 

GDP 

IDI 

JMP 

KII 

MDGs 

MICS 

MHM 

MNT 

MoECS 

MoF 

MoHS 

NGO 

NSO 

PE 

SISS 

UNICEF 

UNFPA 

WASH 

WinS 

Centre for Social Work Excellence (a Mongolian NGO) 

Focus Group Discussion 

Gross Domestic Product 

In-Depth Interview 

Joint Monitoring Programme 

Key Informant Interview 

Millennium Development Goals 

Multiple Indicator Cluster Survey 

Menstrual Hygiene Management 

Mongolian Tugrug 

Ministry of Education, Culture and Science 

Ministry of Finance 

Ministry of Health and Sports 

Non-governmental organization 

National Statistics Office 

Physical Education 

Social Indicator Sample Survey 

United Nations Children’s Fund 

United Nations Population Fund 

Water, Sanitation and Hygiene 

Water, Sanitation and Hygiene in Schools 

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ACKNOWLEDGEMENTS 

This first qualitative study of Menstrual Hygiene Management (MHM) in Mongolia was commissioned 

by UNICEF Mongolia with funds from Global Affairs Canada through the project ‘WASH in Schools 

for Girls: Advocacy and Capacity Building for Menstrual Hygiene Management through WASH in 

Schools Programmes’ (WinS4Girls Project); with technical guidance from Emory University (Bethany 

Caruso, Anna Ellis, Gauthami Penakalapati, Gloria Sclar, Candace Girod and Matthew Freeman) on 

the study design, qualitative data analysis and final report; and with the active participation and 

support of the Ministry of Education, Culture and Science and the Ministry of Health and Sports. 

The authors would like to express their gratitude to the Water, Sanitation and Hygiene (WASH) team in 

UNICEF Headquarters, New York, particularly Murat Sahin, Lizette Burgers, Maria Carmelita Francois, 

Sue Cavill and Yodit Sheido. The authors also appreciate technical guidance from Columbia University, 

particularly Marni Sommer, the UNGEI Advisory Group, and the Gender, Adolescent Development 

and Participation, and Education Advisers in UNICEF Headquarters, New York. Sincere thanks to the 

UNICEF country office team: Roberto Benes, Representative, Judith Bruno, Deputy Representative 

and Batnasan Nyamsuren, Water and Environmental Sanitation Officer, Odgerel Myagmar, C4D 

Officer and Robin Ward and Uranchimeg Budragchaa, WASH Consultants for managing various 

processes in undertaking the study. 

Special thanks go to the research team of CSWE of Mongolia: Erdenechimeg Ts., Research Team 

Leader and Principle Researcher, and field researchers: Naranchimeg Ja., MPH (researcher/editor of 

the report), Oyuntugs S., MA, Altantsetseg B., MSW, Amarjargal T., PhD, Gerelmaa, Ch., BSW, and 

Batsuuri G, BSW. 

Special thanks to all the school authorities, students, teachers and key interviewees, who took part in 

the study and shared their experiences, ideas and thoughts on this sensitive topic. 

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EXECUTIVE SUMMARY 

UNICEF Mongolia and the Centre for Social Work Excellence (CSWE), a Mongolian NGO, with technical 

support from Emory University and the financial support of Global Affairs Canada, conducted the 

first qualitative study on menstrual hygiene management in Mongolian schools from February to 

June 2015. The aim was to understand, from the girls’ perspective, how well schools and dormitories 

meet their needs when they are menstruating; and to gather evidence to inform key stakeholders for 

future actions to ensure a supportive school environment for girls. 

The study identified challenges that limit the ability of girls to manage menstruation hygienically and 

with dignity, especially while in school. These challenges include shame and fear of being teased by 

boys; feeling discomfort; feeling unable to actively participate in class; distancing themselves from 

classmates; distraction during classes; and inadequate water and sanitation facilities in schools where 

girls can manage their menstrual hygiene needs in private. These challenges contribute significantly to 

girls’ reduced participation in class and school and even absenteeism, thus affecting their academic 

performance, as well as impacting on their physical and emotional well-being. 

Broader social and environmental factors that contribute to these challenges include poor communitylevel 

access to water and shower facilities in rural and suburban areas, and often a lack of parental 

support for girls staying in dorms and with host families. Other factors include the quality and 

availability of psychosocial and physical support for girls at home and at school, the affordability and 

availability of sanitary pads at local stores; and access to information via TV and the internet. 

These key recommendations are intended to guide programming for menstrual hygiene management: 

1. Access to safe water and proper sanitation and hygiene facilities is a basic requirement for 

girls in managing their menstruation in school and in dormitories. It is important to strengthen 

the implementation of the “Norms and Minimum Requirements for WASH in Kindergartens, 

Schools and Dormitories” which was approved by the Government in 2015. 

2. Plan, develop and introduce programme interventions to improve the knowledge, attitudes 

and practice of girls and boys, parents and teachers (and particularly male teachers) on 

menstruation and its proper management. This could include developing information materials, 

mini guidebooks and online learning materials, training school doctors and revisiting the work 

responsibilities of teachers, doctors and dormitory teachers, and janitors. 

3. Create a more favourable environment so that schoolgirls have better access to sanitary pads 

during school hours and can get physical and emotional support from teachers, school doctors 

and other school personnel, including boys. 

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INTRODUCTION 

Assessment background 

There is a growing global focus on menstrual hygiene management (MHM), with several assessments 

conducted in Africa, Asia and Latin America (including Rwanda, Bolivia, the Philippines and Sierra 

Leone), as well as recent international conferences on MHM. However, no research or study on MHM 

has ever been carried out in Mongolia. For these reasons, UNICEF and Emory University decided in 

2015 to conduct this current research. 

MHM research from the other countries shows that menstruation poses several common challenges 

to girls: fear, stress, and embarrassment because of different factors, such as inadequate WASH 

facilities in schools and poor knowledge and understanding of MHM, which may have a negative 

impact on girls’ learning, leading to absenteeism, low levels of participation in class, distraction and 

long-term health consequences. 

The aim of this report is to provide information on the challenges girls face in school when 

menstruating, to examine the determinants of these challenges and to provide recommendations for 

decision-makers, school managers and other relevant stakeholders. 

Country and development context 

Mongolia is a large landlocked country located in North-East Asia, bordering the Russian Federation 

to the north and the People’s Republic of China to the south (Figure 1). It is the second-least densely 

populated independent territory in the world, occupying 1,564,900 km 2 with a population density 

outside the capital of less than two persons per square km 1 . The population stands at three million, 

of whom more than a half live in cities and provincial urban centres, and particularly in the capital, 

Ulaanbaatar. 

Figure 1. Map of Mongolia 

1 NSO, Year book 2015. 

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Mongolia has a harsh continental climate, and a prolonged winter with an average temperature of 

minus 15–30°C. 

The country has a decentralized system of government and is divided administratively into 21 

aimags (provinces); each aimag is divided into soums (rural sub-provinces) and baghs (the smallest 

administrative unit in rural areas). There are 330 soums and 1,592 baghs. The capital, Ulaanbaatar, is 

divided into 9 districts (urban districts), and 152 khoroos (urban sub-districts) 2 . 

The rate of urbanization is very rapid in Mongolia. According to 2014 estimates, urban residents make 

up 66.4 per cent of the total population (with 45.5 per cent or 1.31 million in Ulaanbaatar) and 65.3 

per cent of total households. Internal migration towards cities and urban settlements has increased 

since 2000, mainly because herders who have lost their livestock in severe winters (‘dzud’) have 

migrated to urban areas in search of alternative livelihoods. 

Universally, population migration is considered to have a positive influence on economic development 

and to reduce regional imbalances. However, urbanization in Mongolia is accompanied by many 

negative impacts, such as over-population in Ulaanbaatar and urban areas, making it difficult to 

provide services including a water supply 3 . Most of those who have migrated to urban areas live in 

the underserviced ger areas that have limited access to the modern infrastructure enjoyed by their 

city-centre counterparts, such as sanitation and piped water. 

Figure 2. Unplanned ger districts on the outskirts of Ulaanbaatar 

Source: Asia Foundation 

2 NSO, Yearbook 2014. 

3 Achieving the Millennium Development Goals: Fifth National Progress Report, 2013. 

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Mongolia is a youthful country, with 36 per cent of the population under the age of 19. 

Figure 3. Mongolia, population pyramid, 2014 4 

Achieving the Millennium Development Goals: Fifth National Progress Report 2013 gives the 

employment rate in 2009 as 88.4 per cent, which increased to 91.8 per cent in 2012. The target for 

labour force participation is 70 per cent and the actual unemployment rate for 15–24-year-olds is 

2.5 per cent. 

Water, Sanitation and Hygiene 

There is growing political recognition and public 

awareness of the importance of water and 

sanitation as a prerequisite for the country’s 

development, with the Government sitting on 

the Sanitation and Water for All (SWA) steering 

committee from 2015. However, progress in 

this sector remains limited. 

Mongolia’s highly variable and challenging 

environmental and living conditions are 

illustrated by the country’s progress and 

performance in achieving WASH Millennium 

Development Goal (MDG) indicators and 

targets, where sanitation lags behind water. 

Mongolia loses an estimated 35.5 

billion Mongolian Tugrugs (MNT), 

or US$26 million per year, because 

of poor sanitation and hygiene, 

equivalent to approximately 0.5 per 

cent of gross domestic product (GDP). 

UNICEF, Economic Impacts of Sanitation 

in Mongolia (2011) 

4 https://populationpyramid.net/mongolia/2016/. 

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National-level water and sanitation indicators show stagnation, with the use of improved drinking 

water sources increasing from 65.2 per cent in 2010 to only 68.1 per cent in 2013, and the use of 

improved sanitation increasing from 54.3 per cent to only 58.3 per cent during the same period 5 . 

According to WHO/UNICEF Joint Monitoring Programme (JMP) on Water and Sanitation (http:// 

www.wssinfo.org/documents/?tx_displaycontroller[type]=country_files), trend on access to 

improved water and sanitation coverage in Mongolia from 2010 to 2015 is showing a slight increase, 

but almost stagnant (Water: 63% - 64%, Sanitation: 57%-60%). The JMP collects all available 

national survey results (National Census, Multiple Indicator Cluster Survey (MICS), Reproductive 

Health Survey, Pilot Household Survey, Household Income and Expenditure Survey etc.) and estimates 

projections in each year. By the MICS surveys (http://mics.unicef.org/surveys), trend on access to 

improved water and sanitation coverage since 2010 is also slightly increased (Water: 65% - 68%, 

Sanitation: 54%-58%). However, by country specific definition, sanitation coverage is decreased 

considerably (from 83 to 27 %), which explains that ordinary household pit-latrines was considered 

as un-improved in the last survey. 

Table 1. Improved water and sanitation coverage 

Trend 2005 2010 2013/2014 

Improved water coverage, % 71.6 65.2 (77.9*) 68.1 (84.8*) 

Improved sanitation coverage, % 77.2 54.3 (83.1*) 58.3(27.3*) 

Note: *-by country specific definition 

Mongolia is a hugely challenging context for WASH service delivery. Constructing, operating and 

maintaining WASH infrastructure in remote areas is very expensive because of permafrost and 

a lack of local service providers, among other factors. Given these constraints, the vast majority 

of households at the rural and sub-urban district level have pit latrines and inequities for use of 

sanitation are highly pronounced by household location. 

There do not appear to be any strong disparities in terms of gender norms and roles in relation to the 

use of (or exclusion from) improved water and sanitation, and generally adult men bear the burden 

of water collection from off-premises water sources. 6 

In summary, for use of improved water sources and sanitation facilities, there are consistently 

correlated and negative disparities for rural households (especially those outside permanent 

settlements) and poorer households. 

Education in Mongolia 

Mongolia has made great progress in delivering education services for children, with schools becoming 

more child-friendly, and has achieved a high rate of adult literacy and school enrolment. 

One remarkable success is that girls are not disadvantaged in the education system. They have higher 

enrolment and net attendance rates than boys, and lower dropout rates (35 per cent for girls, 65 per 

cent for boys). The student gender ratio is approximately balanced, but there is a higher percentage 

of girls in secondary schools. 7 

5 Multiple Indicator Cluster Surveys (MICS)/Social Indicator Sample Survey (SISS), Mongolia 2013. 

6 SISS(2013, Social Indicator Sample Survey, Mongolia) 

7 NSO, Statistical Year Book, 2014. 

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The country has a 12-year free basic education system, which consists of five years of primary 

education, four years of lower secondary (completing the nine-year compulsory education cycle) and 

three years of upper secondary. The age of admission to primary education is six. 

The education system includes preschool (kindergartens and nursery schools) and general secondary 

schools (primary, lower and upper secondary). Primary, lower and upper secondary levels generally 

do not exist separately. Schools up to grade 12 are mainly found in larger towns and cities. Primary 

and secondary education services are available in all areas including rural districts. 68 per cent of all 

schools are in Ulaanbaatar city and other provincial centres, 31 per cent are in rural soums and the 

remaining 1 per cent are in bagh centres. 

Boarding schools or school dormitories are a special feature of Mongolian primary and secondary 

education, enabling large numbers of herders’ children – who usually live in remote areas outside 

permanent settlements – to be enrolled in school. As the academic school year (September to May) 

unavoidably coincides with Mongolia’s harsh winter, when average temperatures drop to as low 

as -20°C, living permanently in a dormitory is the best way for children to continue their schooling 

without having to travel long distances. Dormitories are most commonly found in rural district schools 

but there are also some in provincial capitals and (rarely) in cities. 

