第六季第29集：月经贫困的经济学

因此现在越来越清楚，这不仅是一个健康问题或性别研究问题，也是一个经济问题。月经健康与性别不平等紧密相连。

So it's now becoming clearer that this is not just a health issue or a gender studies issue, it's also an economic one. That menstrual health is tightly linked to gender inequality.

欢迎收听Vox Dev Talks。我是蒂姆·菲利普斯。围绕月经的污名、羞耻感和社会规范，可能阻碍低收入环境中的妇女和女孩以尊严和卫生的方式应对经期。那么，我们如何提供信息、影响这些规范或改变行为，以改善女性的健康和福祉？慕尼黑大学的西尔维娅·卡斯特罗和格罗宁根大学的克里斯蒂娜·祖赫尔就这些问题进行了广泛的实地研究。

Welcome to Vox Dev Talks. My name is Tim Phillips. Stigma, shame and social norms around menstruation can prevent women and girls managing their periods with dignity and hygiene in low income settings. So how can we provide information or influence those norms or change behaviour to improve women's health and well-being? Silvia Castro of LMU Munich and Cristina Zuhrer of the University of Groningen have conducted extensive field research on these questions.

她们现在都加入了我们的讨论。西尔维娅，欢迎来到VoxDevTalks。

They both join me now. Silvia, welcome to VoxDevTalks.

嗨，团队。大家好。

Hi, team. Hello.

还有克里斯蒂娜也是。

And Christina as well.

你好，蒂姆。很高兴见到你。

Hello, Tim. Nice to meet you.

西尔维娅，目前有多少女性无法获得适当的月经卫生条件？这对她们造成了哪些风险？

Sylvia, how many women lack the access to proper menstrual hygiene at the moment? What risks is this creating for them?

实际上很难给出确切数字，因为全球关于这一主题的数据出奇地匮乏。世界银行估计，全球约有5亿女性缺乏足够的经期卫生管理设施。但这只是冰山一角。以我们进行过大量研究的孟加拉国为例，约65%的适龄女性主要依赖布料作为吸收材料，这些布料通常是从旧衣物等材料中改造而来。尽管如今孟加拉国已有经期专用产品（如一次性卫生巾）广泛供应，但我们距离这些产品的全面普及仍很遥远。

It's actually difficult to say exactly, because the global data on this topic is surprisingly scarce. The World Bank estimates that around 500,000,000 women worldwide lack access to adequate facilities for menstrual health management. But this is just the tip of the iceberg. In Bangladesh, for example, where we have conducted a lot of research, approximately sixty five percent of agile women rely on cloth as main absorbent that is often repurposed from an ulcery or similar materials. And despite this widespread availability in Bangladesh of period specific products, such as disposable sanitary pads, nowadays we're still far from reaching full adoption of these products.

根据孟加拉国统计局最新数据，约29%的亚洲女性现在使用卫生巾。但这仅涉及产品使用情况。在大多数中低收入国家，即使有卫生巾等产品可用，清洁水和私密卫生设施可能仍然匮乏。因此，如今女性仍难以有尊严地管理月经。

Around 29% of Asian women, according to the recent Bangladesh Bureau of Statistics, are now using pads. And this is just talking about products and products used. But in most low and middle income countries, even when products like pads are available, access to clean water, private sanitation might not be there. So the ability to manage menstruation with dignity is nowadays still constrained.

相关风险也不容忽视。一方面，许多生殖道和尿路感染都与经期护理不足或不卫生有关，这些可能造成严重的长期后果；但影响往往超出健康范畴。我们的研究及其他关于母亲的研究显示，经期管理不当可能干扰女童教育，但证据并不明确。直到最近才出现确凿证据表明，例如在喀拉拉邦安装卫生巾自动贩卖机后，辍学率确实有所下降。

Thinking about the risks, they are also significant. So on the one hand, you have a lot of associations with reproductive and urinary tract infections of like insufficient or unhygienic menstrual health care. And these can have serious long term consequences, but these also often go beyond health. So in our research and also research that we have seen for mothers, it has been reported that inabilities to manage menstruation properly can disrupt girls' education, but evidence is not that clear cut. Only recent evidence has really yielded very good and solid evidence that school dropout is decreasing after the installation of pet vending machines in Kerala for example.

若考察女性劳动力市场参与率或职场缺勤情况，证据则更加混杂。但我们常听到服装制造业等女性员工占比较高的雇主对此表示担忧。

And if we look at women's participation in the labour market or the kind of absenteeism at the workplace, then the evidence even more mixed. Yet we often hear that this is also a concern from employers such as manufacturing firms in the garment sector that employ a large share of female workforce.

近来，卫生经期管理对心理健康的影响也受到更多关注，特别是当产品不适用时。对于数百万依赖改造布料作为经期吸收材料的女性，我们必须意识到这些材料并非为月经设计——吸收能力差、易渗漏，且需要仔细清洗晾晒才能保持卫生。例如在学校里因此频繁发生所谓'事故'，女生上课时衣服渗漏的情况相当普遍。这些事件可能导致羞耻、尴尬，造成缺课甚至辍学，从而中断本就有限的教育。

Recently, the mental effects of hygienic menstrual health management has also received more attention, particularly when products are unsuitable. So, for the millions of women that rely on this repurposed cloth as menstrual absorbent, we have to think that these materials are not designed for menstruation, so they often have poor absorption capacity, they can leak easily, and they require careful cleaning and drying to remain hygienic. And for example, as a result, there are a lot of accidents, that they call it, in schools. So, girls breathe through their clothes while in class, and this is quite common. So, these incidents can cause shame, embarrassment, can lead to missed class time, or even school dropout, so disrupting the scarce education.

当女性进入职场后，挑战仍在继续。改造布料难以应对长时间工作，尤其在隐私和卫生设施有限的环境中。虽然一次性卫生巾或月经裤等商品更能满足需求，但女性在获取和使用时往往面临更多障碍，包括经济负担、获取渠道、社会污名化、缺乏职场支持等。不过我们尚未掌握足够证据来评估每种障碍的具体影响程度。

Later in life, when women enter the workforce, they continue to face challenges. Repurposed cloth might not be practical for long working hours, especially in environments with limited privacy or sanitation facilities. And while commercial products like disposable pads or menstrual underwear might be better suited to their needs, women often face additional barriers to accessing and using them, ranging from affordability, availability, social stigma, lack of workplace support. However, we do not yet have enough evidence on the role that each of these barriers impose.

