Title: Menstruation and the Cycle of Poverty:Does the provision of sanitary pads improve the attendance and educational outcomes of girls in school?
Funder: Economic and Social Research Council

Abstract: Summary (Submitted under ESRC/DFID Poverty Alleviation Theme) Myriad press accounts have claimed that poor girls in developing countries cannot go to school because they have no sanitary pads. Though these stories seem to have strong effects on public sentiment, policy makers largely resist the notion that sanitary care interventions can improve female educational achievement, perhaps partly because, to date, there has been no robust test of the impact of sanitary pads on poor girls' school attendance. This resistance, we suggest, has far-reaching consequences: girls' education not only has a bearing on the realisation of Millennium Development Goals, but on the long-term economic health, social welfare and stability of developing countries. The proposed study aims to document the impact of providing sanitary pads and puberty information on girls' education in Kamuli District, Uganda. The study builds on the unexpected findings of our pilot study (conducted in Ghana in 2008/9), in which the circumstances of menarche appeared to catalyze a sequence of negative events for girls, with implications for their health, safety, learning, fertility, community involvement, and economic autonomy. Building on the inferences drawn from the pilot, we seek to conduct a randomized trial in Uganda that will demonstrate the effects of puberty education and sanitary pads on school attendance-and show how the absenteeism that goes otherwise unchecked not only imperils girls' educational futures but increases their vulnerability to poverty and reproductive risk. Because of the connections we found in our pilot between menarche and various negative outcomes, some of them strongly related to reproductive issues, we believe the study will help explain why countries with gender parity for education, but low enrolment rates for girls at the secondary level, still have high rates for fertility, child mortality, disease transmission, and other factors affected by girls' education levels. We will also, following on suggestive evidence from the pilot, look more closely into the relationships between enrolment, attendance, performance, and retention. Currently, development indices rely heavily on enrolment data, but we found that girls enrolled in school may not attend regularly, thus affecting their performance and, ultimately, their retention, especially after menarche. If some combination of sanitary pads and puberty education proves effective in helping girls remain in school, the benefits are potentially huge. However, the practical logistics and expense of providing such an intervention on a global scale are immense. Therefore, our study will begin to investigate the immediate challenges that would face such an initiative: the perception of cost, the environmental impact, and the resistance of the development community. First, journalist accounts often suggest that sanitary pads are simply too expensive for poor households. However, our pilot indicated that it may be the confounding effects of cultural norms, gender expectations and differential investments in household members, rather than poverty per se, that define certain goods as 'luxuries' and others as 'necessities.' Second, though the environmental impact of high fertility rates associated with low levels of education may counterbalance the impact of providing sanitary pads, and though the cost of such an intervention may be less than the labour-intensive programmes that currently attempt to reverse gender differentials in education, a clear and convincing case will have to be made. To accomplish this, we will interview key potential players across the public and private sectors, including both manufacturers and press participants, to determine the nature and the reason for this resistance, and our impact plan will also circle back to these same participants with workshops and policy tools aimed at both the global and local level.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH