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School attendance improves when girls are given free sanitary pads and puberty lessons

December 21, 2016

Oxford University researchers say they have the first robust findings from a large-scale trial on the effects of giving puberty lessons and free sanitary products to girls in African countries. They have found that both the interventions are equally effective in improving girls' attendance levels at schools. The results are significant given the amount of resources that governments, international organisations and local charities invest in these interventions for girls in developing countries. The paper, published in the journal, PLOS ONE, shows that there is now good evidence to back up such efforts to improve the education of girls and women, thereby raising their esteem and job prospects.

The trial carried out by Oxford University involved 1,000 girls at eight schools in Uganda. Researchers found that in the two schools where sanitary pads or puberty education were not provided, over 18 months levels of absenteeism among girls were 17% higher, on average, compared with schools where girls received pads, education, or a combination of both. This amounts to the equivalent of nearly three and a half days of school a month, says the paper.

The paper led by Professor Paul Montgomery, from the University of Oxford's Centre for Evidence-Based Intervention, focuses on how puberty can have negative effects on a girl's education they are given help on how to manage periods and the bodily changes. Researchers used a randomised trial to see whether absenteeism levels improved if girls were given reusable pads, puberty classes, or combinations of both and compared this approach with one where they had no intervention at all. All the schools were in the Kamuli district, one of the poorest, rural areas of Uganda, which is reported to have high dropout rates, and some of the highest illiteracy and fertility rates in the world. It is a district where, according to official government data, only 54% of girls at the local secondary schools are able to read, compared with 69% of boys.

The findings of this study which show the positive effects of such interventions echo an earlier pilot study in Ghana, also carried out by Oxford University researchers. Previous studies have already found that menstruation is viewed widely in developing countries as 'embarrassing', 'shameful' and 'dirty'; being unable to stay clean is one of the main reasons why girls stay away from their lessons. The paper describes how most of the women and girls in Uganda rely on absorbent cloth during their periods, but it is sometimes difficult for them to source enough clean material for this use. The girls also often find the cloth is not sufficiently absorbent and difficult to secure in underwear, or to change and clean, adds the paper.

Professor Paul Montgomery, from the University's Centre for Evidence-Based Intervention, said: 'Many girls don't know about periods before they encounter their first one. They are totally unprepared because they receive no information or training on how to manage them. Just by giving girls lessons in puberty or a purpose-built sanitary pad means they were more likely to stay at school during their periods, minimising the risk of disruption to their schooling. Simple interventions like these can have major long-term economic implications for women in low and middle income countries, which socially empowers them.'

The paper says there have been 'considerable improvements' across the globe in driving up school enrolment levels, particularly at primary level. According to UNESCO, by the end of 2015, nearly three quarters (70%) of countries with data show as many girls as boys in primary schools. Differences emerge, however, once pupils reach their teens. In Uganda, only 22% of girls were enrolled in secondary schools compared with 91% of girls in primary schools, with those living in rural areas being the least likely group to go to school, according to latest official figures.

Co-author Julie Hennegan, also from the University of Oxford, said: 'Our trial does not examine whether there are potential harms in exposing those girls who are menstruating at any given time. In developing countries, it is particularly important to be sensitive to the girls' social norms as we need to avoid stigmatising girls through singling them out for pads. There is therefore an urgent need to carry out further research examining this feature of possible intervention programmes.'
For more information, contact the University of Oxford News Office on +44 (0) 1865 280534 or email:

Notes for Editors

*The PLOS ONE article, 'Menstruation and the cycle of poverty: a cluster quasi-randomised control trial of sanitary pad and puberty education provision in Uganda', is embargoed until December 21, 2016, at 2pm ET. Once live, it will appear at

*The research is funded by the Economic and Social Research Council as part of the project, 'Menstruation and the Cycle of Poverty', in collaboration with SOAS. The study examines how puberty intersects with girls' educational futures in Kamuli District, Uganda. The study builds on the findings of a pilot study (conducted in Ghana in 2008/9), in which the circumstances of menarche appeared to catalyse a sequence of negative events for girls, with implications for their health, safety, learning, fertility, community involvement, and economic autonomy. Building on the inferences drawn from the pilot, the study conducted a randomised trial that demonstrated the effects of puberty education and sanitary pads on school attendance, completion and retention, and investigated its effect on absenteeism that goes otherwise unchecked is articulated through poor performance, discouragement, and drop out. For more information about the project, go to:

*The Centre for Evidence-Based Intervention in the Department of Social Policy and Intervention at Oxford University conducts world-leading research to address urgent social problems. Researchers look at what works in social and psychosocial programmes, and are experts in conducting high-quality randomised trials, systematic reviews and meta-analyses. See:

*Paul Montgomery is Professor of Psycho-Social Intervention whose academic work spans a range of issues, and integrates the use of several high-quality methodological approaches, many of which have not been traditionally applied in the social sciences. He sits on the Cross-Whitehall Trial Advice Panel, through which he advises the UK Cabinet Office on the design and conduct of randomised trials in social policy. Previously, he has served as an advisor to the UK Government's Centre for Excellence in Outcomes, and sits on a World Health Organization guideline development panel related to evidence synthesis in complex interventions.

University of Oxford

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