Can a Piece of Cloth Keep Girls In School?

We know that poor girls in developing countries often lack access to sanitary napkins. But does a lack of pads actually make it more likely that girls will drop out of school?

That's the case that Sheryl WuDunn and New York Times columnist Nicholas Kristof make, in an essay adapted from their book Half the Sky: Turning Oppression into Opportunity for Women Worldwide. As they write, “For fear of embarrassing leaks and stains, girls sometimes stay home during their periods, and the absenteeism puts them behind and eventually leads them to drop out.”

Sounds logical. And certainly, the argument has caught on. A few weeks ago, the New York Times featured the good work of Huru International, makers of reusable sanitary napkins. This organization is doing something great by providing young women (mostly in Kenya) with kits that include terry cloth sanitary pads, underwear, soap and educational materials. To top it off, the drawstring bag that holds these supplies can also be used as a backpack.

This is a good idea. Period (no pun intended).

But do pads actually reduce absenteeism among young women? The case isn't quite so clear.

At least one study suggests the answer's yes. In what was (incorrectly) described as the “first empirical research ever to investigate the question,” researchers at the University of Oxford compared patterns of absenteeism among two groups of girls in Ghana (no ages listed). One group received education about health and hygiene, the other group received the education, as well as sanitary pads. Apparently, among girls who received pads as well as education, average absenteeism dropped from 21% of school days (the pre-intervention rate) to 9% after six months. The study also found that absenteeism dropped among the education-only group, but the effect was described as “delayed,” and no figures have been released yet. (Press release here -- no paper yet, to my knowledge).

Evidence from Nepal, though -- collected in a strong randomized evaluation -- paints a different picture. The study’s authors gave a random selection of girls access to menstrual cups, which they described as a "small, silicone, bell-shaped device used internally during menstruation," and collected attendance and menstruation data for 15 months. (Girls who weren't selected to receive the cups for research purposes were provided them at the end of the study.)

The result? First, the girls who did NOT receive the cups were only 2.9 percentage points less likely to attend school during their period. Plus, these girls had their period on only 8% of school days. Taken altogether, we're talking about only 0.23% of an 180-day school year (0.41 days) -- suggesting menstruation actually has a very small effect on school attendance. At best, use of the cup could only improve attendance by 0.41 days, but results suggested no impact.

When asked why they missed school, 44% of girls pointed to one problem that Huru and similar organizations can't solve with a pad: cramps.

Should efforts to improve the lives of young women by proving access to clean underwear and sanitary pads be lauded? Absolutely. I happened to be visiting a school in western Kenya a few months ago when Huru kits were distributed. The girls were thrilled to have these supplies. Personally, I'm convinced that this work should continue and expand. But I'm also convinced that when we consider these types of programs, we should be careful in evaluating their big claims. Distributing sanitary pads is itself a worthy effort. We don't need to make the case that doing so stops school dropouts if the data suggest otherwise.

Photo Credit: Eric Green