我们很清楚女性健康需求常常被置于次要地位。经期健康是这一现象的典型表现，还是该领域存在额外的障碍？

We know very well that providing for women's health takes second place very often. Is menstrual health typical of that, an aspect of that, or are there additional barriers in this area?

是的。我们确信这是对女性健康整体忽视的一部分，但还叠加了一层独特的沉默与污名。它不仅仅是像其他许多方面那样被忽略，而是似乎被主动隐藏。如果你查看史前文化和宗教的相关报告，会发现月经在其中扮演着极其重要的角色。而大多数叙述都将经血描绘成危险或不洁之物。

Yeah. So we definitely think that it's part of a broader deprioritization of women's health, but it also comes with a unique layer of silence and stigma. So it's not just like neglected as with many other aspects, but it seems to be actively hidden. And so if you look at reports on like prehistoric culture and religion, then also menstruation plays a super important role there. And most of these narratives portray menstrual blood as something dangerous or unclean.

有时它也被赋予积极意义——比如具有魔力，但始终与某种超自然力量相关联。可能是神的恩赐，也可能是对罪孽的惩罚。这些文化认知会产生现实影响。例如在某些地区，经血被视为必须排出体外的污物，女性通过排放经血来清洁身体。还有些女性因此不愿就医治疗诸如月经过多等问题，这可能引发贫血或缺铁等医疗风险。

Sometimes it's also positive that it has magical powers, but always it is something with a greater connection. It could be a gift from the gods or punishment for sins. These cultural perceptions also have real life consequences. For example, in some places menstrual blood is perceived as something that must be released from the body, so the women clean their body by releasing this menstrual blood. And then also you have women who don't seek treatment for, for example, to heavy bleeding, which could be medically risky and it could link to anemia or iron deficiencies and so forth.

当低教育水平和月经话题的沉默文化叠加在这种复杂背景下，许多女性既缺乏准确信息也得不到支持。这不仅是西尔维娅提到的卫生用品短缺问题，更是人们对讨论月经根深蒂固的抵触——这使得通过常规公共卫生宣传来解决任何月经相关问题都变得异常困难。

And so when you also add low education and silence around menstruation to this complex cultural context, then many women lack accurate information and they also lack support. And then it's not just the lack of products that Sylvia has portrayed, but it's also this deep rooted discomfort to talk about menstruation and that makes it much harder to address any issue related to menstruation through conventional public health messaging.

传统上这是否一直被视作公共卫生调查研究的范畴，而非经济学家关注的议题？

Has this traditionally been considered something for public health investigations and research rather than a topic for economists?

确实如此。历史上关于月经健康的研究主要来自公共卫生和性别研究领域。但如今经济学家开始更多关注这个问题，特别是当我们发现月经健康管理障碍可能影响教育程度、劳动力供给甚至长期收入潜力时。这显然不再仅是健康或性别议题，更是个经济问题。我们开始认识到月经健康与教育及职场中的性别不平等密切相关。

Traditionally, yes. Most of the work on menstrual health has come from public health and gender studies, and this was definitely the case. But economists now have started paying more attention, especially as we are starting to see barriers to menstrual health management might affect education, labor supply, or even long term earnings potential. So, it's now becoming clearer that this is not just a health issue or a gender studies issue, it's also an economic one. And so as economies, we're starting to see that menstrual health is tightly linked to gender inequality in both schooling and the workplace.

如果一个女孩每月缺课，或女性因卫生设施不足或害怕污名化而回避某些工作，这就是对人力资本和生产力的制约——这种影响是可量化的。

So if a girl misses school every month, or a woman avoids certain jobs because of inadequate sanitation or fear of stigma, that's a constraint on human capital and productivity, it's measurable.

经济学界整体上也越来越关注文化、宗教和社会规范的解释作用。大量新兴文献记载了这些因素在风险共担、贷款偿还乃至政治态度等领域的广泛影响。特别是当女性在不同领域（最重要的是健康与劳动参与）明显受到有害规范的负面影响时，学界正愈发重视从文化视角和社会规范层面进行分析。

And also in economics in general, there's an increasing interest in trying to explain culture, religion and social norms. And there's also a growing body literature documenting the influence of these concepts in a variety of domains, such as risk sharing or loan repayment, or you can think about political attitudes. And in particular for these cases where women seem to be negatively affected by harmful norms in very different domains, most importantly health and labor force participation, there's an increased focus on looking at also cultural aspects or social norms.

经济学家能为研究方式带来什么贡献？

What can economists bring to the way that the research is done?

一方面，我们可以运用许多经济学工具来严谨衡量影响，但不仅限于确认某项信息是否有效，还要探究其背后的原因。经济学家试图厘清不同机制，这也是我们努力的方向。我们既测试干预措施是否真正带来益处，也试图解析其作用途径。此外，经济学家还能将那些超越健康影响的成本——如工时损失或就学率下降等具有长期影响、加剧贫困与不平等的因素——真正纳入考量。我们认为更重要的是帮助转变讨论框架，使其不仅关乎女性健康，更涉及劳动力市场与不平等议题。

So on the one hand, we can apply many economic tools to rigorously measure impact, but also not just to seek to understand whether an information work, but also why. So economists try to disentangle different mechanisms, and that's what we have also tried to do. So we have tried to test whether an intervention actually helps benefits or not but then also trying to disentangle through which mechanisms. And another thing that economists can bring to the table is to really make these costs that go beyond health effects, such as lost hours of work or reduced school attendance that have also long term consequences that perpetuate poverty and inequality to bring these costs on the table. And why we also think it's important that we can help shift the conversation so that it's not something that is just related to women health, but that has broader implications on labor markets and inequality.

我们将讨论你们合作的三篇以孟加拉为背景的论文。第一篇《文化禁忌与错误信息》是你们共同撰写的，研究团队向孟加拉女性询问经期卫生问题。你们希望从中发现什么？这项研究在哪些社区展开？

We're gonna discuss three papers that you have been working on, all set in the context of Bangladesh, which we've already discussed a little bit. Now in the first one, Cultural Taboos and Misinformation, it's a joint paper for the two of you. You're asking women in Bangladesh about menstrual hygiene. What are you trying to discover from them? And what sort of communities are you doing this research in?

