Karen Macours
Paris School of Economics, and INRAE
Julieta Vera Rueda
Paris School of Economics
Duncan Webb
Nova School of Business and Economics, and NOVAFRICA
ISSN 2183-0843
Working Paper No 2605
August 2026
Abstract
Menstrual stigma is pervasive in low- and middle-income countries, yet we know little about its consequences for girls’ human capital. In a field experiment in 140 schools in Madagascar (N=2,256), we evaluate a school hygiene program focused on reducing menstrual stigma through sanitation infrastructure, menstrual products, and teacher- and peer-led sensitization. The program generates substantial learning gains (0.15 SD) without improving attendance or health. The learning gains are instead explained by psychosocial mechanisms: reduced stigma, lower stress measured by heart rate, and a better school social climate. Our results suggest that menstruation can be a meaningful barrier to girls’ learning.
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