Improving learning outcomes in schools in Madagascar through a combination of menstrual hygiene interventions

“We were not aware that menstrual hygiene can improve academic performance. This will help us to change our awareness-raising activities,” says Eliane Ranosy, Director General in charge of schools for Madagascar’s Ministry of Education.

On May 2, 2024, a national dissemination event and a regional capitalization event were held in Ambositra, the region where the project is being implemented, to highlight the results of the study conducted by PSE and J-PAL on the Kilonga project led by CARE Madagascar and CARE France.

In Madagascar, menstruation has been identified as a barrier to education for girls, leading to repeated absenteeism and an increased risk of dropouts. On the one hand, the lack of suitable infrastructure and access to menstrual products can make it difficult for girls to take part in social, academic and economic activities during menstruation. On the other hand, the social stigma is so prevalent that it can also limit their participation in such activities even when they are not menstruating. According to the NGO CARE, “nearly a quarter of the girls interviewed had already experienced harassment associated with menstruation, from both girls and boys.”

The Kilonga project, which is being implemented in rural areas of the Amoroni Mania region in Madagascar, aims to improve basic hygiene and reduce the stigma attached to menstruation. The program combines basic information on Water, Hygiene and Sanitation (constructing adequate sanitary facilities, training teachers, establishing committees and distributing reusable menstrual products), with an innovative approach, entitled: “Young Girl Leaders”.

Consequently, in each school, “Young Girl Leaders” have been selected and trained to become ambassadors, responsible for providing information, facilitating positive discussion and sharing best practices on menstruation among their peers. From 2021 to 2023, Karen Macours led a research team from the Paris School of Economics, to evaluate the program in 140 schools, and determine whether reducing stigma and promoting dialogue around this taboo subject could have an effect on improving girls’ academic performance and their willingness to attend school.

The results presented by the research team demonstrated that, while the program did not increase school attendance rates, it led to a “significant improvement in girls’ academic performance across all metrics.” The academic results of girls involved in the program improved by 13%, and their chances of advancing to the next grade increased by 15%.

This progress in academic performance can seemingly be explained by reduced stress and an improved psychosocial environment in schools, which creates better quality study conditions and gives girls greater confidence in their own abilities.

The “Young Girl Leaders” initiative, which complements the basic aspects of the program, results in better hygiene knowledge and habits, and helps reduce the stigma around menstruation. “The school’s involvement in the program has encouraged more open discussion, with people being able to speak out, better manage their own situation and inspire others. The efforts started do not end there, because following the initial training, there is a continued role to raise awareness in the next grade, in high school, among families and within the community, as well as other groups,” says a student ambassador for “Young Girl Leaders”.

This study is very encouraging, because it focuses on a problem where the effectiveness of potential solutions had not previously been demonstrated. “We need objective measures which provide reliable, consistent results which can be used to design effective programs. The “Young Girl Leaders” initiative represents the first time that this kind of approach has been used. It’s an innovative strategy which has not been tested in any other context. There have been studies on the stigma around menstruation, but few solutions have been identified,” says Karen Macours, Associate Professor at the Paris School of Economics and lead researcher for the study.

Moreover, it has shown that basic hygiene and menstrual health initiatives are highly effective in improving students’ academic performance, with a major impact comparable to some of the most effective educational programs. In a country like Madagascar, where the Ministry of Education has made quality of learning a priority, these results have garnered considerable interest from public authorities on a national level: “We’ve been looking for ways to improve academic performance by 1 or 2 percent. This type of program, where academic performance has jumped by 13%, is invaluable!” The study has also attracted attention at the local level: “This project has produced tangible results in terms of the momentum in schools and pupils’ motivation. Improving the quality of the school environment has made a positive impact on pupils’ mental well-being and the learning process. As a result, the team has achieved some of the objectives set by the Ministry and improved the lives of young girls. It is crucial that we continue along this path,” says the Regional Directorate of National Education.

The study, which received financial support from the FID via a Stage 2 grant, has demonstrated the potential of new concerted levers for action in the field of public health and education policy. “These very encouraging results are likely to attract interest from various key players in Madagascar and beyond,” said Claire Bernard, FID Deputy Director at the event held in Madagascar on May 2.

Resource links

1. Paper work: Menstrual Stigma, Hygiene, and Human Capital: Experimental Evidence from Madagascar (Karen Macours, Julieta Vera and Duncan Webb)
2. Policy brief (in French): Note de synthèse