Wealthy, urban, educated. Who is represented in population surveys of women’s menstrual hygiene management?

Abstract

Inadequate menstrual hygiene presents a barrier to women's dignity and health. Recent attention to this marginalised challenge has resulted in the first national assessments of menstrual practices. Intuitively, surveys require women to have had a recent menses to be eligible. This study seeks to determine if there are demographic differences between women who are eligible and ineligible to answer questions about their menstrual hygiene during these assessments. Secondary analyses were undertaken on nationally or state representative data collected by the Performance Monitoring and Accountability 2020 survey programme across eight countries (Burkina Faso, Ethiopia, Ghana, India, Kenya, Niger, Nigeria, and Uganda). Female respondents were included in the study and compared on whether they had a menstrual period within the past three months and thus were eligible to answer questions regarding menstrual practices. On average, 29% of surveyed women across samples were ineligible to be asked menstrual hygiene questions. Higher levels of education, wealth, and urban residence were associated with higher odds of eligibility. Young and unmarried women were also more likely to be eligible. Demographic differences between eligible and ineligible women were consistent across all countries. Wealthy, urban, and educated women are more likely to be eligible to answer survey questions about menstrual hygiene. While population surveys may be representative of menstruating women, proportions of menstrual hygiene practices reported underrepresent the experiences of more vulnerable groups. These groups are likely to have greater struggles with menstrual hygiene when they are menstruating.

'It’s like a burden on the head': Redefining adequate menstrual hygiene management throughout women’s varied life stages in Odisha, India

“…Outside of a few key papers that highlight the menstrual experiences of women in the workplace, emergency context, or vaginal bleeding throughout the life course, experiences of menstruation among adult women and outside of school settings remains underexplored [38, 39, 43, 70]. This research confirmed that women need tangible support to manage menstruation, however we uncovered needs for MHM that extend beyond those identified in the JMP definition.…”

“…Moreover, this research gives voice to the experiences of rural women who are underrepresented in studies on menstruation. In an analysis of data across eight countries (including India) from the Performance Monitoring and Accountability 2020 survey programme, Hennegan et al (2018) found that women who were wealthy, urban, educated, young, and unmarried were more likely to be eligible to answer questions about menstruation, resulting in an underrepresentation of data from rural, older, less educated, and married women [70].…”

Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low- and Middle-Income Countries

“…Household level of wealth was derived from the ownership of various assets, building material used for the primary residence, and access to water and sanitation facilities. Wealth quintiles are then calculated and reported by the primary data collectors [ 27 ].…”

School and work absenteeism due to menstruation in three West African countries: findings from PMA2020 surveys

“…The characteristics of this sub-sample compared to the full population of women across PMA2020 surveys are discussed in more detail elsewhere. 30 Further details regarding the PMA2020 surveys are published elsewhere, 29 and available on the survey programme website.…”