60 per cent of all schools have dormitories and accommodate 6.5 per cent of the student population, 

of whom 51.7 per cent are girls. 

It should be noted that many children also stay with host families (mostly relatives) who are close to 

school, so that they can attend school more easily. 

Health education in schools 

In September 2015, at the beginning of the academic year, the Government of Mongolia decided to 

drop health as a separate and dedicated subject in the school programme. Instead it is working to 

integrate health into other subjects, requiring all subject teachers to include relevant information on 

health in their lessons, with a particular focus on physical education (PE) and biology classes. 

The Education Research Institute takes the lead in developing and revising health curricula for 

secondary schools and secondary school teacher training colleges. The previous health curriculum, 

delivered through a dedicated subject on health, was introduced to lower secondary schools about 

20 years ago; all school children from grades 5 to 12 had dedicated lessons on health, aimed at 

improving their life skills. The curriculum mainly aimed to reduce risky adolescent sexual behaviour 

and its consequences, including teen pregnancy and the spread of sexually transmitted infections 

and HIV/AIDS, by providing children and young people with comprehensive and age-appropriate sex 

education and information. 

At present, the future of health education in schools is uncertain. MHM was barely addressed in 

the previous curriculum and it is still not known whether it will be addressed in the new integrated 

curriculum for PE, biology and health, which is not yet in place. School doctors mainly focus on 

cleanliness, sanitation and hygiene in school and do not have sufficient resources to provide sanitary 

napkins for girls in emergency situations. 

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WASH in schools and MHM 

Despite significantly increased focus and the Government’s commitment to WASH in schools (WinS), 

children currently do not receive coordinated health education and continue to face challenges 

because of a lack of child-friendly WASH facilities in schools, especially in rural village (soum) schools 

and dormitories. Location is the main determinant of the standard of school WASH facilities, just as it 

is for households. Although a comprehensive national baseline for WASH in schools is unavailable and 

WASH is not currently included in the Education Management and Information System or national 

educational statistics, a 2007 UNICEF study found that 78 per cent of schools had outdoor latrines. 

WHO’s Global School-based Health Survey (2010), which had a nationwide sample, found that “One 

in ten students (9.7%) said there was no toilet or sink at their school and 35.4 per cent said there 

were not enough toilets or sinks at their school”. 

There have been some improvements since UNICEF’s 2007 study, although these are unquantified, 

but many rural schools and dormitories still have open pit latrines and inadequate WASH facilities, 

particularly given Mongolia’s harsh weather conditions. For children in rural schools and those living 

in school dormitories, having to go outside to use WASH facilities during the extremely cold winter 

months presents real challenges, and many younger children or boys don’t use the pit latrines but 

defecate outside. In most cases, open pit latrines do not have lighting and are located far away 

from school and dormitory buildings. Open defecation in the school environment is likely to be partly 

behavioural, but also partly due to the poor conditions, particularly smelly, dirty or slippery pit latrines 

in winter. In urban areas, although pupils from the ger districts of Ulaanbaatar are likely to use an 

outdoor shared or private pit latrine at home, the schools that they attend will have indoor flushing 

toilets. In rural villages (soum centres), there is sometimes only one public shower block and showers 

may not be available in the school complex. 

Many governmental and non-governmental organizations (NGOs) at national and sub-national levels 

play a crucial role in creating healthy and hygienic conditions in schools. Though very active, the WASH 

in Schools movement is a relatively small sector in terms of the number of actors and funding. The 

main Government duty-bearers include the Ministry of Education, Culture and Science (MoECS), The 

Ministry of Health and Sports, the Ministry of Construction and Urban Development, the Mongolian 

Agency for Standardization and Metrology and the National Water Committee. 

National, international and multilateral organizations, such as WaSH Action, a local NGO, the Asian 

Development Bank, UNICEF, Save the Children Japan, and the Government of Japan, have been 

supporting government efforts to improve the learning environment for children, to implement 

WASH-related projects, to invest in building and renovating school and dormitory buildings and 

school and kindergarten sanitation facilities, as well as integrating hygiene education into the school 

curriculum. WASH in Schools infrastructure projects tend to focus on rehabilitating or constructing 

indoor washrooms in urban and rural areas. 

The Government has adopted many laws and regulations relating to WASH in order to fulfil its 

obligation to create a favourable environment where children can obtain a quality education. Most 

notable and relevant are the Norms and Minimum Requirements for Water, Sanitation and Hygiene 

(WASH) in Kindergartens, Schools and Dormitories that were developed by MoECS, the MoHS and 

the Ministry of Finance (MoF), with UNICEF coordinating sector-wide support and advocacy. They 

were approved by an official decree in June 2015. The Norms and Minimum Requirements reflect 

the experiences of adolescent schoolgirls who were interviewed about these issues, and the insights 

gained from consultation with WASH stakeholders, international and national governments and 

NGOs. 

8


2015 was a milestone year, which saw the start of a coordinated national programme on WASH in 

schools, driven by the adoption of the Norms and Minimum Requirements and led by MoECS. MoECS 

is developing a mid-term plan for implementation of the standards and the first WASH in Schools 

network meeting was recently convened. At this initial meeting, a school self-monitoring checklist for 

the Norms and Minimum Requirements was discussed, a positive development which will hopefully 

see the first government-led national baseline on WASH in schools and routine annual monitoring. 

In summary, although there have been positive developments in recent years, the current WASH 

situation in schools and dormitories remains unsatisfactory in many cases, with significant 

improvements needed. Schools and dormitories are often too crowded and unhygienic, and are still 

far from reaching the national Norms and Minimum Requirements. The challenge of providing WASH 

services in schools is potentially undermining the positive hygiene behaviours that children have 

learned. The start of the WASH in Schools National Programme led by MoECS provides an excellent 

opportunity and vehicle for advancing the MHM agenda for the ultimate benefit of Mongolian 

schoolgirls. 

METHODOLOGY 

Preparatory work 

• A working group was established, including officials and relevant staff from the cooperating 

ministries, MoECS and MoHS. 

• Staff from key ministries, UNICEF and other national stakeholders including NGOs participated 

in an e-course on MHM led by Emory University’s Centre for Global Safe Water and UNICEF. 8 

• Ethical approval to conduct the study was obtained from the National University of Mongolia’s 

Ethical Clearance Committee for Social Studies, which is under MoECS. Copies of the ethical 

approval were then sent to city district and aimag education directors requesting their 

assistance with the research. School directors and administrators of the selected schools were 

also sent copies, along with a detailed description of the research objectives and goals, the 

process and the timeline for data collection. 

Study design/scope 

The study used both qualitative and quantitative research techniques such as in-depth interviews 

(IDIs), focus group discussions (FGDs), key informant interviews (KII)s and observations; in addition, 

girls wrote short stories about their own experience of menarche. 

8 This course was designed to equip practitioners and policymakers with the skills to investigate and understand the challenges 

girls in school face during menstruation, through qualitative research. It was invaluable in enabling this research to be carried 

out in Mongolia. 

9



The Socio-Ecological Framework (Figure 4) was used for data analysis. 

Figure 4. Socio-Ecological Framework for MHM research activities and themes 9 

Research process 

Face-to-face training 

Tools for FDGs, IDIs, KIIs and observations developed by Emory University and UNICEF 10 were translated 

into Mongolian, pretested in two schools and then revised. Researchers advised including a tool for 

dormitory girls so that they could compare their experiences with those of schoolgirls living at home. 

All researchers had three weeks’ training led by the research manager from Emory University. The 

first course, conducted over two weeks, covered the tools and how to adapt them, as well as data 

collection. Topics 11 included WASH, menstruation, research ethics, qualitative data collection methods 

and techniques, and research logistics. The second course focused on data analysis and analytical 

techniques. 

Data collection 

Data collection was completed in May 2015. Due to the dispersed location of schools, three satellite 

teams of researchers were organized to collect data. Researchers collected data together at the first 

location; then subsequently, in three locations at the same time. Each satellite team covered three 

schools and consisted of three researchers: a researcher–facilitator, a note-taker and a local research 

assistant who was mainly responsible for logistics. 

Data collection started after written consent was obtained from school directors, who approved the 

research activities with schoolchildren and staff. Before starting interviews or discussions, signed 

written consent was obtained from each participant to ensure their voluntary participation and 

confidentiality. School directors and teachers provided consent on behalf of parents, who were 

informed by the schools. 

9 WASH in School: Empowers Girls’ Education in Rural Cochabamba, Bolivia, An Assessment of Menstrual Hygiene Management 

in Schools. 

10 ‘WASH in Schools Empowers Girls’ Education, Tools for Assessing Menstrual Hygiene Management in Schools’. 

11 Modules 1–8 of the UNICEF- and Emory University-facilitated online training course, ‘WinS for Girls’ on MHM. 

10


Selection of schools 

The CSWE research team, in consultation with UNICEF Mongolia and Emory University, selected 

11 schools in total. Four were from aimags (in the aimag/province centre) and four from soum 

centres (rural villages) representing Western, Khangai, Central and Eastern regions. Three schools 

were selected in Ulaanbaatar: one in the centre, and two from suburban districts. The purpose 

was to identify the similarities and differences in girls’ MHM experiences, and the challenges and 

needs encountered in geographical locations that vary in terms of environment, WASH infrastructure 

development and the girls’ living conditions. Schools with dormitories were deliberately selected to 

explore the specifics of this sub-population of schoolgirls. 

Table 2. School sampling categories, by location 

Region/aimag or UB district Ulaanbaatar or aimag/soum & school code Boarding 

Urban 

Suburban 

UB: Chingeltei S1 No 

UB: Songinokhairkhan S2 No 

UB: Nalaikh S3 Yes 

Aimag centre 

Soum centre 

Central: Dundgobi S4 S5 Yes 

Eastern: Dornod S6 S7 Yes 

Western Khovd S8 S9 Yes 

Khangai: Khuvsgul S10 S11 Yes 

Figure 5. Areas selected 

Ulaanbaatar 

11



Selection of participants 

Teachers were informed of the research and selected students from specific age groups based on the 

research objectives. Two groups of girls – aged 12–13, and 14 and above – were made up of girls 

who had been menstruating for a few years at the time of the research. The group of boys were 

aged 14–16 and had attended health classes. Children were asked if they wanted to participate in the 

research and only those who expressed a willingness to do so were involved. 

Parents were invited to take part, divided into groups and invited to share their ideas and thoughts 

with the researchers. 

Participants and activities 

A total of 300 people took part in the study, including teenage girls and boys who attend day 

schools, girls living in dormitories, school administrators, teachers, parents of adolescent girls, and 

school/dormitory workers/janitors. In addition, WASH facilities at 11 schools were observed. 

Table 3. Summary of study activities 

Tool Participants/location No. of discussions, 

interviews 

No. of participants 

FGD Girls aged 12–13 (school and dormitory) 11 81 

Girls aged 14–16 (school and dormitory) 11 81 

Boys aged 14–16 6 47 

Mothers of teenage girls 3 16 

Teachers from middle and secondary classes 3 14 

IDI Girls in school and/or aged 12–13 11 11 

Girls from dormitories and/or aged 14–16 11 11 

KII Health teachers 11 11 

School administrators 11 11 

Short interview Janitors 7 7 

Story writing 

Girls’ stories 

Total 85 300 

Stories from girls in soum and aimag schools 

from Eastern and Western regions 

10 10 

Table 4. Observed WASH facilities 

Observed WASH facility 

11 Schools Handwashing facilities 

Indoor toilets 

Outdoor toilets 

7 dormitories Handwashing facilities 

Indoor toilets 

Outdoor toilets 

Number 

129 

124 

64 

40 

23 

10 

12


In-depth interviews 

The objective of the IDIs was to learn about girls’ personal experiences of menstruation, specifically 

what they knew about it, where their information came from and who they trusted. They were also 

asked to describe their first experiences. 

Focus group discussions 

Figure 6. Girls’ FGD 

Separate FGDs were conducted with girls aged 12– 

13, and 14 and above; with boys aged 14–16; and 

with mothers. Each session involved up to eight 

participants. The aim of the girls’ FGDs was to 

discover girls’ typical experience of menstruating 

at school, as well as their typical behaviour, 

coping mechanisms, level of understanding of 

menstruation and the availability of support. 

The facilitator and note-taker led discussions and 

took notes, as well as recording them. 

In the girls’ FGDs, several techniques were used, 

including group discussion, drawing and role 

play. Girls were asked to draw the experiences 

Source: CSWE 

of a typical girl to give researchers a more indepth 

understanding of how they cope and manage menstruation-related issues at school, and the 

challenges and issues to be addressed. FGDs with mothers and boys focused on the same themes, 

providing researchers with a different standpoint to the girls’ challenges and experiences. After 

the FGDs the two-person teams discussed key notes and the process, coded the work and checked 

records. 

Girls’ stories 

Twelve girls from schools in different locations (urban, rural and suburban areas) were asked to write 

a short story about their experiences of menstruation and to seal it in an envelope, without writing 

their names on the envelopes. The aim was to gain a deeper understanding of the challenges and 

impacts that may affect girls’ school performance and other areas of their lives. 

Key informant interviews 

The objective of the KIIs with school staff was to investigate hygiene, sanitation, what students were 

taught about menstrual hygiene, menstruation-related challenges at school and budget- and supplyrelated 

questions. KIIs were conducted with teachers, principals/school administrators and school/ 

dormitory workers/janitors. The interview content was informed by UNICEF’s WASH in Schools 

Monitoring Package. 12 

School/dormitory observations 

In order to understand the challenges faced by Mongolian school children and those whose school 

experience extended beyond the traditional school day, all school and dormitory WASH facilities were 

observed. Tools/checklists were used that were informed by the UNICEF WASH in Schools Monitoring 

Package and adapted to research purposes. 