我们既想记录与月经相关的行为限制、错误认知及卫生管理现状，也想探究其与社会对经期行为规范期望的关联。同时我们关注这些文化因素和社会规范如何影响信息吸收能力。当前全球改善经期健康的努力多集中于提供信息或产品，但信息干预的效果并不显著。

On the one hand, we wanted to really document restrictions due to menstruation, misinformation about menstruation and also menstrual health management. And we wanted to link it to the societal expectations about socially acceptable behavior and managing your menstruation. But then we also wanted to look at how these cultural aspects and social norms can affect the capacity to absorb information. So you have a lot of global efforts that try to improve menstrual health and they usually focus on either providing information or products. And in particular, the information provision didn't show super promising effects.

因此我们探讨：当同时考量信息与污名化时，能否解释信息吸收不佳的现象？我们通过干预前后即时采集的数据论证，观察到的影响只能源自提供的信息。两年后的追踪数据与基线及西尔维娅·卡斯特罗曼（后续讨论论文作者）同期调研结果的对比显示——

So what we wanted to ask is when we look at information and the stigma together, can we explain why information is not absorbed as well? And we provide some convincing arguments, we hope, that describe the effects that we see to our intervention. Essentially, have this information campaign and collect data directly before and after that information campaign. And so this timing where there's little time space between the intervention and the first data collection actually helps us to argue that everything that we observe can only be to the information provided. And then we also go back two years later and compare their data to the baseline that we have and to another study that was conducted by Sylvia Castromang, the paper we talk about later, and they collected data at a similar time than our end client survey.

其研究结果更接近我们的基线数据，这进一步证实我们所发现的效果确实源于提供的信息。

We really see that their outcomes are much closer to our baseline, which also suggests that it's actually the information that we provided that drives the effects that we find.

我们的研究对象是受雇于BRAC集团旗下社会企业Arawong的孟加拉乡村手工艺女性。这些紧密联系的社区位于达卡郊区，妇女们集中在村内刺绣工坊工作。这些工坊正是我们开展研究的场所。

The communities that we work with are artisan women in rural Bangladesh who are employed by Arawong. This is a social enterprise part of the BRAC group. They're close knit communities outside of Dhaka, and all of them work in embroidery centers within their villages. They work all together, and these centers are the locations that we're going to visit to do our study.

那么在基线调查中，他们告诉你最常见的管理月经的做法是什么？

So at baseline, what are they telling you are the most common practices for managing menstruation?

我们已经提到了一些，关键点在于大多数女性在经期会使用改造过的布料，这个比例从40%到70%不等，取决于国家不同地区。当然，达卡市区和农村社区的数据有所不同。有些人也会使用一次性卫生巾，但布料确实是吸收经血的主流方式。这种可重复使用的布料本身并不是问题所在，重要的是如何处理和使用它，对吧？

We've already been mentioning a little bit, and the key part is that most women use repurposed cloth during their periods, and this number ranges from forty to 70%, depending on the area of the country. Of course, the numbers are different in urban Dhaka to rural communities. Some also use disposable pads, but really cloth is the prevalent method for absorbing blood. And this reusable cloth is not per se a problem or the problem. What's important is how it's treated and how it's used, right?

实际上，只有一小部分女性会在再次使用前以卫生的方式清洗和晾干布料。建议用肥皂清洗后在阳光下晒干，这样紫外线可以杀菌。然而，许多女性会偷偷清洗，有时她们甚至为了隐私在厕所里清洗这些用品。有时她们没有足够的干净水或肥皂来清洗。

So, only a small fraction of women actually clean and dry the cloth in a, let's say, hygienic way before using it again. It is recommended that it's washed with soap and then it's dried in the sun so that the UV light can kill the bacteria. However, many women wash it secretly. Sometimes they even use latrines for privacy to wash these products. Sometimes they don't have enough clean water to wash them or soap.

而且，即使布料用肥皂彻底清洗过，她们也会把它藏起来，不挂出来晾干。有时她们直接把它藏在衣柜里、床垫下面，所以当她们再次使用时，布料还是潮湿的。这当然会导致她们即将使用的布料上滋生大量细菌。

And then also, once the product is washed, even if it's well washed with soap, they hide it. They don't hang it out to dry. So, sometimes they hide it directly in cupboards, under the mattress directly, so when they use it again, it's moist. And this can, of course, lead to a lot of bacteria in the product that they were going to use.

那么这些限制，她们管理月经方式上的问题，是因为缺乏信息吗？还是她们有信息，但受限于严格的社会规范而担忧？

So are these constraints, these problems with the way that they are managing their periods? Is this because of a lack of information? Or do they have the information, but they're worried about the restrictive social norms?

根据这项研究，似乎两者都有。我们发现关于月经的知识存在很大缺口。在这项研究的基线数据中，27%的女性认为月经是一种疾病，97%的人，也就是几乎所有人，都误以为月经是排出体内有毒血液的过程。哇。所以确实存在...嗯...

According to this study, it seems to be really both. So we do see large knowledge gaps about menstruation. So at baseline in this study is twenty seven percent of the women thought that menstruation is an illness, and ninety seven percent, so nearly all of them, holds a misconception that menstruation is a process of limiting toxic blood from the body. Wow. So there is the kind of Yeah.

是的，知识方面有改进的空间。但当我们看月经管理实践的知识时，知识缺口就小得多。几乎所有人，同样97%，知道应该用肥皂清洗可重复使用的布料。但在晾干方面，知识缺口似乎更大。只有75%的人知道必须在阳光下晾干，且不应与其他衣物一起存放，这意味着约25%的人不知道如何正确晾干月经布。

Yeah, room for improvement in knowledge. But when we look at knowledge for menstrual practices, then the knowledge gaps are a lot smaller. So nearly all of them, equally 97% are aware that you should wash reusable cloths with soap. But then when we look at drying, seems to be a larger knowledge gap. Only 75% know that you have to dry it in the sunlight and it should not be stored with other clothes, but that leaves like 25% who don't know how to properly dry menstrual cloth.

