Menstruation matters (for keeping girls safe in schools)

What do we know, and what more should we be doing?

Last week education and skills ministers from around the world gathered in London for the annual Education World Forum (EWF). I had the pleasure of attending an EWF event at the Center for Global Development, who hosted a high-level panel discussion on how to improve safety and inclusion in schools across sub-Saharan Africa. We often think of violence in schools (i.e., bullying, sexual abuse) as an issue limited to Western countries like the US and UK, but it is just as pressing in developing countries. It was at this event that I learned that during last year’s EWF, ministers from six African countries signed a declaration committing to the elimination of violence in schools. I was pleasantly surprised to hear from the Sierra Leonean Minister of Basic and Senior Secondary Education, Conrad Sackey, that the country has made good on its pledge.

In recent years, Sierra Leone has invested in a tablet-based attendance monitoring system for both students and teachers. This is especially important given the links between absenteeism, poverty, and violence. Through follow-ups with absent students, the government learned that some poor households were keeping their daughters out of school to work in the market instead, where they were subsequently abused. To solve this problem, Sierra Leone is currently piloting a conditional cash transfer program to help keep these girls in school.

Listening to the panel, it was fascinating to learn about the myriad of initiatives aimed at protecting children in and around schools. But one point remains especially salient: the link between school violence and menstruation. As of 2022, the WHO/UNICEF estimate that around 28 percent of schools globally still lack basic sanitation services. This means that over a fourth of girls in schools worldwide are forced to manage their periods in public facilities or open fields, making them increasingly vulnerable to sexual violence. Even when schools do have toilets, girls may still feel unsafe using them due to fear of harassment and assault. This form of gender-based violence, enabled largely by inadequate sanitation facilities, drives menstruation-related absenteeism.

Those that know me know I was an adamant advocate for improving access to menstrual hygiene products back in college. Knowing how much of an issue this is in the US, I’ve always been shocked by the lack of economic evidence on menstruation and schools in developing countries. In the last year, there has been a proliferation in research on this topic (in relative terms, that is). Four new papers were published, only one of which focused on schools.¹ In this article, I explore the brief history of school-based menstruation research, where interventions have been successful, and what investments still (badly) need to be made.

Giving girls pads isn’t enough to prevent violence

Until recently, most of the reputable evidence we had on menstruation and schools in economics was old. Take, for instance, a 2011 study on Nepal which concluded that menstruation had virtually no impact on school attendance. A companion study, however, did find that schoolgirls that were given menstrual cups were more likely to use it if their friends had access to one as well.

More recently, a study in Kerala, India investigated the impact of a large-scale government program that installed sanitary pad vending machines in schools. Within five years, the initiative has reduced dropout rates by around 33 percent via the discrete provision of free pads. This effect is primarily driven by girls in rural, public, and backward-caste schools, illustrating how cost prevents access to menstrual products.

Similarly, an older feasibility study in Kenya tested how different sanitary technologies (i.e. pads vs. cups) affected schoolgirls’ well-being. While pads reduced absenteeism by 8 percentage points, cups had no impact on attendance. Interestingly, while pad recipients were more likely to report improvements in physical well-being, cup users benefitted more emotionally, demonstrating the trade-off between an easy-to-use, disposable product versus a complex, reusable technology.

Although each of these initiatives significantly improved access to much needed menstrual hygiene products, one pressing disparity remains: adequate toilets for girls to actually use these products. Only then will we see meaningful reductions in school-related gender-based sexual violence.

Is building toilets enough?

The mixed evidence on the provision of menstrual products suggests that the effectiveness of these interventions may be hampered by suboptimal underlying conditions. That’s where menstrual hygiene management (MHM) interventions come into play. These interventions prioritize efforts such as providing improved sanitation facilities and effective pain management. Research is slowly starting to take notice of MHM, incorporating it into practice. For instance, a 2020 multi-component intervention in Uganda found that improved school toilet facilities were especially effective in reducing girls’ anxiety about their next period.

Recent research in India—the first of its kind—takes this a step further, clarifying the link between a MHM and school violence. Specifically, the study illustrates how building gender-segregated toilets in schools reduced the number of reported sexual assaults. Unsurprisingly, these projects were most successful in areas with more gender-equal norms. This suggests that, while infrastructure provides a temporary solution to the problem, broad culture-based change is the long-term goal.

The human capital and human rights case for school-based menstruation interventions

So, where does that leave us? In the words of UNESCO Director of the Division for Peace and Sustainable Development, Christopher Castle: “If children don’t feel safe in schools, they don’t learn, or they certainly don’t learn as well as they should.” As economists call for more investments in education and skills in Africa, policymakers must keep the safety of where these transfers are taking place in mind. Menstrual hygiene management offers to magnify these gains in a way that will offset initial expenditure many times over. Beyond the human capital case, feeling safe enough to manage a period at school is a fundamental human right. There is no progress to be made, economic or otherwise, if half the population is unable to receive an education due to taboos against a natural process.

1. Besides Agarwal et al. (2025) which I discuss, the following papers were published in the last year or so: Czura et al. (2024), Castro and Mang (2024), and Castro and Czura (2025).