12 United Nations Children’s Fund, ‘WASH in Schools Monitoring Package’, UNICEF, New York, April 2011. 

13



Recording and transcribing 

All activities were recorded with prior permission of the participants. All recordings were listened to 

and transcribed verbatim. 

Data analysis 

The CSWE research team completed data analysis in Mongolian, following technical training by Emory 

University on qualitative data analysis. While transcripts of the interviews and discussions were being 

completed, researchers developed a codebook. Each transcript was cleaned by researchers and deidentified 

to maintain interviewees’ anonymity. 

The main codes were identified using the Socio-Ecological Framework and sub-codes were identified 

in the process of analysis. Predefined codes for life changes, knowledge and practice, support, 

context, WASH hardware, WASH software, challenges, consumables, home, school, dorm, impacts, 

risks, and recommendations were used. 

Several people worked on coding a single transcript so that no bias was introduced to ensure the 

quality and credibility of the research analysis. Main themes were developed after consolidating 

coded data and verified by the research team. 

Data gathered through observation was summarized in tables and notes from self-observations were 

reflected in the data analysis to illustrate the context more broadly. 

FINDINGS 

This section analyses the social and environmental context in which the research is situated and the 

challenges girls face at school. The determinants of these challenges are then explored, as well as 

their impact and the potential risks within the Socio-Ecological Framework (see earlier). 

Table 5: Schematic of the research findings 

CONTEXT: 

• Poor community-level access to water and shower facilities in rural and suburban areas 

• Poor WASH facilities in urban, provincial and rural schools 

• Parental support 

• Age of girls at menarche 

• Rapidly increasing access to information and the media 

DETERMINANTS 

CHALLENGES 

VOICED IMPACTS 

POTENTIAL RISKS 

Inadequate school and 

dormitory WASH facilities 

Knowledge, information 

and education 

Access to emergency 

materials to manage 

menstruation 

Supportive psychosocial 

environment 

Biological factors 

Being unprepared 

Hiding menstruation 

from boys 

Leaks, stains and 

odour 

Difficulty in asking 

for help 

Biological challenges 

Physical symptoms of 

menstruation 

Taking time off from 

classes 

Reduced 

concentration 

Withholding urine 

Threat of harassment 

Lower academic 

and sporting 

achievements 

School dropout 

Negative impact on 

girls’ physical and 

emotional well-being 

14


Social and environmental context 

Girls’ experiences during menstruation and the challenges they face are explored within the broader 

social and environmental context. This includes their physical and psychosocial environment, the 

culture they were raised in, and the groups they interact with that have had and continue to have a 

great influence on their past, current and future physical and emotional well-being and behaviour. 

There are five key contextual factors: 

• Poor community-level access to water and shower facilities in rural and suburban areas 

• Poor WASH facilities in urban, provincial and rural schools 

• Parental/family support for girls 

• Age of girls at menarche 

• Increasing countrywide media access, particularly to the internet 

Contextual factor 1. Poor community-level access to water and shower facilities in rural and 

suburban areas 

In rural and suburban areas, particularly in rural soums, access to adequate WASH facilities was limited 

because of water scarcity and poor infrastructure development because of the cost implications of 

such a vast territory. Households were not connected to a piped water supply system and most rural 

soums had only one or two public shower/bath houses. If they were closed for some reason, local 

people had to wash at home, using a bath tub, where facilities were often limited. Rural households 

had no separate shower rooms, making it difficult for girls who are menstruating to wash themselves 

and their clothes. 

“We have only one public shower in the whole soum. So there is always a long 

queue, so we (as girls) are not always able to go there.” (RuralS9_ GirlsIDI_2) 

Herders living in remote places collect water from wells, springs and rivers, and some families use 

snow or ice from the river for drinking and cooking in winter. 

In suburban districts of Ulaanbaatar, people often have to queue to collect water from water 

distribution kiosks. (See Figure 7). 

According to the Social Indicator Sample Survey 2013 (NSO, UNFPA, UNICEF, 2014), it is mostly adult 

men (62 per cent) and boys under the age of 15 (7.3 per cent) who fetch water for their families. 

Figure 7. A water distribution kiosk in a 

suburban area of Ulaanbaatar 

Figure 8. Boys fetching water in a rural area 

Source: B.Mungunkhishig, UNICEF 

Source: B.Mungunkhishig, UNICEF 

15



While this relieves women and girls from this burden and time commitment, it can create difficulties 

when they use more water than other members of the household. 

Contextual factor 2. Poor WASH facilities in urban, provincial and rural schools 

In urban areas, although most schools had flush toilets, access was limited because schools were 

overcrowded. In some schools, three children sat at a table for two and other schools ran three shifts 

a day. For example, the first shift or primary grades have classes from 8 a.m. till 11 a.m., the next 

group of grades (e.g. lower secondary) have classes from 11.a.m. till 4 p.m. and classes for the third 

shift or higher grades are from 4 p.m. till 8 p.m. School time depends on the number of classes each 

grade has, which is usually four or five classes a day, each lasting 45 minutes. 

Researchers found that two of the urban schools had more than 2,000 students and the children 

attended in three shifts, but there were no provincial or rural soum schools with a three-shift system 

during the time of their visit. 

Provincial schools had both indoor flush toilets and outdoor pit latrines. The condition of indoor flush 

toilets was the same as those in the Ulaanbaatar or suburban schools, but the outdoor pit latrines 

were in a similar condition as those in the rural schools. 

Most rural schools had only outside open pit latrines and children felt reluctant to use them because 

of poor sanitary conditions, a lack of privacy, as often toilets had no doors (either broken or not 

installed at all), no locks, no lights and no rubbish bin inside the toilet cubicle, etc. 

According to girls and other research participants, there was usually no toilet paper in the urban and 

rural school toilets. Children are asked to bring a number of toilet rolls to school at the beginning of 

the school year, which are kept in the classroom; when students need to use the toilet, they take a 

toilet roll with them. Children reported using toilet rolls in most cases, but it is difficult to say whether 

this arrangement worked well every single time. 

Contextual factor 3. Parental support 

In Mongolia, girls are traditionally strongly encouraged to pursue an education. Generally, most 

parents give priority to their daughters’ education rather than their sons, as was noted in the girls’ 

statements. Girls reported being well supported by family members such as mothers and sisters as 

well as fathers and grandmothers. Particularly in herder families, parents tend to ask their sons to 

help with herding rather than their daughters, therefore the school dropout rate is higher among 

boys than girls. 

“In rural areas where we live, people pay a lot of attention to a girl child.” 

(RuralS9_ GirlsFGD_1) 

However, for those girls who didn’t live with immediate family members or didn’t have an elder sister 

nearby, there was less support on managing menstruation. Girls in rural areas lived in the school 

dormitory during the academic year and those who couldn’t because of limited dorm spaces stayed 

with host families. 

16


Girls who lived in school dormitories for the whole school year might need special attention and care 

as they are away from their parents but still need the help and support of someone close to them in 

practical terms, for example pads or cash, as well as advice and encouragement. 

Girls in FGDs in different locations told researchers that when dorm girls needed information and 

support, they could turn to their dorm teachers and older girls; but girls who stayed with host families 

didn’t have this option. However, this is an area for further exploration and was not adequately 

addressed in the research design. (See Annex 1 for information on dormitory children.) 

Contextual factor 4. Age of girls at menarche 

Younger schoolgirls, under the age of about 13, face more challenges than their older counterparts 

because their scant experience and knowledge is compounded by a lack of information and support 

at school both before and at menarche. Parents, particularly mothers, in many cases do not brief their 

daughters beforehand, assuming that it is too early, or provide very vague information. Therefore, 

the younger girls are when they begin to menstruate, the more fearful and shocked they feel, and 

are too embarrassed to ask for help on such a sensitive topic. 

Contextual factor 5. Rapidly increasing access to information and the media 

Currently, all districts, both rural and urban, have internet connections and electricity. TV was the 

most common media channel that rural children use, mostly to watch movies; there were a few 

health programmes tailored to children. In urban areas, children used the internet more than any 

other media channel; according to a government report, 13 84 per cent of internet users are in the 

capital. 

“There are almost no children in the school who do not have a smart phone and they 

use it all the time getting connected to the internet. With this, children have access 

to different information faster than us and learn new things more quickly than us.” 

(RuralS7_TeachersFGD) 

Until 2016, people living in rural areas, who make up half of Mongolia’s total population, paid four or 

five times more for internet access. For example, Ulaanbaatar residents paid 13,000 MNT per 1 MBs 

of data, while rural residents paid 55,000 MNT for the same access. Recently the Government has 

tackled this inequality with a policy to improve rural internet access. According to the girls, internet 

access is widely available and is a source of useful information. They felt it would be good for 

information on MHM to be available online; this could be a more equitable means of disseminating 

information and sharing knowledge. 

13 The Government orders to charge equal tarrifs for internet service nationwide. 

See more (in Mongolian language) at: http://zasag.mn/news/view/12341. 

17



Challenges girls face 

Challenges were identified through discussions and interviews with girls on their experiences of 

menstruating. Girls also shared stories with researchers, including how they felt physically and 

emotionally, and how their attitudes and behaviour changed as a result of menstruating. These 

challenges are related to education, psychosocial support and the availability of materials or the 

condition of the physical environment, such as WASH facilities. Girls reported how they felt and 

behaved during menstruation, which might be different if they were in a more supportive environment 

(for example, “I wash my cloth when no one is around”; “I feel ashamed”). 

Being unprepared 

Young girls mostly felt stressed at menarche. They had some information, but when it happened, 

they were still scared and felt shocked. Most girls heard about menstruation before menarche, but 

some did not know anything about managing it. 

• “The first time I had my period, I got scared thinking that I might be dying and 

cried.” (Sub-urbanS3_GirlsFGD_2) 

• “When I had a period for the first time, I was frightened, I felt disgusting and 

worried that someone might notice my period.” (AimagS8_GirlsFGD_2) 

• My period is changeable, with irregular intervals, so I don’t carry sanitary pads.” 

(RuralS9_Girls FGD_1) 

Some girls said they were sometimes unprepared because their menstruation was irregular, and no 

sanitary pads were available. 

Hiding menstruation from boys 

Talking about menstruation with or in front of fathers, brothers and other males is still taboo. Therefore, 

at school, boys’ teasing made it stressful and embarrassing for girls to manage menstruation. They 

worried about leaks and stains on their clothes or that boys would notice that they carried pads with 

them. Keeping pads out of sight from boys was a serious concern for girls. 

• “Our biggest fear was that boys would notice we were menstruating.” (AimagS8_ 

GirlsFGD1_2) 

• “Our teacher told us if there’s a stain on the chair, you should clean it before 

boys notice it.” (AimagS6_Girls FGD_2) 

• “We know one case when boys from another class teased a girl who had stains 

on her clothes and the girl looked embarrassed as she was put in a humiliating 

situation.” (Peri-urbanS3_BoysFGD) 

• “Girls worry that boys will search their bags and if they find pads, they will tease 

them, so they try to hide them in a very secure place in their bags or do not bring 

them to school at all.” (RuralS9_ Girls FGD_1) 

18


Fear of leaks, stains and odour 

Girls from urban and rural areas, regardless of whether they lived in dormitories or at home, all 

experienced emotional stress through fear of leaks, stains and possible bad odour while they were 

menstruating at school. 

• “I worry that bad odours will come, therefore I always avoid sitting next to my 

boyfriend in class.” (Peri-urbanS3_GirlsIDI) 

• “There was a case that one day one of the girls asked the teacher for permission 

to take time off from class, but as it was exam term, the teacher did not let her 

go out and all of a sudden, boys started pointing to her and saying that she peed 

in her pants . . . embarrassing.” (Peri-urbanS3_GirlsFGD_2) 

• “When boys were cleaning the classroom after class, they were pushing a chair 

to each other. Then I noticed there were bloodstains.” (RuralS5_Teachers FGD) 

Difficulty in asking for help 

Due to the existing taboo in the community about not talking about menstruation, girls found it 

difficult to ask anyone about anything related to menstruation, except very close friends. They felt 

they could not ask permission to leave the class if teachers was male, or buy pads in a shop if the 

shopkeeper was male or men were present. 

• “Usually we look for support from our teachers, but if the teacher is male, then 

it would be difficult to ask for help.” (AimagS6_GirlsFGD_1) 

• “It’s especially difficult to tell male teachers and ask permission to use the toilet.” 


• “Usually girls approach the school doctor for pads, but the doctor’s budget is very 

limited and not enough to buy three packets of pads, and therefore sometimes 

we buy them with our own money.” (Peri-urbanS3_TeacherFGD) 

Biological challenges 

There were also biological challenges. These include lower abdomen and back pain, headaches and 

sometimes dizziness, though some girls said they didn’t experience any pain. Girls try to ignore the 

pain by wearing tight underwear or by concentrating on something else, like reading, watching 

movies, or playing games, but they don’t take any medicine. 

Irregular periods posed additional challenges for girls, as they came to school unprepared and worried 

more about possible leaks and stains. 

19



Determinants and contributing factors 

Girls and other participants involved in the research identified the main challenges faced by girls who 

are menstruating at school through IDIs, FGDs and KIIs. Participants also shared their thoughts on 

the reasons why girls face such challenges. These determinants that can be summarized as follows: 

1. Inadequate school and dormitory WASH facilities 

2. Knowledge, information and education 

3. Access to emergency materials to manage menstruation 

4. Supportive psychosocial environment 

5. Biological factors 

Determinant 1. Inadequate WASH facilities in schools and dormitories 

Children spend long periods of time at school, and the physical environment and cleanliness of school 

facilities can significantly affect their health and well-being. Good school WASH facilities help to 

create a safe, healthy and comfortable environment where children can learn and thrive, and can help 

to keep them motivated to go to school. 

