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Paper short abstract:

This study investigates the causal link between menstrual health and hygiene (MHH) and mental health among women in Nepal. Using an instrumental variable approach with the 2022 Nepal Demographic Health Survey, I find that improved MHH significantly reduces the likelihood of anxiety and depression.

Paper long abstract:

The "polycrisis"—an interconnected web of global challenges, including economic instability, conflict, and public health emergencies—poses a significant threat to gender equality and well-being, particularly impacting the health of women, girls, and trans/non-binary individuals. This study investigates the causal effect of improved MHH practices on the likelihood of experiencing anxiety and depression among women aged 15-49 in Nepal. To address endogeneity concerns, I employ an instrumental variable approach, leveraging the perceived barrier of distance to the nearest health facility as an exogenous source of variation in MHH access. Using data from the 2022 Nepal Demographic Health Survey, I find that women with better MHH practices experience a 32.3 percentage point (pp) reduction in the likelihood of experiencing anxiety and a 33.5 pp reduction in the likelihood of experiencing depression. These effects are robust to a battery of sensitivity checks. Notably, the impact is more pronounced for women from disadvantaged backgrounds, highlighting the intersectional nature of MHH and mental health inequities. This study contributes to the limited causal evidence on the MHH-mental health link and underscores the urgent need for comprehensive MHH interventions as a crucial component of promoting health equity in the era of the polycrisis.