Bleeding inequality: How menstrual poverty undermines academic success via social anxiety in female university students—A structural equation modeling study

In this cross-sectional study, we investigated the relationships between income, menstrual poverty, social anxiety, and academic success among 640 female undergraduates at Pamukkale University, Türkiye, using structural equation modeling. We collected data between April 1 and 15, 2025. We found moderate menstrual poverty (mean score 35.87 ± 6.35) and social anxiety (28.94 ± 10.59). Lower income predicted higher menstrual poverty (β = -0.199, p < .001), which directly increased social anxiety (β = 0.316, p < .001) and reduced academic success (β = -0.161, p = .002). Social anxiety also negatively affected academic success (β = -0.039, p = .046). We identified significant indirect effects: income influenced academic success through menstrual poverty (β = 0.032, p = .010) and through the sequential pathway of menstrual poverty and social anxiety (β = 0.002, p = 0.045). Income had no direct effect on academic success (β = 0.207, p = .559). Our findings underscore the need for campus interventions addressing menstrual product access, infrastructure, and mental health support to mitigate educational impacts.