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Reducing menstrual health stigma in Madagascar to improve school outcomes for girls

Progress stage
Jul 2022 to Jul 2026
  • Madagascar
  • Women-men equality
  • Jul 2022 to Jul 2026

The Paris School of Economics proposes to evaluate the “Young Girl Leaders” program conducted by CARE in rural Madagascar to determine whether promoting positive peer-to-peer discussions about menstruation in schools could reduce harmful stigma that surrounds the topic and be a complementary intervention to WASH interventions to maximize their impact.

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Animation sensibilisation hygiène menstruelleAnimation sensibilisation hygiène menstruelle

Context

About 26% of the world’s population gets their period every month, yet menstruation is still widely stigmatized across the world (UNICEF, 2018). For adolescent girls living in poverty, this social stigma leads to discrimination and harassment which may have a direct negative impact on their school attendance and performance as well as on their mental health. A lack of relevant information in discussions can lead to physical risks for their reproductive health.

**In Madagascar, and more particularly in rural areas, menstruation has been identified as an obstacle to girls’ schooling. On the one hand, poor access to suitable infrastructure and menstrual products can make it difficult for girls to participate in social, educational and economic activities during menstruation. **On the other hand, the prevalence of social stigma and the resulting internalization of constraints may also limit their participation outside periods of menstruation.

To tackle the issue, the NGO CARE has designed the “Young Girl Leaders” program, which aims to identify adolescent girls ready to denounce harmful stigma and defend menstrual health in their school.

Sensibilisation d'élèves à MAdagascar

Innovation

The Paris School of Economics (PSE) proposes to evaluate the “Young Girl Leaders” program in three districts of the Amoron’i Mania region, to rigorously determine whether reducing stigma and encouraging discussion of stigmatized topics can have an impact on increasing girls’ ability and willingness to attend school. In each school, 3 to 6 adolescent girls will be selected, trained, and given information on optimal menstrual practices before being encouraged to discuss menstruation in an open and positive manner with their peers.

Studies have proven the effectiveness of peers and ambassadors in changing social norms in schools (Levy Paluck et al., 2020). This new study aims to test whether this approach is effective in the presence of stigma and taboo subjects, where little prior evidence exists.

To measure the program’s effectiveness on absenteeism and dropout, the Paris School of Economics will conduct a randomized controlled trial in 140 schools (private and public, primary and secondary).

  • 70 schools will receive the Young Leaders program and the baseline WASH intervention
  • 35 schools will receive only the baseline WASH intervention
  • 35 schools will be the control group
Jeunes filles en classe

Results and lessons learned

The intervention was evaluated in 140 schools between 2021 and 2023. At the end of this evaluation, the research team from the Paris School of Economics obtained unprecedented results highlighting the importance of a combined approach to improving students’ well-being, the school climate, and, in turn, the learning outcomes of Malagasy girls.

  • The program significantly improved academic performance by 0.13 standard deviations and increased by 0.15 standard deviations* (+15%) the likelihood of promotion to the next grade for girls who benefited from the intervention.

  • A 21% increase in the share of girls reporting that they can speak more freely about the issue, as well as a 48% increase in menstrual hygiene practices, was also observed.

The effects on learning outcomes place this type of intervention among the top 10% of educational interventions in terms of academic performance in Madagascar.

This study therefore demonstrated the potential of combining new levers of action within public health and education policies.

When the results were presented, the Regional Directorate of National Education stressed that “this type of programme, which delivers such a leap in learning outcomes, is priceless.”

Discussions are currently underway with the Ministry of National Education on options for scaling up. A new research phase supported by the FID, focusing on the comparative cost-effectiveness of the different components of the programme, will help inform these discussions.

*In this context, the standard deviation makes it possible to compare the effect of the program between the group that benefited from the program and the control group, as it measures the magnitude of a variation relative to the mean.

See the issue of the journal Questions of Developpement, dedicated to the results and lessons learned from the project, alongside those of another project supported by AFD in Ethiopia.

    Vue de la ville de Dakar au Sénégal
    Paris School of Economics (PSE)

    Paris School of Economics (PSE)

    PSE – Paris School of Economics is a Foundation for Scientific Cooperation founded in 2006 by the CNRS, EHESS, École des Ponts ParisTech, ENS-PSL, INRAE and the University of Paris 1 Panthéon-Sorbonne. It covers a range of topics and is active in most areas of economics. PSE works in partnership with the Projet d’Amélioration de la Gestion des Contributions Foncières (PAGCF), an organization co-managed by the tax administration (DGID) and the research team.

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