WASH minimum standard for toilets are not met by most schools 

The Norms and Minimum Requirements for WASH in Kindergartens, Schools and Dormitories adopted 

by the Mongolian Government in early 2015 state that there should be one latrine or toilet available 

for every 30 girls; and one latrine or toilet, plus one urinal, for every 40 boys 14 (see Annex 2). 

Two of the schools selected in Ulaanbaatar (one in the city centre and one of the suburban schools 

in the ger district) had three shifts per day, which means that only one toilet was available for 56–66 

girls per shift. Keeping the toilet clean and well-maintained in this situation was very problematic. 

Among the participating schools, the standard number was met in one of the suburban schools in 

the remote district of Ulaanbaatar and in rural soums where they had smaller numbers of children. 

When the number of school children exceeded the capacity of school buildings and classes, including 

the number of WASH facilities, it was challenging for children to use the toilets during school hours. 

• “The dormitory toilet does not have lights, it’s difficult to think what girls do in 

the dark and how they change pads in such conditions.” (RuralS9_MothersFGD) 

• “The school toilet is separate for girls and boys. But there is no light, no electricity, 

no waste bin, it’s smelly, there’s no door but there are eight cubicles.” (RuralS9_ 

Girls FGD) 

14 Norms and Minimum Requirements for WASH in Schools, Dormitories and Kindergartens, 2015, MoECS, MoF, MoHS. 

20


Comparison of toilet facilities in urban, provincial and rural schools 

Designation. Around 40 per cent of all toilets were used by girls as well as female teachers. 

However, in the rural soum schools, 18 per cent of toilet cubicles were used by both boys and girls. 

Few toilets were locked for teachers’ use only. As mentioned above, rural soum schools mostly had 

simple open pit latrines. Some toilets were locked or non-functional and have therefore been included 

in the ‘unknown’ or ‘not applicable (n/a)’ category (see Annex 3a). 

“School toilets are separate for boys and girls, but there is no sign indicating who 

the toilet is for, therefore I feel uncomfortable about using them, and nervous that 

somebody might come in at any time.” (AimagS8_GirlsFGD_2) 

Functionality. According to the study’s observation data, only 42 per cent of all toilets in the selected 

schools were fully functional, while 14,5 per cent were either non-functional or their status was 

unknown because they were locked. In dorms, only 24 per cent were fully functional, while 15 per 

cent were non-functional (see Annex 3a and 3b). 

In the rural soum schools, almost 40 per cent of toilets were non-functional, but only around 10 per 

cent in the urban schools. So although toilets may exist, they are not fully functional, as they may 

have no doors (or the doors have no locks on the inside), no lighting or waste bins and they do not 

provide a safe and private environment for children, particularly girls. The location of school toilets 

and the availability of window blinds was also critical. Girls from one urban school told researchers 

that they did not like using the toilets on the first floor because the window did not have a blind, 

allowing anyone to peep in from upper floor windows. 

21



Figure 9. Pit latrine in a rural (soum) school (A) compared with flush toilet in an urban school (B) (Figure 10) 

Source: CSWE, Ulaanbaatar 

Cleanliness. Researchers’ observation data show that 65 per cent of urban school toilets were 

hygienic, 15 versus 29 per cent of those in provincial schools, and only 20 per cent of rural schools. 

Almost half of the toilets were evaluated as ‘dirty’ because of bad smells, flies, dirty floors and 

waste bins or rubbish strewn everywhere because there were no waste bins. Therefore, most children 

avoided using school toilets as much as possible and waited until classes were over when they could 

go home, or even to the dormitory as dorm toilets were preferable. Many girls said that the dormitory 

toilet was much better than school toilets. In some case, insanitary WASH facilities led boys and 

younger children to defecate openly. 

Janitors worked in all the rural, urban and provincial schools. They were responsible for keeping 

toilets clean and free of smells and rubbish. School janitors used different cleaning materials and 

disinfectants, including chloramine which is very widespread and commonly used by local people. 

Girls and other FGD participants explained that toilets were sometimes not very clean and smelled 

because, in most cases, very large numbers of children use them, and the ratio of children per 

latrine is high. In addition, janitors locked their designated toilets over the weekend, and sometimes 

unlocked them after classes began. First floor toilets were usually left open over the weekend, and 

as a consequence were the most dirty. 

“The school janitor cleaned the toilet, but it was still not clean because many children 

use it. So we usually do not use school toilet.” (AimagS8_GirlsFGD_1) 

Lights. Over 75 per cent of the rural school pit latrines had no lighting, compared to 5 per cent of 

the urban schools and 25 per cent of the provincial-level schools. This makes it difficult enough for 

girls to use the toilet ordinarily, but even more so if they need to change sanitary pads. Toilets could 

also be risky to use at night. 

15 Defined as in the WASH in Schools Monitoring package as free from smells, visible faeces in or around the facilities, no flies 

or litter. 

22


“It is dark in the dormitory toilet, there are no lights, that’s why we always ask 

somebody to come with us to use the toilet after dark.” (RuralS9_GirlsFGD_2) 

An inside lock is very important for ensuring girls’ privacy. In the rural schools, only 26 per cent of 

toilets had an inside lock, and only 18 per cent of them were working properly, while in the urban 

schools, 81 per cent of toilets had locks, of which 61 per cent were working properly. At the provincial 

schools, 69 per cent had inside locks, with 41 per cent worked properly. 

Most girls felt anxious about having no private space at school to change and wash their clothes or 

change used pads. 

• “Because there is no privacy we usually avoid going to the toilet at school.” 

(RuralS5 _GirlsFGDs_2) 

• “It’s difficult to change napkins because the toilet is open with no lock.” 

(AimagS4_GirlsFGD_2) 

• “I don’t change it at school. I change it at home in the morning. Then I change it 

again when I come back home.” (RuralS9_Girls FGD_2) 

Because of a lack of privacy, girls usually asked their friends to accompany them to the toilet. In 76 

per cent of toilets in the urban schools, girls did not require a friend to assist or accompany them, 

compared with in 44 per cent of the provincial schools. 

“If we have to go to the toilet, we go together with friends, not alone, so that one 

of us will be holding the door.”( AimagS4_Girls FGD_2) 

Rubbish bins are available in 92 per cent of the urban school toilets, 74 per cent of the provincial 

school toilets, and 26 per cent of rural school latrines. The lack of bins discouraged girls from 

changing their pads at school as there was nowhere to dispose of them, which made girls feel 

awkward. From this we can see that children in rural schools and dormitories had no choice other 

than to wrap up used pads and throw them into the toilet or onto the cubicle floor. During FGDs 

it was reported that although most of the urban school toilets had bins, they were often full and 

therefore not usable. 

WASH facilities in urban and provincial schools with indoor flush toilets 

Table 6 shows that 95 per cent of the urban schools had indoor flush toilets, while almost 90 per 

cent of the rural soum schools had simple outdoor pit latrines. 

23



Table 6 Types of toilet facilities for urban, provincial and rural schools 

Observation Response Urban schools Aimag/provincial 

schools 

Categories Categories No. of toilets, 

N=79 

Type of toilet 

facilities 

% No. of toilets, 

N=77 

Soum schools 

% No. of toilets, 

N=65 

Flush toilet 75 95% 65 81% 7 11% 

Pit latrine 4 5% 8 10% 52 80% 

Improved ventilated 

pit latrine 

0 

0% 

Unknown/NA 0 0% 1 5% 1 2% 

Girls were concerned about water pressure in school flush toilets because if the pressure was low, 

they had to wait and flush the toilet several times to ensure all bloodstains disappeared, as they did 

not want the next user to notice. This shows that girls also hide from each other the fact that they 

are menstruating; or that they fear others blaming them for getting blood on the bowl or being 

unhygienic. 

In the rural schools, toilets were not always well separated for boys and girls, particularly in rural 

areas. Sometimes, outdoor school latrines for boys and girls were separated by a simple plank wall 

between toilet cubicles. 

Sometimes school toilets were closed in the evening (when girls may be attending extracurricular 

activities), which means they had to use whatever other toilets were open, even the boys’ toilets. 

3 

4% 

5 

% 

8% 

“Once we wanted to use the male toilet, there was a male teacher peeing.” 

(UrbanS1_Girls FDG+2) 

Figure 11. Outdoor pit latrine 

Provincial school WASH facilities 

The provincial schools had a mixture of indoor 

toilets and outdoor latrines. When there were 

indoor facilities, handwashing areas were close 

to the toilet area which enabled children to wash 

their hands immediately after using the toilet. 

According to the schoolchildren, indoor latrines in 

most cases were locked as the school management 

was concerned about the cost of emptying them, 

so children were forced to use outdoor latrines. The 

condition of outdoor pit latrines in the provincial 

schools was almost the same as in rural schools. 

Source: CSWE 

WASH conditions in rural schools with outdoor simple 

pit latrines 

Most of the rural schools and dormitories had outdoor open pit latrines, which did not provide privacy. 

In most cases cubicles did not have locks or lighting, which meant girls did not feel comfortable 

changing their pads there. The girls’ reports confirm this description. 

24


The condition of school outdoor pit latrines was mostly poor. Often they had no doors to provide 

privacy, were not separate for girls and boys, were dirty and smelly, had no lights, and became 

slippery during the winter because of snow and because it was not possible to clean them in cold 

weather. Figure 11 shows a typical school outdoor latrine. They are easy to use in the autumn, spring 

or early summer, but would not be so in winter as most of them were not insulated or heated. 

In most of the soum schools and dormitories where there was no water supply system, the boys 

were asked to fetch water from wells or reservoirs by truck or yak-drawn cart for both washing and 

drinking. 

Figure 12. Yak cart for fetching water for rural soum school 

Source: CSWE 

A critical reason why schools did not have functioning toilets was that school administrators were not 

sufficiently aware of the importance of good WASH facilities and therefore made their improvement 

a low priority. For example, one soum school celebrated its sixtieth anniversary the year before 

the research study and carried out 60 investment projects through the funds they raised. The only 

thing they did not spend money on was improving the school toilets, though they needed serious 

renovation. In the FGDs, girls said they should be rebuilt, as there was no way to improve the current 

latrines. 

In some schools, one toilet was locked for teachers’ use only, while all pupils, both boys and girls, 

shared the second latrine (see Figure 13). 

25



Figure 13. Comparison of (a) the girls’ and boys’ toilet and Figure 14. (b) the teachers’ toilet at an aimaglevel 

school 

Figures 15, 16: Ideal toilet (Girls’ FGD) 

Source: CSWE 

Ideal toilets 

In all schools, girls shared thoughts on their ideal toilets. There would be separate toilets for boys 

and girls, with locks on the inside, mirrors to check their dresses, hooks for bags and a place to put 

personal items such as phones. Schools would have operational flushing toilets, with sanitary pads, 

toilet paper and soap available inside toilet cubicles; and toilets would be clean and smell-free with 

sinks for handwashing, waste bins and hand dryers (see Annex 4a, 4b, 4c). 

Figure 15, a drawing from a girls’ FGD, highlights that most importantly, toilets should be clean, wellventilated, 

and separate for girls and boys (Peri-UrbanS3_GirlsFGD_2). In the top half of the picture 

girls drew the current latrine door and in the second half a picture of their dream toilet, highlighting 

that there should be enough toilets for the number of children at the school. 

Handwashing in rural schools 

Urban and aimag centre schools mainly had indoor latrines with modern WASH facilities, including 

sinks for hand washing. However, most rural schools and dormitories did not have handwashing 

facilities with soap close to the latrine area. After using the toilet, children had to go back to their 

classroom or to the dormitory living room and use the simple washstand there. 

26


Figure 17. Simple wash stand in a rural school 

Due to the scarcity of water in rural schools, 

schools advised children to use wet tissues 

or hand sanitizers, such as Sanitol, to clean 

their hands after using the toilet or before 

meals. 

A lack of water creates additional challenges 

for personal hygiene in general. 

“There is no space at school 

to wash up when [blood] has 

leaked through clothes.” 


Source: CSWE 

WASH facilities for dormitory girls 

There were no private rooms at school for dorm girls to wash their clothes so they had to use the 

communal laundry room where all children do their washing. They could use small basins in the 

dormitory to wash smaller items, but had to wait until they went home at the weekend or at the end 

of term to wash any bloodstained clothes. The rural school dormitories usually had open pit latrines 

that were often inadequate; conditions were similar to rural school latrines. Showers were available 

for dormitory children but in some instances there was a schedule and students could only use them 

once or twice a week. If they wished, dormitory children could use the community or soum public 

bath or shower. 

Shower facilities in rural school 

All the rural school dormitories (but not the rural schools) were required to have a shower room. 

This requirement was followed in most school dormitories, where, on average, children shower two 

to four times a month during the school year, following a set schedule. But in one of the four rural 

schools the shower wasn’t working due to maintenance problems. In these cases the children used 

the community or soum public bath. 

Determinant 2: Knowledge, information and education 

Throughout the study, researchers asked girls if they knew about menstruation before menarche, 

what kind of problems and challenges they faced, and what information and advice they had 

received and from whom. Responses varied. 

27



Formal school health curriculum does not cover MHM 

Ministerial Decree No. 369, dated 28 September 2011, ruled that health education was to be included 

in the curriculum from the fifth grade and above as a separate dedicated subject for 34–35 hours 

throughout the school year, or one hour per week. There were many topics to cover, but limited time 

was allocated. 

