Spatial heterogeneity of menstrual discriminatory practices against Nepalese women: a population-based study using the 2022 Demographic and Health Survey

Abstract

Background Menstrual discrimination hampers progress toward Sustainable Development Goals. Examining the spatial heterogeneity of menstrual discriminatory practices may present an opportunity for targeted interventions. Here we evaluate geographical disparities in menstrual related restrictions and assess their association with socio-economic and demographic factors. Methodology We used the 2022 Nepal Demographic and Health Survey data, focusing on women aged 15 to 49 who had experienced a menstrual period in the last year. We explored the spatial heterogeneity of menstrual restriction outcomes using the standard Gaussian kernel density approximation method and the spatial scan statistic. The Poisson regression model with robust standard errors was used to assess the association between the different forms of menstrual restriction and the socio-economic, and demographic factors. Findings Overall, the prevalence of women who reported any form of menstrual restriction was 84.8% and was subject to geographical variations ranging from 79.0% in Bagmati to 95.6% in Sudurpashchim. Religious restrictions were the most prevalent (79.8%) followed by household level restrictions (39.5%) and then Chhaupadi (6.2%). Geographical variations were more prominent for women experiencing Chhaupadi. Strikingly, women who reside in households led by female household heads were less likely to report experiencing household level restriction during menstruation (Adjusted prevalence ratio (aPR) =0.89 [95%CI: 0.84–0.94], p<0.001) whilst those residing in wealthy households were less likely to report experiencing Chhaupadi (aPR =0.26 [95%CI: 0.17-0.39] among the richest). Interpretation We observed geographical micro-variations in menstrual discriminatory practices in Nepal presenting an opportunity for targeted behavioral interventions. Women empowerment is a promising strategy in the fight against menstrual discrimination within the household. Therefore, community-based targeted interventions should be designed and tested to determine their utility against Chhaupadi in these settings.