Menstruation, Sanitary Products, and School Attendance: Evidence from a Randomized Evaluation

Providing adolescent girls with access to menstrual cups in Nepal did not increase their school attendance or performance.


In developing countries, girls have historically had lower school enrollment rates, fewer years of schooling, and lower literacy rates than boys. While the gap is closing in primary school enrollment, girls remain less likely to progress to secondary school. Many factors are thought to contribute to girls’ stopping school earlier including pay barriers, few employment opportunities post-graduation, and less parental investment in girl children. Additionally, girls may face constraints associated with puberty. More specifically, menstruation may inhibit girls’ ability to attend school if they lack access to modern sanitary products. This study evaluates the impact of providing adolescent girls in Nepal with menstrual cups on school attendance and grades.


The study finds that adolescent girls in Nepal miss relatively little school due to their period. While there was a high take-up of the menstrual cup, it had a minimal impact on school attendance.

  • There was no effect of menstruation on school attendance (87% average attendance for girls) or time spent in school (baseline 5.1 hours per day). Similarly, there was no evidence that premenstrual symptoms caused lower school attendance or that girls with more severe cramps missed more school.
  • There was no improvement on girls’ test scores in the treatment group or the control group.
  • There was a high adoption rate of the menstrual cup: 60% of girls in the treatment group actively used the cup. Three months later in a follow-up survey, 61% of treatment girls reported continuing to use the cup and 56% of the control girls reported using the cup.
  • While the cup did not have a significant impact on girls’ school attendance or outcomes, there were non-educational effects including easier management of menstrual blood and more mobility.
  • Compared to the control group (girls who used menstrual rags), girls using menstrual cups spent 20 minutes less per day doing laundry on days they had their period.
  • The menstrual cup did not change the cultural taboos surrounding periods. There was no difference between girls using the menstrual cup and those that did not on religious worship, cooking, eating with the family, or fetching water on days they had their period.

Overall, while menstruation did not impact girls school attendance, nor did using the menstrual cup increase school attendance or performance, using it did reduce time spent on laundry during period days and increase girls’ reported mobility. In short, the results suggest that a lack of modern sanitary products, on its own, is not a major barrier to educational attainment for girls in Nepal.


The study is based on a sample of 198 adolescent girls from four schools in and around Bharatpur City in Chitwan District, Nepal. The girls were randomly assigned into two groups: one that received menstrual cups (including instruction on how to use them) and one that did not (which served as a control group). At the end of the study, the girls from the control group were also provided with menstrual cups. The researchers collected baseline and follow-up surveys as well as monthly time diaries recorded by the girls. They also collected official school records of test scores and attendance, and made unannounced school visits to check attendance. Additionally, each month a nurse visited the schools to answer girls’ questions and help them correct their diaries if necessary. The authors gathered information on girls’ use of the menstrual cups, school attendance, and household activities for 15 months.

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