Recently the Government has overturned this decision and, from the beginning of the academic 

year in 2015, health education was integrated into the biology and physical education curricula. For 

instance, for primary classes, ‘People and the Environment’ and ‘People and Nature’ classes included 

topics on health and exercise, the human body, reproduction and development. Biology classes for 

lower secondary students cover human anatomy, biology, the structure of the reproductive organs, 

and fertility. The physical education class includes topics related to proper clothing in different 

weather condition, healthy living, healthy food, exercise and obesity. 16 

As this research was conducted before health was incorporated into the biology and physical 

education curricula, both boys and girls said they learned about puberty and other health-related 

topics in health education classes. These classes started in the fifth grade, when children were aged 

12, and were delivered for one hour per week. 

• “It was taught from the fifth grade, given that menarche has shifted to an earlier 

age.” (RuralS9_HealthTeacher) 

• “The whole topic on puberty was only for one hour. So menstruation was, of 

course, not covered in detail.” (RuralS9_HealthTeacher) 

Girls confirmed that menarche/menstruation was taught briefly under the topic of ‘puberty’. Many 

girls did not remember what they were taught on menstruation, what it was, why it happened and 

how to manage it, while the other groups of girls thought that only very general information was 

given. 

This may have been because boys and girls attended health education classes together, and teachers 

did not want to embarrass students by talking openly about it; and also boys and girls may have felt 

awkward about talking openly about the issue in front of each other. 

• “We get a certain amount of knowledge from health education [classes] such as 

communications, decision-making, preventing pregnancy.” (RuralS9_Girl_IDI_1) 

• “There’s no independent topic on menstruation in the subject of health 

education. It is somehow mentioned generally within another topic. Information 

on menstruation is not provided consistently. Sometimes, basically only one hour 

is given for that information.” (RuralS9_ Health Teacher) 

Some health education teachers noted that it was difficult to teach the subject as time was limited, 

and that health education textbooks were of poor quality. 

However, as reported by schoolgirls and boys, MHM and puberty-related topics were mentioned 

briefly only in the grade 5 curriculum, not in other classes, which had a different focus. Class teachers 

16 ‘Is it a reform to integrate Health with Natural Science?’, 6 February 2015, Zuuny medee: www.Zms.mn; http://www.polit. 

mn/content/59229.htm. 

28


mainly provided information on the biological process of menstruation rather than management and 

hygiene-related issues. 

Girls’ knowledge and understanding of menstruation 

Girls’ knowledge and understanding of menstruation varied. Most young girls learned about 

menstruation before menarche, usually from their mothers or health education teachers. The first 

information they received was very brief and related only to the biological process, the reproductive 

organs and signs of puberty. 

Girls had very vague ideas about why women menstruated, what menstruation was, for how long 

they would bleed and how often it would happen. When they experienced menarche, they felt 

shocked and scared. In some cases, girls were influenced by the traditional beliefs that have been 

perpetuated in the community for many years. For example, when some girls in one FGD explained 

that menstruation was part of puberty and the physiological changes taking place within the body, 

other girls said their mothers and grandmothers had told them that menstruation was “dirty blood” 

leaving the body to purify it. These traditional myths may persist because menstruation is a sensitive 

topic that mothers felt uncomfortable about discussing openly; or because they did not know a 

better way to explain it; or perhaps because this misconception is still very strong. 

• “Dirty blood is drained from the body through menstruation and the body is 

purified as a result of it.” (UrbanS1_school report) 

• “[My mother] said that bad blood is discharged from the body and the period 

starts.” (RuralS9_GIRL_IDI_1) 

It was clearly seen that age contributed to girls’ understanding of menstruation; older girls were 

likely to have more accurate information as they learned how to manage menstruation and shared 

experiences with their girlfriends at school. From girls’ perspectives, when they learned about 

menstruation during health education classes, they had already acquired good management skills. 

Therefore, in their opinion, such education should be given in grades 5 or 6 when menarche might 

be expected to occur. 

Younger age girls didn’t have a clear understanding of menstruation and there was no sense of them 

talking about tracking their periods. Most girls aged 12–13 reported that they did not know how to 

use a calendar to track menstruation, while girls over 14 could predict their periods by looking out for 

physical signs such as backache or lower abdomen pain. However, they observed that after one and 

half or two years of menstruation, their cycle became more regular. For this reason girls preferred 

to have sanitary pads to hand. 

Girls who didn’t know about menstruation were often were unprepared at school and had to borrow 

sanitary pads from friends. Older girls did not feel too embarrassed to ask and to talk about it with 

female school doctors, female teachers and their mothers or sisters. 

During pretesting of the research, one suburban girl in a girls’ FGD told researchers that before 

menarche, she had heard about menstruation and using pads from her mother and sister, but when 

it happened, she did not know how to use the pads correctly, though she later found out from 

watching TV. 

29



Support and information from mothers and sisters 

Mothers were the first people girls approached when they needed help or wanted information about 

puberty and menstruation, even before menarche. Mothers explained to girls what menstruation 

was, at what age it would occur, how to behave, how to take care of personal hygiene and even 

about the use of sanitary pads. 

As noted above, there were cases where mothers gave misguided information regarding 

menstruation, including references like “dirty blood” or “bad blood” to their daughters. A common 

reason for this misinformation is that the negative understanding is based on the knowledge and 

experiences passed down from their previous generations. As such, some girls made their own 

judgements: 

• “The bad blood or ill blood comes out of the body [during menstruation] and 

women’s blood circulates, refreshing the body, therefore women live longer than 

men. Men do not live longer as their blood is not refreshed during their life 

time.” (RuralS7_Girls FGD_2) 

• “I feel sorry for boys because their body keeps the bad blood, poor boys.” 

(piloting FGD in urban school) 

Urban schoolgirls said their mothers emphasized personal hygiene, telling their daughters to wash 

every day when they were menstruating. However, many rural schoolgirls were advised not to wash 

in the river when menstruating (tradition says one should not pollute water in a river, lake or spring 

by dropping blood or milk into them), and some were told by their mothers not to shower frequently 

to prevent infections. 

Girls believed (and were advised by their mothers and sisters) that if they moved about too much 

or did any physical work, their menstrual flow would be heavier and cause leaks. But in one case, a 

doctor strongly advised a girl not to play sports during menstruation without explaining why. Having 

followed this advice for a while, the girl entered a sporting competition, and only then realized that 

extensive physical activities causes a heavy blood flow. 

Apart from mothers, girls learned about menstruation from their sisters, other female relatives and 

friends, and shared this information and their own experiences with friends. Girls with older sisters 

were more likely to hear about menstruation first and tell their friends what they knew. Girls in urban 

schools also learned about menstruation and puberty from social media, including Facebook. 

Boys’ knowledge and support 

Boys’ FGDs were conducted at six of the selected schools. Urban, suburban and rural schoolboys 

from higher grades had attended health education classes and therefore had some awareness of 

menstruation; some had a very scientific understanding because they were studying fertility and 

reproduction as part of a health course. However, during discussions, the boys behaved oddly, 

laughing, looking sideways, and making fun of each other. 

They admitted that they did not know about menstruation when they were younger, and had teased 

the girls about it. 

30


“We’re used to it now, so we don’t tease the girls anymore. If it had been explained 

to us at a younger age, around fifth grade, we would not have teased the 

girls.”(RuralS11_ Boys FGDs) 

In the boys’ FGDs, researchers conducted an exercise to simulate what girls might experience when 

menstruating. Researchers asked boys to imagine how they would feel and react if their elbow 

suddenly started bleeding in the middle of class. Afterwards some boys admitted they felt sorry for 

teasing girls without knowing how difficult it was for them. 

The girls’ greatest fear was that boys would find out that they were menstruating and would tease 

them, and that it would be even worse if leaks caused bloodstains on their clothes. But the highergrade 

boys said that though younger children might do this, boys in high school wouldn’t. Girls 

agreed that by the time boys reached upper grades, they had become more understanding and 

stopped bullying and teasing. In addition, some boys in upper grades ignored the issue as they felt 

it was none of their business. 

“Boys’ attitudes changed when they grew up. They stopped teasing girls and they 

became very supportive and ready to help when girls needed help.” 

(Peri-urbanS2_ Girls FGD_2) 

Support from teachers at school 

Female teachers made up the majority of school teachers, comprising 70 to 90 per cent of all teachers 

in schools (details in Annex 5). 

Therefore, female teachers are the primary adults in the school environment who could provide 

support when girls are menstruating. Girls mostly approached their female teachers and received 

support, for example when requesting permission to leave the class to use the toilet, or asking for 

extra pads. 

“Two girls approached me saying that one of them had a serious problem because 

she has bloodstains in her pants. I took them to the toilet and gave them a sanitary 

pad. And I explained about menstruation and how to use the pad. The second girl, 

who was the friend, was so surprised and asked, ‘that means this will happen to me 

too?’ They were sixth graders.” (Aimag S10_ Teachers FGD) 

Although it was rare, there were a few cases where even female teachers were reluctant to allow 

girls to take a few minutes off from the class, because they didn’t want them to miss an important 

session. Sometimes girls could not explain the reason they needed to use the toilet in front of whole 

class, so teachers assumed it wasn’t serious, and perhaps was just an excuse to leave the class and 

have fun outside. 

31



“Everybody (every woman) menstruates so it is a normal phenomenon. When 

they grow up, as adult women, they cannot be absent from work because they 

are menstruating. Similarly, students cannot be absent from class because of 

menstruation.” (AimagS_10 Teachers FGD) 

Girls thought that unlike most female teachers, male teachers did not understand girls’ situation 

during menstruation and they did not feel comfortable approaching them. This attitude, of both male 

teachers and the girls themselves, has its roots in the existing taboo around menstruation and the 

belief that it should be hidden from all males. 

School and dorm support staff’s lack of awareness 

The schools’ non-teaching staff, including janitors, dorm guards and dorm teachers, also played 

important roles in supporting or not supporting girls during menstruation. Girls of different ages in 

the FGDs said that some school staff were unsupportive. 

• “At night we go to the toilet all together, and after that the door is locked and 

we’re not allowed to go out to pee. The staff member on duty in the dormitory 

locks us in at 5–6 p.m. in winter and at 7–8 p.m. in summer. And they don’t let us 

go out even when we need to go to the toilet.” (RuralS9_GirlsFGD_2) 

• “Sometimes the cleaning lady does the cleaning during the break and doesn’t let 

children use the toilet.” (UB report) 

• “It’s always locked when I try to use it. Sometimes, when it is not locked, the 

cleaning lady scolds us and doesn’t let us in. She says: ‘Go to another toilet. I’m 

cleaning here, what do you want?’” (AimagC4_GirlsIDI_2) 

Determinant 3. Access to emergency materials to manage menstruation 

Lack of easy access to commercial pads at school 

All participants, including girls, mothers, teachers and health professionals, reported that girls used 

exclusively commercial pads during menstruation, except in rare cases when there were none, for 

example in remote rural areas, when girls might use whatever materials were at hand. For instance, 

one girl described visiting her grandmother in a rural area, who advised her to use a cloth instead of 

a pad if she needed one. 

“All girls use commercial pads as girls report to us during their routine check-up of 

girls’ hygiene at schools.” (KII with rural district Adolescent Health doctor) 

School doctors are required to give children a routine health check at least three times a year, including 

a dental check-up, as well as looking at the sanitary condition of classes and schools. As part of this 

32


process they organize discussions, and provide information and advice for children. Doctors working 

with adolescents mention girls’ hygiene here to highlight specific issues related to them. 

Commercial sanitary pads were widely available in all urban and rural shops. However, access to 

sanitary pads at school varied. Urban schools sold sanitary pads in the school shop, so urban girls 

had no problem accessing them, providing they had the money. At the same time, girls confirmed 

that pads in the school shop were more expensive than outside. It should be noted that, in general, 

pads in rural areas were slightly more expensive than in urban areas. Most rural schools did not sell 

pads within the school compound. If girls needed them, they had to leave the compound and buy 

pads in nearby shops, providing they could afford it. If they couldn’t, girls borrowed money from 

classmates, including boys, or asked for pads from school doctors, female teachers or anybody else 

who could help in an emergency. 

Younger girls said that they felt embarrassed about buying pads from male shopkeepers or when 

men were in the shop, and sometimes went to another store with a female shopkeeper, or waited 

until there were no men present. Older girls said that they did not worry about this so much and felt 

free to ask for money to buy pads from even their male classmates 

In case of emergencies at school, girls either kept pads with them or asked friends, teachers or 

doctors for them. In general, girls tried to keep pads secure and well-hidden so they would not fall 

out or be discovered; sometimes boys rifled through girls’ bags looking for extra pens and pencils, 

and if they found pads, they would laugh and tease the girls (urban schools report). 

“In general girls keep pads in their bags for any emergency. In my experience, 80 per 

cent of girls buy them from shops, 5 per cent of them get them from teachers, 10 per 

cent from friends, 5 per cent from the school doctor.”(AimagS10_ GirlsIDI) 

In the girls’ FGDs, some thought that girls staying in dormitories or with host families might not be 

able to obtain sanitary pads because they had no money, as they did not see their parents often. 

However, it should be noted that none of the girls explicitly said this was the case. This research 

included girls in dormitories in the older girls’ FGDs, but because there weren’t separate questions for 

dorm girls and they did not offer this information, it has not been possible to examine the situation 

of dorm girls in detail within this report. 

Also, although girls in FGDs spoke about the challenges that girls with host families might face, 

none identified themselves as living with host families, and therefore it was difficult to explore any 

specific challenges. 

