Improving human capital by reducing menstrual stigma in Madagascar: the role of young female leaders

Last registered on February 14, 2022


Trial Information

General Information

Improving human capital by reducing menstrual stigma in Madagascar: the role of young female leaders
Initial registration date
February 13, 2022

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
February 14, 2022, 1:10 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.


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Primary Investigator

Paris School of Economics

Other Primary Investigator(s)

PI Affiliation
Paris School of Economics
PI Affiliation
Paris School of Economics

Additional Trial Information

On going
Start date
End date
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
We study an intervention that aims to engage adolescent girls, “Young Girl Leaders”, as ambassadors who are encouraged to speak out in their schools against the harmful stigma that surrounds the topic of menstruation in a context where material constraints to hygienic practices are also lifted. We aim to test whether the intervention, taking place in rural Madagascar, increases girls’ ability and willingness to attend school, increase their access to health-related information, and improve their psychosocial wellbeing, by reducing stigma and encouraging discussion of stigmatized topics,
External Link(s)

Registration Citation

Macours, Karen, Julieta Vera and Duncan Webb. 2022. "Improving human capital by reducing menstrual stigma in Madagascar: the role of young female leaders." AEA RCT Registry. February 14.
Experimental Details


Building on earlier projects by CARE in rural Madagascar, CARE will recruit, train and support Jeune Fille Leaders (JFLs, “Young Girl Leaders”): school girls who are willing to speak out against harmful social norms and act as advocates for menstrual hygiene in their school.

The JFLs will be a group of between 3 and 6 adolescent girls per school, who will be selected, trained, given information regarding optimal menstrual practices, and encouraged to discuss menstruation in an open and positive way with their female peers at school. They will be encouraged to (i) directly share information on menstrual hygiene with their peers, and (ii) reduce menstrual stigma by promoting positive and open discussion of the topic. Through both of these channels, the JFL program could transform the human capital of girls in schools by reducing school absenteeism, by improving health behaviors and health outcomes, as well as socio-emotional wellbeing.
Intervention Start Date
Intervention End Date

Primary Outcomes

Primary Outcomes (end points)
School absenteeism measured using unannounced spot-checks and survey data

Psychosocial wellbeing
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Take-up of reusable menstrual pads (vouchers used, and incentivized measure of willingness to pay for pads)

Knowledge on facts about menstruation and appropriate health behaviors

Self-reported exposure to discussions on hygiene/menstruation.

Measures of social stigma and social norms, including (i) incentivized lab-in-the-field experiments (measuring willingness to break taboos/discuss menstruation), (ii) measures of second order beliefs, (iii) measures of bullying and teasing

Outcomes of caregivers: (i) knowledge index about menstruation of the mother (ii) Willingness to pay for menstrual hygiene products
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The study will evaluate the effectiveness of the JFL program for reducing stigma and adolescent absenteeism.

The sample includes 140 schools in 3 rural districts in Madagascar. Randomization is at the school level, stratifying by (i) whether the school has functional infrastructure providing access to water at baseline; (ii) whether the school is primary or secondary; and (iii) the number of girls in the school aged 12 or greater. The treatment arms are:
(1) JFL (structured sessions) + Base Treatment (35 schools): receive the JFL program where JFLs are trained, and run structured classroom sessions about menstrual hygiene and WASH, plus the “base treatment” (described below).
(2) JFL (organic) + Base Treatment (35 schools): receive the JFL program where JFLs are trained, and are encouraged to have informal conversations with their peers about menstrual hygiene and WASH, plus the “base treatment”.
(3) Base treatment (35 schools). Only receive base treatment before endline, and receive JFL program after endline data collection.
(4) Control (35 schools). Receive no interventions.

The “base treatment”, delivered to groups (1), (2) and (3), includes (i) the construction of WASH infrastructure at schools, (ii) a voucher system providing access to reusable menstrual pads from local providers, (iii) the creation of “WASH committees” at the school level involving students and parents, and (iv) teacher training on WASH subjects.

There will also be district-wide interventions targeting girls and parents of all schools (treatment and control), including (i) a local newspaper encouraging positive WASH behaviors, (ii) training of local seamstresses to make menstrual pads, (iii) community-level celebrations of WASH-related world days.

In addition to primary data collection through baseline, midline and endline surveys, we will carry out unannounced spot-checks in schools during the first and second academic year of the program, with 5 spot checks per school, and 1 school-level survey at endline. These spot-checks will involve a roll-call in classrooms carried out by enumerators to provide a reliable measure of absenteeism at the school and individual level. The main primary data collection are a baseline (July-September 2021), midline (after 1 year) and endline (early 2023), using surveys of the teenage girls attending the targeted schools at baseline, as well as their parents.
Experimental Design Details
Not available
Randomization Method
Randomization done in office by a computer
Randomization Unit
Randomization at school level
Was the treatment clustered?

Experiment Characteristics

Sample size: planned number of clusters
140 schools
Sample size: planned number of observations
The sample includes 17 girls per school in each school, giving a total sample of 2,380. In addition, surveying JFLs and girls in their network will add an estimated 8 additional girls in the 70 schools with the JFL intervention, yielding a total predicted sample size of 2,940.
Sample size (or number of clusters) by treatment arms
35 schools in the JFL arm with structured sessions + base treatment, 35 in the JFL arm with organic diffusion + base treatment, 35 with the base treatment only (construction of WASH infrastructure, voucher system for sanitary pads, creating of WASH committees at the school level, teacher training on WASH subjects), and 35 in control.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
The design allows for an MDE of 0.2 standard deviations for main treatment effect when comparing 70 JFL treatment schools to 35 base treatment or control schools. This analysis assumes a power of 80%, significance threshold of 5%, intra-cluster correlation of 0.1, and an ANCOVA analysis with assumed correlation between baseline and endline outcomes of 0.5.

Institutional Review Boards (IRBs)

IRB Name
IRB Paris School of Economics
IRB Approval Date
IRB Approval Number
2021 011