然而当我们观察实际的月经处理方式时，这些知识并未真正体现在实践中。对吧？正如西尔维娅所说，大多数女性倾向于在无人看见的地方清洗可重复使用的布条，仅有8%到9%的人会将其晾晒在外。我们在定性访谈或交谈中也了解到，这些行为会被视为羞耻的——如果你看到外面晾着月经布，就会被认为不符合社会规范等等。这些现象在我们收集的社会规范数据中也有所体现。

Then when we look at actual menstrual practices, then this knowledge is not really reflected in that. No? So as Sylvia already said, most women prefer to wash their reusable cloth where they cannot be seen, and only eight to 9% actually dry them outside. We also heard a bit in qualitative interviews or in conversations that yeah those practices would be seen as shameful so if you see cloth drying outside then it's being considered as socially inappropriate and so forth. And we also do see that in the social norms that we elicit.

我们发现提供的信息确实有助于改变人们对晾晒月经布的一些观念。

We do see that our information actually can help to shift some of the perceptions for drying menstrual cloth.

嗯。

Mhmm.

但另一方面，月经血其实已经离开了经期用品。而对于清洗月经布而言，污名化似乎更为严重，因为此时月经血仍残留在布条上，被视作有毒或不洁的象征。

But then you also have that the menstrual blood is already out of the product. And for washing menstrual cloth, the stigma seems to be much stronger because then you still have the menstrual blood that is stigmatized and considered toxic or impure still in the product.

所以你们试图评估提供信息的有效性。具体是哪种干预措施？你们提供了哪些信息？

So you were trying to evaluate how useful it is to provide information. What is the intervention here? What information are you providing?

我们与当地非政府组织合作，为所有女性开展一小时的科普宣讲会。内容包括基础知识：什么是月经、自然生理现象及其背后的生物学原理，以及如何保持经期卫生的实用建议。指导者会演示正确清洁布条的方法、卫生巾使用及处置方式，甚至讨论常见疼痛症状及应对措施。这些课程不仅旨在传递信息，更希望在当地环境中将月经知识学习正常化——不是作为羞耻之事，而是生物学与健康的一部分。

We work with a local NGO to run one hour information awareness sessions for all the women. And these sessions cover the basics: what menstruation is, what's natural, what's the biological process behind it. And then also practical tips on how to manage it hygienically. The facilitators showed how to properly clean cloth, how to use pads, how to dispose of them, and even talk about common pain symptoms and how one can deal with them. The overall goal of these sessions is to give information, but also to normalize learning about menstruation and periods in the setting, not as something shameful, but as part of biology and health.

你们是以团体形式而非一对一开展这些活动的吗？

And you're delivering this in a group setting, not one to one?

是的。我们认为这正是让月经话题常态化的部分原因。如果仅限于一对一交谈，那就无法真正实现月经讨论的常态化，也无法在同龄人群体中形成普遍认知。

Yeah. And we think that is part of what makes it like normalizing conversations about menstruation. If you would confine it to a one to one meeting, then it doesn't really make talking about menstruation yeah. It doesn't normalize it in a also in a group of peers.

那么你们观察到了哪些具体效果？这些效果是否具有持续性？

So what effects do you find from this? Do you find that the effects are persistent?

部分效果立竿见影且出乎意料地持久。例如课程结束后，认为户外晾晒月经布不合适的观念显著下降。两年后，许多女性仍认为阳光晾晒是合乎社会规范的。她们也表示羞耻感减轻，我们观察到自我报告的卫生实践有所增加。正如克里斯蒂娜提到的，虽然干预改善了卫生处理方式，但在洗涤习惯方面未见转变。

Some effects were immediate, but surprisingly long lasting. For example, after the sessions, the belief that drying cloth outside is inappropriate dropped dramatically. Two years later, many women still report that it's socially appropriate to dry cloth in the sun, to outside. They also describe feeling less ashamed, and we observe an increase in self reported hygienic practices. And as Christina was mentioning, while the intervention helped improve these hygienic trying practices, we didn't find any shifts when it comes to washing practices.

因此，某些规范——比如避免在公共洗衣区清洗月经布——依然根深蒂固。信息传播固然有效，但并非万能钥匙。改变深层规范可能需要超越事实灌输，引发更深层的文化变革。本文属于描述性研究，结果应视为未来研究的基础。我们另有项目基于这些发现，通过随机对照试验分析宣传活动的因果影响，结果显示出高度相似的效果。

So, some norms such as avoiding public wash facilities to clean menstrual cloth, like with the rest of the laundry, remain strong and unchanged. While information helps, it's not a silver bullet. Changing sonar norms might require more than just facts, they might need a deeper cultural change. The paper's descriptive, the results should be viewed as a foundation for future research. And we have other projects that build on these observations and analyse the causal impact through RCTs of this information, this awareness campaigns, and they show extremely similar effects.

你们还有两篇以孟加拉职场为背景的论文。关于月经如何影响孟加拉国女性工作表现，目前有哪些发现？

You have two further papers, both set in the workplace in Bangladesh. What do we know about how menstruation affects women's work in Bangladesh?

我们的研究起点是某些将月经视为高收入国家劳动力参与差异潜在解释的既有成果。

So we started from some work that also looks at menstruation as a possible explanation for a differential labor force participation in high income countries.

明白。

Right.

是的。此外，有研究表明女性比男性有更高的缺勤率，且月经会导致缺勤和出勤但效率低下的现象，即在岗时生产力下降。前提是在低收入国家，由于卫生经期健康实践的有限可用性和使用，这些影响可能会被大幅放大。我们查阅了之前进行的定性研究，孟加拉国的许多本地组织估计，女性服装工人中30%至70%的缺勤是由于不良的经期健康状况。这些数字看起来相当庞大。

Yeah. Also, was some work that showed indications that women have more absentees than men, and also that menstruation leads to absenteeism, also presenteeism, so reduced productivity when at work. The premise was that in low income countries, these effects could be probably amplified a lot due to the limited availability and also the use of hygienic menstrual health practices. We have looked at qualitative studies that have been conducted before, and many local organizations in Bangladesh had estimates that between thirty to seventy percent of absentees among female garment workers are due to poor menstrual health. And these numbers seemed massive.

而且当我们与服装工厂交谈时，他们对此表现出极大兴趣，因为他们表示女性工人的缺勤确实打乱了他们的生产线。因此，如果能减少这种情况，他们会非常高兴。他们也认为提供更好的经期健康管理方案实际上有所帮助。而对于职业女性来说，影响可能相当严重。不。

And also when we talked to garment factories, they were extremely interested in that because they said that absenteeism of their female workers is really disrupting their production lines. So if they can reduce that, they would be extremely happy. And they also thought that providing better menstrual health management possibilities actually helps. And the effects for working women could be fairly severe. No.