One mother explained that, because of a lack of water or space to wash bloodstained clothes, some 

girls were driven to stealing other girls’ clothes. 

“Because the children in dormitories have no napkins and have no money to buy 

pads, there have been cases where some of them stole and wore my daughter’s 

clothes.” (RuralS9_Mothers FGD) 

Girls staying in dorms were usually from herder families, and were unable to go home frequently and 

therefore lacked parental support. Participants in the mothers’ FGDs thought some parents might not 

be aware that their daughters who were staying in dormitories needed money to buy pads. 

33



Girls chose thin pads 

Girls preferred to wear very thin, small pads, thinking that they were better, more comfortable to use 

and most importantly, less noticeable, so others would not realize they were menstruating. However, 

it should be noted that if girls experienced leaks and stains, these thinner pads may not provide 

enough protection. 

“We choose to buy thin and long sanitary napkins, they allow ventilation. Also they 

should have deodorizers and good absorption capacity.” (RuralS9_GirlsFGD_2) 

Some, but not all girls mentioned using different pads for different purposes. For instance, during 

the night and while at school, they used night pads which are thicker and longer; and at other times 

used thin ones. 

Mother and fathers are willing to buy good quality pads for their daughters 

Girls usually kept a supply of pads at home. Mothers offered practical support to their daughters by 

buying pads whenever they were needed, and explained the pros and cons of different types. Mothers 

confirmed that cost was not the most important factor when buying pads for their daughters. 

Some girls reported that fathers did support their daughters by providing money to buy sanitary 

pads, and even purchased them themselves, though it was rare for fathers to involve themselves in 

these matters. 

• “The price isn’t important, but the quality is. Some napkins cause allergic 

reactions. The thin ones are for girls. Those small pink ones from China are also 

not good. There’s a green one with a very breezy scent. They [the girls] say it has 

deodorizers.- Those smaller and narrower ones, you know. Those are for daily 

use.” (RuralS9_MothersFGD) 

• “Well I didn’t know about these things last year. I was wondering how those 

small ones are used, then my daugther said, ‘Mom, these are nice to use, you 

should use them’. (RuralS9_MothersFGD) 

• “My husband advised me ‘Buy our daughter good quality good pads, I cannot 

do it because she would feel embarrassed with me’.” (AimagS10_TeachersFGD) 

Determinant 4: Supportive psychosocial environment 

School regulations on toilet use 

Not all schools allowed children to use the toilet whenever they needed it. 

Usually, there was only a five-minute break between classes, which gave children just enough time to 

get to the next classroom, but not enough to use the toilet. There was only one longer 10–15-minute 

break during the day and if toilets were crowded, or latrines were located a long way from school 

buildings, not all girls were able to use the toilet or change their pads. 

34


• “We don’t manage to use the toilet during breaks. There is only one toilet for 

boys, one for girls and one for teachers indoors, so break-time is insufficient. 

There is a pit latrine for girls with two pits outside, but it’s still not enough.” 

(AimagS6 Girls FGD) 

• “It is far away from the school building. Even if we run to the toilet, we still don’t 

manage to use it because there’s a long queue.” (RuralS11_ Girls FGD_1) 

Some schools required all children to do physical exercise during the longest 10–15-minute break, 

which leaves less time for using the toilet. 

• “Since girls are not able to use the toilet during break, they have to ask permission 

to go during class. But some teachers let them go to the toilet, some don’t.” 

(RuralS9_GirlsFGD_1). 

• “We are not able to tell our classroom teacher because our class teacher is a 

male” (laughter). (RuralS9_GirlsFGD_2 

As girls explained, they believed that physical activity, such as running and jumping would lead to a 

heavier flow that might result in leaks and stains. Therefore, they tried their best not to attend PE 

classes, giving different excuses and even lying if the teacher was male. 

It was also observed that even when latrines were available, some schools opened them in turn, or 

during class time, and locked them when classes were over. This may be to reduce work for the 

janitor or save funds for maintenance, which also require funds and manpower. 

• “The third break time at school lasts 10 minutes, the longest, and so many 

children want to use toilets, so we have to wait in a very long queue.” (RuralS9_ 

GirlsFGD_1) 

• “While we wait in the queue, break time finishes and so we have to hurry back 

to class. If we are late, the teacher would be angry and ask where we were.” 

(RuralS9_GirlsFGD_1) 

• “The school toilet is always closed during class and open only during break time.” 

(AimagS8_GirlsFGD_1) 

Support at home, in dorms and at school 

At home, most girls confirmed that they received strong support from female members of the family 

and even in some cases from their fathers. This included information, accessing sanitary pads, and 

being released from doing heavy physical work around the house, such as fetching water. However, 

girls who stayed in dorms or lived with host families had less support. Nonetheless, it should be noted 

that girls thought that some might still experience difficulties when menstruating. 

35



“In schools on the outskirts of the city, more than 45 per cent of the students are 

from low-income families, the children of mine workers, and some parents can’t 

afford sanitary napkins for their daughters. Girls from such families are quiet, not 

confident, feel weak.” (Peri-urbanS3_Girls FGD_report) 

Though nowadays children are becoming more open than older generations, many girls still did not 

talk about menstruation-related topics with their fathers and brothers. 

Girls living in dormitories received emotional and material support from the classmates, friends and 

dormitory teachers. However, as their parents lived far away, these girls lacked cash and found it 

difficult to buy pads; girls living with the host families encountered similar problems. In these cases, 

girls borrowed money or pads from their friends. 

Determinant 5: Biological factors 

Biological factors include the age of menarche, frequency of menstruation and painful symptoms. 

From the stories girls shared with researchers, the age of menarche ranged from 9 to 14 years of age. 

Younger girls were more vulnerable because they had not yet learned about menstruation and were 

still learning to care for themselves. First experiences of menarche are described in the girls’ stories; 

all shared the same fear, stress and shock. 

Irregularity is one of the contributing factors to leaks and stains. Particularly in the early stages, girls’ 

menstrual cycles are not regular and the flow is also not always consistent. Because girls did not 

know when to expect their periods, they went to school unprepared, though older girls reported that 

they carried sanitary pads in their bags when their period was due. 

Girls reported that they began menstruating between the ages of 10 and 14, but most mothers and 

teachers expected it would be later, at 13–15 years of age. 

“It has changed nowadays, it [menstruation] begins earlier than in our time. It began 

at 14 in my daughter. In our time, it started at 15 and 16.” ( RuralS9_MothersFGD) 

In general, physical changes and especially height were different in rural and urban girls. In rural areas, 

especially in soums, girls tended to be shorter than urban teens. It would therefore be worthwhile 

segregating data and information on adolescents’ growth and the speed of the process into urban 

and rural groups, and further studying the issue in depth. 

Mothers also assumed that teachers would advise girls on managing menstruation, while teachers 

expected mothers to do this. Some mothers did not teach their daughters about sanitary pads 

because they assumed they already knew about them from school or elsewhere. 

36


Impacts on and risks to education and health 

The challenges girls face during menstruation may impact on their health and education and pose 

risks. ‘Voiced impacts’ are the impacts that girls, mothers and teachers mentioned during interviews 

as negatively affecting girls’ health and education at school, as well as their behaviour, as expressed 

in the participants’ own words. 

Voiced impacts 

Voiced impact 1. Physical symptoms of menstruation 

Some of the challenges girls experienced during menstruation included abdominal cramps and back 

pain as well as general weakness and lowered levels of activity. They felt uncomfortable and could 

not sleep well because they were worried about leaking and staining the bed linen, which meant they 

felt exhausted in class the next day. 

“Girls worry and can’t even sleep calmly at night. We have to sleep on one side or 

another without facing up worrying that it may leak.” (AimagS4_ Girls FGD_2) 

Voiced impact 2. Taking time off from classes, particularly PE 

Girls and teachers reported that girls frequently left the classroom to use the toilet and that in 

particular they missed PE when they were menstruating. Girls said that it was very difficult to 

participate in PE when they had their periods, as they feared leaking if they ran, jumped or exercised. 

Also, most girls were advised not to run when menstruating. 

If PE teachers were male, girls felt embarrassed and avoided asking their permission to leave the class. 

• “Girls skip physical training once a month.” (AimagS10_Teachers FGD) 

• “If I need to change a pad in the middle of the class, I would request leave from 

the teacher and go home.” (Urban school report) 

• “Sometimes I have to lie to leave a class to change pads. I would say that I had 

something urgent at home.”(RuralS9_GirlsFGD_2) 

Girls left classes from time to time, and sometimes even had lie in order to use the toilet, change 

their pads or because of abdominal pain. 

Voiced Impact 3. Reduced concentration and class participation 

When girls were menstruating, they were less inclined to participate in class and less able to concentrate. 

They did not like being asked to stand in front of the class to answer teachers’ questions, as they 

feared movement might cause leaks or exposing potential stains. Because they were preoccupied with 

these anxieties, they found it difficult to pay attention to what was going on in class. 

37



• [talking about a hypothetical girl] “All the time at school, she spends worrying 

about her trousers. She cannot ask the teacher for time off, and she cannot skip 

lessons, so she spends the day just sitting, immovable. This reduces her ability to 

concentrate . . . on the subject.” (RuralS9G_FGD_1; S9_GirlsFGD_2) 

• “She takes one of the back seats.” (RuralS11_Girls FGDI_1) 

• “Unable to concentrate on the topic of the lesson.” (RuralS11_GirlsFGD_2) 

• “I worry about leakage so much that I frequently stand up and check if my chair 

is stained.” (Peri-urbanS2_GirlsFGD) 

• “I once forgot to bring sanitary napkins into school. That day we had seven hours 

of classes. During the last hour, I had a terrible feeling that I was about to leak 

and stain the chair. . . . Eventually I worried so much that I got up from the chair 

from time to time. While walking back home, I was worried all the way, wishing 

I wouldn’t leak before I reached home. That day was a dreadful one. That’s a 

terrible memory.” (Peri-urbanS2_GirlsIDI) 

Voiced impact 4. Withholding urine 

“Because access to the girls’ toilet was poor and it was closed at 17:00, we had to go 

to the male toilet. There had been cases [where a girl’s had to face] a male person 

there, especially a male student, and gets embarrassed and frightened.” (UrbanS1_ 

GirlsFGD_2) 

Classes usually took place between 8 a.m. and 7 p.m. However, school janitors finished work at 

around 5 p.m. and after cleaning the toilets they locked the doors and left. This meant that children 

who took part in extracurricular activities did not have access to school toilets until the next morning. 

This often happened in urban schools with indoor flush toilets. In some cases, half of the toilets, 

either the boys’ or the girls’, were closed while the other half were open during and after school 

hours. 

“The rural school dormitory outdoor latrine was located far from the dormitory and 

in winter time or at night, [girls] asked their friends to go out together or asked the 

dormitory teacher to accompany them to the toilet.” (RuralS9_ GFGD_2) 

Because of these conditions and to avoid using unhygienic and cold facilities, girls tried their best not 

use toilets when needed and withheld urine as much as they could. However, it should be noted that 

avoiding urination and defecation while at school seems common for both girls and boys because of 

the lack of adequate toilets. 

38


How girls felt before and after menarche 

Girls participating in the FGDs discussed the changes they had experienced after menarche. They 

were organized into groups and after some discussion decided to draw or make a list of the things an 

imaginary, ‘ordinary’ girl would experience both before and after menarche (see Figures 18 and 19). 

Girls’ experiences before and after menarche 

Before menarche: 

Happy, friendly and open Active, loved to run, jump 

and play sports Liked to travel around with their 

families, visited relatives, could stay away from home 

Could wear any clothes they liked Were careless, did 

not worry about anything, open and straightforward 

Could play with boys Did not take care of themselves 

Figures 18, 19. Girls before and after 

menarche 

After menarche: 

Felt nervous, uncomfortable and distracted, their 

attention only on menstruation Became worried, 

irritable, shy, lonely and quiet Avoided interacting with 

boys, liked to sit at the back of the classroom Did not 

like to make sudden movements, jump or dance with 

friends Had back and stomach ache when menstruating 

Did not like to travel anymore or spend the night 

away from home at a camp or at relatives’ Started 

paying more attention to what to wear, how they look 

Preferred to wear dark clothes, trousers, rather than 

skirts Became more conscious of their appearance 

and how they behave and talk to others, esp. boys 

Became more open with other girls as they shared the 

same experience Cared more about cleanliness and 

hygiene, started washing their clothes more frequently 

Source: S6_GirlsFGD_1 

Potential risks/potential health impacts 

Risk 1. Lower academic performance and sporting achievements 

Girls’ poor concentration in class when they are menstruating means they miss lesson content. This 

could affect how well they perform in exams and lead to lower academic achievements. 

Similarly, limiting movement during menstruation and being frequently absent from PE classes could 

also reduce their sporting achievements. 

Risk 2. School drop out 

Boys frequently tease girls when they are menstruating, causing the girls great embarrassment and 

feelings of shame, which may even lead to them dropping out of school. 

39



“There has been a case where a girl was ridiculed by boys when [blood] leaked 

through her clothes and she had to change her school.” (AimagS10_Girls FGD_2) 

Boys’ teasing and bullying seems to be a big problem in schools, with girls afraid that boys will notice 

they are menstruating or carrying pads in their bags. However, male teachers do not have enough 

knowledge or skills to talk to boys or girls about the issue and are even reluctant to support girls 

or stop the boys teasing. Unfortunately, if boys don’t understand that this is unacceptable, either 

during menstruation or at any other time, there is a danger this behaviour could escalate, making 

girls dislike and even drop out of school, lose their self-esteem and self-confidence, and even cause 

mental problems. 

