Sanitary products, absenteeism and psychosocial well- being: Evidence from a three-arm cluster randomized controlled feasibility study in Western Kenya

Does access to sanitary products improve schoolgirls’ well-being? We conduct the first cluster randomized controlled feasibility study to provide different sanitary technologies (sanitary pads or menstrual cup or usual practice) to 644 primary schoolgirls in western Kenya, across 30 schools with 10 schools per treatment arm. Inclusion restrictions were: ages 14-16 years, having experienced at least three menses, and no precluding disabilities. We find that disposable sanitary pads led to a 7.9 percentage point reduction in absenteeism. In addition, using a wider dataset from the 30 schools, we show that (1) boys have similar levels of absences to girls, (2) replication of the results using official school register data fails to detect the treatment effect, illustrating the need for high quality data on school absences. Narrow focus on absences limits our understanding of the effect that sanitary products have on schoolgirls’ welfare: both sanitary pads and menstrual cups improved physical, emotional, social and educational well-being over time. Physical well-being improved in the sanitary pads group by 6.2%, and girls with heavy periods reported 10.1% improvements in emotional well-being from the menstrual cup. The results tapered off toward the end of the study in the sanitary pad group, but remained in the menstrual cup group—highlighting the trade off between strong initial effects of an easy to adopt disposable product compared with delayed and sustained effects of a complex, reusable technology at a significantly lower unit cost.