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Menstruation and the Cycle of Poverty: A Cluster Quasi-Randomised Control Trial of Sanitary Pad and Puberty Education Provision in Uganda

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  • Paul Montgomery
  • Julie Hennegan
  • Catherine Dolan
  • Maryalice Wu
  • Laurel Steinfield
  • Linda Scott

Abstract

Background: Poor menstrual knowledge and access to sanitary products have been proposed as barriers to menstrual health and school attendance. In response, interventions targeting these needs have seen increasing implementation in public and private sectors. However, there has been limited assessment of their effectiveness. Objectives: Assess the impact of providing reusable sanitary pads and puberty education on girls’ school attendance and psychosocial wellbeing outcomes. Methods: A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. Schools were allocated to one of four conditions: the provision of puberty education alone; reusable sanitary pads alone; puberty education and reusable sanitary pads; and a control (no intervention). The primary outcome was school attendance. Secondary outcomes reflected psychosocial wellbeing. Results: At follow-up, school attendance had worsened for girls across all conditions. Per-protocol analysis revealed that this decline was significantly greater for those in the control condition d = 0.52 (95%CI 0.26–0.77), with those in control schools having a 17.1% (95%CI: 8.7–25.5) greater drop in attendance than those in any intervention school. There were no differences between the intervention conditions. High rates of school drop-out and transfer meant the trial suffered from substantial participant drop-out. Intention-to-treat analyses using two different imputation strategies were consistent with the main results, with mean differences of 5.2% attendance in best-case and 24.5% in worst-case imputations. Results were robust to adjustments for clustering. There was no impact of the interventions on girls’ self-reported shame or insecurity during menstruation. Conclusion: Results of the trial support the hypothesised positive impact of providing sanitary pads or puberty education for girls’ school attendance in a developing country context. Findings must be interpreted with caution in light of poor participant retention, intervention fidelity, and the attendance measures used. Trial Registration: Pan African Clinical Trials Registry PACTR201503001044408

Suggested Citation

  • Paul Montgomery & Julie Hennegan & Catherine Dolan & Maryalice Wu & Laurel Steinfield & Linda Scott, 2016. "Menstruation and the Cycle of Poverty: A Cluster Quasi-Randomised Control Trial of Sanitary Pad and Puberty Education Provision in Uganda," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-26, December.
    • Handle: RePEc:plo:pone00:0166122
    DOI: 10.1371/journal.pone.0166122
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    2. Czura, Kristina & Menzel, Andreas & Miotto, Martina, 2024. "Improved menstrual health and the workplace: An RCT with female Bangladeshi garment workers," Journal of Development Economics, Elsevier, vol. 166(C).
    3. Vinish Shrestha & Rashesh Shrestha, 2023. "The Combined Role of Subsidy and Discussion Intervention in the Demand for a Stigmatized Product," The World Bank Economic Review, World Bank, vol. 37(4), pages 675-705.
    4. Ernestina Coast & Samantha R. Lattof & Joe Strong, 2019. "Puberty and menstruation knowledge among young adolescents in low- and middle-income countries: a scoping review," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(2), pages 293-304, March.
    5. Kristina Czura & Andreas Menzel & Martina Miotto, 2019. "Menstrual Health, Worker Productivity and Well-being among Female Bangladeshi Garment Workers," CERGE-EI Working Papers wp649, The Center for Economic Research and Graduate Education - Economics Institute, Prague.
    6. Krenz, Astrid & Strulik, Holger, 2021. "The impact of menstruation hygiene management on work absenteeism of women in Burkina Faso," Economics & Human Biology, Elsevier, vol. 43(C).
    7. Krenz, Astrid & Strulik, Holger, 2019. "Menstruation hygiene management and work attendance in a developing country," University of Göttingen Working Papers in Economics 364, University of Goettingen, Department of Economics.
    8. Evans, David K. & Mendez Acosta, Amina, 2023. "How to measure student absenteeism in low- and middle-income countries," Economics of Education Review, Elsevier, vol. 96(C).

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