During boys’ FGDs, they were taken through a simulation exercise and asked to imagine what it 

would be like to menstruate. One of the boys said, “I’m embarrassed that I laughed at the girls. Now 

I feel sorry for girls” (in a peri-urban area during pretesting). This demonstrates the importance of 

making boys more aware of the situation. 

Risk 3: Negative impact on girls’ physical and emotional well-being 

Hiding menstruation, not being able to discuss it openly with people close to them, constantly feeling 

stressed, fearful and anxious can impact on girls’ physical and emotional well-being. 

Many girls when menstruating keep themselves apart from others because of their fear of odour, 

leaks and stains and that others will notice that they are menstruating. This could affect girls’ selfesteem 

and self-confidence and they may end up becoming lonely, isolated and unsociable. In 

addition, inadequate, unhygienic toilets can spread infection and disease among children, and in 

particular, girls. 

As reported, many girls tried their best not to use unsatisfactory sanitation facilities and instead 

withheld urine for many hours until they got home. This could also have negative consequences for 

girls’ health, leading to Urinary tract infections. 

Summary of the key findings 

Figure 20. Different socio-ecological levels 

The challenges girls faced during menstruation occur at different socio-ecological levels, as grouped in 

Figure 20. 

40


Societal level: Recently the Government has made tremendous efforts to improve WASH facilities in 

schools so that children can learn and reach their full potential in a child-friendly environment. Most 

notable is the key policy document, the Norms and Minimum Requirements for WASH in Schools, 

Dormitories and Kindergartens, which was approved in 2015 with the active support of three key 

Ministries (MoECS, MoHS and the Ministry of Finance). All national and sub-national government 

authorities have started working to implement these Norms and Minimum Requirements, and some 

provincial and district-level governments have already been allocating funds from national and local 

development budgets to improve school WASH facilities. However, not all government good will was 

realized in terms of school WASH facilities and the responsible agencies and the local government 

were not eagerly allocating funds to this very important sector. Even when funds were allocated, the 

amount was often meagre compared to the need. 

The existing taboo on menstruation influences people’s perception and behaviour. Many people, 

including parents, teachers, community members and schoolgirls themselves, tried their best to hide 

anything related to menstruation from others, and particularly from men and boys. Boys teased girls 

if they found out that they were menstruating. 

Environmental level: Not all school WASH facilities were adequate to meet the needs of girls in 

managing menstruation in a private and comfortable environment, without fear and embarrassment. 

In particular, rural school WASH facilities were in need of infrastructure improvement and maintenance 

through long use. 

Interpersonal level: Due to their low level of knowledge about managing menstruation, girls 

often felt stressed and isolated themselves from others, sitting at the back of the classroom, not 

participating in school activities with other children, and trying to minimize their movements through 

fear of triggering heavy bleeding. Girls tried hard to prevent others, particularly boys, from noticing 

that they were menstruating and did not talk about it with anyone except their mothers or very close 

friends. There was a common understanding that menstruation should be strictly hidden from males, 

an understanding was very strong among girls. 

Personal level: At a younger age, girls had very little knowledge of menstruation and how to 

manage it, relying mainly on their mothers’ and sisters’ advice. Girls became anxious and irritable as 

they worried about how to handle menstruation, including their lack of knowledge about the quality 

of pads, and they did not sleep well as they worried about staining the bed linen or clothes. Most girls 

felt things had been much better before menarche, that they were happier, braver and more active. 

Biological level: Girls experienced back pain, stomach cramps and sometimes dizziness and tiredness 

during menstruation, but most did not know how to manage these symptoms. Some took medicines, 

but most tried to relieve the pain by focusing on other things or wearing tight underwear to minimize 

it. The irregularity of menstruation was also quite challenging, particularly for younger girls. 

41



RECOMMENDATIONS 

1. RECOMMENDATIONS FROM PARTICIPANTS 17 

WASH facilities: 

• There is a pressing need to install as many indoor toilets as possible on each floor of a school 

or dormitory building. They should have locks, good lighting, mirrors, hand dryers, soap, toilet 

paper, and a waste disposal bin. In addition, it would be good to set up a drawer in the toilets 

containing sanitary pads. 

• Handwashing facilities should be close to the toilet so children can wash their hands immediately 

after using it. 

• A separate space or room in the school compound for emergency use and equipped with a 

mirror, chair, shelves and skirts would enable girls to change or wash dirty clothes, and would 

really help relieve girls of some of the stress of menstruation. 

• Toilets should be clean and well-maintained, and renovated when necessary. 

Children’s participation: 

• The school administration should encourage the participation of schoolgirls and boys in 

planning, implementing and monitoring school WASH activities through organizing school 

campaigns or regular child-led activities at school. 

Knowledge and information: 

• Teachers’ awareness and understanding of the challenges girls face should be increased, 

especially that of male teachers, by providing them with special training. 

• Male teachers could play an important role by becoming role models for boys, learning and 

sharing information with them and talking to them about menstruation related-issues. This 

would help boys understand and stop bullying girls. 

• Schools could plan and carry out awareness-raising campaigns for teachers, parents, boys and 

girls on managing menstruation. 

• A crucial step forward would be to develop communications on positive MHM experiences 

and MHM support for girls, such as posters, newsletters, online training or video clips, and 

to disseminate them to community members, parents, school doctors and education sector 

workers. 

• As children in all rural schools have access to and use the internet widely, MHM-related 

information could be developed and disseminated through this channel. 

17 See Annex 6. 

42


Access to sanitary pads: 

• To improve access to sanitary pads, schools could sell them or establish a system to provide 

emergency pads using the school’s internal budget. 

School doctors’ and dormitory teachers’ roles and responsibilities: 

• School doctors should be actively involved and provide support in improving school WASH 

facilities to meet the standard requirements, strengthening the awareness and understanding 

of school workers, teachers (including male teachers) and boys, developing the communications 

mentioned above, and providing advisory services. 

2. RECOMMENDATIONS FROM RESEARCHERS 

National level: 

• It is important for the Government to prioritize mobilizing all possible efforts to implement the 

Norms and Minimum Requirements for WASH in Schools, Dormitories and Kindergartens, along 

with other developmental programmes. WASH facilities are a basic human need that relates 

closely to the issue of respecting girls’ human dignity and greatly affects their educational 

achievements. 

• A key developmental issue in coming years would be to carry out a nationwide campaign 

to increase the awareness of decision-makers, planners and staff in governmental and nongovernmental 

organizations, as well as the general public, of the need to prioritize improving 

WASH facilities, particularly in schools, dormitories and kindergartens. This is particularly 

important, given the fact that it will help to raise physically and mentally healthy children, vital 

for the development and future of Mongolia. 

• Based on careful analysis of the content of the previous health curriculum, new content 

should be developed and introduced as part of the school curriculum (both in formal and nonformal 

settings) focusing on the practical needs of schoolchildren, particularly covering girls’ 

specific needs (MHM), healthy behaviour, healthy eating and the principles of healthy living. 

• Health teachers and school doctors need to be trained and retrained on the health curriculum’s 

new content and the correct health messages for children. 

• It is crucial to put maximum effort into developing and disseminating information on 

menstruation and hygiene to the wider public, including teachers and parents, to increase 

awareness. The internet could be a more equitable means to disseminate information and 

share knowledge widely, from government officials to local people, including schoolgirls, 

boys, teachers and parents. 

• Key WASH in school indicators should be included in the Education Management and 

Information System (EMIS) reporting system and regularly monitored by stakeholders, involving 

the main users at national, sub-national and local levels to improve school WASH facilities. 

These indicators could be key criteria for selecting schools for the Best Schools award. 

43



• More women should be promoted to school management positions, in particular to school 

director posts. As researchers observed, the condition and maintenance of WASH facilities 

were much better in the schools with female directors. This hopefully should not pose any 

difficulties in Mongolia, where the majority of teachers are female, though currently, most 

school directors are male. 

Sub-national level: 

• Aimag and soum governments need to prioritize improving WASH facilities in schools, 

dormitories and kindergartens and make all efforts to establish model WASH facilities as 

per the Norms and Minimum Requirements on Water, Sanitation and Hygiene in Schools, 

Dormitories and Kindergartens. 

• Aimag and soum governments and members of the citizens’ representative khurals should 

prioritize and focus more on planning and allocating the necessary budget from Local 

Development Funds or on raising funds by any other means to improve WASH facilities in 

kindergartens, dormitories and schools, in consultation with aimag/soum residents. 

School level: 

• School management teams should focus on improving MHM facilities in schools and increasing 

the awareness and understanding of girls’ specific needs among male teachers, boys, and 

school support staff (including dorm staff and janitors). 

• Teachers and children themselves could be key players in monitoring and reporting the progress 

of WASH access in their own schools. Child-led monitoring could play a vital role in this area. 

• School management should make sure that in school WASH facilities all toilet doors are lockable 

to ensure privacy for children when using toilets, the washroom, and when showering. 

• Schools should set up a system that provides girls with easy access to sanitary pads at school 

during school hours. This could be a small shop, the school doctor, or a special room for girls 

– whichever is most convenient for girls – and could be organized as a local initiative by dorm 

or class teachers. 

44


REFERENCES: 

1. United Nations Children’s Fund, WASH in Schools Monitoring Package, UNICEF New York, 

April, 2011 

2. Norms and Requirements for Water, Sanitation and Hygiene for Kindergarten, Dormitory 

and School, MOECS, MOF, MOHS, 2015, Ulaanbaatgar 

3. Monitoring Package of Norms and Requirements for Water Sanitaton and Hygiene for 

Kindergarten, Dormitory and School, MOECS, MOF, MOHS, 2015, Ulaanbaatar 

4. Analysis of the Situation of Children in Mongolia, UNICEF, 2014, Ulaanbaatar 

5. WASH in School: Empowers Girls’ Education in Rural Cochabamba, Bolivia, An Assessment of 

Menstrual Hygiene Management in Schools 

6. UNICEF, Economic Impacts of Sanitation in Mongolia (2011) 

7. SISS (MICS, 2013, Social Indicator Sample Survey, Mongolia 

8. Millennium Development Goals Implementation, The Fourth National Report, Summary,2011 

9. Achieving Millennium Development Goals, Fifth National Progress Report, 2013 

10. https://populationpyramid.net/mongolia/2016/ 

11. “WASH in Schools, Empowers Girls’ Education, Tools for Assessing Menstrual Hygiene 

Management in Schools”, UNICEF, Emory University 

12. http://zasag.mn/news/view/12341. 2016-03-02 14:54. http://zasag.mn/news/view/12341 

13. Is it a reform to integrate health with Natural Science? 6 Feb,2015. Zuuny medee. www.Zms. 

mn&http://www.polit.mn/content/59229.htm 

14. WASH in Schools, Empowers Girls’ Education, Proceedings of the Menstrual Hygiene 

Management in Schools Virtual Conference, 2013, Columbia University, UNICEF, 

15. WASH in Schools, Empowers Girls’ Education: An Assessment of Menstrual Hygiene 

Management in Schools, Emory University, Center for Global Safe Water, UNICEF 

16. Education, Science Sector Policy Reform, 1999-2014, Ulaanbaatar, 2014 

17. Field Guide: The Three Star Approach for WASH in Schools, GIZ, UNICEF, 2013 

18. Modules, WinS4Girls E-Course, Emory University, 2015 

45

ANNEXES: 

