Beyond the Silence: Evaluating a Holistic Menstrual Health and Hygiene Intervention in Tamil Nadu Schools

• In Event: Watering Young Minds: Evidence from Water, Sanitation and Hygiene-Related Interventions in Schools in Asia

Proposal

The second paper presents findings from the evaluation of the Happy Periods project, implemented by Sanitation First in Tamil Nadu, India. The Happy Periods project is a comprehensive menstrual health and hygiene (MHH) initiative that integrates WASH improvements to support adolescent girls’ dignity, health, and school participation. The project includes hygiene education, and distribution of reusable sanitary products in government schools.

The project addresses critical gaps in menstrual knowledge and access to safe sanitation. Data from India reveal that nearly 50% of girls were unaware of menstruation prior to menarche, and many relied on cloth due to limited access to sanitary products. The evaluation uses a prospective matched comparison group design and mixed methods to assess changes in MHH knowledge, attitudes, behaviors, and school attendance among students in Grades 8–9. Early results suggest that the project is fostering positive shifts in menstrual literacy, reducing stigma, and improving girls’ ability to manage their periods safely and hygienically at school.

The evaluation covers 106 government schools in the Thiruvallur district, using a mixed-methods, quasi-experimental design. Baseline data collected in early 2025 reveals that while nearly all schools had at least one functioning toilet, significant gaps remain in hygiene standards and supply availability. Only 71% of schools had clean and sanitary toilets, and soap was available at handwashing stations in just 33% of schools. Although 90% of schools had running water, only 57% of students reported consistent access to it, and 65% noted the presence of dustbins for menstrual waste disposal.

Student perceptions aligned with enumerator observations, indicating moderate cleanliness and limited hygiene supplies. These WASH deficiencies were linked to menstruation-related school absences, with 6% of menstruating girls citing inadequate facilities as a reason for missing school. Furthermore, 12% of girls reported missing school during their last menstrual cycle, underscoring the importance of accessible and hygienic WASH infrastructure.

The Happy Periods program aims to address these challenges by supporting girls in managing their monthly periods. The intervention’s theory of change posits that MHH education and stigma reduction will lead to improved menstrual management, reduced absenteeism, and greater empowerment among girls. Baseline findings affirm the relevance of WASH-focused components in school-based MHH interventions. Despite high usage of sanitary pads (97%), the lack of clean, private, and well-equipped facilities continues to hinder effective menstrual management. The evaluation’s endline phase will assess the program’s impact on WASH-related outcomes, contributing to the evidence base for integrated approaches to adolescent health and gender equity in educational settings.

By targeting an important topic in the WASH domain and facilitating behavior change and education, Happy Periods contributes to a more inclusive and supportive learning environment—one where girls can thrive without interruption to their education.

Authors

• Adria Molotsky, American Institutes for Research

• Averi Chakrabarti

• Chinmaya Holla, American Institutes for Research (AIR)

• Garima Siwach