她们大多在一种工作环境中，缺勤的日子是没有报酬的。如果她们缺勤，后果对她们来说也一定相当严重。

They are mostly working in a setting where they don't get paid for missed days at work. The consequences for them must be fairly high if they miss days at work as well.

是的，当然。克里斯蒂娜，你的论文名为《改善工作场所的经期健康》。在这项干预中，你们向服装工人提供了信息和卫生巾。你们关注哪些结果？

Yeah. Of course. Now, Christina, your paper is called Improve Menstrual Health in the Workplace. In this intervention, you provided information and menstrual pads to garment workers. What outcomes are you interested in?

我们当然关注这类劳动力市场的结果，即在密集边际上的劳动力参与，你可以想到缺勤率以及生产力，我们用收入作为代理指标。我们还希望更进一步，稍微解开因果效应的链条。因此，我们不仅关注经期实践，还关注健康和福祉作为潜在渠道，通过这些渠道，信息提供或卫生用品最终影响劳动力市场结果。我们也希望区分信息与财务约束的影响，并理解它们如何相互作用。所以我们不仅单独考察了两种处理方式，还研究了它们如何互动。

We were, of course, interested in these kind of labor market outcomes, labor force participation at the intensive margin, so you can think about absentees and also productivity, which we proxy by earnings. We also wanted to go further and a bit unpack the causal chain of effects. So looking at menstrual practices, but then also health and well-being as potential channels through which this information provision or the sanitary pets actually affect these labor market outcomes down the line. We wanted to also look at disentangling information from financial constraints and also understand how they interact. So we didn't have just both treatments individually, but we also looked at how they interact.

因此，问题是，真的是产品的可负担性，还是信息帮助采纳了这项技术？此外，这些信息是否可能帮助改善传统实践，从而改善劳动结果？

So to ask the question, is it really the affordability of products or is information helping to adopt the technology? And then also can this information maybe help to improve traditional practices and thereby labor outcomes?

是的。你们是如何设计这个研究，以便能够区分所有这些你们试图发现的因素的？

Yes. How did you structure this to be able to separate all these things that you're trying to find out?

于是我们在孟加拉国的服装厂开展了这项研究。在这些工厂里，我们基本设立了四个不同的小组，以理解这两个维度及其相互作用。第一个小组是信息提供组，与我们联合研究中的非政府组织相同。他们在工厂内以20名女性为一组，进行一小时的集体信息宣传活动。

So we run this study in garment factories in Bangladesh. And in these garment factories, we essentially created four different groups to understand both these dimensions and also the interaction. So the first one is a provision of information. It's the same NGO that we have in our joint study. So they provide a one hour information campaign in groups of 20 women of the same factory.

第二个小组我们分发卫生护垫。她们会获得这些护垫，或者可以在工厂医务室领取每月配给的卫生护垫，我们持续提供了六到八个月。第三个小组则同时获得信息和护垫。第四个小组是纯粹的对照组，不接收任何干预。嗯。

And then we have a second group where we distribute sanitary pets. And they get these pets or they get a monthly ratio of sanitary pets that they can pick up in the medical rooms of the factory, and we provide this for six to eight months. And then we have a third group that gets both, so the information and the pets. And then we have a fourth group that is the pure control group that doesn't get anything. Mhmm.

所以你可以将信息干预和护垫视为两个处理维度，但我们实际上采用了完整的2×2设计，最终形成四个处理组。

So you can think about information intervention and pets as two treatment dimensions, but then we have a full two by two design with four resulting treatment groups.

这种干预是否成功帮助女性在工作期间管理月经？

And is that successful in helping women to manage menstruation at work?

是的。在这方面我们确实看到了相当显著的效果。观察免费提供卫生护垫的情况，报告使用卫生护垫的女性比例增加了约23%。而信息干预则提升了关于晾晒可重复使用产品的知识——这是我们观察到效果的主要领域。

Yes. So there we definitely see quite substantial effects. So if we look at the provision of free sanitary pads, then you have an increase of women who report to use sanitary pads by around twenty three percent. And if we look at information, then that also increases knowledge on drying reusable products. So this is the main category where we see effects.

此外，接受信息干预的工人正确晾晒可重复使用布料的概率提高了95%。可见在月经健康管理方面效果显著。但我们没有发现交叉效应——提供护垫并未提升知识水平，信息干预也未增加护垫使用率。有趣的是，我们也没有发现任何交互效应。

And then also we see that workers who are in this information treatment are ninety five percent more likely to actually dry reusable cloth properly. So we see quite large effects on like kind of menstrual health management. We don't find any crossover effects. So providing pets does not improve knowledge or information doesn't improve pet uptake. And also, interestingly, we don't find any interaction effect.

这意味着获得护垫后，信息干预并不会进一步促进护垫技术的采用。研究显示：消除信息约束确实能通过改善晾晒方式（特别是可重复使用布料）来提升传统月经卫生实践；而消除财务约束则真正有助于采用卫生护垫这种新型卫生产品的技术。

So information is not further improving technology adoption of pets once you receive pets. So it really seems that relaxing information constraints fosters also hygienic traditional menstrual practices by better drying, in particular the reusable cloth, and relaxing the financial constraints really helps to adopt the new technology of this hygienic new product, namely sanitary pads.

这些数字显示出行为上的显著差异。回到我们的出发点，这种工作出勤率的改变是否提升了女性的福祉？

Now those numbers represent quite a difference in behavior. Going back to our starting point, is this changing attendance at work earnings improving the women's well-being?

部分如此。我们发现对自我报告健康状况有相当大的影响。我们调查了尿路感染情况，发现两种处理方式实际上都将尿路感染减少了约0.14个标准差。这些都是显著且不可忽视的效果。再次强调，我们并未发现炎症与宠物之间存在交互作用，但似乎无论是更卫生地使用传统方法，还是使用本身就更卫生的新产品，对自我报告健康的影响是相同的。

Partially. So we do find sizable effects on self reported health. We ask for urinary tract infections, and there we see that both treatments actually reduce these urinary tract infections by around 0.14 standard deviations. So these are nice and not negligible effects. And again, we don't really find any interaction between inflammation and pets, but it really seems that both using traditional practices more hygienically and using new products that are more hygienic per se has the same effects on self reported health.