ANNEX 1. NUMBER OF STUDENTS IN DORMS IN THE STUDY SCHOOLS 

School 

code 

School location & 

region 

Total students 

of which in dorms 

% of students in 

dorms 

S1 Urban 2,640 n/a n/a 

S2 Urban 2,975 n/a n/a 

S3 Suburban 1,426 91 6.4% 

S4 Gobi aimag 1,057 100 9.5% 

S5 Gobi soum 1,100 84 7.6% 

S6 Eastern aimag 274 28 10.2% 

S7 Eastern soum 584 116 19.9% 

S8 Western aimag 1,059 n/a n/a 

S9 Western soum 613 110 17.9% 

S10 Khangai aimag 760 n/a n/a 

S11 Khangai soum 512 110 21.5% 

46

ANNEX 2. WASH STANDARDS FOR GIRLS’ TOILETS IN THE SELECTED SCHOOLS 

Region Level No.of shifts No. of 

students, 

categories 

No.of students 

No. of 

toilets 

No. of female 

students 

No. of 

toilet seats 

for girls* 

No. of girls per 

toilet per shift 

The standard 

met or not met 

UB city 3 Over 2,001 2,640 19 1,489 6+3/2 66 Not met 

UB ger district 3 Over 2,001 2,975 24 1,524 18/2 56 Not met 

UB remote 

district 

2 1,001–2,000 1,426 29 726 23 16 Met 

Gobi aimag 2 1,001–2,000 1,057 18 552 9 31 Not met 

Gobi soum 2 1,001–2,000 1,100 16 558 6 47 Not met 

Eastern aimag 1 Up to 500 274 7 134 3 45 Not met 

Eastern soum 2 501–1,000 584 6 280 2 70 Not met 

Western aimag 2 1,001–2,000 1,059 12 525 6 44 Not met 

Western soum 2 501–1,000 613 15 302 8 19 Met 

Khangai aimag 2 Up to 500 380 24 372 11 17 Met 

Khangai soum 2 Up to 500 254 18 268 5+8/2 15 Met 

* seats for 

girls+all student/2 

47

ANNEX 3A. SUMMARY OF OBSERVATIONS OF SCHOOL TOILETS AND WASH FACILITIES 

Observation Response UB aimag soum 

categories categories No. of toilet 

seats, N=79 

per cent No. of toilet 

seats, N=77 

% No. of toilet % 

seats, N=65 

1. Designation For girls 32 41% 34 43% 24 37% 

For boys 17 22% 35 44% 23 35% 

For all students 3 4% 0 0% 12 18% 

For female teachers 1 1% 0 0% 2 3% 

For male teachers 1 1% 0 0% 2 3% 

For all teachers 5 6% 2 3% 1 2% 

Unknown/ n/a 20 25% 6 8% 1 2% 

2. Type of toilets Flush toilet 75 95% 65 81% 7 11% 

Pit latrine 4 5% 8 10% 52 80% 

Improved ventilated pit latrine 0 0% 3 4% 5 8% 

Unknown/ n/a 0 0% 1 1 2% 

3. Functionality Functional 53 67% 30 38% 13 20% 

Semi-functional 17 22% 23 29% 22 34% 

Non-functional 8 10% 23 29% 25 38% 

Unknown/ n/a 1 1% 1 1% 5 8% 

4.Cleanliness Clean 51 65% 23 29% 13 20% 

No so clean 16 20% 41 51% 15 23% 

Dirty 5 6% 8 10% 31 48% 

Unknown 7 9% 5 6% 6 9% 

5.Lighting Lit 50 63% 56 70% 8 12% 

Not well lit 18 23% 0 0% 2 3% 

Dark 4 5% 19 24% 49 75% 

Unknown/ n/a 7 9% 2 3% 6 9% 

6.Lock inside Yes, can be locked 48 61% 33 41% 12 18% 

Yes, but can’t be locked 16 20% 22 28% 5 8% 

No locks 8 10% 14 18% 42 65% 

Unknown/ n/a 7 9% 8 10% 6 9% 

48

Observation Response UB aimag soum 

categories categories No. of toilet per cent No. of toilet % No. of toilet % 

seats, N=79 

seats, N=77 

seats, N=65 

7. Lock outside Yes, can be locked 74 94% 24 30% 16 25% 

Yes, but can’t be locked 0 0% 18 23% 0 0% 

None 0 0% 34 43% 47 72% 

Unknown 5 6% 1 1% 2 3% 

8. Assistance of 

friend NOT required 

Yes 60 76% 35 44% 42 65% 

No 8 10% 38 48% 21 32% 

Unknown 11 14% 4 5% 2 3% 

9. Rubbish bin Yes 73 92% 59 74% 17 26% 

No 6 8% 18 23% 48 74% 

10. Toilet paper Yes 2 3% 5 6% 7 11% 

No 77 97% 72 90% 58 89% 

11. Access for disabled 

Yes 0 0% 1 1% 0 0% 

No 79 100% 76 95% 65 100% 

ANNEX 3B. FUNCTIONALITY OF THE DORM TOILETS SEATS 

SchoolCode Fully functional* Semi-functional** Non-functional*** total 

3.9_Urban 7 0 0 7 

4.9_Provincial 0 8 0 8 

5.9_Rural 0 0 4 4 

6.9 Provincial 0 8 0 8 

7.9_Rural 1 4 1 6 

Total 8 20 5 33 

24% 61% 15% 100% 

49

ANNEX 4A. IDEAL FUNCTIONAL TOILETS COMPARED WITH CURRENT SITUATION AT URBAN SCHOOLS 

School Location urban schools 

School code School S1 School S2 School S3 

FGD age/gender Girls aged 12–13 Girls aged14+ boys Girls aged 12–13 Girls aged 14+ Girls aged 12–13 Girls aged 14+ 

functional toilet characteristics ideal now ideal now ideal now ideal now ideal now ideal now 

1 rubbish bin √ + √ + √ + √ + √ X 

2 inside lock √ X √ X √ X √ X 

3 separate for boys and girls √ + √ X √ X √ √ X √ + 

5 mirrors √ X √ + √ + √ X √ + √ X 

6 clean √ X √ X √ X √ X √ X √ X 

7 place to put belongings √ X √ X √ X √ X 

8 lights √ X 

9 hooks √ X √ X √ X 

10 no smells √ X √ X √ X √ X 

11 air circulation or window opens √ + √ X √ X √ X 

12 sanitary pads available √ X √ X √ X √ X √ X √ X 

13 chlorine disinfectant √ X 

14 handwashing facilities + √ √ + + 

15 hand dryer √ + √ + √ √ X + 

16 toilet paper and soap √ X √ X √ X √ X √ X 

17 info board √ X 

18 flush operational √ X √ X √ X √ X 

19 available on every floor √ + √ X 

50

ANNEX 4 B. IDEAL FUNCTIONAL TOILETS COMPARED WITH CURRENT SITUATION IN PROVINCIAL SCHOOLS 

School Location aimag/provincial schools 

School code School S4 Gobi School S6 Eastern School S8 Western School S10 Khangai 

FGD age/gender Girls 12-13 yrs Girls 14+yrs Girls 12-13 yrs Girls 14+yrs Girls 12-13 yrs Girls 14+yrs Girls 12-13 yrs Girls 14+yrs 

functional toilet characteristics ideal now ideal now ideal now ideal now ideal now ideal now ideal now ideal now 

1 rubbish bin √ + √ + √ √ X 

2 inside lock √ + √ X √ + √ X √ X √ X 

3 separate for boys and girls √ X NA NA NA NA NA NA NA 

5 mirrors √ √ X √ + √ X √ X √ X 

6 clean √ X √ X √ √ X √ X √ X 

7 place to put belongings √ X √ X √ X √ X √ X √ X 

8 lights √ X √ X 

9 hooks √ X √ X √ X √ X √ X √ X 

10 no smells √ X √ X √ X √ X √ X 

11 air circulation or window opens √ + √ X √ X √ X √ X 

12 sanitary pads √ X √ X √ X √ X √ X √ X √ X 

13 disinfectant √ X √ X √ √ X √ X √ + 

14 handwashing facilities √ + √ X √ X √ X 

15 hand dryer √ X √ X √ + √ X √ X √ X 

16 toilet paper and soap √ X √ X √ X √ X √ X √ X √ X √ X 

17 info board √ X √ X √ X √ X 

18 flush operational √ X 

19 available at every floor NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 

20 enough space √ X 

21 operational all the time √ X 

23 with CCTV camera √ X 

51

ANNEX 4C. IDEAL FUNCTIONAL TOILETS COMPARED WITH CURRENT SITUATION IN RURAL SCHOOLS 

School Location soum level rural schools 

School code School S5 Gobi S5 School S7 Eastern School S9 Western School S11 Khangai 

FGD age/gender Girls 12–13 Girls aged 

14+ 

Boys Girls aged 

12–13 

Girls aged 

14+ 

Girls aged 

12–13 

Girls aged 

14+ 

Girls aged 

12–13 

Girls aged 

14+ 

functional toilet characteristics ideal now ideal now ideal now ideal now ideal now ideal now ideal now ideal now ideal now 

1 rubbish bin √ X √ X √ X √ X √ X 

2 inside lock √ X √ X √ X √ X √ X √ X √ X √ X 

3 separate for boys and girls 

4 inside lining/can’t be seen √ X √ X √ X √ X √ X 

5 mirrors √ X √ X √ X √ X √ X √ X 

6 clean √ X √ X √ X √ X √ X √ X √ X 

7 place to put belongings √ X √ X √ X 

8 lights √ X √ X √ X √ X √ X √ X 

9 hooks √ X √ √ X 

10 no smells √ X √ X √ X √ X √ X √ X 

11 air circulation or window opens √ X √ X √ X √ √ X √ X 

12 sanitary pads √ X √ X √ X √ X √ X √ X √ X 

13 disinfectant √ X √ X √ X 

14 hand washing facilities √ X √ X √ X √ X √ X 

15 hand dryer √ X √ X 

16 toilet paper and soap √ X √ X √ X √ X √ X √ X 

17 info board √ X √ X √ X 

18 flushing NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 

19 on every floor NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 

20 enough space √ X √ X √ X 

52

ANNEX 5. NUMBER OF TEACHERS FOR THE PARTICIPATING SCHOOLS, BY GENDER 

School code Region Location Total no. of 

teachers 

No. of male 

teachers 

No. of female 

teachers 

Percentage of female 

teachers 

S1 Urban city centre 99 12 87 88% 

S2 Urban suburban 131 14 117 89% 

S3 

Urban 

remote 

district 74 16 58 78% 

S4 Gobi aimag 66 15 51 77% 

S5 Gobi soum 60 12 48 80% 

S6 Eastern aimag 17 4 13 76% 

S7 Eastern soum 31 9 22 71% 

S8 Western aimag 66 10 56 85% 

S9 Western soum 34 6 28 82% 

S10 Khangai aimag 52 10 42 81% 

S11 Khangai soum 33 7 26 79% 

53

ANNEX 6. SUMMARY OF RECOMMENDATIONS FROM THE PARTICIPANTS. 

Determinants 

Recommendations for schools and school administrators 

Girls, aged 

12–13 

Girls, aged 

14+ 

Boys aged 14+ 

Teachers 

Mothers 

School administrators 

School 

WASH 

facilities 

improved 

Create 

supportive 

psycho 

social 

environment 

• Sufficient number of toilets segregated for girls and boys 

are built, renovated 

• Toilets ensured privacy for use by girls 

• Each toilet booth had locks from inside, good lighting, mirrors, 

hand dryers, soap, toilet paper rolls 

• Each toilet booth had a waste bin 

• A hand wash stand installed close to toilet area to enable 

children wash their hands immediately after use of toilets 

• Had a drawer inside the toilet booth that keeps sanitary 

pads for girls 

• A separate room is established in school and dormitory for 

girls to change and wash their clothes in case of need 

• Toilets are kept and maintained clean at all time 

• Timely renovation of school toilets is ensured 

• School campaign, school wide activities on MHM, monitoring 

of WASH facilities conducted by child-led organizations 

are fully supported and encouraged by school management. 

Understanding the girls special needs and the support to them 

increased through involving teachers, particularly male teachers 

and boys in sensitization training on the topic so that the male 

teachers became roles models for boys and boys stop bullying 

girls 

Teachers should allow girls to use the toilet whenever they need 

School budget should include the cost of napkins. The education 

sector budget is allocated by budget lines. If some money 

is saved on fuel costs, then it would be taken back. Instead 

this money should be given to WASH improvements 

S4 

S1, 

S4, 

S5, 

S9, 

S7, 

S11, 

S10 

S1 

S9 

S1, 

S2, 

S3, 

S4, 

S10 

S11, 

S5 

S9, 

S7 

S9 S11 S10 

S9 

S9 

54

Strengthen 

the 

knowledge, 

information 

and 

education 

of 

all 

Improve 

an access 

to emergency 

menstrual 

management 

materials 

Biological 

factors 

Dedicated health subject continued and included in the curriculum 

and taught separately to boys and girls. Children are 

equipped with scientific knowledge on MHM 

Handouts or booklets for girls should be of practical use, not 

too much theory, easy to read based on real stories or experiences. 

The IEC materials to include how to keep a calendar 

and how to deal with menstrual cramps, whether should use 

tablets when it is painful, why it disappears for two or three 

months and then starts again and if it is possible to stop it 

Also handouts for girls should include information about what 

napkin is, how to use and how often to change napkins, how 

to take care of themselves etc. 

Handouts can be prepared as brochures. Recommendations 

can be disseminated via the internet and brochures to school 

children, boys and girls 

Schools should be responsible for providing information on 

the menstruation to children on a monthly or weekly basis or 

through mail boxes where children could ask questions. There 

should be a room for individual meetings. 

Peer educators can be used for educating girls. Girls listen 

more to the school leader girls and accept their word better 

than the teacher and school doctor. 

Movies and videos can be used to raise awareness of children 

because they like videos. 

Janitors should be educated on girls’ situation and be trained 

on communication skills 

Boys should be educated on the needs of girls in the class and 

taught not to tease girls 

Parents should be open with their girls and regularly give money 

to the daughters to by pads and fathers also should take 

care of their daughters 

Parents should take care of their girls, particularly in maintaining 

personal hygiene, and not let them lift heavy things 

Parents should be involved in the training and a brochure, 

handbook should be provided to them also 

Access to sanitary pads for girls improved through different 

measures, like through setting up of a point selling sanitary 

pads or establishing other system using school internal 

resources. 

Female teachers or school doctors should arrange access to 

emergency pads by creating funds through collecting money 

from girls or at least keep pads available when girls need 

them. The cost of sanitary pads could be reflected in the 

school budget for use by girls when they are in emergency 

need 

Timely and relevant, practical guidance are provided to girls 

by school doctors, teachers and dormitory teachers on how to 

take care of themselves, what to do and not to do and what 

sanitary pads to use, ways to relieve uncomfortable feelings 

including pains during the menstruation 

Health check-ups with a doctor should be arranged for girls at 

least once a year 

S9, 

S2 

S11, 

S5 

S10 

S4, 

S10, 

S9, 

S10, 

S7, 

S11, 

S3, 

S4 

S6, 

S6 

S4 

S2 

S10 S6 S6 S8 

S4, 

S10, 

S5, 

S11, 

S4, 

S10, 

S5, 

S11 

S2, 

S4, 

S7 

S5, 

S7 

S5, 

S9, 

S7 

S2, 

S9 

S3, 

S7 

S7 S10 

S10 

S10 

S6, 

S11, 

S9, 

S2, 

S3, 

S8, 

S6, 

S9 

S2 

S9 

S6, 

S10 

S4, 

S5 

S5, 

S3 

S10 

S2 

S6 S3, 

S9 

55

56

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