Menstrual Health Management and Social Norms: Experimental Evidence from Bangladesh

Masterarbeit, Fachbereich Quantitative Economics, 54 Seiten, engl.

Summary:

The master thesis looks at the topic of the social and health restrictions that menstruation poses on women's lives in Bangladesh. Menstruation is a regular physiologic process, part of the menstrual cycle, that a ects adolescent and pre-menopausal adult women through most of their lives. In order to manage their hygiene during the menstrual days, women have developed different methods that vary largely depending on the available resources, socioeconomic situation, local traditions, cultural beliefs and education. If menstruation is not adequately managed, it can pose many challenges in both the public and private sphere of a woman's life.

Research has shown that improved menstrual health management (MHM onwards) can reduce the probability to miss working days due to menstruation or help improve female school attendance rates (Krenz and Strulik, 2019; Montgomery et al., 2016; Tolonen et al., 2019). The channels through which this improvement operates are not clear yet and, to date, there is no experimental evidence that measures whether social norms experience changes when improved MHM management is provided. In my master thesis, I present the results of a lab-in-the field carried out in rural Bangladesh that measures whether an improvement in MHM knowledge produces changes in the the level of adherence of women to the restrictive social norms that surround menstruation.

I conducted the lab-in-the field in a developing country because there are several reasons to believe that MHM affects more dramatically women in poor settings. Proper MHM involves the access to adequated materials, information, and support with which to manage menstruation in a healthy, safe, and dignifed manner. In low-income countries, woman rely on materials such as old cloth, cotton wool, leaves or ash to manage their menstrual flow (Sumpter and Torondel, 2013; Van Eijk et al., 2016). They often lack private and safe facilities where to change their menstrual absorbents (UNICEF, 2013). Cleaning, drying, storing or even purchasing the absorptive materials pose often a challenge due to the lack of knowledge on how to properly do so or due to the secrecy and restrictive taboos that surround menstruation (McMahon et al., 2011; Crichton et al., 2013). The general population's knowledge regarding menstruation is often inaccurate, holds missconceptions and it is not uncommon for girls to reach menarche without any previous knowledge about it (Ali and Rizvi, 2010). Inadequate hygiene during menstruation can have adverse consequences both for the women who use such methods and for their families, in the form of lower education participation (Montgomery et al., 2012, 2016; Tolonen et al., 2019), adverse health effects (Das et al., 2015; Hullan et al., 2015) and higher work absenteeism (Krenz and Strulik, 2019).

To date, the literature has not provided with evidence on the strength of social norms affecting MHM, neither on the possibility to obtain behavioral change through a reduction of social norms in an area where stigmatization and taboos are widespread. If interventions, such as the provision of free pads or better MHM education, conflicts with social norms, they will remain deprived of the support and cooperation of the local population. Thus, persistent discriminatory social norms can be an explanation for why in many low-income countries, despite of the vast availability of sanitary pads, their take-up rates are still low or why practices such as not properly washing or drying the cloth used for menstruation is still common practice.

In the master thesis, I evaluate the level of restrictiveness of the aforementioned social norms surrounding menstruation in Bangladesh and I address the question of whether awareness and information training can influence social attitudes towards menstruation. For that purpose, a lab-in-the field was conducted in the rural district of Manikganj (Bangladesh) where 113 female artisans were surveyed with the collaboration of a local non-profit organization. A one-hour information session was held aimed at providing knowledge about puberty, sexual development and MHM methods. Furthermore, the degree of restrictiveness of social norms was measured through an incentivized elicitation method that uses a simple coordination game (Krupka and Weber, 2013). The social norms were measured twice, before and after the training session.

Along with the information intervention, a range of outcomes for study participants were measured, including demographic data, behaviour and well-being during menstruation and previous knowledge about MHM.

The results show that there still exist strong restrictive social norms surrounding menstruation. I also find a statistically significant reduction of taboos that affect mobility and that prevent adequate menstrual health management practices. The experimental evidence suggest that improved MHM can lead to an update in the beliefs and attitudes that surround menstruation. There is an important exception: religious mandates seem to remain unaltered as I find no effect of the treatment on the social norms arising directly from religious rules.