但在因果链条下游我们没发现其他影响。既未发现对自我报告幸福感的其他影响，在查阅工厂人力资源记录的行政数据时，也未发现缺勤率或收入方面的变化——既没有缺勤减少，也没有收入或生产力的提升。

But we don't find any other effects down the causal line. So we don't find other effects on self reported well-being. And when we look at administrative data from the factory's HR records, we also don't find anything on absentees or earnings. So no reductions in absenteeism and no increase in earning or productivity.

这很令人意外，不是吗？

That's surprising, isn't it?

是的。我们讨论了可能导致这种情况的几个原因，对吧？一方面，我们当然强调女性健康的改善本身就很重要。

Yeah. We discussed several reasons for why that could be the case, no? So on the one hand, we of course stress that these improvements in female health are important on its own.

就其本身而言，确实如此。

On their own, yes.

正是。但可能像0.14个标准差的提升还不足以降低缺勤率。而且这是个高压工作环境，女性不上班就没有工资。

Yes, exactly. But probably like a 0.14 standard deviation increase is not sufficient enough to reduce absenteeism. And this is a high pressure work environment where women don't get paid when they don't go to work.

当然。

Of course.

首先，女性可能已经只遗漏那些绝对必要的日子。其次，我们讨论了一些更技术性的问题，比如电力，同时我们也观察到对照组中宠物使用率随时间上升。这限制了我们的发现范围。但该研究的两大核心结论是：提供信息能帮助更卫生地使用传统月经用品，这可能是推广不同产品时更具成本效益的政策选择。我们正在进行后续研究，运用网络计量经济学技术来测量宠物治疗方式通过现有社交关系的实际扩散情况。

Women may already only miss those days that are absolutely necessary. And third, have some more technical things that we discuss such as power, and also we see an increase of pet use in the control group over time. So that also limits what we can find. But essentially the two main takeaways that we see from that study is that providing information can also actually help use traditional menstrual material more hygienically, and it may be a cost effective policy alternative to actually promoting different products. And we also do a follow-up study now where we apply network econometric techniques to actually measure the diffusion of our pet treatment along existing social connections.

我们确实发现这些提供的卫生宠物用品在社交网络中有着显著的扩散效应。

And we do find there is a substantial diffusion of these provided sanitary pets in our networks.

是的，非常鼓舞人心。西尔维娅，在你的论文《打破沉默》中，你聚焦于购买一次性卫生巾的污名化问题。为何这种污名如此顽固？

Yeah. Very encouraging. Sylvia, in your paper Breaking the Silence, you're focusing on the stigma around purchasing disposable pads. Why is this stigma so strong?

在全球大多数国家，月经仍被视为羞耻且私密的事。这种羞耻感导致——比如购买卫生巾意味着当众承认自己正处于或即将经历月经期。想象一下孟加拉国的情境：几乎每个街角小店或药房都由男性经营。女性不得不与陌生男性讨论这个禁忌话题，而周围可能还有其他顾客。

Menstruation is still treated as something shameful and private in most countries in the world. And then with this shame attached to it, for example, buying pads means admitting oftentimes in public that you are on your period or you will be. Then now if we think of a setting like Bangladesh, where almost every corner shop or pharmacy is run by men. Right. So, a woman has to discuss or mention a taboo topic with a male stranger, while other customers might be around.

这种性别规范、对闲言碎语的恐惧，以及经期不洁的根深蒂固观念交织在一起，形成了强大的社会成本。我们假设即使卫生巾可获得、价格合理，这种心理障碍仍会阻碍使用率——这正是我们研究中想要验证的。

So, this mix of gender norms, maybe fear of gossip, and ingrained ideas that periods are impure, can create a powerful social cost. So, we were hypothesizing that this might be a barrier to the adoption, even when paths are available, they're known, and they're even not so expensive. And this is what we wanted to test in the study.

你们如何尝试改变'向男性购买卫生用品是不恰当或羞耻的'这种观念？

How did you try to change that belief that purchasing from men would be inappropriate or shameful?

于是我们组织了时长一小时、仅限女性参与的讨论小组，每组约15至20名参与者，当时全是女性员工在房间里。与之前讨论的那些信息宣传活动项目有所不同的是，这里不涉及意识提升或额外外部信息提供。两位女性引导者只是让女性们交换个人故事，比如你第一次了解月经是什么时候、在工作中如何处理月经问题。没有讲座，没有PPT演示，只是一个安全的空间来交谈。听到同龄人表达同样的忧虑，甚至可能对此一笑置之。让女性更新她们对其他女性真实想法和经历的心理认知图景。

So we organized one hour women only discussion groups of around 15 to 20 participants, all female workers at the time, in the room. And what's a bit different from these projects, of the previous information campaigns that we discussed, is that here it was not about awareness or additional external information provision. Two female facilitators simply asked women to swap personal stories, like when did you first learn about periods, how do you handle them at work, No lecture, no PowerPoints, just a safe space to talk. Hearing peers voice the same worries, or maybe even laugh about them. Let women update their mental map of what other women really think, what other women go through.

换句话说，我们试图直接打破沉默，因此论文以此为标题。

So, other words, we try to attack the silence directly, therefore the title of the paper.

这些讨论改变了行为吗？

Did these discussions change behavior?

是的，而且相当迅速。我们对此有两个衡量指标。首先是对已知产品的估值，即一次性卫生巾。我们在会后向研究中的所有参与者——包括对照组和治疗组的女性——征询她们的支付意愿。我们发现治疗组的女性愿意为一包卫生巾多支付约25%的费用。

Yeah, and quite quickly. We have two measures for that. First, the valuation, the general valuation of a product that they know, so disposable pets. We elicit their willingness to pay after this session to everybody, all the participants in the study, women in the control group and treatment group. And we saw that the women in the treatment group were willing to pay about 25% more for a pack of pets.

