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Menstruation and Education in Nepal

In many parts of the world, social and cultural taboos and restrictions exist for women during their menstrual period. In Chitwan, Nepal, researchers offered adolescent girls sanitary products to evaluate their effect on school attendance, attainment, self-esteem and health. While product uptake was high, researchers found no evidence that this menstruation technology affected school attendance or test scores. This suggests that merely providing modern sanitary products to girls may not be the solution to substantially reduce barriers for girls related to menstruation.

Policy Issue 

Throughout the world, cultural stigma has often excluded women from seeking the same education and employment opportunities as men. For less developed nations in particular, women may embody a previously untapped source of human capital, and those countries that have embraced more aggressive policies in regards to gender equality in education can be expected to see greater social and economic benefits. Findings from a variety of countries indicate that educating girls is one of the most cost-effective ways to reduce poverty, but dropout rates for adolescent girls remain high.

Context of the Evaluation 

Test In many parts of the world, social and cultural taboos and restrictions exist for women during their menstrual period. Women in very rural areas of Nepal are often restricted to separate huts or cow sheds during menstruation. Other activities are also restricted, such as preparing and consuming food, socializing, traveling, and importantly, attending school. Female school attendance is of particular importance as Nepal harbors marked gender disparities in literacy rates: only 24 percent of females are literate, compared to 52 percent of males.1

There is no evidence that menstrual blood is unclean or dangerous and therefore it has often been concluded that these traditions exist largely as a strong cultural norm. To the extent that these traditions are harmful for women, this project measures whether these taboos could be overcome with technological advancement in sanitary products. In particular, given a menstrual cup, women may be able to keep their periods private, thus increasing their mobility and activities during their menstrual cycles.

A nurse explains sanitary products to girls and mothers in Chitwan, Nepal.
A nurse explains sanitary products to girls and mothers in Chitwan, Nepal.
Details of the Intervention 

Four schools in Chitwan, Nepal were identified and 60 seventh and eighth grade girls were invited, with their mothers to participate in this study, which aimed to measure the uptake and effect of sanitary products on school attendance, attainment, self-esteem and health among adolescent girls. Participation in the study was contingent on attendance at the first study meeting, at which time girls received pens and stickers, and mothers received 100 Nepali Rupees (US$1.45). Approximately 79 percent of girls participated with their mothers.

Prior to randomization, a baseline survey was administered to girls and their mothers that included questions on demographics, schooling, menstruation, and self-esteem. Researchers then randomized the allocation of a re-usable menstrual cup to girls and their mothers, and a nurse gave those in the treatment group detailed instructions on the use of the menstrual cup. Girls were also given diaries for each month where they were asked to record the dates of their period, time spent on daily activities, and school attendance and performance. After the initial meeting girls were followed for approximately 15 months, at the end of which, a follow-up survey was administered. At this time, comparison girls and their mothers were also given the menstrual cup.

Results and Policy Lessons 

School Attendance: In contrast to existing claims about menstruation and education, this evaluation finds no evidence that this form of menstruation technology affects school attendance. Girls not allocated menstrual cups in the initial randomization were 2.6 percentage points less likely to be in school on days they were menstruating. This falls well below the 10-20 percent estimates made by policy makers.

Educational Attainment: Similarly, the allocation of a menstrual cup has no effect on test scores, and this is not due to low adoption of the cup: 60 percent of treatment girls report using the cup six months into the study. The low impact of modern sanitary products may be due, in part, to the fact that sanitary products only help with management of menstrual blood, rather than cramps or fatigue. Forty-four percent of girls in this study report that the primary reason they miss school during their periods is due to cramps.

Product Uptake: Despite the lack of schooling effects, this study does support some value to these products. Successful usage of the menstrual cup increased dramatically in the first six months, from 10 percent in January to 60 percent in June. The share of girls attempting to use the cups increased from only 60 percent to 80 percent over the first months of the study and declined some in the period after that, likely reflecting a decrease in girls who continued to attempt to use without success. Furthermore, once a girl used the cup once, continued usage was extremely high. After one month of successful usage, girls used the cup in 91 percent of subsequent periods. In addition to reporting increased ease with mobility and management of menstrual blood, girls who were in the treatment group spent 20 minutes per day less doing laundry on days they had their period. Results suggest that there are indeed barriers for girls related to menstruation. However, merely providing modern sanitary products to girls may not be the solution to substantially reducing these barriers.

Oster, Emily, and Rebecca Thornton. 2011. "Menstruation, Sanitary Products, and School Attendance: Evidence from a Randomized Evaluation." American Economic Journal: Applied Economics 3(January): 91-100.

Oster, Emily, and Rebecca Thornton. 2012. "Determinants of Technology Adoption: Peer Effects in Menstrual Cup Take-Up." Journal of the European Economic Association 10(6): 1263-1293.

1 National Planning Commission Secretariat, Central Bureau of Statistics, "Section V: Literacy and Education,"