Menstrual hygiene practices among adolescent women in rural India: a cross-sectional study

Abstract

Background Exclusive use of hygienic methods (sanitary napkins, locally prepared napkins, tampons, and menstrual cups) to prevent the visibility of bloodstains during menstruation is still considerably low among adolescent women in rural India. However, no prior research has explored the prevalence and determinants of exclusive hygienic methods among rural Indian adolescent women. To address this gap, this study examines the factors affecting adolescent women’s exclusive use of hygienic methods in rural India. Additionally, this study explores state- and district-level geographical disparities in the exclusive use of hygienic methods among adolescent women in rural India. Methods Information on 95,551 adolescent women from rural India from the latest round of National Family Health Survey (NFHS-5) was analyzed. Bivariate statistics and multilevel logistic regression analysis were used to assess the Individual- and community-level factors associated with exclusive use of hygienic methods among adolescent women in rural India. Choropleth maps were used to discern the geographical disparities in the exclusive use of hygienic methods. Results In rural India, only 42% of adolescent women exclusively used hygienic methods, with substantial geographic disparities at the state and district levels. At the state level, the exclusive use of hygienic methods varied from 23% in Uttar Pradesh to 85% in Tamil Nadu. Even greater variation was observed at the district level. There was a clear north-south divide in the exclusive use of hygienic methods among adolescent women in rural India. The results of multilevel logistic regression indicated a considerable amount of variation in the exclusive use of hygienic methods at community level which further reduced when controlled for individual and community-level factors. Rural Indian adolescent women with higher education (AOR:3.20, 95% CI: 2.81–3.64), from general category (AOR: 1.14, 95% CI: 1.07–1.21), with medium mass media exposure (AOR: 1.43, 95% CI: 1.35–1.51), and from richest wealth quintile (AOR: 3.98, 95% CI: 3.69–4.30) were more likely to use hygienic methods exclusively. Conclusion Wide differential across biodemographic and socioeconomic groups, and substantial geographic disparities at state- and district-level in the exclusive use of hygienic methods suggests a need to adopt context-specific interventions for adolescent women in rural India. Distribution of subsidized or free menstrual hygiene methods to disadvantaged adolescent women, and in the low-prevalence districts may increase the level of exclusive use of hygienic methods remarkably.

Spatial heterogeneity in the exclusive use of hygienic materials during menstruation among women in urban India

“…There were seven options for response: cloth, sanitary napkins, locally made napkins, tampons, menstrual cups, nothing, and others. On the basis of these responses, we created a binary outcome variable titled ‘exclusive use of hygienic materials’, in which women using materials such as sanitary napkins, locally made napkins, tampons, and menstrual cups were coded as “1”; and those using non-hygienic and reusable materials such as cloths, both hygienic and non-hygienic materials, or not using any form of menstrual materials were coded as “0” ( Anand, Singh & Unisa, 2015 ; Ram et al, 2020 ; Vishwakarma, Puri & Sharma, 2020 ; Roy et al, 2021 ; Singh et al, 2022a ; Singh et al, 2022c ; Singh et al, 2022b ).…”

“…The choice of independent variables was guided by existing literature on menstrual hygiene management ( Anand, Singh & Unisa, 2015 ; Kathuria & Raj, 2018 ; Ram et al, 2020 ; Vishwakarma, Puri & Sharma, 2020 ; Chauhan et al, 2021 ; Roy et al, 2021 ). To illustrate how different factors are associated with women’s exclusive usage of hygienic materials, a conceptual framework has been adopted from a previous study ( Singh et al, 2022b ). We considered a range of demographic predictors such as current age of respondents (in years), age at menarche (in years) and socioeconomic predictors such as age at marriage (married before 18 years, and married after 18 years or not-married), respondent’s years of schooling (in years), religion (Hindu, non-Hindu), social groups (SC/ST, non-SC/ST), household wealth status (poor, non-poor), and mass-media exposure (no mass-media exposure, exposure to any of the mass-media).…”

Menstrual Hygiene Practices and its Predictors Among Young Women in India: Findings from the National Family Health Survey-5 (2019–2021)

“…18 Sanitary napkins, locally produced napkins, menstrual cups, and tampons have all been selected hygienic menstrual practices. 3, 19, 20 Let’s say a woman employs one of these four methods during her period, which is labeled as a hygienic practice (coded as “1”), while the others are considered unhygienic (coded as “0”). This variable has the same definition throughout several Indian works that are currently available.…”

“…This variable has the same definition throughout several Indian works that are currently available. 3, 19, 20…”

“…This variable has the same definition throughout several Indian works that are currently available. 3,19,20 Predictor Variables Women's socio-demographic and economic aspects were taken into account as predictive factors. These factors include the age of the women (15-19 years and 20-24 years), religion (Hindu, Muslim, Christian, and others), social group (Scheduled Caste, Scheduled Tribe, Other Backward Classes, and General), education (no education, primary, secondary, and higher), place of residence (urban and rural), households wealth quintile (poorest, poorer, middle, richer, and richest), type of toilet (flush, pit/dry, others, open), women's autonomy (low, medium, and high), and mass media exposure (no, partial, and full exposure).…”