这是一种她们熟知且可获取的产品，但我们发现讨论实际上帮助她们更重视该产品。我们的第二个衡量指标是实际采用率。她们是否开始使用新的经期专用产品？正如克里斯蒂娜提到的，工厂有兴趣为女性提供经期专用产品，以替代布料。因此我们向她们提供全新的抗菌月经内裤。

And this is a product that is available, that they know well, but we see that actually discussions help them value the product more. A second measure that we have is actually the adoption. Are they taking up new period specific products? So, as Christina mentioned, the factories are interested in making period specific products available to women, so they swap from cloth. And so we offer them a brand new antibacterial menstrual underwear.

在这个项目中，我们与开发这项新技术的非政府组织合作。产品是免费的，在由男性经营的服装厂商店里提供。结果显示治疗组中有额外14%的女性去领取了这个产品。尽管她们必须在同事可能看到的情况下从男性店主那里领取，她们仍选择去获取。

So for this project, we collaborated with an NGO that was developing this new technology. It was for free, it was made available at the Garment Factory store, run by men, of course. And then either 14% more women in the treatment group go collect this product. So they choose to pick it up, even though they have to pick it somewhere where your colleagues might see you actually from a mail shopkeeper.

你知道是什么驱动了这种行为改变吗？背后的原因是什么？

Do you know what's driving this change in behavior? What's behind it?

讨论并未使卫生巾变得更便宜或神奇地更好，没有。真正改变的是社会成本，我们在论文中尽可能详细地探讨了这一点。例如，我们观察到社会规范的转变——在对话前，大多数女性认为从男性那里购买卫生巾是社会不适宜的。

The discussions didn't make pads cheaper, no, or magically better. No. So what changed was the social cost, and we try as much as possible in the paper to look at this in detail. So we observed, for example, a social norm shift. So before the chats, most women said buying pads from a man was socially inappropriate.

之后，主流观点转变为这是社会适宜的。甚至在研究结束六个月后的跟踪调查中，这种改变依然存在。此外，我们还通过离散选择实验发现，参与过讨论的女性相较于学校环境，对店主性别或在公共场所购买产品的顾虑显著降低。这表明驱动力源于对产品获取过程中的污名化与羞耻感的减少。

Afterwards, the modal answer flips to it's socially appropriate. And we follow-up even six months later after the study, and this change was there. In addition, we also have a choice experiment, a discrete choice experiment in the study, and it shows that women that have been in these discussions care less about the shopkeeper's gender or the fact that they need to buy the products in a public space compared to the school. So it seems that the drivers are reduction on stigma and this shame of accessing the product.

这项研究非常鼓舞人心。当然，孟加拉国的研究背景既丰富又充满挑战。但这绝非仅限孟加拉国的难题。你们是否计划在其他环境中继续这项研究？

So this is very encouraging research. And of course, the setting in Bangladesh is a particularly rich, particularly challenging one. But of course, this is not just a challenge in Bangladesh. Are you planning to continue your research in other settings as well?

是的，毫无疑问。我们认为全球女性在经期管理方面仍面临诸多障碍有待探索。为此我们正在构建全球研究框架：目前正与乐施会合作，在中非共和国、马里和索马里兰的人道主义环境中开展项目，即将发布关于女性对经期产品偏好的论文草案。同时在尼泊尔对学生进行的信息干预研究，正重点针对这些污名化问题。

Yes, absolutely. So we think there's still so much to learn about barriers that women face around the world when managing their menstruation. And we started to build up a global research agenda around it. So we are cooperating with Oxfam to look at a project in humanitarian settings in Central African Republic, Mali, and Somaliland, and there will be a draft paper soon also on, like, preferences of women and how they value different menstrual products. We also have a current study ongoing in Nepal with school children where we have an information intervention that focuses precisely on these stigma components.

我们还将与德国-尼泊尔NGO组织NEDISI启动第二个项目，旨在进一步解构围绕月经的 restrictive社会规范。明年计划重返孟加拉国服装厂，开展聚焦职场包容性的研究，探索月经健康如何影响劳动力参与——这是与专注服装行业水资源管理的德国NGO DRIP by DRIP的合作项目。可以说，我们在多领域都有并行项目推进。

And we are also launching a second project with our partner. That's a German Nepali NGO called NEDISI to also try to unpack a bit more these restrictive social norms around menstruation. And next year, we hope to go back to the garment factories in Bangladesh in the workplace to launch a project that focuses a bit more on workplace inclusivity, all related to menstrual health, but then like, yeah, revisiting this evidence that how it affects labor force participation. And that is in collaboration with a German NGO, DRIP by DRIP, who focuses also on, yeah, water management in the garment sector. So, yeah, we have a lot of projects ongoing in different settings.

同时您也能看到，我们正竭力让实践者与政策制定者参与进来，共同解决这些问题。

And you also see that we try to engage practitioners and policymakers as much as possible to really answer these questions.

与此相关的是实践者的重要性——最近对此感兴趣的人越来越多。四周前，西门子基金会表示有意资助东非地区的相关研究（该地区我们尚未覆盖）。我们已启动小型试点，细节仍在敲定中，非常令人兴奋。可以肯定的是，相关研究即将陆续展开。

Linked to this, the relevance of practitioners and how many people are now interested on this very recently. So, four weeks ago, the Siemens Stifton has indicated that they are interested in supporting financially research on the topic in East Africa, which is we have not yet done research there. We launched a very small pilot. The details are still being finalized, very exciting. Things are definitely in the pipeline on the topic, so there will be research coming up.

许多新问题、新项目，但它们都围绕着理解和消除MSRA健康管理的障碍展开，无论这些障碍涉及财务、信息还是文化层面，仍有许多需要学习的地方。

Many new questions, projects, but they're all centered on understanding and breaking down barriers to MSRA Health Management, and whether these are related to financial, informational, cultural aspects, there's still a lot to learn.

最初我提出过这个问题：这属于公共卫生问题还是经济学问题？但当然，它没有理由非此即彼。在这些公共卫生与经济学性别理论家合作的领域，协作研究将使研究受益。

At the beginning, I asked the question, is this something that is a public health question or an economics question? But of course, there's no reason why it should be either or, is there would research benefit from collaborative research in these areas where public health and economist gender theorists work together.

