Until relatively recently, the topic of menstruation has been overlooked both in international conventions on human rights (Boosley and Wilson, 2013) and in body politics in development. The first attempts to address the issue in an international context originated primarily within the Water, Sanitation, and Hygiene sector in Africa and Asia, and have largely focused on Menstrual Hygiene Management (MHM) (UNICEF, 2013).
MHM programs have mainly been implemented in schools and are based on the general assumption that poor girls in developing countries share the same situation: lack of information about the menstrual cycle, shame and discomfort during menstruation due to cultural myths and taboos, limited choices about affordable products, insufficient access to private and safe facilities to manage bleeding and menstrual products, and high school dropout rates due to difficulties relating to mensuration (FSG, 2016; Kirk and Sommer, 2006; Mythri Speaks, 2016; Sclar et al., 2018; Sommer, 2010; Sumpter and Torondel, 2013; Winkler and Roaf, 2015). However, evidence to support the efficacy of MHM programs is far from conclusive (Accerenzi, 2018; Bobel, 2019; Hennegan, 2020).
A common limitation of such programs is that they often fail to include parents in their activities. However, it is important to acknowledge that parents are hugely influenced by social norms and are responsible for making the decisions on this matter at the household level. Hence, both parents’ knowledge and their social norms play a critical role in the information that adolescents receive and how they behave.
As a consequence, in this paper we focus on parents’ knowledge and predictions about the age of menarche. We explore whether parents have accurate knowledge about the age of menarche and whether they are able to predict or guess the distribution of the modal value of other parents’ responses, in other words, the social norm (Nagel, 1995; Krupka et al., 2013). To overcome possible social desirability bias in the study (Krumpal, 2013; Latkin, 2017; Stuart and Grimes, 2009), we paid participants based on the accuracy of their answers (50 Honduran Lempiras if they hit the right answer).
There are two important aspects to consider in this study. First, access to accurate, timely, and age-appropriate information about menstruation is an essential part of menstrual health (Hennegan et al., 2021). Evidence shows that girls primarily obtain information from their mothers and/or other female family members (Chandra-Mouli and Patel, 2017; Lesch and Kruger, 2005; Uskul, 2004; Zakaria et al., 2019). Hence, determining whether parents are adequately informed is of paramount importance, given that if they are misinformed they might not only provide girls with incorrect information, but they might also provide it too late, which leaves girls unprepared to face their first cycle (Uskul, 2004).
Second, most societies have established social norms about how menstruators and others are expected to behave in a given social situation (Gavrillets and Richerson, 2017; Lapinski and Rimal, 2005). General societal misinformation about the age of menarche could indicate that what parents consider “normal” is incorrect, which could lead them to making bad decisions regarding their daughters’ health.
To determine to what extent the general assumptions regarding parents’ knowledge about menstruation are accurate in West Honduras, we conducted a pre-registered field experiment in Santa Rosa de Copán (a region where no MHM or similar programs have ever been implemented)
To this end, we explored two research questions: a) do parents have accurate knowledge about the age of menarche? and b) can they accurately predict or guess whether other parents also have accurate knowledge about the age of menarche? The rest of the paper is organized as follows. The next section presents the methods and procedures. Section III describes the sample. Section IV focuses on the results and Section V presents the conclusions.
1To understand the magnitude of this phenomenon, see Menstrual Hygiene Day http://menstrualhygieneday.org, Menstrual Health Hub https://mhhub.org/, and Society for Menstrual Cycle Research http://menstruationresearch.org/.
2While self-reported answers might be truthful or not, incentive compatible mechanisms (paid predictions) are strategy proof. In other words, a subject fares best by being truthful. For example, a country is having elections and there are two political parties: A and B. If a follower of party B is asked who will win, they will say B due to their own preferences/wishes, regardless of the true distribution of votes. In turn, a follower of party A would say A. However, if they are asked to “predict” the results and paid based on their accuracy then their best strategy would be to tell the truth, regardless of their own preferences.