Practices and Predictors of Menstrual Hygiene Management Material Use Among Adolescent and Young Women in Rural Pakistan. A Cross-Sectional Study.

Abstract

BackgroundIn low- and middle-income countries, women often use inappropriate materials to manage menstruation, which can pose a hazard to their health. Inappropriate menstrual hygiene management (MHM) can also have important downstream consequences beyond physiologic health, including the restriction of adolescent girls’ access to academic pursuits. This impacts one’s quality of life and has potential economic consequences for society. Methods Among menstruating adolescent and young women 15-23 years of age living in rural Pakistan (n = 25,305), we aimed to describe MHM practices and generate a predictive model of the socioeconomic and demographic factors related to the use of MHM materials. Beliefs and barriers around MHM were also summarized. The outcome variable included: those who practiced appropriate (reported use of a sanitary pad or/and new piece of cloth) and inappropriate MHM (reported use of an old cloth and/or nothing). Logistic regression was used to generate the predictive model, with results presented as odds ratios (OR) and 95% confidence interval (CI). ResultsInappropriate MHM practices were reported by 75% of participants. The majority (61.9%) reported using old cloths, 12.6% used nothing and 0.5% used old cloth with sanitary pad. One fourth of participants reported appropriate MHM material use, including, 16.2% sanitary pads, 8.6% new cloth and a few reported using sanitary pads with new cloth (0.2%). Inappropriate MHM practices were more common in lowest wealth quintile (OR 4.41; 95% CI = 2.77 to 7.01, P<0.0001), followed by those with no education (OR 3.9; 95% CI = 3.36 to 4.52, P<0.0001). Mothers were the primary source of information about menarche (84.5%). Among school-going girls, 22% reported not going to school while menstruating. The affordability of menstrual hygiene products, awareness of appropriate practices, access to clean supplies, and cultural beliefs were identified as factors contributing to MHM practices.ConclusionsFindings indicate the need for multi-sectorial efforts to introduce MHM-specific and MHM-sensitive interventions to improve MHM practices, ranging from availability of low-cost MHM materials to the inclusion of MHM education in school curriculums and within community platforms. Trial RegistrationThe trial was registered on ClinicalTrials.gov (Identifier: NCT03287882).