确实如此。这个领域非常需要协作，而协作也确实大有裨益。公共卫生研究者带来了经期健康生物医学和行为层面的深厚专长，经济学家则通过区分成本、收益和行为约束来构建框架，这样我们才能系统思考障碍。这种合作还能促使两个学科严谨评估哪些措施有效，并帮助它们在方法论上使用共同语言。随机对照试验和因果推断等方法有助于确定最有效、可扩展的干预措施，但只有基于对卫生系统、污名化和社会背景的深刻理解——这些通常是公共卫生专家的专长——这些方法才有意义。

Yeah, this is very true. This is a space where collaboration would be very helpful, and it's very helpful. Public health researchers bring deep expertise in biomedical and behavioral aspects of menstrual health, while economists are structuring by separating costs, benefits and constraints to behavior, and this way we have to think about barriers. It also helps the both disciplines use rigorously, evaluate what works and what, and it clearly helps the both disciplines speak the same language method wise. Our methods like randomized controlled trials and causal inference help identify the most effective, scalable interventions, but they are only meaningful if they are grounded in a deep understanding of health systems, stigma, and social context that normally public health experts have an advantage on.

你们正在大力改变这个话题的讨论方式，但显然讨论得还不够。我想其中一个问题是，全球半数人口——以及远超过半数的政策制定者——从不需要日常面对这些问题。我们如何才能创造更大的关注度来打破这些禁忌和社会规范？

You're doing a lot to change the way in which this is discussed, but it's clearly not discussed enough as yet. And I guess one of the problems is that half the world's population and far more than half the world's policymakers never have to deal with any of these problems day to day. How can we create a greater focus that would help to break down these taboos and these social norms?

没错，你精准指出了挑战所在。这个问题对许多人——尤其是仍以男性为主的掌权者——是不可见的，但它确实对健康、尊严、教育、经济机会产生现实影响，主要针对女性，但若考虑到生产流程中断或女孩过早辍学导致的人力资本配置次优等问题，所有人都会受到影响。我们认为前进方向之一是创造更多证据，表明月经禁忌不仅是个人不便，更会影响就学率、劳动生产率和卫生系统成本。另一条路径是更多采用叙事传播策略。

Yeah. You nailed down the challenge. So the issue is invisible to many people, in particular those in power who are still predominantly male, but they also have real life consequences on health, dignity, education, economic opportunity, mainly for women, but at the same time also, yeah, everybody is affected if you think about disruption to production processes or suboptimal human capital allocation if girls drove out of school too early and so forth. We think that like kind of one way forward is really to create more evidence to show that a taboo like menstruation isn't just person inconvenience, but it actually affects school attendance, labor productivity, and health system costs. Then another way is to engage a bit more in storytelling.

因此我们也与擅长为女性经历发声的合作伙伴共事，其叙事方式令人难以忽视。若能将这种叙事与我们基于数据建立的学术研究和证据体系结合，人们就更难对此视而不见。我们认为极其重要的另一点是让男性也参与这些讨论。当前许多研究聚焦女性，提升她们对认知差距和污名的意识，但让男性同龄人、教师和管理者产生同理心同样重要。NAPA项目正在尝试这样做。

So this is why we also work with partners who are much better at giving voices to women experiences in a way that it's hard to ignore. And then if we can combine that with academic research and evidence base that we create from the data, then it becomes much harder to look away and to ignore these facts. And another thing that we think is extremely important is to bring men on board in these discussions as well. So a lot of the research at the moment focuses on the women and making them aware of knowledge gaps and stigma, but it's also important to sensitivatize male peers and teachers and managers. And so in NAPA we are just trying to do that.

我们开展了面向女孩的信息宣传，同时也面向男女学生，以此对比效果差异。即便在高收入国家，这些约束仍然重要——虽然在中低收入国家更为严峻。在高收入国家，讨论月经仍未常态化。那里有许多社交媒体活动帮助提高人们对月经周期带来挑战的认知。我们希望这种趋势能持续下去，唤起更多关注。

So we have the information campaign that we deliver to girls and then also to girls and boys and essentially compare what the effects are. And so yeah, we think also in high income countries these constraints are still important. I mean they are much more severe in low and middle income countries, But also in high income countries, you see that it's still not normalised to talk about menstruation. And they have a lot of social media campaigns that help to create awareness and challenges that women face because of their menstruation cycle. And yeah, we hope that this will continue and create more awareness.

我也希望如此。祝你未来的工作顺利。感谢你今天与我讨论这些。谢谢你，克里斯蒂娜。

I hope so too. And good luck with your future work. Thank you for discussing it with me today. Thank you, Christina.

是的，不客气。这次交流非常愉快。谢谢。

Yes, you're welcome. It was a lot of fun. Thanks.

也谢谢你，西尔维娅。

And thank you, Sylvia.

非常感谢你，蒂姆。

Thank you so much, Tim.

这是我们讨论过的论文资料。第一篇是西尔维娅·卡斯特罗和克里斯蒂娜·祖拉的《孟加拉国农村地区关于月经健康管理的文化禁忌与错误信息》，发表于2025年《世界发展》1月刊。然后是克里斯蒂娜·祖拉、安德烈亚斯·门采尔和玛蒂娜·宫本的《改善月经健康与工作场所——针对孟加拉国女性服装工人的随机对照试验》。

So here are the papers we have been discussing. The first one is Silvia Castro and Cristina Zura. It is Cultural Taboos and Misinformation about Menstrual Health Management in Rural Bangladesh that was published in World Development 01/1988 in 2025. Then we have Christina Zura, Andreas Menzel, and Martina Miyoto. Improved menstrual health and the workplace, an RCT with female Bangladeshi garment workers.

该论文发表于2024年1月的《发展经济学杂志》。还有西尔维娅·卡斯特罗与克拉丽莎·芒的《打破小组讨论与月经健康技术采纳》，同样发表于2024年《发展经济学杂志》1969年1月刊。若想通过Voxdev了解相关内容，可阅读文章《通过公开月经讨论推动健康技术采纳》，作者是艾米丽·欧容、西尔维娅·卡斯特罗和杨·施伦克，发表于2023年9月。

That was published in the Journal of Development Economics January 2024. And Sylvia Castro, Clarissa Mang, Breaking the Group Discussions and the Adoption of Menstrual Health Technologies that was published in the Journal of Development Economics as well, 01/1969 in 2024. If you want to read about this on Voxdev, then the article Breaking the Advancing Health Technology Adoption Through Open Discourse on Menstruation. And that's Emily O'Jung, Sylvia Castro, and Yang Schlenk. That was published in September 2023.

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